A practical overview of managing adolescent gynecologic conditions in the pediatric office

摘要

On the basis of strong research evidence, the 3 most common causes of vaginitis are bacterial vaginosis, Candida infection, and trichomoniasis. These conditions can be diagnosed based on the following signs and symptoms: presence of erythema or inflammation makes candidiasis more likely, presence of fishy odor is highly predictive of bacterial vaginosis, the lack of odor decreases the likelihood of bacterial vaginosis and increases the likelihood of candidiasis, and the lack of itching makes candidiasis much less likely. Trichomonas vaginalis symptoms include diffuse frothy, green, white, or gray, malodorous, watery discharge and vulvar irritation. (4)(6) ? On the basis of strong research evidence, chlamydia and gonorrhea are often asymptomatic but can be characterized by mucopurulent vaginal discharge. They are effectively tested using nucleic acid amplification tests froma nonclean catch urine void or a self-collected vaginal swab. There is increasing cephalosporin resistance in gonorrhea, so the most updated antibiotic regimen must be used. (5) ? On the basis of strong research evidence, genital ulcers are commonly caused by herpes simple virus but also have numerous nonsexually transmitted origins. Treatment is largely symptomatic. (5)(7) ? On the basis of strong research evidence, the human papillomavirus vaccine should be offered to all adolescents between ages 11 and 26 years, optimally before the onset of sexual activity, to decrease the risk of cervical cancer and genital warts. (8) ? On the basis of strong research evidence, pelvic pain has a wide differential diagnosis and a variety of gynecologic origins, including ovarian cysts and masses, ovarian torsion, pelvic inflammatory disease, ectopic pregnancy, dysmenorrhea, and endometriosis. (9)(10) ? On the basis of some research evidence and consensus, pelvic inflammatory disease can be diagnosed on the basis of pelvic pain and cervical motion tenderness and adnexal or uterine pain when no other source of illness can be identified. Cervical motion tenderness and adnexal or uterine tenderness are most accurately examined via a bimanual examination. (5)