294 Obstetrics and Gynecology Board Review •••
❍ Which are the most specific criteria for the diagnosis of PID?
Signs of infection with pain and fever combined with; Endometrial biopsy with histological evidence of
endometritis, transvaginal ultrasound or MRI showing thickened fluid-filled tubes with or without free pelvic
fluid, cystic mass on adnexa suspicious for abcess, or laparoscopic findings of PID.
❍ What is the most sensitive criterion for detection of PID?
Pelvic motion tenderness on examination.
❍ Is a test of cure for Chlamydia routinely recommended?
No, unless patient is pregnant, therapeutic compliance is in question, symptoms persist or reinfection is suspected.
If indicated should be done 3 to 4 weeks after treatment is completed.
❍ What are the clinical criteria for bacterial vaginosis and how many do you need to make the diagnosis?
Amsel criteria are used to make the diagnosis.
The diagnosis is made if at least three of the following criteria are present:
(1) Homogeneous, thin, white discharge that coats the vaginal walls.
(2) Clue cells on microscopic examination.
(3) Vaginal PH >4.5.
(4) Whiff test positive.
❍ What is the definition of recurrent vulvovaginal candidiasis (VVC)?
Four or more episodes in 1 year.
❍ What is the first-line maintenance regimen for recurrent VVC?
Oral fluconazole weekly for 6 months (100–150 or 200 mg weekly).
❍ What are the characteristics of complicated VVCs?
Recurrent VVC, severe VVC, non-albicans candidiasis, women with uncontrolled diabetes, debilitation,
immunosuppression, or pregnancy.
❍ When should the partner be treated when you made the diagnosis of chancroid?
The partner should be treated if sexual contact occurs within the last 10 days preceding the symptoms.
❍ What is the most sensitive test for diagnosis of herpes simplex virus (HSV)?
PCR.
❍ What other vaginal lesions can resemble HSV?
CMV, hand-foot-mouth disease, and Behcet disease.
❍ What type of HSV causes genital tract lesions?
HSV-2 has classically been linked with genital tract lesions but now HSV-1 has started to make up a larger fraction
of genital ulcer cases.