Female GU and reproductive Flashcards
COC
Contraindications for use: Current Breast Ca or dx in last 5 years; hx of DVT or PE, DM with complications or > 20 years; ischemic CVD or multiple risk factors for CVD or LVH; Less than 21 days postpartum; 35 and smoker; stroke, lupus; AED, with aura and any age;
Copper IUD
combo Hormonal IUD
copper IUD contraindications
PID, cervicits, active STI
Implant
Injection:
What does progesterone do?
inhibit ovulation by suppressing LH, thickening endocervical mucus, hampering implantation by endometrial atrophy
What are estrogenic effects?
suppression of FSH and LH; alter the endometrial cellular structure.
Noncontraceptive benefits of COC:
lower rates of breast tumors and dysmenorhea (volume reduced by 60%); reduced iron deficiency anemia; decreased endometrial, ovarian and colon cancers; decreased PID; decreased acne, hairiness;
Missing pills advice:
Vomitting within 2 hours:
retake
If one pill is missed
take immediately
if more than 1 pill:
take today’s pill and last forgotten pill; if 7 active pills left; take pills and use a condom or obstain for 7 days.
COC drug interactions:
AED (or minimum of 30 mcg of estradiol);
Progestins that are derived from testerterone
Drosperinone: had potassium sparing qualities Cautions:
renal or hepatic impairment, ACE/aRB; postassium salts or potassium sparing diurectic.
POP advantages?
good f or women that are breastfeeding. taken daily
POP disadvantages?
bleeding irregularity, failure rate is 13%; return to fertility quickly
CCP patch and ring have a greater risk of VTE than COC who is contraindicated?
obese, > 35, smokers, personal or famility hx of Blood clots
Nexplanon Advantages
99% effective, radioopaque, reduced seizures; effective for up to 3 years.
Nexplanon disadvantage
irregular bleeding and headache.
DMPA advantages
= reduced seizures; can be given as home administered SubQ
DMPA disadvantages:
reduced fertility for 6=12 months post cessation; injection for 3 months. use back up method of BC if given > 5 days after start of menses. reduced bone; encourage supplementation.
How to manage bleeding on DMPA?
use a prostaglandin inhibitor such as ibuprofen; or naproxyn for 3-5 days. also estrogen supplement for reduction in bleeding
Diaphragm
increased UTI
Emergency contraception reduction?
75%
method of action?
- inhibit or delay ovulation
- inhib tubal transport of sperm or ovum
- interfere with fertilization
- Upristal my change the endometrium
- unlikely interference with implantation
What are some methods?
oral levonorgesterel (LNG); oral ulipristal; copper IUD;
How soon should this method be used after unprotected sex?
within 72 hours but can be effective for up to 120 hours post coitus
take both pills at same time or separate by 12 hours.
Uliprstal (ella) MOA?
direct inhibitory effect on follicular development
How long after sex?
5 days or 24 hours-only by prescription
Average age of menopause?
51.3 years
Where are estrogen receptors concentrated?
vulva, vagina, urethra, and trigone of the bladder less dense locations include vascular bed, heart, bone, brain
lifestyle modifications for reducing vasomotor symptoms?
honestly ridiculous
Non HT for vasomotor symptoms?
low dose SSRi and SnRI; venlafaxine; sertraline and paroxetine. Gabapentin;
medication for symptoms during peri menopause?
low dose COC.
contraindications to postmenopausal HT
unexplained bledding, liver disease, impaired liver function, thrombotic disease; neuro-opthalmic disease, Breast cancer, seizure disorder (caution) dyslipedmia (caution)
HT with calcium reduces fx risk by?
50%
How does HT effective UTI and vaginal atropy?
reduces
What is the literature on phytoestrogens?
fes studies support. Little of the active substance recieces the target tissues. NA menopause society views them as an option
When does pap screening begin?
21 yold
When is screening by cytology only
21-29
What are recommendations for 30-65 years?
- cotesting every 5 years.
- cytology every 3 years
- may cease at 55 if negative screen in previous 10 years.
- Hx of CIN2 and CIN3 or aenocarcinoma insitu screen for 20 years regardless of age.
- > 30 if no previous HPV testing; repeat in 1 year
- if HPV positive, repeat co-test in 1 year if absent HPV 16 and 18
- If HPV positive and type is 16 0r 18; refer for colposcopy
- if 21-24 and HPV positive, repeat in 1 year
Offer STI testing for all who test positive for a single STI
Test possibilities: HIV, Hep B, syphillis; also Hep C and HSV;
Immunizations for A, Hep B; HVP
Chancroid
Causitive organism:
Haemophilius ducreyi
S/sx:
ulcer, multiple lesions, inguinal lymphadenitis
Treatment: Azithromycin 1g; or ceftriaxone IM;
alternative: Cipro 500 mg TID
Genital Herpes: Causative organism:
HSV 2 or less common HSV 1
S/sx:
painful ulcerated genital lesion, inguinal lymphadenopathy, fever, body aches. second outbreaks usu less severe
Where is the virus found?
intact skin, lesions, mucosal surfaces, genital secretions and oral secretions.
How frequent is virus shed in asymptomatic pt?
10%
how is it detected?
PCR of a genital lesion;
Purpose of serology?
AB in the blood; detect a new infection from a recurrent infection
Percentage of people with HSV-2? and % of these with a clinically evident disease?
15%; 10-20%
Treatment:
acyclovir
Nongonococcla urethritis and cervicitis
Causitive organism:
C. trachomatis (chlamydia) and mycoplasma genitalium ( assume coinfection with N.gonorrheoae) incubation 7-14 days.
S/sx:
irritative voiding symptoms; dysuria, dyspareunia, postcoital bleeding; mucopurlent vaginal discharge, 50% have urethral infection and 1/3 have endometrial.
treatment:
Azithromycin (single dose), doxycicline, erythromycin (intracellular organisms) no test of cure unless pregnant (test after 3 weeks) or presistent symptoms.
What is retest recommendation?
retest all positives 3-4 months after completing treatment
gonococcal urethritis and cervicitis
Causitive organism:
N. gonorrhoeae usu with beta lactamase activity; 1-5 days post coitus
80% of women and 20% men infect with single act.
S/sx:
irritative voiding symptoms; occasional mucopurlent discharge with occasional blood contains large numbers of WBCs.
treatment
ceftriaxone IM (or cefexime- oral) plus (for coinfection with trichomatis) azithromycin
Pen allergy; azithromycin plus gentamicin or gemifloxacin
Genital Warts (condyloma acuminatum -verruciform lesion). most common?
HPV 6 or 11 (16. 18. 30. 33, 39, 45 associated with GU malignancies)
S/sx:
verruca form lesions or subclinical
treatment:
similar to wart therapy. podofilox, imiquimod (immune modulator); cryotherapy,
What percentage of anogential and cervical cancers are attributed to HPV infections?
> 70%
Percentage of spontaneous regression of HPV lesions?
50%
Prevention:
Gardisil (9-45 years)
Syphilis
causative organism
treponema pallidum
The onset of symptoms?
2 to 4 weeks after contact
s/sx of primary, secondary and tertiary
Primary: Chancre (firm round painless genital or anal ulcer) localized lymphadenopathy; then resolved;
2nd state: nonpruritic diffuse skin rash esp on hands and soles of feet; gen lymphadenopathy; malaise, arthralgias and myalgia, HA
tertiary: Gumma (granulomatous lesion involving the skin, mucous membranes, bone, aortic insufficiency, aortic aneurysm,
Treatment: depends on stage:
Stage 1 and 2: penicillin G IM preferred.; doxy or tetra with Pen allergy
Stage 3: Pen G IM q week for 3 weeks
Lymphogranuloma Venereum
Causitive
chlymadia trachomatis
s/sx:
vesicular or ulcerative lesion on external genitalia iwth inguinal lymphadenitis or buboes. symptoms typically occur after 4-6 weeks.
treatment:
doxycycline for 21 days alternative: erythromycin
Bacterial vaginosis
overgrowth of anerobes; garnerlla and mycoplasma hominis
S/SX
Thin grey discharge; burning and itching positive w hiff text. pH < 4.5
Treatment: metronidazole; oral or vaginal cream alternative clyndaycine cream or oral.
Candidiasis
Causative
candida
s/sx:
itching, burning, thick white to yellow adherant discharge. vulvovaginal excoriation, pyphae, ph < 5.
Treatment: Flucanzole, miconazole,
PID:
gonorrhoeae, C. trachomatis, E. coli, mycoplasma and ureaplasma, others
s/sx:
irritative voiding symptoms, fever, abd pain, CMT, mucopurulent vaginal discharge, adenexal tenderness, adenexal mass (tubu-ovarian abcess); 60% of cases are from STI
Labs? vitals?
eleveate ESR, elevated CRP; leukocytosis; 101.5 temp and WBC 16,000
Emperic therapy?
for all sexually active young women at risk for STIs if they have pelvic or lower abd pain. with one or more of the follow criteria:
What is the diagnostic criteria?
CMT or uterine tenderness or adenexal tenderness
Imaging? shows?
Transvaginal ultrasound; tubal thickneing with or with free pelvic fluid.
offer screening for all women 25 and under
Treatment;
Ceftriazone IM plus doxycycline
Trichamoniasis
Causitive
T. vaginalis
Sx: dysuria, itching, vulvovaginial irritation; dyspareunia, yellow-green dischrge, cervial petehaie (strawberry cervix); motile organisms
Treatment: Metrodiazole avoid alchool.
multiple other regimes
CDC screening guildelines for patients and HIV
Routine screening for all patients 13-64; opt out ability
