Key Point:Treatment of syphilis and vaccination against hepatitis B in early pregnancy are very effective for reducing the risk of verticaltransmission. Screening for syphilis and hepatitis B virus infection should be performed in all pregnant patients.Explanation:Screening for syphilis and/or hepatitis B virus infection should be performed in all pregnant patients and repeated at variousintervals in high-risk populations. Treatment with penicillin before 20 weeks gestation can result in a negligible rate of verticaltransmission. Inadequate prenatal screening is at the root of most current cases of congenital syphilis. Vertical transmissionof the hepatitis B virus approaches 90% in untreated cases, and up to 90% of infected neonates will become chronic carriersas adults. Routine screening for HBV during early pregnancy is recommended because treatment with hepatitis Bimmunoglobulin and hepatitis B vaccine is very effective in reducing the rate of vertical transmission.Unvaccinated, HBsAg-negative gravidas who are exposed during the pregnancy to HBV should receive both hepatitis Bimmuno- globulin and vaccine.Reference:Calder KK, Chronic Medical Illness During Pregnancy. In Rosen’s Emergency Medicine. 2014; 179: 2300-231520.CorrectQuestion Tools:Report QuestionA 30-year-old 32-weeks’ pregnant woman with pre-gestational diabetes reports vulvaritching, burning, and a whitish-thick discharge for the past 7 days. Exam demonstratesdiffuse erythema of the vulva and vagina, with a thick white discharge adherent to thevaginal walls. No abnormal odor is noted. Pseudohyphae are noted on microscopy.Which of the following best describes her diagnosis?bacterial vaginosistrichomoniasis
82vulvovaginal candidiasislichen simplex chronicusCorrectEducational Objective:Diagnose vulvovaginal candidiasis.Key Point:Suspect vulvovaginal candidiasis in a patient presenting with pruritus, erythema and white, thick, curd-like vaginal discharge.Diagnose with microscopy of wet mount.Explanation:The condition described is vulvovaginal candidiasis. Diagnosis is made by microscopy or culture. Treatment of vulvovaginalcandidiasis includes oral fluconazole 150 mg in a single dose or topical antifungal preparations. In patients with complicatedcases such as the one described, a second dose of fluconazole 150 mg given 3 days after the first increased the cure ratefrom 67% to 80%. Trichomoniasis is a sexually transmitted disease diagnosed by visualization of motile trichomonads onmicroscopy. Bacterial vaginosis does not typically affect the vulva and is characterized by a fishy odor, thin gray/greenvaginal discharge, and clue cells on microscopy. Lichen simplex chronicus can be initiated by an underlying candidainfection; however, it does not typically involve the vagina.
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