Common gyn infections and STIs

Question 1

What are the wet mount and KOH findings for the infectious causes of vaginitis?

Answer 1

• BV: clue cells on wet mount, +whiff test with KOH testing
• Candida: normal wet mount; hyphae with KOH testing
• Trichomonas: motile trichomonads on wet mount, possible fishy odor on whiff test

Question 2

What are the pH findings for the 3 causes of vaginitis?

Answer 2

candida has normal pH; BV and trich have pH >4.5 (considered high)

Question 3

What are risk factors for TSS?

Answer 3

prolonged tampon use, prolonged intravaginal contraception use, or postpartum/postabortal infection

Question 4

What are the clinical signs and symptoms of TSS?

Answer 4

N/V, diarrhea, sore throat, HA, high fever, macular rash, possible hypotension, resp distress, and desquamation of the palms and soles

Question 5

What lab findings are seen in TSS?

Answer 5

-elevated AST/ALT, low platelets; possible AKI

Question 6

What is the treatment for chlamydia in a pregnant woman?

Answer 6

azithromycin (would be doxycyline in a non-pregnant woman). always treat for gonorrhea too

Question 7

What non-sexually transmitted infections can cause PID?

Answer 7

bacteroides, e coli, streptococci

Question 8

What is the presentation of tubo-ovarian abscess?

Answer 8

pt with PID who also has signs of sepsis or peritonitis. these pts need inpatient tx with hydration, IV antibiotics, and surgical drainage of the abscess

Question 9

What are the stages of syphilis infection?

Answer 9

1. primary- painless chancer that resolves within 9 wks. range for primary syphilis is 1-13 wks post-exposure; average of 3 wks
2. Secondary- begins as chancre heals and lasts up to 12 wks. Pts have HA, malaise, fever, maculopapular rasho on palms and soles, LAD, papules in moist areas (condyloma lata
3. latency
4. tertiary: seen in 1/3 for pts 1-30 yrs post infection; gummas of skin, bone, and liver, and tabes dorsalis seen

Question 10

How do you diagnose syphilis?

Answer 10

RPR or VDRL as screens; confirm with FTA (fluorescent treponemal antibodies) or microhemagglutination assay

Question 11

What is the treatment for syphilis?

Answer 11

penicillin G, IV for severe tertiary cases

Question 12

What are the complications of syphilis?

Answer 12

gummatous destruction of skin, bones, and liver; CV spyhilis with aortic regurgitation and aortitis, neurosyphilis

Question 13

What is the clinical presentation of chancroid?

Answer 13

seen in tropics or in immunocompromised; small papule near area of contact forms within 2 wks and then converts to a painful ulcer. Pts also have significant inguinal swelling

Question 14

What are the labs for chancroid? What is the tx?

Answer 14

gram stain of culture from ulcer shows gram negative rods tx: ceftrizxone, erythromycin, or azithromycin

Question 15

What is lymphograuloma venereum?

Answer 15

disease caused by L1, 2, or 3 serotypes of clhamydia trachomatis. pts get a self-healing painless ulcer with malaise, HA, fever within 2 wks. After 1 month, they get signficiant inguinal buboes

Question 16

What are complications of lymphogranuloma venereum?

Answer 16

bubo ulceration, elephantiasis (CT swelling due to lymphatic blockage), fistula formation, and abscess formation

Question 17

What is granuloma inguinale?

Answer 17

disease caused by infection by klebsiella granulomatis. papule on external genitalia forms severe weeks after contact and rapidly becomes a painless ulcer with a beefy red base and irregular borders

Question 18

What are the lab findings for granuloma inguinale?

Answer 18

lesion biopsy shows Donovan bodies (red incapsulated intracellular bacteria)

Question 19

What is the treatment for granuloma inguinale?

Answer 19

doxycycline or TMP-SMX for 3 wks