cervicitis Flashcards
Gonorrhea in neonates can lead to?
Ophthalmia neonatorum (gonococcal conjunctivitis) which can lead to blindness.
What is the treatment for Gonorrhea ?
ceftriaxone 500 mg IM <150 kg (300 lb)
ceftriaxone 1000 mg IM ≥ 150 kg (300 lb)
What surfaces afftected by gonorrhea?
Any mucocutaneous surface: oral, urethral, vaginal, cervical, and anal
Persistent Pharynigitis (sore throat) should make you consider a diagnosis of ?
Gonorrhea
most common curable sexually transmitted infection in the United States
Gram-negative obligate, nonmotile intracellular bacteria known as Chlamydia trachomatis
second most common sexually transmitted infection in the US
Gram-negative diplococci bacteria Neisseria gonorrhoeae.
What are the serotypes that cause lymphogranuloma ?
Chla,ydia trachomatis L1. L2 & L3
What is lymphogranuloma venerum ?
Ulcerative sexually transmitted infection of the genital area caused by chlamydia trachomatis
What are the 3 stages of lymphogranuloma venerum?
Primary stage: Short lived PAINLESS genital ulcer at inoculation site.
Secondary stage: 2-6 weeks later-> PAINFUL unilateral or bilateral inguinal/ femoral lymphadenopathy (also called buboes).
——–>proctocolitis can develop.
Late stage with strictures, fibrosis, and fistulae of the anogenital area.
What is the 1st stage of lymphogranuloma venerum?
Short lived PAINLESS genital ulcer at inoculation site
What is the 2nd stage of lymphogranuloma venerum?
2-6 weeks later: PAINFUL unilateral or bilateral inguinal/ femoral lymphadenopathy (also called buboes).
——–> Proctocolitis can develop: rectal discharge, anal pain, pain with defecation, rectal bleeding, tenesmus
What is the 3rd stage of lymphogranuloma venerum?
Late stage: Necrosis and rupture of the lymph nodes—–>strictures, fibrosis, and fistulae of the anogenital area.
How is lymphogranuloma venerum treated?
all nonpregnant patients is doxycycline 100 mg oral twice daily for 21 days.
azithromycin or erythromycin for pregnant people
I&D of Buboes to avoid rupture or sinus tract formation.
What are some complications of gonorrhea and chlamydia ?
Pelvic inflammatory disease
Infertility
Chronic pelvic pain
How are pregnant patients diagnosed with chlamydia treated?
Azithromycin 1000 mg PO x1
NEVER GIVE DOXYCYCLINE TO A PREGNANT PERSON!!!!
How are non-pregnant people diagnosed with chlamydia treated?
Doxycycline 100 mg BID x7 days
What should a pregnant person with chlamydia obtain a test of cure?
In 4 weeks. & retest in 3 months.
In men chlamydia can also cause?
Epididymitis = unilateral pain & swelling of scrotum.
Signs of chlamydial infection in newborns may include
Fever, cough, wheezing, and crackles (in pneumonia)
Conjunctival erythema, mucoid discharge, or periorbital swelling (in conjunctivitis), often bilateral
Ceftriaxone is safe to use in pregnant people diagnosed with gonorrhea. T/F
T
a 22-year-old patient presents with a complaint of painful blisters on the vulva and vaginal introitus. She admits to a prodrome of burning, tingling, and pruritus before the appearance of lesions. Upon examination, you note vesicles on an erythematous base.
Herpes Simplex Virus 2
Herpes Simplex Virus: what is?
Enveloped double-stranded DNA viruses that affect the skin and mucous membranes
What is the genital presentation of Herpes simplex
Prodromal burning, tingling or itching before lesions
Multiple grouped vesicles on an erythematous base
Painful inguinal lymphadenopathy.
How should a pregnant women with a hx of herpes and desires vaginal birth be treated?
Antiviral therapy at 36 wks - delivery
If outbreak is present at the time of delivery = C-section
What is the diagnosis of HSV?
Viral culture: Gold
Polymerase chain reaction: more sensitivity and specific
Tzanck prep: multinucleated giant cells
What is the tx for HSV
Acyclovir (TID)
Valacyclovir (BID)
When is viral suppression indicated in pts w HSV?
> 6 episodes in 1 year
->valacyclovir 500 mg once daily
Where does HSV 2 lie dormant
Sacral Ganglia
Genital warts is caused by
HPV type 6 and 11
Which HPV cause cervical cancer ? Which is the most common type?
HPV 16 & 18 is the most common type
HPV 31, 33 & 35 also cause cervical cancer
Which vaccine protects against HPV causing cervical cancer?
HPV 9-valent vaccine
What are some treatments for genital warts?
Pt applied podophyllin &Topical imiquimod
Clinician: trichloroacetic acid & Cryotherapy with liquid nitrogen
Chancroid is caused by the pathogen ?
Haemophilus ducreyi: gram neg rod
A pt presents with complaints of a cauliflower like lesion on her vulva. What solution can be used to confirm it diagnosis?
4% acetic acid applied will turn the area white = positive finding for genital warts.
outpatient treatment for pelvic inflammatory disease, Regimen A consists of a single intramuscular dose of ____________ followed by oral antibiotics __________ and _____________ for 14 days.
outpatient treatment for pelvic inflammatory disease, Regimen A consists of a single intramuscular dose of ceftriaxone followed by oral antibiotics doxycycline and metronidazole for 14 days.
_________________ is a complication of pelvic inflammatory disease depicted by a fluid-filled fallopian tube on ultrasonography.
hydrosalpinx
_________________________and Neisseria gonorrhoeae are the most common sexually transmitted organisms associated with pelvic inflammatory disease
Chlamydia trachomatis
Pelvic inflammatory disease can lead to _________________syndrome which is an infection of the liver capsule and “violin string” adhesions of peritoneum to the liver
Fitz-Hugh–Curtis syndrome
_______________ sign refers to cervical motion tenderness, elicited in patients with pelvic inflammatory disease.
Chandelier sign
What are some complications of PID?
infertility, ectopic pregnancy, tubo-ovarian abscess (adnexal mass), fitz-hugh-curtis syndrome
___________ is a feature of tertiary syphilis that is described as a pathological pupil that shows accommodation but does not react to light.
Argyll-Robertson pupil
_________is the spirochete bacterium that causes syphilis and initially produces small, painless indurated genital lesions.
Treponema pallidum
The treatment for syphilis is______
Penicillin G
-> doxycycline can be used if allergy rxn
What is the tx of early syphilis (primary & secondary & early latent syphilis) ?
Single dose of intramuscular penicillin
What is the tx of late syphilis (latent syphilis & teritary syphilis)?
IM penicillin weekly for x3 weeks.
What does primary syphilis entail?
a single painless genital ulcer at the site of inoculation.
-> smooth base with firm well-demarcated borders
inguinal adenopathy
Secondary syphilis entails?
Dissemination of syphilis into bloodstream weeks - months after primary.
-> Pink-brown maculopapular rash: starts a trunk and spreads to sole & palms.
->condyloma lata: smooth white painless wart-like lesion.
What is amsel criteria? What diagonsis is it associated with ?
Amsel is the dx criteria used for BV. Most have 3/4 for a dx.
Homogeneous, thin, white-gray discharge
> 20% clue cells on saline microscopy
Vaginal fluid pH > 4.5
Positive potassium hydroxide whiff test result
What are cell cells?
Clue cells are vaginal epithelial cells that have a stippled appearance due to coccobacilli that adhere to the edge of the cell.
What is the whiff test?
Detection of a fishy odor (caused by amines) when vaginal secretions are placed in 10% KOH
What are the risk factors for vulvovaginal candidiasis?
Oral contraceptive use, recent antibiotic therapy, corticosteroid therapy, pregnancy, poorly controlled DM, and tight-fitting undergarments. Infection with HIV has been associated with an increased incidence of persistent or recurring infections.
How is the diagnosis of vulvovaginal candidiasis made?
Identification of pseudohyphae in vaginal secretions mixed with 10% KOH confirms the diagnosis. Vaginal pH is normal (<4.5).
