EBCOG Part 1-Postnatal Care & Sexual Reproductive Health-Day 7 (EMQ)

A. Aciclovir 400 mg orally three times per day for 21 days

B. Azithromycin 1 g orally as a single dose

C. Ceftriaxone 1000 mg intramuscularly single dose

D. Clindamycin orally 300 mg twice daily for 7 days

E. Clotrimazole vaginal pessary 1 g for 5 nights

F. Fluconazole 1 g orally

G. Fluconazole 150 mg every 72 hours for three doses

H. Metronidazole 1 g orally as a single dose

I. Metronidazole 500 mg orally twice daily for 14 days

J. Nevirapine intravenous stat dose

K. Ofloxacin 400 mg twice daily orally plus oral metronidazole 400 mg twice daily for 14 days

L. Valaciclovir 500 mg twice daily for 5 days

M. Zidovudine intravenous infusion

Each of the following clinical scenarios relates to a woman with a pelvic infection. For each woman, select the single most appropriate initial management from the list above. Each option may be used once, more than once or not at all.

1. A 26-year-old woman attends the gynaecology emergency services complaining of painful blisters and ulceration on her vulva for last 2 days. She has dysuria and vaginal discharge. On examination, there is bilateral tender inguinal lymphadenitis.

2.A 21-year-old woman who suffers with alcohol dependence attends the gynaecology clinic complaining of a persistent watery vaginal discharge. There is no history of irritation or pruritus. She smokes ten cigarettes a day. On vaginal examination, there is an offensive fishy-smelling vaginal discharge.

3. A 23-year-old university student complains of persistent purulent vaginal discharge. On vaginal examination, there is contact bleeding from the cervix. Microscopy of a Gram-stained endocervical swab specimen showed monomorphic Gram-negative diplococci within polymorphonuclear leucocytes.

4. A 49-year-old menopausal diabetic woman presents with vulval soreness and pruritus, and a non-offensive thick white vaginal discharge. She gives a history of at least four episodes in past of similar episodes over the last 12 months and suffers from superficial dyspareunia. On examination, there is erythema and some fissuring of the vulval skin