Combined OCs: Absolute contraindications include hx of DVT, CVA, CAD, DM, pregnancy, gyn bleeding, age > 35 with HTN or DM, LDL > 160, trigs >250. Remember ACHES (abd pain, chest pain, HA, eye problems, or severe leg pain)
Progestin only: good choice for lactating women, women with CV risks. If pill is 3h late, r/o pregnancy rises
Depo-provera: no effect on milk production, long return to ovulation
-BV: on microscopic exam: vaginal pH > 4.5, clue cells, positive whiff test, few WBCs. Flagyl 500mg BID x 7 days
-Candidiasis: candida albicans- itching, burning, thick white to yellow curd-like dc, miconazole, fluconazole
-Chancroid: caused by h. ducreyi, painless genital ulcer, treat with azithromycin 1g bomb
-Herpes simplex: HHV-2, painful ulcerated lesions with lymphadenopathy, tx with acyclovir 400mg PO TID x 7-10 days
-Lymphogranuloma venereum: vesicular or ulcerative lesion, caused by LI-3 serovar of c. trachomatis: doxycycline 100mg PO BID x 21 days
-nongonococcal urethritis and cervicitis: c. trachomatis: Azithromycin 1g PO bomb
-gonococcal urethritis and vaginitis: caused by n. gonorrhoeae, single dose tx for uncomplicated infection- cefixime 400mg PO, ceftriaxone 125mg IM
-PID: caused by n. gonorrhoeae, c. tachomatis, e. coli, mycoplasma, take ofloxacin 400mg PO BID with flagyl 500mg BID x 14 days.
-Trichomoniasis: caused by t. vaginalis, *cervical petechial hemorrhages (strawberry spots) in 30%. On Exam, motile organisms and WBCs. Take Flagyl 2g Bomb.
-Genital warts: caused by HPV, patient applied tx included podofilox 0.5% or imiquimod 5% cream.
-pap smear, CBC, rubella titer, blood type, antibody screen, VDRL/RPR, HIV, GC/chlamydia, PPD, Hg electrophoresis (consider), HBsAg, UA, urine C&S