5-31
Assessment:
Differential Diagnosis - bacterial vaginosis, gonorrhea or chlamydial infection, atrophic vaginitis, candida
vaginitis (see Symptom GYN Problems: Vaginal Discharge Table and STD Chapter).
Plan:
Treatment
Primary: Metronidazole 2 gm po X 1 or metronidazole 500 mg po bid x 7 days (95% cure rate)
Note: Pregnancy: Oral therapy after the first trimester. Intravaginal Metrogel is recommended in the first
trimester. If this is not available, consider vaginal clotrimazole or other antifungal (50% effective) if patient is
very symptomatic, followed by oral metronidazole after the first trimester. In a mildly symptomatic patient in
the first trimester of pregnancy, delay therapy until the 2nd trimester (after 12 weeks). During this time patient
should abstain from intercourse. Douching is contraindicated in pregnancy.
Patient Education
General: Taking medication as directed is essential for cure. Partner must be treated with same regimen.
Partner often asymptomatically carries trichomonas in the urethra.
Activity: Refrain from intercourse until treatment complete.
Diet: As tolerated
Medications: Refrain from alcohol and use of alcohol-containing products during treatment because of
Antabuse-like effect (vomiting, anxiety, myalgia, etc.) with metronidazole
Prevention and Hygiene: Recommend condom use. Discuss STD risks and prevention.
No Improvement/Deterioration: Return for reevaluation.
Follow-up Actions
Return evaluation: Highly recommend GC/Chlamydia cultures - co-infection is common. Consider HIV
testing.
Consultation Criteria: No improvement after first course of medication
NOTES: Always err on the conservative side - If there is any consideration of PID treat accordingly, including
the partner.
Chapter 12: Zoonotic Diseases
MAJ Joseph Williamson, VC, USA and CPT William Bosworth, VC, USADiseases/Acquired Camels Sheep
From Llamas Cattle Goats Horses Pigs Dogs Birds
Diseases/Agents
Anthrax x x x x x
Ascaris suum x
Blastomycosis x
Botulism x
Brucella canis x
Brucella suis x
Brucellosis x x x x
Diseases/Acquired Camels Sheep
From Llamas Cattle Goats Horses Pigs Dogs Birds
Diseases/Agents
Campylobacteriosis x x x x x
Cheyletiellosis (Dermatitis) x
Chlamydia psittaci x