Special Operations Forces Medical Handbook

3-48

• Vaginal itching- Perineal itching- Swelling and redness of the vulva with irritation +/- dysuria- Clumpy, white to yellow-white discharge- ODORLESS- No pelvic pain- Dyspareunia may be present because of vaginal irritation- Fishy smelling vaginal discharge causes vaginal and perineal irritation due to abnormal pH- Patient will not have pelvic pain or fever- Dyspareunia may be present because of vaginal irritation- External dysuria may be present- Large amount of yellow-green discharge which may or may not smell fishy, causes significant irritation of the vulva and vagina- Patients often have dyspareunia and external dysuria (the urine pH irritates)- No pelvic pain or fever

INFECTIONCandida Vaginitis

• Vaginal pH <4.5- Discharge visualized either on external genitalia or in the vagina is consistent with diagnosis- Patient will not have tender uterus and will not complain of pelvic pain- KOH prep will show hyphae- Vaginal pH >4.5- Odor should be apparent at time of exam- Thin yellow-white discharge present on vulva and vagina- Vagina may be tender on exam, but uterus and ovaries will be WNL- Wet prep reveals clue cells- Vaginal pH >4.5- Vulva may appear red and swollen - discharge present on vulva with or without odor- Cervix may appear red, vagina will be tender- Uterus and ovaries will be WNL- Wet prep reveals motile, flagellated organisms


• Intravaginal antifungal, such as:

clotrimazole

&

miconazole- If oral

fluconazole

is

available, give 150 mg po x 1 - Flagyl

500mg po bid x

7 days (1st choice)- Clindamycin

300mg

po bid x 7 days- Ampicillin

500mg po

qid x 7 days (last choice, cure rate only 60%)- Flagyl

2 grams po x 1

• Flagyl

500mg po bid x

7 days- Flagyl

is the only

recommended therapy - if the patient cannot take it, give vaginal clotrimazole

(48% cure

rate)

• A patient with complaints consistent with Candida may be treated empirically without examination. Follow-up if discharge worsens despite treatment.- t

reat with

Flagyl

if

patient fails anti-fungal and has a foul-smelling discharge, also consider STD testing.- If unable to perfor

m

speculum exam and microscopic exam of discharge, the diagnosis can be suggested based on the type of discharge, the patient’s symptoms and the abdominal exam- A bimanual exam is necessary if patient complains of pelvic pain.- As Trich is sexually transmitted, partners must be treated and intercourse should be stopped until treatment is complete- Patients should be tested for STDs if possible

SYMPTOMS

DIAGNOSIS

TREATMENT

NOTES

Bacterial Vaginosis Trichomonas

Table 3-4: GYN Problems: Vaginitis