Firecracker - Gynecologic Infectious Disease Flashcards
What is the cause of bacterial vaginosis?
- BV is caused by Gardnerella vaginalis. It is the most common cause of abnormal vaginal discharge in women of child bearing age.
- Note - BV does not cause vaginal inflammation. Inflammation suggests a mixed vaginitis
- BV is an overgrowth of abnormal bacterial flora that replaces the normal vaginal flora (lactobacilli) and it is not a sexually transmitted disease
- Potassium hydroxide wet mount will cause an increase in odor (positive ‘‘Whiff’’ test)
- The vaginal discharge in bacterial vaginosis is thin, white and ‘fishy’ smelling with pH > 4.5 (normal vagina pH is <4.0)
- Saline white mount of the discharge will show ‘‘Clue cels’’ - epithelial cells covered with multiple attached bacteria
- Bacterial vaingosis is treated with metronidazole. Recall metronidazole causes a disulfiram-like reaction when drinking alcohol and therefore patients must be counseled not to drink alcohol when using this medication.
How are relapsing urinary tract infections treated?
- Uncomplicated UTIs are treated with 3 days of TMP-SMX or a fluroquinolone
- If the UTIs are relapsing, antibiotics should be given for 14 days
- Recall that fluoroquinolones and TMP-SMX are teratogenic - common antibiotics used to treated UTIs in pregnancy include nitrofurantoin and cephalosporins.
What are the symptoms in the different stages of lymphogranuluoma venerum?
- The primary stage of lymphogranuloma venerum occurs in the first two weeks of contraction and presents with the following symptoms:
- Malaise
- Headache
- Fever
- Papule formation at contact site that transforms to a painless ulcer healing after a few days
- The secondary stage occurs a month following contraction and is marked by the development of inguinal buboes (painful inflammation and enlargement of the lymph nodes). This finding is more common in men than in women
- The tertirary stage (anogenital syndrome) is charactersised by the following symptoms:
- Proctitis
- Rectal stricture
- Rectovaginal fistula
- Elephantiasis (swelling due to lymphatic obstruciton)
What is trichomoniasis?
- Trichomans vaginitis or trichomoniasis is caused by Trichomonas vaginalis, an anaerobic, sexually transmitted protozoan and often causes intense vulvar pruiritus and inflammation
- Trichomoniasis presents with profuse, malodorous, frothy vaginal dischage which may have greenish discolouration. It has a pH > 4.5
- The characteristic ‘‘strawberry cervix’’ of a patient with trichomoniasis is caused by punctate epithelial papillae but occurs in less than 10% of patients.
- Saline wet mount shows motile trichomonads
- Ptoassium hydroxide wet mount may yield a positive whiff test
- Trichomoniasis is also treated with metronidazole - because this is a sexually transmitted infection - it is imperative that the partner (s) be treated as well.
What is the role of Thayer-Martin growth media in the diagnosis of cervicitis?
Culturing on Thayer-Martin agar can be used to detect the presence of Neisseria gonorrhoeae.
What are common urinalysis findings in a patient with a urinary tract infection?
Urinalysis of a patient with UTI will often show:
Increased nitrates
Increased leukocyte esterase
White blood cells, but not WBC casts
What are the characteristics of the discharge seen in trichomoniasis?
Trichomoniasis presents with profuse, malodorous, frothy vaginal discharge, which may havegreenish discoloration. It has a pH > 4.5.
How are uncomplicated urinary tract infections treated?
Uncomplicated UTIs are treated with 3 days of TMP-SMX or a fluoroquinolone.
In addition to vaginal discharge and bleeding, what other symptoms may be associated with cervicitis?
- Many women with cervicitis will be asymptomatic (more than 50% of patients with Chlamydia infection are asymptomatic) and the finding is incidental during a cervical examination
- When symptomatic, women will present with purulent or mucopurulent discharge (milder if Chlamydia) and/or intermenstrual or postcoital bleeding
- In addition to vaginal discharge and bleeding, women may present with:
- Dyspareunia
- Dysuria (if urethral infection is also present)
- Vaginal irritation
What are possible complications of urinary tract infections?
- Complications of UTIs include:
- Pyelonephritis
- Renal failure
- Abscesses
What saline wet-mount finding is associated with bacterial vaginosis?
Saline wet-mount of the discharge will show “Clue cells” – epithelial cells covered with multiple attached bacteria.
What does a potassium hydroxide wet-mount of bacterial vaginosis yield?
Potassium hydroxide wet-mount will cause an increase in odor (positive “Whiff” test).
What is PID?
Pelvic inflammatory disease (PID), also known as acute salpingitis, is a long-term consequence of untreated STDs and is a major cause for infertility and ectopic pregnancies.
The infection results from ascending infection from the vagina through the cervix to the uterus. It can pass through the fallopian tubes into the peritoneal cavity.
Gonorrhea and Chlamydia are the principal causative agents and account for 40% of cases. However, most cases of PID are thought to be polymicrobial, caused by anaerobic bacteria and bacteria from the GI tract, such as E coli.
What are the risk factors for the development of PID?
Risk factors for the development of PID include:
Multiple partners
Recent history of douching
Prior history of PID
Cigarette smoking
Who most often develops pelvic inflammatory disease?
PID most commonly affects sexually active women in the 15-25 age range.
How is lymphogranuloma venerum diagnosed?
Diagnosis of lymphogranuloma venerum is usually made based on clinical suspicion. However, genital and lymph node samples can be tested for Chlamydia.