2nd midterm Flashcards
1
Q
Define infertiliry
A
no conception after 12 months of intercourse without contraception <35
no conception after 6 months of intercourse without contraception >35
2
Q
what are 2 types of infertility
A
1º-nulligravida
2º with h/o pregnancy
3
Q
Causes of female infertility: Pelvic
A
PID, STI, Septic abortion, endometriosis, pelvic tuberculosis.Surgical: dilation and curettage, ruptured
appendicitis, endometriosis, adnexal surgery, fibroids
Contraception and Pregnancy History: prior intrauterine
device use, DES exposure in-utero, ectopic pregnancy,
habitual abortion
Menstrual Cycle abnormalities: secondary amenorrhea,
endometriosis, cyclic abdominal or pelvic pain
4
Q
Causes of infertility: ovulatory
A
Secondary amenorrhea
abnormal uterine bleeding, luteal phase defet, premature ovarian failure, PCOS, elevated prolactin, hypothyroidism, prior use of ant-estrogens
5
Q
Other causes of infertility
A
delayed childbearing, insulin resisitance, substance abuse
malabsorption, unexplained
6
Q
male factor of infertility
A
varicocele, unexplained, obstrusctive azoospermia, undescended testis
7
Q
evaluation of male
A
semen analyisis after 2-5 days of abstinence. Volume 2-5mL, >20 mil/mL sperm #, motility>50% or >25% rapid, forward motility, 35% normal morphology
8
Q
Is a cause of infertilty always determined
A
NO
9
Q
what should you cut down on to achieve a successful pregnancy
A
decrease smoking, alcohol, coffee, BMI
10
Q
Things that help deal with infertility for the woman
A
stress reduction, acupuncture, diet, therapy, supplements(multivitamin, B12 to regulate menses, arginine for uterine blood flow), antioxidants, decrease smoking, increase AO levels, magnesium, selenium, Vitex(chaste tree), green tea,tribulus, rhodiola, phytoestrogens, progesterone, DHEA
11
Q
Things that help deal with infertility for the man
A
Antioxidants, Vit C and E for fragmented sperm, folic acid, zinc sulfate, phytoestrogens and the decrease caffein nicotine pot and alcohol. eat fruits and veggies
12
Q
What are complications of ovarian mass
A
torsion, ruupture, infection, hemorrhage, malignant potential
13
Q
What are the 3 types of functional cysts
A
Follicular(mc), Corpus luteum(lc), theca lutein
14
Q
what is the most common ovarian mass
A
functional cysts
15
Q
What are follicular cysts
A
- Dominant follicle failing to rupture(persisitent follicle)
- Immature follicle failing to undergo normal atresia
- Usually disappears within 1-3 months
- blood can fill the cavity of the cyst(hemorrhagic/chocolate cyst)
16
Q
What is significant about luteum cysts
A
clinically more important
associated with endocrine function or prolonged progesterone secretion
17
Q
What is a corpus luteum cyst
A
-results if the sac doesn’t dissolve but seals off after the egg is released then fluid builds up inside.
-occurs 2-4 days post ovulation
-resolves within a few weeks
-
18
Q
What is the % chance of recurrence of corpus luteum? How big can they grow?
A
31
4” and may bleed or cause torsion
19
Q
Decribe Theca Lutein Cysts
A
bilateral
- asymptomatic
- caused by prolonged or excessive stimulationof ovaries by endogenous or exogenous gonadotrophins
20
Q
Do theca lutein cysts resolve spontaneously?
A
typically yes
21
Q
when are functional ovarian cysts discovered
A
they are often asymptomatic and seen on a routine pelvic exam
- they can present as unilateral pressure, fullness or pain in lower abdomen
- dull ache in low back and thighs
- pain during sexual intercourse
- producing excess hormones-dysmennorhea, n/v, breast T
22
Q
When do you refer?
A
-pain with fever and vomiting
-sudden, severe abdominal pain
-fainting, dizziness, or weakness
-rapid breathing or heart rate (tachypnea,
tachycardia)
23
Q
what is another name for dermoid cyst
A
teratoma
24
Q
What is a teratoma?
A
monstrous growth, containing all 3 germ layers.
-composed of skin and filled with hair glands,muscle, bone and teeth, cartilage, respiratory/GI
epithelium, thyroid tissue
etc.
Can be benign or malignat
25
epidemilogy of Teratoma
```
-Most common ovarian neoplasm in
prepubescent girls & teens
-50% 25-50 yo
-20% post menopausal are benign
-also discovered on pelvic exam and then removed d/t malignant potential which is low
```
26
What is an endometrioma
An oma of the endometrium that is dx with US, is painful, and recurs if not completely resected.
27
What is a Tubo-Ovarian Abcess?
infection in tubo/ovarian junction and is usually caused by Gonn/Chlam
28
What are sx of ubo-Ovarian Abcess?
```
tubal/ovarian swelling or enlargement
-pelvic pain
-fever
-vaginal discharge
all leading ot infertility and chronic pelvic pain
```
29
Does your risk of malignancy go up after menopause with overian mass
Yes
post-45%
pre-13%
30
50% of all GYN cancer deaths are from what?
ovarian cancer
31
what are risk factors for ovarian cancer
- fam hx
- nullparity
- early menarch or late menopause
- fertility promoting drugs
- N. America, europe
- ethnicity(A. jews)
- sedentary
- high fat diet
- endometriosis
32
WHat are the sx of ovarian cancer?
Usually there are non until late stage
| if any it is LBP, menses abnormal and GI sx
33
What is the best way to screen for ovarina cancer?
CA-125(there are false negatives with fibroids, etc) and transvaginal ultrasound
34
There are invasive follow up tests for ovarian cancer, after Ca125 and US. They are invasive, but are they necessary?
NO, Potential harms outweigh potential benefits of screening
35
Describe staging and survival rate of ovarian cancer.
```
Stage 1=75-1oo%
Stage 2=45-60%
*Stage 3 = 15-50%
Stage 4 =5%
*malignant pleural effusion mets to liver and majority of patients with ovarian
```
36
what is gold standard test for ovarian mass
US
Finding: Cystic, smooth, unilocular, unilateral, small (<5cm) are
likely benign
-Solid or mixed cystic/solid, multilocular, bilateral,
irregular, large (>10cm+) with internal septae or
papillae are suspicious
37
When do you consider laparoscopy with ovarian mass?
>7-10cm
continue to enlarge
looks suspicious
hx, presentation, PE?
38
What helps you prevent ovarian cancer?
breast feeding, hormonal contraception, BL tubal litigation, prophylactic BL oophorectomy
39
Who gets small functional cysts 1-2 cm that regress in months?
newborns
40
who gets teratomas/dermoids?
premenarchal girls
41
Who gets functional cysts, endometriomas, tubo-ovarian
| abscesses, PCOS, ectopic pg, teratoma?
reproductive age women
42
who must r/o cancer and have increased risk of malignancy (both primary ovarian
carcinoma and metastatic from uterus, breast or GI)
post menopausal women
43
who gets cervical cancer?
women who have never been screened, have not been screened within past 5 years, have not received appropriate follow up after an abnormal Pap smear.
44
How is cervical dysplasia graded?
There is organized growth of the cervical cells. when this becomes disorganized you get cervical dysplasia. Disorganization is mild-CIN 1
moderate-CIN2
severe-CIN3 carcinoma in situ
45
where do you find dysplasia and carcinoma in situ
abnormalities are confined to the surface of cervix
46
WHat are the screening rules for cervical cancer
- screen 21-65 with pap every 3 years
| - 30-65 who want to test every 5 years must do pap and HPV test
47
Who does the USPSTF recommend against screening for?
women under 21
48
WHat is atypia of cervical cells
variation of normal, irritation or inflammation
49
What is ASCUS
abnormal squamous cells of undetermined significance
| benign changes that should be monitored
50
What is CIN I: cervical intraepithelial neoplasia
mild dysplasia
| aka LGSIL: Low grade squamous intraepithelial lesion
51
What is CIN II: cervical intraepithelial neoplasia
moderate dysplasia
| aka HGSIL: high grade squamous intraepithelial lesion
52
CIN III: cervical intraepithelial neoplasia
severe dysplasia
| aka HGSIL: high grade squamous intraepithelial lesion
53
CIS: carcinoma in situ
Precancer
54
How long does it take to cause HR-HPV mutations?
3y
55
Is HPV contagious?
yes, 70% of adults have it
| in teens and early 20s 70% of HR-HPV and 90% LR-HPV regress after 3 y.
56
Whats the bad news about HPV?
Rates of progression of carcinoma are 22%-60% and no early signs
57
The good news about HPV?
Vaccine for 9-26yo, 3 injection series, $360 for full series, but only covers 4 strains.
BUT-HPV is slow growing, 70-90% are transient and resolve without intervention
if detected early, tx min invasive.
58
Your patient has an abnormal pap, what next?
colposcopy- Direct magnification and viewing of
cervix, vulva,vagina, and/or perianal
tissue plus biopsy of tissue
59
Treatment for cervical dysplasia involves cryotherapy, describe it
probe is placed against cervix, which
damages the cells by freezing them. These
are then shed over the next month in a heavy
watery discharge.
Has had high failure rate for treating large
areas of dysplasia & areas that extend into
the cervical canal
60
What is a LEEP?
```
Uses a fine wire loop with electrical energy
flowing through it
-Tissue that is removed is sent to lab
-Good for treatment and diagnosis
- Done under local anesthesia
- Causes little discomfort
```
61
What is conization?
Removes a cone-shaped piece of the cervix
Better for diagnosing, but may have removed all
of the undamaged tissue as well
High success rate, may interfere with future
childbearing
62
Whats the deal with DES?
Diethylstilbestrol
synthetic non-steroidal estrogen
used to prevent miscarriage & other pregnancy
complications from 1938-1971.
Women who took DES during pregnancy have a slightly
higher risk of breast cancer
as well as AI disorders, cx dysplasia. Men exposed have issues with infertility and reproductive tract anomalies
63
DES daughters screening
first pap at onset of menses, 14 y.o. or onset
of intercourse
Baseline colposcopy after onset of intercourse
Vaginal and cervical paps every 6-12 months
until 30 y.o.
Thereafter, yearly cervical and vaginal paps
64
What is the flow of lymph
breast -> axilla ->supraclavicular
Axillary regions: pectoral, central, lateral, subscapular
Breast ->supraclavicular nodes
cervical nodes, opposite breastabdominal lymphatics
65
WHere is the mc site for fibrous cystic change
upper outer quadrant
then the inframammary line(from the bra)
If symmetrical and mobile=less worry
66
When to do a clinical breast exam
5 days post menses
67
What are the borders of the breast?
B/t ribs 2-6, b/t sternal edge and midaxillary line, include the "tail" UOQ->axilla
68
What is mastalgia?
breast pain and T, mc in premenopausal women
69
Is mastalgia a sx of breast cancer
rarely, cancer presents with discomfort 5% of time
70
What causes mastalgia
hormones, PMS, trauma, acute infection, m/s, cancer
| 60-80% spontaneous remission.
71
What is a fibroadenoma?
Benign,
- affects 10%,
- fibrous stroma
- respond to est/progest
- 15-50yo, not common in menopause unless HRT
- rubbery firm mobile painless
72
How do you manage fibroandenoma?
CBE, mammogram, US, needle bx
they can regress over time
tx: surgical excision or watch and wait
73
What are simple cysts?
fluid filled lesion that are soft and firm, mobile and cyclic fluctuations. Appear 15-50
74
How do you manage simple cyst
PE: difficult to differentiate from a solid mass
DX: Mammogram, U/S, Fine Needle Aspiration
Surgical Biopsy: if bloody aspirate, palpable mass doesn’t resolve with
aspiration, multiple recurrence in short period, no fluid aspirated.
CBE after tx, mammogram
75
Do recurrent large simple cysts have increased risk of cancer
yes in some studies
76
Whats important to know about fibrocystic breast change?
Common non cancerous change in breast tissue. 60% of women, swelling pain T.
From increased estrogen and decreased progesterone
often resolves with menopause
77
What are sx of fibrocystic breast change?
cyclic pain, variation in size, heavy, multiple nodules, premense aggravation, swelling, mobile, itschy, UOQ
78
What has a big impact on reducing sx of fibrocystic breast change?
methylxanthines
abstinence =97% improvement
take Vit E(relieves PMS)
EPO increase prostaglandin
79
What is mastitis?
infection seen during lactation or with skin disruption
80
How does mastitis present
```
fever/chills
erythema
pain
n/v
You get it from S.aureus, S. epidermis or strep
```
81
What are risk factors of mastitis
breast feeding, trauma, breast augmentation
| mc 2-4 weeks postpartum
82
What is Galactocele?
Blocked/obstructed breast duct after lactation. it is T and enlarged
Tx-excise and drain
83
What is the most common cause of nipple discharge
benign breast disease
10-15% benign
3-11% of malignant dz
84
how do you recognize benign discharge
BL,
nonspontaneus
multiple ducts
serous d/c may be caused by hormones
85
how do you recognize pathologic discharge
unilateral
spontaneous
d/c 2º to breast carcinoma may have color
frank blood, serous, green/grey
86
What is the number one cause of benign nipple d/c?
intraductal papilloma
can be bloody or serous
surgical excision
87
Whats galactorrhea
inappropriate lactation in nonpuerperal woman(during/after preg)
88
What is a subareolar abscess
An abscess from S. aureus or anaerobic organisms
You get yellow crusty discharge
It is recurrent with inverted nipples or nipple piercing
Tx with drainage antibiotic excision
89
What is the mc cancer in women
breast
| 1/3 will die, leading cause in 40-55yo
90
What is recommendation for breast cancer screening
Biennial women over 50-74yo
91
IN women over 60 with risks what is screening rec.
annual
92
When is screening recommended >40
with increased risk-fam hx 1st degree, dense breast
93
US is ineffective as a screening tool for BC. Whywould you order one?
Lump felt but not seen on mammography
OR
Lump with corresponding abnormality on mammagram
94
When would you order an MRI for BC
- Those with current or past diagnosis of BrCa
- dense breasts
- rectify inconclusive mammogram & U/S
- high risk
95
When to use needle aspiration
Bloody aspiration =biopsy rec.
| Cysts that reoccur within 2w and or require >1 aspiration
96
What is the incidence of + bx
Increases with age
>50y 20% carcinoma
>70y 33% carcinoma
97
What is definitive step to determine that a mass is benign or malignant
BX
Usual sequence: mammogram U/S core
biopsy
98
Where do most breast cancers start in men
under the nipple and more likely to have nippe discharge
99
T/F 90% of patients with breast cancer do not have a 1º relative with BC
T
| 75% of patients have no major risk factors
100
What are si and sx of early and late stage bc
Early: firm, irregular, immobile,unilateral
Late: skin/nipple retraction, T, lymphadenopathy, erythema, pain , fatigue, peau d'orange
101
How does Paget's disease of breast present
adenocarcinoma of nipple, itching burning erythema, ulcerations. Can be confused with tinea or fungal infection
102
What % dx at early stage BC
80%
| stage 1 2cm or less
103
The incidence of reoccurrence of BC correlates with ?
1º tumor size and status
1ºtumor type
previous tx
Reoccurence=worse px
104
What modifiable risk factors increase BC risk
hormone use
repro/breast feeding
lifestyle
environ exposure
105
What decrease risk of bc
```
menarche after 15 and early menoparuse
-3+ pregnancies prior to 30
-prolonged lactation
-healthy diet
-exercise
-minimal HRT/oc
take VIt D
```
106
Alcohol can increase risk of cancer, T/F
T
colon cancer increase with beer consumption
breast - alcohol decrease folate
107
Who has a 60-100%higher risk for BC
overweight postmenopause
108
What % of pregnancies are unintended
50%
| 20-24yo most and 40-44yo then 15-19yo
109
What % of women who get prego are on birth control
60%
b/c of user reliability
even when perfect use failure rate of 2%
110
How does hormonal contraception work
```
Suppresses FSH and LH surge
Inhibit follicular maturation; no ovulation
Thicken cervical mucus
barrier to sperm
Alters endometrial lining
so implantation unlikely
```
111
Ortho-Evra the patch
20mcg progestin every 24hrs
- patch changed each week 3x with one week off
- compliance88%
- avoid GI and live interference
112
What is disadvantage of orthoevra
```
Dysfunctional uterine bleeding
Dysmenorrhea, breast tenderness
No STD protection
Application site reactions ~ 17%
TOO MUCH HORMONE???
Higher rsik of prego
```
113
Nuva Ring
```
15mcg progestin daily
-Vaginal insertion 3 weeks and 1 week out
for menses (ok for continuous use)
-avoid gi/liver
-left in 21 days
-can be taken out for 3hrs
-can be uncomfortable
-Side effects: HA, vaginitis
```
114
Injectable Hormones-DMPA, lunelle
DMPA inject quarterly
Lunelle inject monthly
-First rule out pregnancy
Inject within 7 days of normal menses or
4 weeks postpartum if NOT breast feeding
6 weeks post partum if breast feeding (DMPA only)
use alternative BC for the first two weeks
effective during the first cycle if given as directed
Can take a long time to get your cycle back 12-24 mo
there is a decreased risk of endometrial cancer with this
115
IUS(IUD) progestin only
```
Mirena good for 5 years
20mcg release of levonorgestrel daily
-thickens cervical mucus
-reduce menses
-decrease endometrial cancer
```
116
Implanon
rod injected underneath skin of upper arm
-slowly releases progetogenic hormone
recommended d1-5 of menses to be inserted and use back up control for a week
117
Who should be on progestin pills
women breast feeding an dhave risk for blood clots
| all of these type of pills have hormone,no placebo
118
what are some bonuses to taking oral contraceptives
no prego, osteoporosis decrease, decrease colon cancer
- improve DUB, mood/pms, acne/hirsutism/PCOS, menorrhagia,
- decrease risk ovarian and endometrial cancer
- relief of migrain, breast chnge and functional ovarian cysts
119
Disadvantages of hormonal contraception
CVD, decrease glucose tolerance, BTB, Vaginitis, N/V, leg cramps, Weight gain, HA, decrease serotonin, Decrease in many vitamins esp. B
120
is there increased risk of breast cancer with hormonal contraception
Yawwss
121
Drug interactions with oral contraception
```
Acetaminophen
Alcohol
Antibacterials/ antivirals/
antifungal (diflucan; cipro)
Anticonvulsants/barbituates
Beta blockers
St. Johns Wort
Anti hypertensives
Bronchodilators
Corticosteroid
Hypoglycemics
Tricyclic antidepressant
Rifampin (TB med)
```
122
Contraindications to hormonal contraception
```
Liver disease
Pregnancy
History/current HTN or heart/vascular disease
-Migraine with focal neurological sxs
Breast cancer
Smoking >15 cigs and >35yoa
```
123
What are guidelines for back up contraception when starting OCs?
-The 1st Sunday after the first day of menses-needs one week back up
-The first day of the menstrual cycle-no back up
-Cyclical or continuous
Seasonal” is an 84 day OC
124
What is considered a missed pill and then what do you do?
A pill not taken within 6 hrs of its normal time.
-Miss 1 pill: take missed pill asap. Normally taken at 6am, but forgets until 1pm:
take 1 pill now, take next pill at 6am next day as
usual
-Miss 2 in a row
read the directions on the pack unless you cant read. Consider using barrier protection, unless you dont know what that is.
125
What are non-hormonal methods of birth control
```
copper-T IUD(10 years)
Condoms
Spermicides
Cervical cap
diaphragm(not the one you breathe with, that is not considered bc)
```
126
What does a copper IUD do?
reduces the sperms ability to swim, bad rxn b/t copper and sperm
it also prevents the sperm from fertilizing the egg
127
What are early danger signs of IUD
```
Late/missed period (r/o preg)
Abdominal pain
Fever, chills
Increased discharge
Odorous discharge
Big changes in bleeding:
breakthrough bleeding, heavy
periods, clots
```
128
Contras to copper IUD
```
Abnormal uterine anatomy
Enlarged uterus
Nulliparous
Current/ past PID
Hx of ectopic pg
Known or suspected Pg
DUB of unknown cause
Suspected malignancy
Copper allergy or Wilson's disease
```
129
What forms of contraception have spermacide
condoms, diaphragm and cervical cap
130
what does spermicide do
destroy sperm cell membrane, but must insert 30 min prior to sex , may increase risk for UTI or vaginitis and its messy
131
Condoms are effective?
for the most part 85% but do not protect from skin to skin HSV, HPV. Protect from HIV GC andCT.
132
when should you not use a diaphragm?
severe prolapse
allergy to latex or spermicide
vaginal septa or fistula
recurrent/chronic UTI
they can also have problems with compliance/efficacy
vaginal irritation, infections, odor, comfort self or partner
133
What is necessary when using a cervical cap?
Requires compatible cervix & proper fitting
by physician
Risks: vaginal/cervical abrasion, infection, TSS,
odor, allergy, discomfort
4% of users will develop an abnormal
pap smear so repap in 3months
134
Contraindications to cervical cap?
- Abnormal PAP
- Allergy to rubber; spermicide
- Acute cervicitis; vaginitis
135
What is fertility awareness technique
Helps identify days of the month pregnancy is likely, to avoid or encourage pregnancy.
Can be complicated by altered physiology or fever, vaginitis, travel, sleep.
136
What is the most effective way to track fertility awareness technique?
```
Symptothermal 86% effective
followed by
BBT
Cervical mucus
calendar
```
137
What is tubal sterilization?
Sterilization intended to be a permanent method of birth control
2% failure rate/10yrs
138
What is a vasectomy?
surgical procedure severing the vas deferens - the tubes
that carry sperm from the testes
Incision and non incision(freeze) and only 30 min under local anesthetic
139
How do you know a vasectomy worked?
Semen produced in seminal vesicles & prostate
Sperm continue to be made in testes & reabsorbed
Ejaculation unchanged
15-20 ejaculations post-op to flush remaining sperm;
alternative method of contraception needed
After 2-3 mo check to assure no sperm are present.
Around 1/40-50 men will have their vasectomy
reversed “vasovastostomy”
140
what are side effects of vasectomy?
- pain, stops in a week
- infection
- granulomas-result of leakage of sperm from cut end of vas into scrotal tissues
- epidiymitis
- abcesses
- erectile dysfunction
- prostate cancer
141
When can Plan B or Preven be used?
5 days after unprotected sex
| you can use IUD as well if inserted within 5 days of unprotected sex
142
What is the mechanism of emergency contraception?
inhibits/delays ovulation, alter endometrium, thicken cervical mucus, alter sperm or ovum transport
DOES NOT AFFECT AN ESTABLISHED PREGNANCY
143
are all reproductive tract infections sexually transmitted
no
144
Do women suffer longer and have more severe sx with RTIs
Yes
They get PID, inferitlity, ectopic prego, chronic pelvic pain, prego loss, preterm birth,c ervical cancer
They are usually asymptomatic
145
Who is more likely to get an STI
| woman or man
woman
| or anyone who is receiving
146
What is the most common gyn complaint?
vaginitis
itching, burning, discharge, odor, pain
usually maintained by lactobacilli acidophilus
147
How do you recognize bacterial vaginitis?
your first clue cell is that it smells like fish on KOH wet mount.
also homogenous discharge and pH>4.5
148
What agents contribute to vaginitis
gardnerella, haemophilus, group B strep, sexually associated in lesbians
149
What is pathogenesis of BV?
Lactobacilli control the environment;
if low other bacteria (gardnerella, Group B strep) overgrow
then amino acids production-> increase vaginal pH(elevated pH kills normal flora) -> squamous cell desquamation leads to classic discharge
150
what are complications of BV?
high recurrence rate 60%
- cervicitis
- PID
- post surgical infection
- increased HIV/STI risk
- pregnancy
151
what is the recommended tx for BV
antibioitics: metronidazole or clindamycin
- lactobacilli-to make H2O2
- lactic acid gel
- Povidone-iodine
- Boric acid
152
What is a yeast infection?
overgrowth of a fungus that lives in healthy vaginas
| candida albicans
153
what are sx of yeast infection?
pruritis, whit-yellow d/c, erythematous tissue, vulvar fissures
154
How do you dx a yeast infection
10% KOH wet mount
pseudohyphae
budding yeast
pH of 3.8 to 4.5 (normal)
155
Tx of yeast infections
```
Treat underlying cause
-antifungal-an azole
-boric acid
-OTC topical steroids for sx relief
-oral/vag acidophilus
sitz bath
diet
TX OF PARTNER NOT NECESSARY
```
156
What is Trichomoniasis vaginalis?
STI, Protozoal flagellate Trichomonas vaginalis
-associated with the presence of other STIs
-Facilitates the transmission and acquisition of HIV &
other STI
157
Dx of Trich
Normal saline mount, motile organisms with flagella and increased PMNs
158
What is the presentation of Trich
Vaginitis, cervicitis, urethritis
Affecting vagina, skene's ducts and lower UTI.
asymptomatic for years
159
Who gets a strawberry cervix and yellow/green discharge
Patients with TRICH
be sure to tx partner
metronidazile or tinidazole
160
Chlamydia and gonorrhea are both bacteria that infect genital columnar cells but have different presentions what are they?
Both can be asymptomatic and have cervicitis, urethritis and PID but chlam gives you reiter's and gon give you pharyngitis and arthritis
161
MC reported STI in oregon?
Chlam followed by gonn
162
Who is more likely to get the gonn
African american women 5x
163
What are signs of the chlam and the gonn in women?
```
ASYMPTOMATIC
vaginal discharge
dysuria
dyspareunia
low ab pain-CPP
unusual bleeding
```
164
What are signs of the chlam and the gonn in men?
```
ASYMPTOMATIC
penile discharge
dysuria
burning/pruritus
pain with ejaculation
pain and swelling of testes
```
165
What are recommendation for CT/NG
annual screening of sexually active females<25
or >25 with risk factors
rescreen women 3-4 months after treatment d/t high prevalence of repeat infection
166
is it possible that lactobacillus may prevent NG/CT infection?
yes
167
How do you recognize epididymitis?
```
scrotal pain and swelling
fever
penile discharge
chills
ab pain
pelvic pain
frequent urge to pee
dysuria
hematuria
painful ejaculation
```
168
Dx epidiymitis
DNA prob for GC and CT, LCR urine test
examination of 1st void urine for WBCs
test and treat partner
169
What is interesting about prostatitis
50% of men experience disorder during their
lifetime.
Most common urological disorder > 50 third most
common disorder in men younger than 50.
-Escherichia coli
- Klebsiella
- NG/CT
170
Risk factors of prostatitis
```
Bladder outlet obstruction (stone, tumor, BPH)
Diabetes mellitus
Suppressed immune system
Urethral catheterization
STI’s
Unprotected anal/vaginal intercourse
bacteria
enters urethra, prostate
```
171
what do we need to know about proctitis
```
Anoscopic
Specimen collection for HSV, NG, CT, syphilis
Painful perianal or
mucosal ulceration on
anoscopy
presumptive therapy for
HSV
```
172
How does HPV (condyloma accuminata) present?
visible genital warts
subclinical infection
oropharyngeal infection
173
Who has HSV
50% of americans HSV 1
| 1 in 5 have HSV-2
174
Do condoms prevent HSV infection
Not necessarily, asymptomatic viral shedding spreads most HSV>70%
175
What is 1º herpes
First infection with either HSV 1 or 2
Most severe symptomatic form
presents as erythematous papule vesicle, pustule, ulceration, encrustation
also include regionals lyphadneopathy as well as fever malaise arthralgia HA
176
First episode non primary herpes is?
Initial genital infection in a patient who has already
| experienced infection with the other HSV type
177
How long does transmission take for HSV
avg 4 days can be 2-20 days
Virus replicates in ganglia migrates to mucosa
replicates in epithelium lesions or symptoms
length of viral dormancy varies
178
Are recurrent herpes as dramatic as primary herpes?
No usually milder and shorter
systemic and neuro sx rare
Patients get prodrome: local paresthesia, itching, pain.
triggers are: stress, fatigue, intercourse, menstruation, diet/lifestyle, menopause
179
what is lab dx for HSV
viral culture
Only if in pustular stage; (most sensitive)
Tzank smear*
Only if in pustular stage
antigen detection tests (direct fluorescent antibody test)
180
If you have HSV can you transmit it to your baby?
Perinatal transmissionis highest in undx mothers
50% born thru 1º lesions become infected
<3% born thru non 1º lesion become infected
181
Can syphilis infect any organ in the body?
yes treponema pallidum can, its a blood born pathogen. spirochete
182
What does the last stage of syphilis cause?
heart disease, brain
| damage, spinal cord damage, blindness, and death
183
What does 1º syphilis entail?
- Chancre within 3 weeks-90days, contagious
- chancre is painless, firm with indurated borders and can appear anyhwere on body
- regional lymphadenopathy
184
2º Syphilis-GO
```
2-8 weeks after chancre Patient develops rash on palms and soles
-fever less than 101º
-sore throat
-weakness
-patchy hair loss
-weight loss
lymphadenopathy
-nervous system sx-neck stiff, HA, irritabiity, paralysis, unequal reflexes, irregular pupils
```
185
what is latent stage of syphilis
if untreated- After secondary-stage rash goes away, no symptoms =
latent period; may be as brief as 1 year or range from 5
to 20 years.
A person is contagious during early part of latent stage
may be contagious even when no symptoms are
present.
must do blood test to dx
186
What is 3º stage syphilis
most destructive
-If untreated, tertiary stage may begin as early as 1
year after infection or at any time during a
person's lifetime.
-Gummata large sores inside the body or on skin.
Cardiovascular affects heart and blood vessels.
Neurosyphilis affects brain or related structures.
187
How do you dx syphilis
screening antibody testing/VDRL/RPR
for non-specific ‘reagin’ antibody
screening test (false positives common)
-flourescent treponemal antibody absorption (FTA- ABS),
microhemagglutination test (MHA-TP)
188
What is a chancroid?
STI caused by infection with bacterium
| Haemophilus ducreyi
189
Where do you get chancroids?
causes one or more ulcers on genitalia and are associated with inguinal lymphadenitis
they may progress to abcess formation.
190
Do chancroids co exist with other STI
Yes, HSV, the chlam, syph
191
Are chancroids painful
Yes can be single or multiple painful circumscribed nonindurated ulcers
192
Can you go to tropical islands and get a chancroid?
Yes, incubation 1-7 days, lesion appears 2-3 days-1 mo after exposure. can be aymptomatic
193
LYMPHOGRANULOMA VENEREUM
STI involving inguinal lymph glands caused by a specific strain of chlamydia. Incidence is highest among sexually active people living in tropical or subtropical climates
it starts small then spreads to lymph nodes 3-30dys after exposure
194
What is granuloma inguinal?
```
Klebsiella
Granulomatous
s/sx vascular leasion
prone to easy
bleeding
Dx clinical with
confirmation of KG on
stained culture
```
195
How long can pediculosis pubis live on fomite?
1 month
196
How do you get pediculosis pubis?
sex, shared bed, shared clothing
| then it lays eggs(nits) at base of hair shaft. Eggs hatch 7-9 days
197
What is a viral STI that has small painless papules on genitals, inner thighs, and butt?
Molluscum contagiosum
| it spontaneously resolves by 6 months or take antivirals
198
What cells are most affected by HIV
activated T cells
199
Which cells are susceptibel to HIV infection
langerhans
200
How can you get HIV?
sexual contact, contaminated blood, bone donor tissue, occupational risks, mother to child delivery, breast milk
201
What body fluids can be infected with HIV
1. Blood 2. Semen and pre-seminal fluid 3. Vaginal fluid 4. Breast milk 5. Sweat 6. Saliva 7. Tears
202
What body fluids transmit HIV
1. Blood 2. Semen 3. pre-seminal fluid 4. Vaginal fluid 5. Breast milk
203
What are the routes of transmission of HIV?
1. Vagina 2. Rectum 3. Mouth 4. Urethra 5. Inside of eyelids
204
Can HIV concentration vary in different body fluids?
Yes
205
How do you dx HIV?
ELISA-screening test(sensitive)
| Western Blot-confirmatory test(specific)
206
Do HIV screening test detect the virus?
No they detect antibodies. This is a drawback because of the window of time it takes to produce antibodies after transmission. New technology you can test within 3-5 weeks.
207
What HIV test detects the virus itself?
PCR, but not first line of testing, not specific
208
When are the largest # of HIV infected cells detectable?
6-12 weeks post infection and after 15 y
209
WHen is the onset of AIDS?
T4 cells fall below 200 per cu mm,cell proportion <14% virus titers rise rapidly and immune activty drops. loss of immune competence enables opportuistic microbes to cause infections
210
What is the major cause of death in late stage AIDS
candidiasis, pneumocystis carnii, mycobacteria avium complex
