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Senior - OB 3 > 16 - Gynecologic Infections (old deck) > Flashcards

16 - Gynecologic Infections (old deck) Flashcards

1
Q

Causes of vaginal discharge?

A

Vaginitis

  • BV
  • VVC
  • trichomoniasis
  • other (atrophic, FOB)

Cervicitis/urethritis

  • chlamydia
  • gonorrhea

Physiologic discharge

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2
Q

Why does the vaginal mucosa produce glycogen?

A

Nutrients for many vaginal ecosystem species -> converted to lactic acid
- decreases in menopause

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3
Q

Vaginal mucosa is made of?

A

Stratified squamous epithelium

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4
Q

Actions of vaginal stratified squamous epithelium?

A 
Secretory
Estrogen responsive
Homeostatic
Produces glycogen 
Vaginal pH
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5
Q

Low vaginal pH =

A

4-4.5

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6
Q

What is the predominant microorganism of the vagine?

A

Lactobacilli

  • lactic acid
  • hydrogen peroxide
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7
Q

Lower reproductive tract flora

Aerobes

A

Gram pos

  • lactobacillus
  • diphtheroids
  • staph aureus
  • staph epi
  • GBS
  • e. Faecalis
  • staph spp

Gram neg

  • E. Coli
  • klebsiella spp
  • proteus spp
  • enterobacter spp
  • acinetobacter spp
  • citrobacter spp
  • pseudomonas spp
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8
Q

Lower reproductive tract flora

Anaerobes

A

Gram pos cocci

  • peptostreptococcus spp
  • clostridium spp

Gram pos bacilli

  • lactobacillus
  • propionibacterium
  • eubacterium
  • bifidobacterium
  • actinomyces iraelii

Gram neg

  • prevotella
  • bacteroides
  • bacteroides fragilis
  • fusobacterium
  • veillonella

Yeast
- candida albicans and others

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9
Q

Things that offset balance of the microflora?

A 
Antibiotics
Douchbags
Semen
FOB
Hypoestrogenized (atrophic)
- menopause
- pregnancy
- contraception
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10
Q

3 main causes of vaginitis?

A

Bacterial vaginitis (BV) - 40-50%

Candida vulvovaginitis - 20-30%

Trichomonas - 15-20%

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11
Q

Categories of vaginitis?

A

Inflammatory

  • desquamative vaginitis
  • trichomonas
  • candida
  • atrophic vaginitis
  • GAS
  • FOB
  • irritants
  • mucosal erosive disease

Non-inflammatory

  • BV
  • candida
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12
Q

MC cause of bacterial vaginosis?

A

BV

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13
Q

S/s of BV?

A

Profuse grey milky discharge

Strong, fishy odor
- esp after sex

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14
Q

What causes BV?

A

Sift in normal flora
- overgrowth of anaerobes
(Not listing them again)
- reduction/loss of lactobacilli

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15
Q

Risk factors for BV?

A 
Oral sex
Douchbags
Black race
Cigarettes
Sex during menses
Intrauterine device
Early age of sex
New/multi partners
WSW sex
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16
Q

BV diagnosis requires?

A

Min 3 of:

  • Homogenous discharge
  • pH >4.5
  • pos “whiff” test
  • clue cells on wet prep
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17
Q

Acute BV tx?

A

Metronidazol (flagyl)
Metronidazole gel (metrogel vaginal)
Clindamycin cream

Doses and shit on slide 32 (original deck)

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18
Q

Recurrence of BV?

A

Recurrence is common (50% w/in 12 mo)

Probiotics have benefit ofr recurrence of chronic BV (not acute)

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19
Q

Should you treat the partner for BV?

A

Doesnt help women w recurrent sx

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20
Q

Consequences of BV?

A
  • Increased risk of STI infections
  • turbo-ovarian abscess
  • PID
  • persistence of HPV
  • endometritis
  • vaginal cuff cellulitis (post hysterectomy)
  • premature rupture of membranes
  • postpartum fever
  • post-abortion infection/sepsis
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21
Q

Pt presents w chronic/recurrent BV you should?

A

Revisit pt hx
Perform speculum exam
Obtain NAAT and KOH/Wet prep

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22
Q

Chronic/recurrent BV tx?

A 
No prior long term tx:
- metronidazol (oral or vaginal)
- tinidazol (oral)
- cindamycin (vaginal)
(Treat for 2 wks)
w hx of long term tx
- metronidazol (oral or vaginal)
- tinidazol (oral)
- cindamycin (vaginal)
(Suppress w weekly/biweekly x 6 months)
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23
Q

What is the goal of tx of chronic BV?

A

If cannot cure the goal is to control rather than eliminate

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24
Q

Adverse pregnancy outcomes of BV?

A

PROM
Preterm delivery
Intra-amniotic infection
Post-partum endometritis

  • all pregnant women should be treated
  • high risk pregnancy should be screened
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25
Q

2nd MCC of vaginitis?

A

Vulvovaginal candidiasis

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26
Q

Symptoms of vulvovaginal candidiasis?

A 
Vaginal burnin/itching
Irritation
Post-voiding dysuria
Odorless thick white discharge
- “cottage cheese”
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27
Q

Cases of vulvovaginal candidiasis?

A

C. Albicans - 80-92%

C. Galbrata

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28
Q

Diagnosis of vulvovaginal candidiasis?

A

Vulvovaginal erythema
PH <4.5
Budding yeast/pseudohyphae on KHO
Culture

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29
Q

Risk factors of vulvovaginal candidiasis?

A 
H estrogen
Immunosuppression
Environmental (tight clothes, condoms etc) 
DM
Antibiotic use
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30
Q

Topical agents for candidiasis?

A

Big ass chart on 221 (review deck)

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31
Q

Risk factors for recurrent vulvovaginal candidiasis?

A

Most women dont have risk factors
- its a host issue not a bug issue

But they are:

  • OCP
  • diaphragm
  • DM
  • abx use
  • pregnancy
  • immunosuppression
  • tight clothing
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32
Q

Recurrent vulvovaginal candidiasis?

A

> /= 4 episodes in 1 yr
5% of women
- get a culture

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33
Q

What to do if your pt has recurrent vulvovaginal candidiasis?

A

Revisit pt hx
Speculum exam
NAAT and KOH wet prep
Get a fungal culture w sensitivities

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34
Q

Tx for recurrent vvc?

A

Tx:

  • local intravaginal therapy 7-14 days
  • fluconazole PO

Suppressive:
- oral fluconazol weekly x 6 months

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35
Q

Tx for VVC external irritation?

A

Topical mid-potency steroid

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36
Q

3rd MCC of discharge

A

trichomoniasis - 10-20% of cases

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37
Q

S/s of trichomoniasis?

A

50% asymptomatic

But:

  • frothy green-yellow discharge
  • odor is strong or “musty”
  • dyspareunia
  • occasionally dysuria
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38
Q

Diagnosis of trichomoniasis?

A 
Frothy discharge
Strawberry 🍓 cervix
PH >4.5
Trichomonads on wet prep
NAAT
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39
Q

Gold standard for trichomoniasis?

A

NAAT

40
Q

Tx for trichomoniasis?

A 
Metronidazole either/or
- 2gm PO 
- 500 mg BID x 14 days
Tinidizole 
- 2gm PO

Test of cure at 1 and 6 months

41
Q

Most prevalent STI?

A

HSV

1 and 2

42
Q

Why are HSV 1 and 2 so easy to spread?

A

Only 10-20% know they have it

70% transmission from asymptomatic viral shedding

43
Q

S/s of HSV?

A

Prodrome:

  • tingling
  • itching
  • burning
  • paresthesias

Painful burning
Vesicles/ulcers

44
Q

HSV 1st infection symptoms?

A

Fever
Ha
Malaise
Inguinal lymphadenopathy

45
Q

HSV transmission?

A

Toilet seats
Saliva
Direct contact

46
Q

HSV risk to fetus?

A

Initial infection = greatest risk

- mom has no antibodies

47
Q

Genital warthogs are?

A

HPV

- types 6, 11

48
Q

Transmission of HPV?

A

Contact
Inanimate objects
- (like the back seat of a volkswagon?)
Birth canal -> larynx

49
Q

Genital warts diagnosis?

A

Clinical
- acetic acid application

Biopsy if unresponsive to tx

50
Q

Rx for genital warts?

A

Provider applied:

  • podophyllin
  • trichloroacetic acid (TCA)
  • bichloroacetic acid (BCA)
  • cryotherapy

Pt applied:

  • podofilox
  • imiquimod (no preggos)

Surgical:

  • tangential scissor excision
  • tangential shave excision
  • curettage
  • electrosurgery
51
Q

Primary syphilis is?

A

Treponema pallidum -> bacterial spirochete

52
Q

Primary syphilis transmission?

A

Contact

Transplacental

53
Q

Clinical diagnosis for syphilis?

A

Clinical:

  • Isolated painless chancre (ulcer)
  • hard, smooth, raised rounded borders
  • > actively sheds spirochetes

Screening:

  • RPR
  • VRDL
  • FTA-ABS (confirmation)
54
Q

Where does syphilis present?

A 
Cervix
Vagina
Vulva
Mouth
Anus
55
Q

Untreated syphilis?

A 
Chancre heals in 6 wks
Infection remains (dun dun dunnnnnn)
56
Q

Tx for syphilis?

A

PCN 2.4 million units IM

57
Q

Secondary syphilis presentation?

A 
Bacteremia - 6 wks - 6 mo after chancre
- 1/3 of cases 
Rash (hallmark)
Fever, malaise
Lymphadenopathy
Exanthem (sheds spirochetes)
Condylomata lata
58
Q

Hallmark rash of secondary syphilis?

A

Maculopapular rash of:

  • palms
  • soles
  • mucous membranes
  • sometimes whole body
59
Q

What is condylomata lata?

A

Broad, pink or gray-white highly infectious plaques

- in warm, moist areas of bodies

60
Q

Tx for secondary syphilis?

A

PCN 2.4 million units IM

61
Q

Latent syphilis timelines?

A

Early latent
- 1st yr following 2ndary w/o tx

Late latent
- > 1yr after initially infection

62
Q

What is tertiary syphilis?

A

Can be up to 20 yrs after latency

Presentation can be:

  • cardiovascular
  • CNS
  • musculoskeletal involvement
63
Q

What if the syphilis pt has PCN allergy?

A

PCN is the only proven tx

- may need to desensitized

64
Q

What is jarisch-herxheimer reaction?

A

Occurs in 50% of 1st degree syphilis
90% of 2nd degree syphilis

Caused by release of endotoxin when large #s of organisms are killed by antibiotics
- persistence fever, malaise and HA

65
Q

Tx of syphilis:
< 1y

and

latent, tertiary and cardiovascular syphils

A

<1 yr
- bnezathine PCN G once

Late latent, tertiary and cardi
- benzathing PCN G IM weekly x 3

66
Q

Syphilis tx needs?

A

Follow up
- after 6 months

If retreatment is req weekly PCN inj x 3 weeks

67
Q

Chancroid is aka?

A

Haemophils ducreyi

68
Q

Clinical presentation of chancroid?

A

Erythematous papule -> pustule -> ulcerates w/in 48hrs

Edges of ulcer = irregular w erythematous non-indurated

Ulcer red and granular, soft

PAINFUL

69
Q

Chancroid tx?

A

Azithromycin 1 gm PO
Or
Ceftriaxone 250mg IM

70
Q

Sx of chlamydia?

A

Asymptomatic

  • 70% of women
  • 50% of men

Urethritis
cervicitis

71
Q

Dx for chlamydia?

A

Culture
Antigen test
PCR

72
Q

Tx for chlamydia?

A

Azithromycin 1gm po x 1
Doxy x 7 days

Test of cure if pregnant

73
Q

S/s of gonorrhea (clap)

A

asymptomatic

  • most women
  • 5% of men

Urethritis
Cervicitis

74
Q

Dx for gonorrhea?

A

Gram stain
Culture
DNA/nucleic acid PCR

75
Q

Tx for gonorrhea?

A

Primary
- ceftriaxone + azithromycin

Secondary
- cephalosporin PO/IM + azithromycin

Tertiary
- cephlosporin PO/IM + doxy

76
Q

What is no longer recommended for gonorrhea?

A

Quinolones

77
Q

What is PID?

A

Upper GI tract inflammation/infection

78
Q

MC organisms for PID?

A 
Chlamydia trachomatis
N. Gonorrhea
BV microflora (anaerobes)
Genital mycoplasmas
- M. Homiminis
- U. Urealyticum 
- M. Genitalium
79
Q

PID sequelae

A

Infertility
Ectopic pregnancy
Chronic pelvic pain

80
Q

PID risk factors?

A 
Douchbags
Single status
Substance abuse
Multiple sex partners
Lower socioeconomic status
Recent new sex partners
Younger age (10-19)
STI
Sexual partner w urethritis or gonorrhea 
Previous infection of PID
Not using mechanical or chemical contraceptive barriers
81
Q

clinical PID symptoms

A

Silent infection
- not clinical dx

Woman w tubal-factor infertility who lacks hx compatible w upper tract infection

Often has antibodies to:

  • chlamydia
  • gonorrhea

Prior tubal infection signs:

  • adhesions
  • hydrosalpinx
82
Q

Acute PID clinical symptoms?

A

Usually develop during/soon after menstruation

  • lower abd/pelvic pain
  • yellow vaginal discharge
  • heavy menstrual bleeding
  • fever/chills
  • anorexia
  • N/V/D
  • dyspareunia
  • UTI sx
83
Q

PID diagnostic criteria

A

Minimum

  • uterine/adnexal or cervical motion tenderness
  • lower abdominal pain

More specific

  • > 101* F
  • mucuopurulent cervical discharge/friability
  • WBC on saline microscopy
  • elevated ESR/CRP
  • lab diagnosis STI

Most specific
- US, MRI, laparoscopic-

84
Q

PID inpatient criteria?

A 
Pregnant
Adolescent
Drug addict
Severe disease
Suspected abscess
Uncertain diagnosis
Generalized peritonitis
Temp >38.3
Failed therapy
Recent intrauterine instrumentation
WBC > 15,000
N/V preclude oral therapy
85
Q

PID tx?

A

GC/Chlamydia abx

Inpatient
- cefoxitin IV and doxy IV

Outpatient (all x 2 wks)

  • ceftriaxone IM
  • doxy PO
86
Q

What if PID pt has concomitant trich or recent instrumentation?

A

Add metronidazole 500mg BID x 2 wks

87
Q

Wht is tubo-ovarian abscess?

A 
PID complication (10%)
Rupture leads to peritonitis, sepsis
88
Q

How to distinguish TOA from endometritis/saplingitis?

A

Presence of tender inflammatory adnexal mass

  • US
  • CT
  • MRI
  • laproscopy
89
Q

Tx for TOA?

A

Broad spectrum IV abx
- 85% response rate

Surgery if no improvement x 24-48hrs

90
Q

Toxic shock syndrome

A

Exotoxin from s. Aureus

2 days post surgery/mensturation

Super absorbent non-Cherokee hair tampons

91
Q

Triad of TSS?

A

Fever, Malaise, Diarrhea

Diffuse macular rash

Orthostatic hypotension

Thats like a fivead but what do i know. I’m not a doctor

92
Q

Tx for TSS?

A

Abx

Systemic support

93
Q

TSS diagnostic criteria?

A

Major and minor

94
Q

Major criteria for TSS?

A 
HOTN
Orthostatic syncope
Diffuse macular erythoderma
Temp < 38.8
Late skin desquamation
95
Q

Minor criteria TSS?

A

Organ system involvement

  • GI: Diarrhea/vomiting
  • mucous membranes involvement
  • muscular: myalgia, creatinine
  • renal: BUN and creatinine, WBC in urine
  • Heme: platelet <100k
  • Hepatic: SGOT, STPT bilirubin H
  • CNS: alter LOC
96
Q

Knock knock

Who’s there?

A

Chlamydia, go get checked out

Senior - OB 3 (6 decks)

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