Alterations in Women's Health and STIs Flashcards
Normal Menstrual Characteristics
Cycle length: 21-35 days, day 1 = first day of menses
Amount of flow: average 25-60ml
Variations are normal (typically 3-5 days but may last up to 7 days)
Amenorrhea: Primary
Menstruation has not been established by age 13-14 and no secondary sexual characteristics noted
Or no menses by age 16 in the presence of secondary sexual characteristics
Amenorrhea: Secondary
No menses in 6 months for a woman who has had a previously established (longer than 3 months) menses
Causes of Amenorrhea
Hypothalamic dysfunction: often stress or weight loss induced (runners, dancers/athletes with low BMI)
Pituitary dysfunction: pituitary adenoma, psych meds can impact prolactin levels
Chronic anovulation or ovarian failure: PCOS, thyroid or adrenal issues
Anatomic abnormalities: structural issues like congenital absence of uterus, ovaries or vagina or imperforate hymen
Amenorrhea: Dx and Tx
H&P
Pregnancy test
Pelvic exam (or u/s) esp for those that have never menstruated
Blood tests (prolactic, FSH, TSH)
Tx: depends on cause
Menstrual Disorders
Oligomenorrhea: irregular infrequent interval >40 days
Menorrhagia: heavy and/or prolonged length but at normal intervals
-common causes: fibroids, polyps, infection, IUDs
Metrorrhagia: normal amount of bleeding but at irregular intervals
-common causes: cancerous or benign tumors of the uterus, IUD’s, OCP use, cysts, trauma, polyps, cervicitis, cervical dysplasia
Menometrorrhagia: excessive in amount and duration and at either regular/irregular intervals
TSS
Cause: Staphylococcus aureus
S/Sx: fever, shock, rash on trunk then palms/soles, vomiting, watery diarrhea, severe myalgia, CNS changes, renal/hepatic/CBC changes
Early dx and tx is vital
Preventative Ed: tampon use, contraceptives
Dysmenorrhea: Primary
Cramps w/o underlying disease
Begin 12-24 hours prior to onset of menses and lasts x 12-24hrs.
Caused by increased endometrial production of prostaglandins (myometrial stimulant and vasoconstrictor) which increase uterine contractility and decease uterine artery blood flow causing ischemia
usually resolves after a first pregnancy
Dysmenorrhea: Secondary
pain occurs at any point in the menstrual cycle
related to: endometriosis, pelvic adhesions, fibroids, IUD’s, pelvic tumors, residual PID, cervical stenosis
Dysmenorrhea: Tx
- non-steroidal anti-inflammatory drugs (prostaglandin inhibitors)
- oral contraceptives (inhibit ovulation)
- regular exercise and rests
- heat/ warm bath
- good nutrition
- biofeedback
- acupuncture
PMS
behavioral and physical changes
occurs in luteal phase of menstrual cycle (2 days to 2wks prior menses after ovulation and symptoms subside with menses)
exact cause is unknown (suspect hormonal changes)
may have affective or somatic sx
occurs in at least 3 consecutive menstrual cycles
PMDD
premenstrual dysphoric disorder
cause unknown
marked by 5 or more sx each month, more severe than PMS
sx relief w/ menstruation
sx occur during most cycles
Chronic Pelvic Pain
pain in pelvic region that lasts >6 months or longer resulting in functional or psychological disabilities
S/Sx: sharp, crampy, pressure, dyspareunia, pain with bowel movements, intermittent or steady
tx: pain management, hormones, antibiotics, antidepressant, nutritional therapy
PCOS
polycystic ovarian syndrome
complex disorder, no clear etiology
elevated estrogen, testosterone, and LH, decrease in FSH, multiple follicular cysts on ovaries leading to ovulatory and menstrual dysfunction, hyperandrogenemia, and polycystic ovaries
Sx:
- menstrual dysfunction (amenorrhea or oligomenorrhea)
- androgen excess (hirsutism and acne)
- obesity
- hyperinsulinemia, glucose intolerance, insulin resistance
- infertility
Endometriosis
chronic inflammatory disease in which the presence and growth of endometrial tissue is found outside of the uterine cavity (ovaries are the most common sites)
the tissue is estrogen dependent, most common during the reproductive years
cause is unknown
sx: pelvic pain, pressure, pain with defecation, dyspareunia, abnormal uterine bleeding, infertility
dx: laparoscopy
tx: interrupt cyclic ovarian hormone production (OCP’s, depo, danazol which stops GmRH), pain meds (NSAIDs)
- surgical: laparoscopy, hysterectomy
- complementary and alternative medicine (CAM)
UTI and Older Woman
older women are more susceptible to UTIs d/t:
- suppressed immune system
- weakened muscles of the bladder that increases the risk for incomplete emptying of the bladder
- decreased levels of estrogen which can alter the normal vaginal flora allowing for growth of E.coli which can spread to the urinary track
don’t present w/ common signs of UTI such as fever. If fever is present = serious UTI that needs immediate tx
can cause confusion and abrupt changes in behavior, agitation, poor motor skills, falling
Pyelonephritis
edema of renal parenchyma, swelling of ureter
temporary suppression of urinary output
sx: sudden onset w/ chills, fever, CVA tenderness or flank pain, n/v, malaise, frequency/urgency/burning w/o urination, decreased output
tx: antibiotics, urinary analgesic (Pyridium), pain management, antipyretic, bed rest, possible catheterization
Pregnancy risk: increased risk of PTL, PTD, adult RDS, septicemia
Uterine Fibroids
aka leiomyomas
most common benign disease entity in women
RF: early menarche, low parity, obesity
s/sx: pelvic pressure, dysmenorrhea, pelvic pain, urinary frequency, urgency, palpation of tumor
dx: pelvic u/s
tx: myomectomy, hysterectomy, GnRH agonist, uterine artery embolization
Endometrial Cancer
most common female genital tract cancer
RF: white, older, obesity, nulliparity, hx infertility, hx menstrual irregularities, hx DM, long term use unopposed estrogen, early menarche and late menopause
sx: postmenopausal bleeding
dx: endometrial bx
high cure rate w/ early detection
Ovarian (Adnexal) Masses
common ovarian abnormality (mostly benign)
ovarian cysts (>50% functional cysts) can be fluid, blood or cell filled
Risks for ovarian cancer:
- no relationship between benign masses and cancer
- most fatal of all female cancers
- older, nulliparity, hx of breast ca, early menarche, late menopause, gene mutation
Sx of ovarian cancer: bloating, increasing abdominal size, difficulty eating, abdominal or pelvic pain, urinary sx (urgency/frequency)
Dx: u/s, laparoscopy or laparotomy
Cervical Abnormalities
Cervicitis Cervical Cancer (2nd most common female cancer): -RF: IC before 16 multiple partners, exposure/hx of STIs/HPV, long term OCP use, smoking
Abnormal Paps: How are they managed?
- Bethesda system for specimen
- evaluation of abnormal cytology
- colposcopy-visualization of cervix with a microscope
- ECC
- surgical tx (Leep)
Disorder of Pelvic Support
factors that contribute to relaxation:
-childbirth, deterioration w/ age, prolonged lifting, chronic coughing, chronic constipation, obesity
types of pelvic relaxation:
- cystocele: downward displacement of bladder
- rectocele: anterior wall of rectum protrudes forward
- uterine prolapse
GYN Surgeries
hysterectomy: removal of uterus d/t leiomyomas, endometriosis, uterine prolapse
D&C Uterine ablation Salpingectomy Oophorectomy Vulvectomy
Benign Breast Conditions
- Fibrocystic breast changes
- Fibroadenoma (2nd most common breast lesion)
- Galactorrhea (various causes, generally nonsignificant but can occur w/ OCP use, fibrocystic changes, psych meds, and HRT)
Malignant Breast Disease
Predisposing factors: age, female gender, prior breast ca, known gene mutation, fam hx, >5yrs HRT, overweight, ETOH use, no pregnancies, or first pregnancy >30YO, never breastfed, early menarche and late menopause, hx high dose radiation to chest, physical inactivity
50% originate in upper outer quadrant
Vaginitis
inflammation of the vagina d/t disruption of the vaginal ecosystem
sx: vaginal burning, itching, or irritation, and may have a malodorous discharge
types: bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis
VVC
RF: hormonal changes, pregnancy (d/t increased estrogen), depressed cell-mediated immunity (suppressed immune system, steroid use), antibiotic use
Sx: thick, white, cheesy vaginal discharge, severe itching, dysuria, and dyspareunia
Dx: wet prep or culture
Tx: cream (ending in -zole)
BV
most common vaginal infection caused by disruption in vaginal flora
RF: new sexual partner, multiple sexual partners, douching, antibioticcs
Sx: thin, watery, milky, white-gray discharge, “fishy” vaginal odor
Dx: wet prep, culture
Tx: flagyl orally or intravaginal gel, clindamycin
can cause preterm labor and endometritis if pregnant
Risk of Untreated STI’s
cervical cancer PID infertility ectopic pregnancy chronic pelvic pain
Trichomoniasis
Protozoan
s/sx: asymptomatic or mild sx
-yellow or green frothy vaginal discharge, malodorous discharge, vaginal wall inflammation, “strawberry cervix”, vulvar itching
dx: wet prep and culture
tx: metronidazole or tindamax
- both partners avoid intercourse until cured
- implications in pregnancy
Chlamydia
most common bacterial infection in US
transmission: vaginal sex, can be in urethra and live in throat and rectum
s/sx: 50% of women are asymptomatic
- mucopurulent d/c from cervical os, easily induced bleeding, edema in the area of ectopy
- can cause impaired fertility
dx: NAAT test/endocervical swab, urine
tx: antibiotics, avoid intercourse until cured, implications of pregnancy
PID
acute infection of the upper female genital tract (involving the uterus, fallopian tubes, ovaries and can spread to the peritoneum).
- most cases caused by more than 1 organism (most common organism = chlamydia, gonorrheoea, BV)
- occurs w/ ascending spread of microorganisms at the end of or following menses (open cervical os, lack of cervical mucus barrier)
RF: younger than 25, multiple partners, hx of STIs, douching
Consequences: post-infection tubal damage associated with infertility and ectopic pregnancy risk is 10x greater, chronic pelvic pain
PID: Sx
bilateral severe abdominal, uterine and ovarian pain
fever >100.4 chills mucopurulent cervical or vaginal discharge irregular bleeding n/v
*can also be asymptomatic
PID: Dx
lab tests (CBC, sed rate, cultures) "chandelier sign"
Tx: antibiotics
hospitalization for pregnant women, severely ill, with IV fluids, pain meds
-tx sexual partner
-reevaluate after 48-72hours and if PID responds to tx f/u in 4-6wks
Herpes Simplex
viral organism - HSV-1 and HSV-2
-recurrent lifelong infection
Transmission: vaginal, anal, or oral sex
- skin-to-skin contact with an infected site
- incubation period of 2-20 days
Primary Outbreak:
- blister-like vesicles
- difficult urination, urinary retention
- enlargement of inguinal lymph nodes
- flu-like sx, genital pruritus, tingling
Dormant phase: after lesions heal, enter dormant phase and residing in nerve ganglia of affected area
Dx: clinical appearance, culture, PCR
Tx: antiviral therapy, no cure
Implications in Pregnancy: SAB in 1st trimester, IUGR, PTL and neonatal infection if occurs in late 2nd to 3rd trimester, prophylaxis 36+wks
Syphilis
bacterial organism
transmission: vaginal, oral, anal sex
- exposure to exudate from infected individual, transplacental transmission can occur during pregnancy
Early stage: painless, discrete enlargement of painless lymph nodes,
Secondary stage: symmetric papillosquamous eruptions on palms, soles, mucous membranes, and trunk
Tertiary: bacteria spreads throughout the body and sx are r/t damage of the organs
Dx: early primary = microscopic exam of chancre
- labs
- antibody titers
Tx: penicillin G
Implications in pregnancy:
-IUGR, preterm birth, and stillbirth
HPV
viral organism
causes cervical and anorectal cancers
transmission: vaginal, oral, anal sex (skin to skin contact)
not 100% preventable w/ condoms
sx: painless genital warts, pruritis, mostly asymptomatic
tx: therapies for wart removal, surgical removal, vaccines
Pubic Lice
parasite
transmission: intimate sexual contact, sharing towels, bed linens
Sx: inflamed skin and small red or bluish irritations caused by lice bites and defecation, intense itchiness of infected area
Dx: naked eye or magnifying glass, or under microscope for louse or egg
tx: cream
Scabies
parasite
transmission: intimate sexual contact
sx: itching, erythematous, papular lesions or furrows, worst at night or when they are warm
tx: cream
Viral Hepatitis: Types
Type A: fecal-oral, contaminated food or water
- immunization available
- not chronic
Type B: blood/body fluids
- immunization available
- chronic
Type C: blood/blood products
- NO immunization
- chronic
Type D: blood/body fluids
- NO immunization
- chronic
Type E: fecal-oral
- NO immunization
- not chronic
Viral Hepatitis: Sx
jaundice anorexia n/v malaise fever arthritis arthralgia in B, C, D
HIV
transmission: exchange of body fluids
seroconversion occurs w/in 6-12 wks after HIV enters body
Seroconversion is usually w/o sx, may have flu-like sx of fever, HA, nigh sweats, nausea, diarrhea, weight loss, sore throat and rash
AIDS
develop over months to years with estimated median time of 11 yrs.
can be fatal in absence of tx
alters presentation of STIs
complicates tx of STI
fetal implications: w/ antiretroviral use and delivery at 38wks via c/s the transmission risk drops to <2%
