Small gram variable rods g vaginalis morphotypes

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Small gram-variable rods (G vaginalismorphotypes, scored 0–4)3.Curved gram-variable rods (Mobiluncusspp. morphotypes, scored 0–2)The total score ranges from 0 to 10. A score of 7–10 is consistent with bacterial vaginosis.TreatmentTreatment should be administered to symptomatic patients and considered inasymptomatic patients. Several treatment regimens exist (Table 39–12). Of importance, intravaginal administration of oil-based clindamycinreduces theeffectiveness of condoms and diaphragms. For pregnant women, metronidazole250 mg orally 3 times daily is recommended for 7 days or, alternatively, clindamycin300 mg orally twice daily for 7 days. There is no evidence supporting the use of topical agents during pregnancy. Management strategies for recurrent vaginosis include use of condoms, longer treatment periods, prophylactic maintenance therapy, oral or vaginal 9
application of yogurt containing lactobacillus acidophilus, intravaginal planting of other exogenous lactobacilli, and acidification of the vagina. Treatment of the male rarely helps in preventing recurrence in the female.Trichomonas VaginitisEssentials of DiagnosisProfuse, frothy, greenish, and foul-smelling dischargepH of the vagina usually exceeding 5.0Vaginal erythema with multiple small petechiae (strawberry spots)Wet mount reveals an increase in polymorphonuclear cells and motile flagellates in 50–70% of zculture-confirmed casesTreatmentSystemic therapy with metronidazoleis the treatment of choice,Neisseria GonorrhoeaeOf women infected by N gonorrhoeae, 85% are asymptomatic. The glandular structures of the cervix, urethra, vulva, perineum, and anus are most commonly infected. In acute disease, patients present with a copious mucopurulent discharge and gram-negative diplococci within leukocytes. However, diagnosis should be confirmed with nucleic acid amplification or aculture from the endocervix, urethra, rectum, or mouth. An estimated 15–20% of women with lower tract disease develop upper genital tract disease with salpingitis, tubo-ovarian abscess, and peritonitis. Ectopic pregnancy and infertility are classic long-term consequences. If active infection is present during vaginal delivery, the newborn may develop conjunctivitis by contamination. Uncomplicated gonococcal infections of the cervix are treated withceftriaxone 125 mg administered intramuscularly (IM) in a single dose. Single oral doses ofcefixime 400 mg,ciprofloxacin500 mg,ofloxacin400 mg, orlevofloxacin250 mg are other recommended regimens. Quinolones are no longer recommended because some strains ofN gonorrhoeaeare quinolone-resistant. Spectinomycin 2 g IM in a single 10
dose is an option for patients sensitive to cephalosporins. Empirical Treatment of C trachomatisshould be considered, as this infection often coexists.Chlamydia TrachomatisThe screening of sexually active young women for C trachomatisis important because some infections are asymptomatic, and some present witha mucopurulent cervicitis, dysuria, and/or postcoital bleeding. trachomatis
C

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