Abstract
Gynecologic medical problems are common presentations to urgent care centers. Having a basic understanding of clinical symptoms and treatment is essential to providing care in this setting.
Keywords
Bartholin gland, dysmenorrhea, genital warts, vaginitis, pelvic inflammatory disease, vaginal bleeding, vaginal foreign body
4
What are the CDC criteria for treatment of bacterial vaginosis?
Bacterial vaginosis can be diagnosed in the presence of three of the following four criteria: vaginal discharge, pH >4.5, positive amine test (emittance of a fishy odor upon addition of KOH to the vaginal discharge), and presence of clue cells on wet prep.
5
How can vaginitis be treated?
The treatment of vaginitis involves treating the underlying etiology. Bacterial vaginosis is treated with antibiotics such as metronidazole (500 mg po bid for 7 days) or clindamycin (300 mg po bid for 7 days). For treatment of trichomoniasis, metronidazole (500 mg po bid for 7 days or a one-time 2-g dose) is indicated. Similarly, fungal ( Candida ) vaginitis can be treated with fluconazole (one dose, 150 mg po) or topical imidazole. Contact vaginitis is treated by removal of the foreign body or offending agent, whereas atrophic vaginitis is treated with topical estrogen creams.
8
What are the most common presenting signs and symptoms of PID?
The most common presentation of PID is lower abdominal pain. Other signs and symptoms include vaginal discharge, fever, nausea, vomiting, and dyspareunia. As the signs and symptoms are very nonspecific, PID should be considered in any female presenting with complaints of lower abdominal pain.
9
How can PID be diagnosed?
In the urgent care setting, PID is a clinical diagnosis. Ancillary testing that can aid in making the diagnosis include urine analysis, urine pregnancy test, wet prep, and gonorrhea/chlamydia. If there is suspicion for tubo-ovarian abscess, pelvic sonography can be used as a definitive imaging study. Laparoscopy remains the most accurate test and the gold standard imaging test for diagnosing PID; however, this is not very useful in the urgent care setting.
10
What are the clinical criteria for diagnosing PID?
The triad of minimal criteria for diagnosing PID includes lower abdominal tenderness, adnexal tenderness (usually bilateral) on pelvic exam, and cervical motion tenderness. Additional criteria include fever, vaginal discharge, elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), leukocytosis, and laboratory evidence of gonococcal/chlamydia infection.
11
What is the treatment for PID?
There are multiple outpatient and inpatient regimens recommended by the CDC for the treatment of PID. These are outlined in Boxes 8.1 and 8.2 .
- 1.
Ceftriaxone 250 mg IM in a single dose PLUS doxycycline 100 mg orally twice a day for 14 days WITH or WITHOUT metronidazole 500 mg orally twice a day for 14 days
OR
- 2.
Cefoxitin 2 g IM in a single dose and probenecid 1 g orally administered concurrently in a single dose PLUS doxycycline 100 mg orally twice a day for 14 days WITH or WITHOUT metronidazole 500 mg orally twice a day for 14 days
OR
- 3.
Other parenteral third-generation cephalosporin (e.g., ceftizoxime or cefotaxime) PLUS doxycycline 100 mg orally twice a day for 14 days WITH or WITHOUT metronidazole 500 mg orally twice a day for 14 days
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