General infection review Flashcards
What is the most common infectious cause of vaginitis in general? In pregnancy?
BV for both
What are the Amsel criteria for diagnosis of BV?
Diagnosis is made if three of the following are present:
- homogeneous thin grey discharge coating vagina
- pH > 4.5
- positive whiff test
- clue cells seen on saline wet mount
Describe how the whiff test is performed.
Potassium hydroxide is added to a sample of vaginal discharge - if a fishy odour ensues, the whiff test is positive
When you send a vaginal swab to the lab, what score does the lab use to diagnose BV?
Nugent score (points awarded for presence of lactobacillus, gardnerella, bacteroides on Gram stain)
List two options for treatment of BV. What treatment modalities are contraindicated in pregnancy?
Flagyl 500 mg bid x7d
Flagyl 0.75% gel 5 g pv daily x5d
Clindamycin 300 mg bid x7d
Clindamycin 2% gel 5 g pv daily x7d
Vaginal treatments are contraindicated in pregnancy
List five exam findings or office tests supportive of a diagnosis of trichomoniasis.
Yellow-green malodorous discharge Patchy vaginal erythema Colpitis macularis (strawberry cervix) pH > 5 \+ whiff test Wet mount showing motile trichomonads
For which organisms must you also treat the patient’s sexual partner?
Trichomonas
Chlamydia
Gonorrhea
Define complicated vulvovaginal candidiasis.
- Recurrent (4+ episodes/y)
- Severely symptomatic
- Host is immune compromised
- Non-albicans species
What congenital anomaly is associated with oral fluconazole use in the first trimester of pregnancy?
Tetralogy of Fallot
What is the most common cause of ophthalmia neonatorum?
Chlamydia
List three risk factors for chlamydial infection.
New partner Previous STI Street-involved Young age (< 25) Contact with a known case 2+ partners in the past 6m
When is a test of cure required following treatment of chlamydia?
In pregnancy
Which is more strongly linked to obstetrical complications: chlamydia or gonorrhea?
Gonorrhea - associated w/ PPROM, PTB, chorioamnionitis, postpartum infection, septic abortion, post-abortal PID
What are the risk factors for PID?
Age < 25
Previous PID
Recent upper genital tract instrumentation
IUD
What are the minimal & specific criteria for diagnosis of PID?
Minimal: uterine, adnexal, or cervical motion tenderness
Specific: laparoscopy w/ evidence of salpingitis/peritonitis (gold standard), endometrial biopsy showing endometritis, imaging showing hydrosalpinx/TOA
In cases of PID:
- When should you remove an IUD?
- When is your approach to TOA?
Remove IUD after 48h if not responding to tx (in mild-to-moderate disease; less evidence to guide management in severe dz)
Approach to TOA: antibiotics first, percutaneous drainage if not responding to antibiotics, washout last
Give two options for treatment of:
- Primary herpes
- Recurrent herpes
- Suppression
Primary:
- Acyclovir 400 mg tid x7d
- Famciclovir 250 mg tid x7d
- Valacyclovir 1g bid x7d
Recurrent:
- Acyclovir 400 mg tid x5d
- Famciclovir 250 mg bid x5d
- Valacyclovir 500 mg bid x5d
Suppression:
- Acyclovir 400 mg bid
- Famciclovir 250 mg bid
- Valacyclovir 1 g daily
How many episodes of clinically apparent herpes in a single year warrant suppressive treatment?
6 episodes/year
What are the symptoms of secondary syphilis?
Non-pruritic maculopapular rash on trunk, palms, or soles Genital condylomata lata Alopecia Generalized non-tender lymphadenopathy Mucous patches Fever Malaise
How long after primary syphilis does secondary syphilis occur?
4-10 weeks (the ulcer of primary syphilis may still be present)
What is being measured when a non-treponemal test for syphilis is done?
Anti-cardiolipin antibodies (cardiolipin is a component of the mitochondrial cell membrane that is released when the spirochete damages the membrane, allowing formation of antibodies)
List two causes of a false positive treponemal test.
Any other spirochete:
Malaria
Leprosy
Management of abnormal FHR secondary to Jarisch-Herxheimer reaction.
Expectant management (if possible) - will resolve with resolution of the reaction in 24-48h
What is your differential for painful genital ulcers?
HSV
Chancroid (Haemophilus ducreyi)
LGV (although ulcer is usually gone by the time this comes to clinical attention)
Behcet’s disease
