Case Definition

Consider Gonorrhea/Chlamydia

  • Purulent dischargeE, T, dyspareuniaF, T
  • Treat partnersE, F, G, H, K

Consider Trichomonas Vaginitis

  • Profuse malodourous yellow/green, frothy, adherent discharge, vulvar pain, itching, new partnerF
  • Treat partnersE, F, G, H, K

Consider Bacterial Vaginosis

  • Mild vaginal discomfort/itchingF
  • Thin white/grey, homogeneous vaginal dischargeF, H,

Consider Candida vaginitis

  • White, odourless “cottage-cheese” like discharge, severe external itching, correlation with menstrual cycle and antibiotic use, redness of labiaC,F, T

Red Flags

Rule out pelvic inflammatory disease (pelvic exam if suspectedC)

  • Pelvic pain, cervical motion tendernessC,E, F,, feverC and adnexal tendernessC,G,, and not pregnant by LMPE
  • Treat partnersE, F, G, H, K

Management

Pelvic inflammatory disease 

  • Ceftriaxone 250-500mg IM once + metronidazole 500mg PO BID 14d + doxycycline 100mg PO BID x14dE, G, H, K
  • Alt: Ciprofloxin 1g once + doxycycline 14dE
  • Alt: Azithromycin 2g PO once + metronidazole 500mg PO BID x14d + doxycycline 100mg PO BID x14dG

Gonorrhea/Chlamydia

  • Treat for both:
    • Gonorrhea: Cipro 500mg or ceftriaxone 125-250mg IM onceE, G, H, T or azithromycin 2g poG, K, T
    • Chlamydia – azithromycin 1g PO once, or doxycycline 100mg PO BID x 7-14dE, G, H, T

Trichomonas Vaginitis

  • Metronidazole 500 mg bid for 7-14d or 2g po onceE, F, G, K

Bacterial Vaginosis

  • Metronidazole 250-500 mg bid x 7-10 daysC,F, H, T or 2g once20 or gel pv daily x5dC,F,
  • Clindamycin 300 mg bid x 7dF, H, or 2% cream 5g pv at bedtime x 7dF, H

Candida vaginitis

  • Fluconazole 150mg x1C,F, H, I, T or Clotrimazole 100mg od x 3-14dC,E, F, G, I
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Organization A

Locations: Nicaragua
Trips per year: 4
Format of trips: Mobile medical clinics and standing clinics
Setting: Rural
Type of Organization: Secular

Organization B

Locations: Guatemala
Trips per year: Variable
Format of trips: Clinics
Setting: Rural
Type of Organization: Secular

Organization C

Locations: Haiti
Trips per year: Variable
Format of trips: Clinic
Setting: Urban
Type of Organization: Faith-based

Organization D

Locations: Dominican Republic
Trips per year: 3
Format of trips: Clinic
Setting: Rural
Type of Organization: Secular

Organization E

Locations: Haiti
Trips per year: 7
Format of trips: Not mentioned
Setting: Rural
Type of Organization: Secular

Organization F

Locations: Honduras, Ecuador, Belize, Guyana, Guatemala
Trips per year: 5
Format of trips: Mobile brigades
Setting: Rural and Urban
Type of Organization: Faith-based

Organization G

Locations: Ecuador, Guatemala, Dominican Republic
Trips per year: 100 (spread over 6 sites)
Format of trips: Mobile brigades
Setting: Rural and Urban
Type of Organization: Secular

Organization H

Locations: Ecuador
Trips per year: 3
Format of trips: Mobile brigades in schools/Clinics in health centers
Setting: Rural
Type of Organization: Secular

Organization I

Locations: Honduras
Trips per year: 1
Format of trips: Mobile brigades in 20 villages
Setting: Rural
Type of Organization: Faith-based

Organization J

Locations: Jamaica, Haiti
Trips per year: 4
Format of trips: Mobile brigades, Permanent clinics/hospital medicine
Setting: Rural and urban
Type of Organization: Secular

Organization K

Locations: Haiti
Trips per year: 4
Format of trips: Clinic
Setting: Rural
Type of Organization: Secular

Organization L

Locations: Guatemala, Nicaragua
Trips per year: 3
Format of trips: Mobile clinics
Setting: Rural
Type of Organization: Faith-based

Organization M

Locations: Nicaragua, Honduras
Trips per year: 51
Format of trips: Mobile brigades, Hospital-based
Setting: Rural
Type of Organization: Faith-based

Organization N

Locations: Guatemala
Trips per year: 12
Format of trips: Hospital
Setting: Rural
Type of Organization: Secular

Organization O

Locations: Honduras
Trips per year: Up to 50
Format of trips: Mobile brigades in school and churches
Setting: Rural
Type of Organization: Faith-based

Organization P

Locations: Haiti
Trips per year: Variable
Format of trips: Mobile brigades and clinics
Setting: Rural and urban
Type of Organization: Secular

Organization Q

Locations: Dominican Republic, Haiti
Trips per year: 12 to 15
Format of trips: Mobile brigades
Setting: Rural
Type of Organization: Secular

Organization R

Locations: Honduras, Nicaragua, Panama
Trips per year: Hundreds
Format of trips: Mobile brigades in community centre or school
Setting: Rural
Type of Organization: Secular

Organization S

Locations: Honduras
Trips per year: 4
Format of trips: Mobile brigades, Specialty hospital services
Setting: Rural
Type of Organization: Secular

Organization T

Locations: Haiti
Trips per year: Approximately 40
Format of trips: Mobile clinics in 14 villages and Standing clinic
Setting: Rural
Type of Organization: Faith-based