Chapter 16 Infections of Lower Female Reproductive Tract

Question 1

a clean voided midstream urine sample can be sent for UA and microscopic examination. what is indicative of UTI?

Answer 1

hematuria, leukocytes, leukocyte esterase, or nitrates

Question 2

approx 80-85% utis caused by

Answer 2

escherichia coli

Question 3

if UC negative, pts with symptoms consistent with urethritis, should be tested for

Answer 3

chalmydia trachomatis and nisseria gonorrhoeae using a midstream collection. another etiology of urethritis is herpes simplex virus.

Question 4

treatment of UTI

Answer 4

trimethoprim-sulfamethoxazole
nitrofurantoin
fluoroquinolone for 3-7days.

Question 5

syphilis is a chronic systemic infection caused by spirochete

Answer 5

treponema pallidum

Question 6

2ndary syphilis is a systemic disease occurs as T.pallidum disseminates and begins around 1-3 months after primary stage resolves. classically

Answer 6

maculopapular rash may appear on palms of hands or soles of feet.

Question 7

tertiary syphillis (rare today) characterized by

Answer 7

granulomas of skin and bones, neurosyphilis with meningovascular dx, paresis,

Question 8

screening for T pallidum

Answer 8

performed with nontreponemal anticardiolipin antibodies. 2 types of nontreponemal serologic tests for syphillis:

1. veneral disease research lab (VDRL)
2. rapid plasma reagin (RPR)

Question 9

positive result must be confirmed with specific treponemal antibody studies such as

Answer 9

1. fluorescent treponemal antibody absorption (FTA)

2. and treponema pallidum particle agglutination assay (TPPA).

Question 10

false positive results in < ___.

Answer 10

<1%

Question 11

drug of choice for treatment of syphilis

Answer 11

penicillin.

Question 12

primary, secondary or early latent syphilis can be treated with

Answer 12

BENZATHINE PENICILLIN G 2.4MILLION UNITS IM one time.

Question 13

for late latent of unknown duration syphilis, treatment consists of

Answer 13

penicillin g2.4 million units IM weekly for 3 weeks.

Question 14

treatment success verified by

Answer 14

following rpr or vdrl titers at 6, 12,24months.

titers should decrease fourfold by 6 months and become nonreactive by 12-24 months after completion of treatment.

Question 15

acute febrile reaction accompanied by fever, chills, headache, myalgia, malaise, pharyngitis, rash or other symptoms occur within first 24 hrs

Answer 15

JARISCH HERXHEIMER RXN.

Question 16

jarisch herxheimer rxn is a transient inflammatory reaction, which is related to

Answer 16

treatment of syphilis and can be seen with other treatment of spirochetes as well such as Lyme disease.

Question 17

majority of genital herpes lesions caused by

Answer 17

hsv2.

Question 18

many new cases of genital hsv are now attributable to

Answer 18

HSV1, as much as 80%

Question 19

how is hsv transmitted?

Answer 19

direct contact with incubation period of 2-10 days after exposure.

Question 20

symptoms of primary hsv infection

Answer 20

malaise, myalgias, nausea, diarrea and vefer. vulvar burning and pruritus preced the multiple vesicles that appear next and usually remain intact for 24-36 hrs before evolving into painful genital ulcers.

Question 21

after initial outbreak, recurrent episodes can occur as frequently as

Answer 21

1-6 times / year. recurrence is more frequent in HSV2

Question 22

primary infection treatment of HSV:

Answer 22

acyclovir 200mg 5 times / day
acyclovir 400mg 3 times/ day
famciclovir 250mg 3 times/ day
valacyclovir 1g 2 times / day
for 7-10 days

Question 23

recurrent infections:

Answer 23

oral acyclovir 400mg 3 times/ day
800mg 2 times/ day
x5 days

Question 24

90% of genital warts are caused by

Answer 24

serotypes 6 and 11

Question 25

cervical cancer is more associated with

Answer 25

serotypes 16, 18, 31.

Question 26

treatment of warts

Answer 26

local excision, cryotherapy, topical trichloroacetic acid, topical 25% podophyllin and efudex5%.

Question 27

for motivated pts with uncomplicated condyloma, 2 options

Answer 27

1. imiquimod (ALDARA)

2. podofilox (CONDYLOX)

Question 28

IMIQUIMOD aldara use:

Answer 28

3 times / week washed off after 6-10hrs.

Question 29

PODOFILOX

Answer 29

2 times/ DAY x 3 days LEFT IN PLACE FOLLOWED BY NO TREATMENT FOR 4 DAYS. repeated up to 4 cycles.

Question 30

recurrence rate

Answer 30

20% regardless of treatment modality.

Question 31

vaginal culture should be obtained to idetify nonalbicans species such as

Answer 31

C. glabrata (which are less responsive to azole therapy)

Question 32

recurrent cases / complicated cases:

Answer 32

longer duration of therapy ex. 7-14 days of topical regimen or
2-3 doses of fluconazole oral therapy every 72 hrs.

Question 33

firstline maintenance therapy for recurrent cases:

Answer 33

oral fluconazole weekly for 6 months.

Question 34

nonalbicans candidiasis: treatment with

Answer 34

600mg vaginal boric acid capsules daily for 14 days.

Question 35

symptoms of trichomonas vaginalis worse immediately after menses because of

Answer 35

transient increase in vaginal pH at the time.

Question 36

microscopy for trich

Answer 36

60-70%

Question 37

treatment for T. vaginalis is

Answer 37

metronidazole 2g orally or
tinidazole 2 g orally .
in cases of metronidazole single treatment failure, metronidazole 500mg bid x 7 days is prescribed. sexual partners should be treated.