Cervical Disorders Flashcards
What is used for STD testing?
Nucleic Acid Amplification Test (NAAT)
What is a “chandelier sign”?
Cervical Motion Tenderness (CMT) on bimanual pelvic examination
_______ _____ is a polymicrobial syndrome that results in replacement of normal flora (lactobacillus) of the vagina with anerobic bacteria.
Sx include…..
Watery/Grey Discharge
Absence of urinary Sx
Absence of pain
“Fishy” Odor
Bacterial Vaginosis
In bacterial vaginosis…..
Would the pH of the vagina be more acidic or basic than baseline?
More Basic ( >4.5)
What criteria is used to diagnose bacterial vaginosis?
Amsel Criteria (Need 3 of 4)
The presence of what on wet prep would be diagnostic of bacterial vaginosis?
Clue Cells
What medication is first line for treatment of Bacterial vaginosis?
Metronidazole (Flagyl) 500 mg BID x7 days
What STD results from a protozoan infection?
Trichomonas Vaginalis
What would be seen on wet prep in a patient with trichomonas?
Numerous WBC
Motile Trichomonads
What are TWO first line treatments for Trichomonas?
2 g of Metornidazole x1 dose
OR
2 g of Tinidazole x1 dose
In which STD would you more likely expect to have colored/purulent discharge…..
Trichomonas or Bacterial Vaginosis?
Trichomonas
What is the most commonly reported bacterial infection in the US?
Chlamydia
Gonorrhea is 2nd most
Are males or females more likely to be asymptomatic with chlamydia infections?
Females are more likely to be asymptomatic
Males often have dysuria
What are long term sequelea of chlamydial infections in females?
PID Infertility Ectopic Pregnancy Chronic Pelvic Pain Neonatal Infection
How is chlamydia diagnosed?
What would be observed on a wet prep?
NAAT
Wet Prep: WBCs
(Use these in combination with clinical suspicion)
T/F: Routine annual STD screening should occur in all sexually active females <25 y.o.
True
During what trimester should all pregnant women be screened for STDs?
1st
How is Gonorrhea treated?
25 mg of Ceftriaxone IM
PLUS
1 g Azithromycin PO
(*both given in a single dose)
How is chlamydia treated?
1 g Azithromycin PO
_______ _______ is described as a sporadic, uncomplicated fungal overgrowth
Vuvlovaginal Candidiasis
What is the most common causative agent of Vuvlovaginal Candidiasis
Candida Albicans
T/F: Abx use is NOT a risk factor for developing Vuvlovaginal Candidiasis
False
It is a risk factor
What are common symptoms of Vuvlovaginal Candidiasis?
Pruritis
Burning
Thick, White Discharge
What may be seen on wet prep in Vuvlovaginal Candidiasis?
Yeast
What medication is typically used to treat Vuvlovaginal Candidiasis?
150 mg of Fluconazole PO x1 dose
An 18 year-old female comes to the clinic with the complaint of increased vaginal discharge and vaginal odor. She also complains of urinary frequency and dysuria. On physical examination there is evidence of thin, gray, frothy discharge in her vagina. The cervix appears erythematous and the vaginal pH is 6. Which of the following is the most likely diagnosis and how would you treat it?
A. Candida vulvovaginitis, treat with Terconazole
B. Bacterial vaginosis, treat with Metronidazole
C. Trichomonas vaginitis, treat with Metrogel
D. Chlamydia trachomatis, treat with Azithromycin
E. Trichomonas vaginitis, treat with Tinidazole
E. Trichomonas vaginitis, treat with Tinidazole
Is genital HSV more commonly related to HSV 1 or HSV2?
HSV 2
How can HSV 1 or HSV 2 cervicitis/vaginitis be dianosed?
Culture
*DNA polymerase chain reaction can also be used and more sensitive
T/F: topical acyclovir is effective for treating HSV cervicitis/vaginitis
False
It is not effective
What medications can be used to treat HSV cervicitis/vaginitis?
Oral Acyclovir/Famicyclovir/Valcyclovir
T/F: Patients who have a prodrome with HSV cervicitis/vaginitis should practice abstinence to prevent spreading
True
A 54 year old married menopausal female presents complaining of vaginal pruritis, dyspareunia and thin discharge. On examination her vulva is smooth and shiny, the vaginal mucosa is pale and thin and a small amount of yellow discharge is present with a pH of 6.0. Wet prep shows WBCs and fewer than normal superficial epithelial cells. What is the suspected diagnosis and treatment?
A) Vulvovaginal candidiasis/OTC antifungal agent
B) Trichomonas vaginalis/oral Metronidazole
C) Genitourinary Syndrome of Menopause/topical Estrogen
D) Bacterial vaginosis/Metrogel vaginal
C) Genitourinary Syndrome of Menopause/topical Estrogen
What is genitourinary syndrome of menopause?
Decreased estrogen stimulation of the vulva, vagina, and lower urinary tract resulting in dryness and thinness
What is a common physical examination finding in genitourinary syndrome of menopause?
Vulvar Atrophy
What are common urinary symptoms of genitourinary syndrome of menopause?
Vaginal Symptoms?
Urinary Sx:
Urgency
Frequency
Dysuria
Recurrent UTIs
Vaginal Sx:
Dryness
Discharge
Dyspareunia
Spotting
T/F: Pelvic organ prolapse is not associated with genitourinary syndrome of menopause
False
It is
What is the mainstay of genitourinary syndrome of menopause treatment?
Estrogen replacement
What would a nulliparous appearance to the cervic indicate?
Parous cervix?
Nulliparous: No prior pregnancies/babies
Parous: Previous vaginal delivery or close to vaginal delivery
What is the most common benign neoplasia of the cervix?
Polyps
Can cervical polpys be asymptomatic?
Yes, but they can present with abnormal bleeding
How are cervical polyps treated?
Avulsion with polyp forceps or cautery
A _________ cyst is described as a mucinous retention or epithelia inclusion cyst on the ectocervix
Nabothian Cyst
How are nabothian cysts treated?
There is no treatment
How does a Bartholian Gland Cyst occur?
When does it become an abscess?
The Bartholin Duct becomes occluded with mucus
These become abscesses once they get infected
How does a Bartholian Cyst present?
These are typically asymptomatic and are found incidentally
Where can Bartholian Cysts be palpable on PE?
Lower medial labia majora
How are Bartholian Cysts managed in patients < 40 y.o?
> 40 y.o?
<40 y.o: No Treatment
> 40 y.o: I&D with biopsy to rule out malignancy
How would a Bartholian Gland Abscess be treated?
should you give ABx?
I&D with placement of a Word Catheter
ABx should only be considered for recurrent abscesses, MRSA suspicion, or STI +
