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Womens Health > cervicitis > Flashcards

cervicitis Flashcards

1
Q

complications of cervicitis?

A

If untreated, cervicitis can result in Pelvic Inflammatory Disease & lead to higher risk of infertility, ectopic pregnancy & chronic pelvic pain

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2
Q

what causes the s/sx of cervicitis?

A

edema and increased vascularity, making the cervix appear swollen and reddened → Presence of hypervascularity, erythema & ectopy may be found with either squamous metaplasia or inflammatory changes requiring therapy

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3
Q

how can cervicitis be diagnosed?

A

histologically when polymorphonuclear leukocytes, lymphocytes, or histiocytes are noted

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4
Q

can cervicitis occur w/o a vaginal dz?

A

YES

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5
Q

WHAT Is acute cervicitis?

A

Purulent vaginal discharge is the primary sign and symptom of acute cervicitis → Some women have vaginal bleeding, most frequently after sexual intercourse, although intermenstrual bleeding and bleeding during examination can also occur

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6
Q

what is chronic cervicitis?

A

-leukorrhea
-may have purulent d/c or thick tenacious, turbid
Intermenstrual or postcoital bleeding may occur → Also associated with lower abdominal pain, lumbosacral backache, dysmenorrhea, dyspareunia, urinary frequency, urgency and dysuria

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7
Q

chlamydia etiology?

A

Chlamydia Trachomatis
Most common cause of cervicitis
Causes LGV in developing countries → Rare in U

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8
Q

s/sx of chlamydia

A 
May be asymptomatic
Mucopurulent cervicitis
Increased frequency, dysuria
Abd pain, PID, post coital bleeding 
LVG → PAINLESS genital ulcer → PAINFUL inguinal lymphadenopathy
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9
Q

dx of chlamydia?

A

Nucleic Acid Amplification → PCR test most spp/sensitive

Cultures, DNA probe

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10
Q

tx of chlamydia

A

Azithromycin → 1g PO x 1 dose
OR
Doxycycline → 100mg PO BID x 10d

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11
Q

2cd line tx of chlamydia

A

Erythromycin, Ofloxacin, Levofloxacin

can co-treat with gonorrhea- cetriaxone

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12
Q

complications of chlamydia?

A

PID, infertility, ectopic pregnancy, premature labor

Reactive arthritis

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13
Q

gonorrhea etiology

A

Neisseria Gonorrhoeae

IP 3-5 day

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14
Q

s/sx of gonorrhea

A 
May be asymptomatic
Vaginal discharge
Cervicitis
Increased frequency
Dysuria
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15
Q

dx of gonorrhea

A

Nucleic Acid Amplification → PCR most specific/sensitive

Cultures, DNA

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16
Q

tx of gonorrhea

A

Ceftriaxone → 250mg IM x 1

CO-TREAT for Chlamydia
Azithromycin → 1g PO x 1
Doxycycline →PO BID x 10d

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17
Q

2cd line tx of gonorrhea

A

Cefixme

Azithromycin 2g can also be given as an alternative but associated w/GI sxs

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18
Q

complications of gonorrhea

A

PID, infertility, ectopic pregnancy

Reactive arthritis

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19
Q

HSV etiology

A

HSV-2 causes most genital herpes infxns

HSV-1 causes some through oral–genital or genital–genital contact

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20
Q

s/sx of HSV

A

Produces cervical lesions similar to those found on vulva

First the lesion is vesicular → becomes ulcer → Heal w/o scarring

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21
Q

what is important to know about HSV primary infxn?

A

extensive & severe → constitutional sxs of low-grade fever, myalgia & malaise x ~ 2 weeks

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22
Q

pt educations for HSV

A

Virus continues to reside in the nerve cells of the affected area for life → Can shed when asymptomatic

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23
Q

dx of HSV

A

Viral culture, PCR, and direct fluorescence Ab

Most laboratories moving toward non-culture assays such as PCR → high sensitivity and specificity

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24
Q

what will you see on a wet prep with HSV

A

Enlarged, multinucleated cells w/ ground-glass cytoplasm & nuclei containing inclusion bodie

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25
Q

tx of HSV

A

Acyclovir

Valacyclovir

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26
Q

complications of HSV

A

Women w/ active infxn or asymptomatic HSV shedding from normal-appearing skin can infect their infants during vaginal delivery

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27
Q

HPV etiology

A

+↑Oncogenic → 16 & 18, 31, 33, 35

+Also causes genital warts
Genital warts → 6, 11 have low oncogenic potential

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28
Q

s/sx of HPV

A

May be asymptomatic

Flat, pedunculated or papular flesh-colored growths → ‘cauliflower-like’ lesions
+ postcoital bleeding

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29
Q

dx of HPV

A

Whitening with 4% acetic acid application
Clinical diagnosis
+/- Colposcopy, biopsy → Look for dysplasia or cancer

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30
Q

tx of HPV in office

A

Trichloroacetic acid
Podophyllin → Wash off after 4h to minimize irritation - NOT used on bleeding lesions

Cryotherapy

Surgical removal

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31
Q

tx of HPV outpt

A 
Podofilox
Imiquimod (Aldara)
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32
Q

complications of HPV

A

Cervical Dysplasia

Cervical Cancer

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33
Q

chancroid etiology

A

Haemophilus Ducreyi → Gram - bacillus
Uncommon in US
IP 3-5 days

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34
Q

s/sx of a chancroid

A

Genital Ulcer → Soft, shallow, painful, may have foul discharge from the ulcer

+/- Small vesicles or papules
PAINFUL inguinal lymphadenopathy

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35
Q

dx of chancroid

A

clinicla

culture

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36
Q

tx of chancroid

A

Azithromycin (first line)
Ceftriaxone 250mg IM x 1 dose
Erythromycin
Ciprofloxacin

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37
Q

complications of chancroid

A

Secondary infections

Scarring

38
Q

what is syphilis aka?

A

Known as ‘the great imitator’ because the rash and disease can present in many different ways similar to other diseases

39
Q

what causes syphilis

A

spirochete Treponema pallidum

40
Q

how is syphilis transmitted

A

Direct Contact → Of an infected lesion during sexual activity & contact with lesions (including mucous membranes)

May also be transmitted to the fetus via the placenta

Organism enters tissue from direct contact, forming a chancre at the inoculation site and from there, goes to the regional lymph nodes before disseminating

41
Q

what is the incubation period of syphilis?

A

3 days and 3 months → 3 phases

42
Q

what is the primary incubation phase?

A

Chancre → Painless ulcer at/near the inoculation site with raised indurated edges
Usually begins as a papule that ulcerates

Chancres heal spontaneously → Average within 3-4 weeks even without medical management

Non-tender regional lymphadenopathy near the chancre site lasting 3-4 weeks

43
Q

what is the secondary incubation phase?

A

Secondary sxs may occur a few weeks to 6 months after the initial sxs

44
Q

what are s/sx of secondary phase?

A

maculopapular rash, chondyloma lata

systemic sx: Fever, lymphadenopathy (may be tender), arthritis, meningitis, headache, hepatitis (elevated alkaline phosphatase)

45
Q

describe the secondary maculopapular rash of syphilis

A

Diffuse bilateral maculopapular lesions → Involvement of the palms/soles common
Lesions may be pustular in some patients

46
Q

what is a condyloma lata?

A

Wart-like, moist lesions involving the mucous membranes & other moist areas → Especially near the chancre site → Highly contagious

47
Q

tertiary/late phase of syphilis? (when does it occur?)

A

May occur from 1 to >20 years after initial infection or after latent infection

48
Q

s/sx of tertiary/late phase?

A
  • GUMMA
  • neruosyphilis
  • Argyll-Robertson pupil
  • cardiovascular
49
Q

what is GUMMA?

A

Non-cancerous granulomas on skin & body tissues (ex: bones)

50
Q

describe neurosyphilis

A

Headache, meningitis, dementia, vision/hearing loss, incontinence

51
Q

what is tabes dorsalis?

A

Demyelination of posterior columns → Ataxia, areflexia, burning pain, weakness

52
Q

argyll-robertson pupil

A

Small, irregular pupil that constricts normally to near accommodation but does not constrict/react to light

53
Q

cardiovascular sx of syphilis

A

Aortitis, aortic regurgitation, aortic aneurysms

54
Q

describe early syphilis

A

Clinical syndrome that occurs within the first year of infection → Includes primary, secondary and early latent syphilis

55
Q

describe latent syphilis

A

Asymptomatic infection + Normal physical exam but positive serologic testing

56
Q

stages of latent syphilis

A

Early Latent → If <1 year → Patients are usually highly infectious
Late Latent → > 1 year → Associated with lower transmission rate → Except in fetal transmission

57
Q

describe symptoms of congenital syphilis

A

+Hutchinson Teeth → Notches on teeth
+Sensorineural hearing loss, +CNS abnormalities
+Saddle-nose deformity
+ToRCH Syndrome

58
Q

dx of syphilis in pts with chancre of condyloma lata

A

Darkfield Microscopy → Allows for direct visualization of the spirochete
Indications → Used in patients with a chancre or condyloma lata

59
Q

screening tests for syphilis

A

Non-treponemal testing → Nonspecific → False positives can be seen with antiphospholipid syndrome, pregnancy, TB, rickettsial infections (RMSF)

Rapid Plasma Reagent (RPR) → These tests look at titers (Ex: Positive test indicated a titer of 1:32 or greater)
Changes in titers help determine therapeutic response → However, these tests are also nonspecific in initial testing & must be confirmed by more specific treponemal testing (ex: FTA) → RPR is usually positive 4-6 wks after infection

VDRL → Venereal Disease Research Laboratory

60
Q

what are the confimatory tests for syphilis?

A

FTA-ABS → Fluorescent Treponemal Antibody Absorption

Microhemagglutination test for T. pallidum antibodies

61
Q

tx of syphilis in all stages

A

Pen G

62
Q

what are adr of pen g

A

Jarisch-Herxheimer Reaction → Acute febrile response due to rapid lysis of many spirochetes with antibiotic administration → Associated with myalgias & headaches
Antipyretics during the 1st 24 hours reduces the incidence of the reaction

63
Q

what if pt is allergic to pen g

A

Doxycycline or Tetracycline, Macrolide, Ceftriaxone → None are as effective as PCN

64
Q

pt f/u after syphilis tx

A

All patients should be reexamined clinically & serologically @ 6 & 12 mos after tx → 4 fold reduction in the titer of the nontreponemal antibody serologic tests within 6 mos denotes adequate management → If not, may indicate re-infection or treatment failure → ALL patients with syphilis should be tested for HIV

65
Q

describe lymphogranuloma venereum

A

Genital/Rectal lesion with softening, suppuration & lymphadenopathy

66
Q

what is LGV causes by?

A

aggressive L serotypes (L1, L2 or L3) of Chlamydia trachomatis

67
Q

where is LGV most commonly found?

A

tropical and subtropical nations of Africa & Asia but also seen in southeastern US

68
Q

how is LGV transmitted?

A

sexual contact → Men > Women (6:1) → Incubation Period = 7-21 days

69
Q

what other infection is LGV associated with?

A

HIV

70
Q

what is the MC s/sx of LGV in heterosexuals

A

Tender, usually unilateral inguinal and/or femoral lymphadenopathy

71
Q

what may occur at the site of inoculation?

A

genital ulcers

72
Q

what s/sx of rectal exposure in LGV?

A

Can result in proctocolitis, including mucoid and/or hemorrhagic rectal discharge, pain, constipation, fever or tenesmus

73
Q

sx of late phase

A

fever, headache, arthralgia, chills and abdominal cramps may develop

74
Q

how is LGV dx?

A

Based on clinical suspicion, epidemiologic info & exclusion of other etiologies → Proven only by isolating C. trachomatis from genital or lymph node specimens and confirming immunotype

75
Q

what is a complement fixation test?

A

heat-stable antigen that is group-specific for all Chlamydia species available
Titer of >1:64 is considered positive, whereas a titer of <1:32 is considered negative

76
Q

what are some complications of LGV?

A

lead to chronic, colorectal fistulas and strictures, which can involve the entire sigmoid

Vulvar elephantiasis can cause marked distortion of the external genitalia

Vaginal narrowing and distortion may result in severe dyspareunia

77
Q

how is LGV prevented

A

condome/avoid screwing infected pt

78
Q

tx of LGV

A

first line: doxy 100 mg po bid 21 days (repeated of dz persists)

79
Q

what is 2cd line tx for LGV?

A

erythromycin

80
Q

what is local/surgical tx for LGV

A

Anal strictures should be dilated manually at weekly intervals → Severe stricture may require diversionary colostomy
If disease is arrested → Complete vulvectomy may be done for cosmetic reasons
Abscesses should be aspirate

81
Q

what is PID?

A

scending infection of the upper reproductive tract

82
Q

what are complications of PID?

A

sepsis, ectopic prego, infertility, chronic pelvic pain

Fitz-hugh Curtis syndrome

83
Q

what is fitz-hugh curtis syndrome?

A

Hepatic fibrosis/scarring & peritoneal involvement

RUQ pain due to PERIHEPATITIS (liver capsule involvement) → May radiate to the right shoulder

Often have normal LFTs

‘Violin String’ Adhesions on the anterior liver surface

84
Q

what are the main etiologies of PID?

A

Most commonly N.gonorrhoeae & Chlamydia, G. vaginalis, anaerobes, H. flu, etc.

85
Q

RF for PID?

A

Multiple sex partners, unprotected sex, prior PID, age 15-19, nulliparous, IUD placement

86
Q

s/sx of PID?

A
  • Lower abdominal tenderness
  • Fever
  • Purulent cervical discharge + bleeding
  • CHANDELIER SIGN → CERVICAL MOTION TENDERNESS to palpation & rotation so severe they seem to rise off the bed as if ‘reaching for the chandelier’
87
Q

how is PID dx?

A

rimarily a clinical diagnosis → Obtain a 𝛃-hCG to rule out ectopic pregnancy

pelvic US-may be used if adnexal or abscess suspected

laparoscopy

88
Q

PID dx criteria

A

Abdominal tenderness + rebound tenderness if severe + cervical motion tenderness + adnexal tenderness + > 1 of the following:

\+gram stain, 
temperature >38℃, 
WBC > 10,000, 
pus on culdocentesis or laparoscopy,
 pelvic abnormality on bimanual exam or US, ↑ESR/CRP
89
Q

out pt tx of PID

A

doxy + ceftriaxone +/-metronidazole

90
Q

inpt tx of PID

A

IV doxy + 2cd gen cephalosponre (cefoxitin or cefotetan)

OR

clinda + genta

Womens Health (24 decks)

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