05. GYN Infections

Question 1

Which strains of HPV are targeted in Gardasil?

Answer 1

16, 18, 6, 11

Question 2

Which strains of HPV are known to increase risk of cervical cancer?

Answer 2

16, 18

Question 3

Which strains of HPV are known to cause most cases of genital warts?

Answer 3

6, 11

Question 4

How can HSV be diagnosed in a patient with exposure but no outbreak?

Answer 4

Antibody tests

Question 5

What symptoms will a patient experience during the prodrome phase of an HSV outbreak?

Answer 5

Tingling/itching of skin in region where lesion(s) will appear

Question 6

How long does a primary HSV infection generally take to heal?

Answer 6

7-14 days

Question 7

How long does viral shedding continue after a primary HSV infection?

Answer 7

2-3wks

Question 8

What is the preferred tx for HSV?

Answer 8

Acyclovir (cheapest) or Valacyclovir (easiest BID dosing)

Question 9

What are the preferred topical treatments for tinea?

Answer 9

Clotrimazole; miconazole; Ketoconazole

Question 10

What organisms cause tinea?

Answer 10

Trichophyton rubrum; Epidermophyton floccosum

Question 11

What oral treatments can be used for severe or unresponsive cases of tinea?

Answer 11

Itraconzole; Griseofulvin

Question 12

What condition is associated with intense burning, pruritus, and erythema of the vaginal region with associated thick, curdy discharge?

Answer 12

Vaginal candidiasis

Question 13

When diagnosising vaginal candidiasis, what characteristic should be observed on a wet mount?

Answer 13

Pseudohyphae

Question 14

Are oral or topical therapies preferred for tx of vaginal candidiasis in a pregnant patient?

Answer 14

Topical

Question 15

If a “strawberry cervix” and diffuse, malodorous, yellow-green d/c are observed during a specular exam, what STD should be suspected?

Answer 15

Trichomonas vaginalis

Question 16

What treatments are effective for Trichomonas infections?

Answer 16

Systemic - Metronidazole or Tinidazole; Intravaginal NOT effective

Question 17

A patient comes to clinic complaining of vaginal discharge that is thick and milky and smells “fishy”. What is your leading differential diagnosis based on the patient’s description?

Answer 17

Bacterial vaginosis

Question 18

Is bacterial vaginosis an STD?

Answer 18

This is is a change in the balance of bacteria normally present in the vagina. It is NOT an STD, but it is considered a “sexually-associated infection”.

Question 19

What are indicative lab findings of bacterial vaginosis?

Answer 19

Clue cells (>20%) on microscopic eval of d/c; fishy odor during “whiff test”; vaginal pH >4.5

Question 20

What oral treatment is used for BV?

Answer 20

Metronidazole x 7 d

Question 21

What topical treatment is used for BV?

Answer 21

Clindamycin crm 2% QHS x 7d

Question 22

What STD causes target-shaped lesions on palms and soles?

Answer 22

Secondary syphilis

Question 23

What is the first line treatment for syphilis?

Answer 23

Benzathine PCN G 2.4 million units IM (not the same as Strep tx)

Question 24

What treatment can be used to treat syphilis in pts allergic to PCN?

Answer 24

Doxycycline BID x 28 d

Question 25

How can a chancroid be differntiated from a chancre d/t primary syphilis?

Answer 25

Chancroid infxn is painful. Primary syphilis chancre is painLESS.

Question 26

What is cervicitis?

Answer 26

Inflammation and infection of endocervical cells. MCC = GC & chlamydia.

Question 27

S/Sx of cervicitis

Answer 27

Often asymptomatic. Mucopurulent cervicitis/vaginal d/c. DYSURIA THAT MAY BE CONFUSED WITH UTI. POSTCOITAL BLEEDING D/T FRIABLE CERVIX. Suspect CHL when sterile pyuria with UTI symptoms present

Question 28

Tx of cervicitis

Answer 28

Presumptive tx for women

Question 29

PID

Answer 29

Pelvic inflammatory disease. Inflammation of the upper female genital tract. Often d/t GC and/or CHL

Question 30

Minimum criteria for Empiric Tx of PID

Answer 30

Pelvic/lower abdominal pain, AND Cervical motion tenderness or Uterine tenderness or Adnexal tenderness

Question 31

Definitive Dx of PID

Answer 31

Transvag U/S, or MRI, or Laparoscopy showing endometritis

Question 32

Tx of PID

Answer 32

Cefoxitin + Doxy +/- Metronidazole

Question 33

Fitz-Hugh-Curtis Syndrome

Answer 33

PID accompanied by RUQ pain resulting from inflammation of peritoneum around the LIVER. Laparoscopy reveals thins adhesions "violin strings" in abdomen d/t chronic inflammation.

Question 34

Complications of PID

Answer 34

Tubo-ovarian abscess (TOA); Adhesions, scarring, chronic pain; Infertility

Question 35

What genital tract infection results primarily from IUD placement?

Answer 35

Actinomycosis (d/t Actinomyces israelii)

Question 36

Tx of Actinomycosis

Answer 36

PCN & surgical drainage

Question 37

Tx of Genital TB

Answer 37

RIPE regimen x 24-36 mo

Question 38

CDC Criteria for TSS

Answer 38

Temp >38.9 C/102.2 F Diffuse rash, intense erythroderma, blanching "boiled lobster", with subsequent desquamation, esp. of palms & soles Involvement of 3 or more organ systems