A 24-year-old female presents for her annual examination. She is single and has had several male sexual partners during the past year. You include screening for chlamydial infection in your evaluation, and the test is reported as positive. She is asymptomatic.
Which one of the following is true concerning this situation?
Correct Answer A:
It is recommended that sexually active women under the age of 25 years be screened routinely for Chlamydia trachomatis. Treatment of asymptomatic infections in women reduces their risk of developing pelvic inflammatory disease, tubal infertility, ectopic pregnancy, and chronic pelvic pain. A 1-gram dose of oral azithromycin is an appropriate treatment, including during pregnancy. Sexual contacts during the preceding 60 days should be either treated empirically or tested for infection and treated if positive. The patient should avoid sexual intercourse for 7 days after initiation of treatment. Consistent use of barrier methods for contraception reduces the risk of C. trachomatis genital infection.
Which one of the following is appropriate treatment for asymptomatic chlamydial infection during the second trimester of pregnancy?
Several clinical trials suggest that 7-day regimens of erythromycin or amoxicillin, and single-dose regimens of azithromycin, are effective for treating chlamydial infections during pregnancy. Doxycycline and levofloxacin are contraindicated during pregnancy due to potential ill effects on the fetus, and metronidazole is not effective for the treatment of chlamydial infections.
A 23-year-old sexually active female presents to your office with a 2-week history of vaginal discharge and mild coital discomfort. On physical examination, you note the presence of a mucopurulent vaginal discharge and cervical friability. She is afebrile and there are no other positive physical findings. No trichomonads or yeast is seen on vaginal preparations. Material for Chlamydial trachomatis-specific DNA testing is submitted and results will be available in 2 days.
Which one of the following is true regarding appropriate management?
Correct Answer D: Patients with suspected genital chlamydial infections and their partners should be instructed to refrain from sexual intercourse until therapy is completed (specifically, until 7 days after a single-dose regimen or until the completion of a 7-day regimen). Suspicion of chlamydial infection warrants treatment, with or without positive laboratory findings. Metronidazole is not useful for treatment and there is no difference in random clinical trials with regard to the efficacy of a 7-day course of doxycycline compared to that of a single 1-g dose of azithromycin.
A 42-year-old white female has a 2-month history of vaginal itching. Another physician prescribed three courses of antifungal therapy, but the condition persists. The patient says there has been no discharge, and there are no skin lesions anywhere else. The physical examination is remarkable only for a lacy white rash on the labia minora.
Which one of the following is the most likely diagnosis?
Correct Answer B:
This lesion fits best with the diagnosis of vulvar lichen planus, analogous to oral lichen planus. The genitals are a common site, and when mucous membranes are involved, there will be a lacy white or light gray reticulate pattern like that seen on the buccal mucosa with oral lesions. The cause of the condition is unknown, and it typically resolves spontaneously after 6-24 months. There is no treatment that shortens the disease, but topical corticosteroids may relieve the itching and improve cosmetic appearance. This woman is a little too young for atrophic vaginitis and a little too old for vaginal adenosis. Contact dermatitis is a nonspecific erythema without white patches. Chronic candidiasis in an otherwise healthy woman would be expected to respond to conventional therapy.
Compared to forceps, which one of the following is a potential advantage of the vacuum extractor (VE) in an assisted vaginal delivery?
Correct Answer C: Forceps operations have become less popular, and vacuum extraction (VE) procedures are more common in recent years. There is long-term debate concerning when assisted delivery is appropriate and which instrument (vacuum extractor or forceps), is best In breech presentations, VE use is contraindicated. A vaginal breech delivery is a potential indication for the application of forceps.
Any instrumental delivery is associated with an increased risk of perineal/rectal injury versus the incidence of these complications following either a spontaneous or a cesarean delivery. A consistent finding is an increased incidence of perineal tears following forceps as opposed to VE deliveries.
Facial nerve (VII) palsies are more common following forceps operations (4.5 per 1,000) than VE procedures VE operations are more likely to fail than forceps procedures.
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