STI and Other Infections
Recommended Reading
LEARNING MODULES: National STD Curriculum
ARTICLE: Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020
ARTICLE: Sexually Transmitted Infections: Updates From the 2021 CDC Guidelines
POWERPOINT: Vaginitis
WEBSITE: Sexually Transmitted Infections Treatment Guidelines, 2021
Board Questions
A 24-year-old female presents with a 2-day history of mild to moderate pelvic pain. She has had two male sex partners in the last 6 months and uses oral contraceptives and sometimes condoms. A physical examination reveals a temperature of 36.4°C (97.5°F) and moderate cervical motion and uterine tenderness. Urine hCG and a urinalysis are negative. Vaginal microscopy shows only WBCs.
The initiation of antibiotics for treatment of pelvic inflammatory disease in this patient
A) is appropriate at this time
B) requires an elevated temperature, WBC count, or C-reactive protein level
C) should be based on the results of gonorrhea and Chlamydia testing
D) should be based on the results of pelvic ultrasonography
ANSWER: A
Pelvic inflammatory disease (PID) is a clinical diagnosis, and treatment should be administered at the time of diagnosis and not delayed until the results of the nucleic acid amplification testing (NAAT) for gonorrhea and Chlamydia are returned. The clinical diagnosis is based on an at-risk woman presenting with lower abdominal or pelvic pain, accompanied by cervical motion, uterine, or adnexal tenderness that can range from mild to severe. There is often a mucopurulent discharge or WBCs on saline microscopy. Acute phase indicators such as fever, leukocytosis, or an elevated C-reactive protein level may be helpful but are neither sensitive nor specific. A positive NAAT is not required for diagnosis and treatment because an upper tract infection may be present, or the causative agent may not be gonorrhea or Chlamydia. PID should be considered a polymicrobial infection. Pelvic ultrasonography may be used if there is a concern about other pathology such as a tubo-ovarian abscess.
A 52-year-old female sees you because of a vaginal discharge. An examination reveals a malodorous, greenish-yellow, frothy discharge, and inflammation of the cervix and vagina. Which one of the following is the most likely diagnosis?
A) Atrophic vaginitis
B) Irritant/allergic vaginitis
C) Bacterial vaginosis
D) Trichomoniasis
E) Vulvovaginal candidiasis
ANSWER: D
Trichomoniasis classically presents as a greenish-yellow, frothy discharge with a foul odor. Erythema and inflammation of the vagina and cervix are often present and can include punctate hemorrhages (strawberry cervix). Atrophic vaginitis may cause a thin, clear discharge and is usually associated with a thin, friable vaginal mucosa. Irritant/allergic vaginitis causes burning and soreness with vulvar erythema but usually does not cause any significant discharge. Bacterial vaginosis more commonly presents as a thin, homogenous discharge with a fishy odor and no cervical or vaginal inflammation. Vulvovaginal candidiasis presents with white, thick, cheesy, or curdy discharge.
