0071643192.pdf

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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.
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