Clinical Gynecology and Sexual Health Lecture Review

Bacterial Vaginosis (BV) is characterized by a specific clinical presentation featuring a thin gray or white vaginal discharge and a distinct fishy odor.
Standard diagnostic findings for BV include a vaginal $pH > 4.5$ and the detection of clue cells via microscopy.
The Amsel criteria serve as the diagnostic standard; a patient must meet at least $3$ of the $4$ total Amsel criteria for a definitive diagnosis of BV.
The primary first-line pharmacological intervention for BV is metronidazole, prescribed at a dosage of $500\,mg$ administered BID (twice daily) for a duration of $7$ days.
Preventive patient education focuses on the avoidance of douching to maintain normal vaginal microflora.

Chlamydia: Diagnosis is performed via Nucleic Acid Amplification Testing (NAAT). The established treatment regimen is doxycycline at a dosage of $100\,mg$ BID for a duration of $7$ days.
Gonorrhea: The standard treatment is a single IM (intramuscular) injection of ceftriaxone. The dosage is stratified by patient weight:
- For patients weighing $< 150\,kg$ , the dose is $500\,mg$ .
- For patients weighing $> 150\,kg$ , the dose increases to $1\,g$ .
Syphilis: For primary or secondary disease, the treatment is a single IM administration of benzathine penicillin G at a dosage of $2.4 \times 10^6$ units.
Screening Guidelines: Annual screening for both chlamydia and gonorrhea is recommended for all sexually active women aged $≤ 25$ .

Menopause is clinically defined by the occurrence of $12$ consecutive months without menstruation.
Genitourinary Syndrome of Menopause (GSM) is managed through the application of local vaginal estrogen therapies.
There are several significant contraindications to estrogen therapy that must be evaluated:
- History of Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE).
- Diagnosis of migraine with aura.
- Uncontrolled HTN (hypertension).
- Current or recent history of breast cancer.
- Individuals who are smokers aged $≥ 35$ .
- Postpartum status for a period of $< 21$ days.

Subdermal Implant: This contraceptive method is $> 99\%$ effective and has a functional lifespan of approximately $3$ years.
Copper IUD: This device has a typical-use effectiveness rate of approximately $99.2\%$ .
Emergency Contraception (EC) timing and efficacy:
- Levonorgestrel EC must be administered within a window of $≤ 72$ hours.
- Ulipristal EC must be administered within a window of $≤ 120$ hours.
- The copper IUD is classified as the most effective form of emergency contraception available.

American Cancer Society (ACS) 2020 Standards:
- Routine cervical cancer screening should commence at age $25$ .
- The preferred modality is primary Human Papillomavirus (HPV) testing every $5$ years ( $q5y$ ).
USPSTF 2018 Standards for Ages $30$ to $65$ :
- Option 1: Pap test every $3$ years ( $q3y$ ).
- Option 2: Primary HPV testing every $5$ years ( $q5y$ ).
- Option 3: Co-testing (Pap and HPV combined) every $5$ years ( $q5y$ ).

Secondary Amenorrhea: When a patient presents with secondary amenorrhea, the first clinical step is always to perform a pregnancy test.
Polycystic Ovary Syndrome (PCOS): This is categorized as a diagnosis of exclusion. Management strategies emphasize lifestyle modification, particularly when metabolic health or being overweight are identified concerns.
Pelvic Inflammatory Disease (PID):
- Empiric treatment is indicated if a patient presents with Cervical Motion Tenderness (CMT), uterine tenderness, or adnexal tenderness.
- The standard pharmacological regimen involves ceftriaxone and doxycycline, with the optional addition of metronidazole.
- Clinical reassessment of the patient must occur within $72$ hours of initiating treatment.