0071643192.pdf

OBSTETRICS AND GYNECOLOGY

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DIAGNOSIS

■ Definitive diagnosis requires direct visualization of the liver capsule via la-

paroscopy.

■ RUQ ultrasound, CT abdomen, and CXR may be used to exclude other

causes of RUQ pain. CT abdomen may show a perihepatic fluid collection.

■ The combination of RUQ pain, fever and/or elevated markers of infection

(WBC, ESR), positive cervical cultures for chlamydia or gonorrhea, and

the absence of other cause of RUQ pain (pneumonia, cholecystitis, pyelo-

nephritis, hepatitis) allows a presumptive diagnosis of FHC syndrome.

TREATMENT

■ Treatment is the same as for PID.

■ Outpatient treatment is acceptable for well-appearing patients who can

tolerate PO and are not pregnant.

■ Discharge instructions should recommend use of condoms, treatment of

partners, and further testing for HIV and syphilis.

LYMPHOGRANULOMA VENEREUM

A sexually transmitted infection caused by an aggressive L serotype of C. tra-

chomatis. It is rare in the United States, but endemic in parts of Africa,

Southeast Asia, South America, and the Caribbean.

SYMPTOMS/EXAM

■ Inguinal, vulvar, and rectal ulceration

■ Inguinal lymphadenopathy and lymphedema

■ Anorectal lymphedema occurs early and leads to anal stricture.

DIFFERENTIAL

Disseminated TB, early syphilis, chancroid

DIAGNOSIS

Isolation of C. trachomatisfrom specimens confirms the diagnosis. A positive

complement fixation test also aids the diagnosis.

TREATMENT

■ Doxycycline 100 mg BID for 21 days or

■ Erythromycin 500 mg QID for 21 days

■ Anal strictures may need dilation or surgical management.

CHANCROID

This is a sexually transmitted disease characterized by a painful genital ulcer.

The causative organism is Haemophilus ducreyi. It occurs more frequently in

Asia and Africa but is also endemic to certain parts of the United States.

SYMPTOMS/EXAM

■ Suppurative inguinal adenopathy with painful ulcers is pathognomonic.

■ The early chancroid lesion is a vesicopustule on the perineum, vagina, or

cervix that ulcerates and produces a heavy foul discharge that is contagious.