Overview of Sexually Transmitted Infections and Reproductive Health

Protozoan and Vaginal Flora Imbalances

While some infections are strictly categorized as STIs, others involve changes to the natural microbial balance of the reproductive tract.

Trichomoniasis

This is a protozoan infection that presents with distinct physical findings.

• Symptoms: Patients often report a purulent, frothy, green, and malodorous (foul-smelling) vaginal discharge, accompanied by itching and dysuria.
• Diagnosis: A wet mount microscopic examination is used to identify the organism.
• Treatment: Flagyl (Metronidazole) 2 grams orally (PO) in a single dose. Partners must be treated to prevent reinfection.

Bacterial Vaginosis (Gardnerella vaginalis)

Bacterial Vaginosis (BV) is technically an infection of the reproductive tract rather than a strictly classified STI. It occurs when the normal vaginal flora is disrupted, leading to a high vaginal pH.

• Symptoms: A thin, grayish-white discharge with a characteristic "fishy" odor.
• Diagnosis: The presence of clue cells on a wet mount examination.
• Treatment: Metronidazole 500mg PO twice daily (BID) for 7 days.
• Note: Unlike many other STIs, treating the sexual partner is not considered helpful for BV.

Viral Infections

Viral infections present unique challenges because, unlike bacterial infections, they cannot be "cured" with antibiotics; management focuses on symptom suppression and preventing transmission.

Herpes Genitalis (HSV-1 and HSV-2)

Caused by the Herpes Simplex Virus, this condition is characterized by periodic outbreaks.

• Symptoms: The hallmark of an outbreak is the appearance of vesicles (small fluid-filled blisters) that cause severe vulvar pain and dyspareunia. These vesicles typically rupture within 1–7 days. Primary infections may also present with flu-like symptoms.
• Diagnosis: Clinical presentation or a culture of the fluid from a vesicle.
• Management: While there is no cure, the virus can remain dormant and cause recurrences. It can be suppressed using medications such as Valtrex, Zovirax, or Famvir.
• Pregnancy Risk: The virus can be spread to a baby during birth, potentially leading to severe neurological sequelae.

HPV (Condylomata acuminata)

Human Papillomavirus (HPV) can manifest as genital warts, known as Condylomata acuminata.

• Clinical Significance: There is a close link between HPV and the development of cervical cancer, necessitating close clinical follow-up.
• Diagnosis: Identified via direct visualization or Pap smears.
• Treatment: Focuses on the physical removal of the warts.
• Pregnancy Note: Treatment is often deferred until postpartum because genital warts are highly vascular, and removal during pregnancy carries a high risk of significant bleeding.

HIV (Human Immunodeficiency Virus)

HIV requires proactive management, particularly in obstetric settings.

• Screening: Routine testing is required for all pregnant women. Rapid HIV testing can provide preliminary results in as little as 30 minutes.
• Management: The use of suppressive therapy during pregnancy and delivery can reduce the risk of transmission to the infant by nearly 80%. AZT (Zidovudine) is a key medication utilized in the management of HIV.

Summary Table for Quick Review

Exam Tip: If a question asks about a patient with a "fishy" odor and "clue cells," think Bacterial Vaginosis and Metronidazole. If the question mentions "vesicles" and "painful rupture," think Herpes Simplex.