GENITAL TRACT INFECTIONS (AB)

Question 1

What is the normal pH range of vaginal discharge in premenopausal women?

Answer 1

3.8 - 4.5

Question 2

What organism predominantly maintains the acidic environment of the vagina?

Answer 2

Lactobacilli

Question 3

What are the microscopic findings of normal vaginal discharge?

Answer 3

Acidic rods, lactobacilli, or diphtheroids

Question 4

What are some symptoms associated with abnormal vaginal discharge?

Answer 4

Superficial dyspareunia, dysuria, odor, vulvar burning, and pruritus

Question 5

What is the most common symptom in gynecology?

Answer 5

Vaginal discharge

Question 6

What causes bacterial vaginosis?

Answer 6

Replacement of normal hydrogen peroxide-producing lactobacillus with mixed anaerobic flora

Question 7

Is bacterial vaginosis considered an STI?

Answer 7

No, it is sexually associated but not classified as an STI

Question 8

What are the components of Amsel’s Criteria for diagnosing BV?

Answer 8

1) Thin gray-white discharge, 2) pH ≥ 4.5, 3) Positive Whiff test, 4) Clue cells on wet mount

Question 9

What are clue cells?

Answer 9

Epithelial cells surrounded by bacteria, seen on wet mount

Question 10

What is the gold standard diagnostic test for BV?

Answer 10

Gram stain with Nugent scoring

Question 11

What Nugent score indicates bacterial vaginosis?

Answer 11

7-10

Question 12

What is the most common treatment for BV?

Answer 12

Metronidazole 500mg PO BID for 7 days

Question 13

Should sexual partners be routinely treated for BV?

Answer 13

No, routine treatment of partners is not recommended

Question 14

What organism causes trichomoniasis?

Answer 14

Trichomonas vaginalis

Question 15

What is the preferred pH environment for Trichomonas vaginalis?

Answer 15

Alkaline pH (around 6)

Question 16

What is the classic discharge in trichomoniasis?

Answer 16

Frothy, yellow-green, malodorous discharge

Question 17

What is the classic physical sign of trichomoniasis?

Answer 17

Strawberry cervix (erythema with punctate hemorrhages)

Question 18

What is the gold standard test for trichomoniasis before NAAT?

Answer 18

Culture using Diamond medium

Question 19

What is the CDC recommended treatment for trichomoniasis?

Answer 19

Metronidazole 2g orally as a single dose or Tinidazole 2g orally as a single dose

Question 20

Should male partners be treated in trichomoniasis?

Answer 20

Yes, male partners should also be treated

Question 21

What is the most common Candida species causing vulvovaginal candidiasis?

Answer 21

Candida albicans

Question 22

Is vulvovaginal candidiasis sexually transmitted?

Answer 22

No

Question 23

What are risk factors for vulvovaginal candidiasis?

Answer 23

Hormonal factors, antibiotic use, obesity, diabetes, pregnancy, immunosuppression

Question 24

What is the predominant symptom of vulvovaginal candidiasis?

Answer 24

Vulvar itching

Question 25

What does the vaginal discharge in candidiasis typically look like?

Answer 25

White, curdy, cottage cheese-like

Question 26

What pH is associated with candidiasis?

Answer 26

<4.5

Question 27

What is seen on wet mount in candidiasis?

Answer 27

Yeast, hyphae, or pseudohyphae

Question 28

What is the first-line diagnostic test for candidiasis?

Answer 28

Wet preparation with saline and 10% KOH

Question 29

What is the treatment for uncomplicated VVC?

Answer 29

Fluconazole 150 mg orally as a single dose or OTC/topical azoles

Question 30

How is recurrent VVC defined?

Answer 30

Three or more episodes of symptomatic VVC within 1 year

Question 31

What is the treatment for recurrent VVC?

Answer 31

Induction with fluconazole 150 mg every 72 hrs x3, then maintenance therapy for 6 months

Question 32

What type of discharge and pH is seen in bacterial vaginosis?

Answer 32

Thin, white/gray discharge with pH > 4.5

Question 33

What are the findings on wet mount in BV?

Answer 33

Clue cells and positive amine odor after KOH

Question 34

What type of discharge and symptoms are seen in candidiasis?

Answer 34

Thick, white curdy discharge with pruritus and burning

Question 35

What are the findings on wet mount in candidiasis?

Answer 35

Hyphae or spores

Question 36

What type of discharge and findings are seen in trichomoniasis?

Answer 36

Frothy yellow discharge with motile trichomonads on wet mount and pH > 4.5

Question 37

What are the etiologic agents of mucopurulent cervicitis (MPC)?

Answer 37

C. trachomatis, N. gonorrhoeae, Mycoplasma genitalium, bacterial vaginosis.

Question 38

Do most women with C. trachomatis or N. gonorrhoeae infections have MPC?

Answer 38

No, most do not.

Question 39

Do most women with mucopurulent cervicitis have C. trachomatis or N. gonorrhoeae infections?

Answer 39

No, most do not.

Question 40

What physical exam findings are suggestive of mucopurulent cervicitis?

Answer 40

Yellow mucopurulent cervical discharge, hypertrophy/edema/increased erythema in cervical ectropion, cervical ulceration bleeding, friability.

Question 41

What is the causative organism of gonorrheal infection?

Answer 41

Neisseria gonorrhoeae.

Question 42

What is the Gram stain appearance of N. gonorrhoeae?

Answer 42

Gram-negative intracellular diplococci.

Question 43

What is the primary site of gonorrheal infection in females?

Answer 43

Endocervix.

Question 44

What findings should raise suspicion of gonorrhea?

Answer 44

Cervical bleeding, friability, ectopy, and increased leukocytes on gram stain.

Question 45

What other STIs are commonly co-infected with gonorrhea?

Answer 45

Chlamydia, syphilis, and HIV.

Question 46

What is the most common sexually transmitted bacterial pathogen?

Answer 46

C. trachomatis.

Question 47

What type of organism is C. trachomatis?

Answer 47

Obligate intracellular organism.

Question 48

Where does C. trachomatis primarily attach in the body?

Answer 48

Columnar epithelium of the cervix.

Question 49

What is the most common site of C. trachomatis infection in females?

Answer 49

Cervix.

Question 50

What age group has the highest prevalence of chlamydia?

Answer 50

Patients below 24 years old.

Question 51

What is the most important risk factor for chlamydia?

Answer 51

Age.

Question 52

What are the symptoms of chlamydial cervicitis?

Answer 52

Increased vaginal discharge, intermenstrual/postcoital bleeding, deep dyspareunia, burning urination, abdominal pain/tenderness.

Question 53

What is the gold standard for diagnosing C. trachomatis and N. gonorrhoeae?

Answer 53

Nucleic Acid Amplification Test (NAAT).

Question 54

What are other diagnostic findings in chlamydial cervicitis?

Answer 54

≥10 PMN leukocytes/field, >30 PMNs/100 fields highly suggestive.

Question 55

What medium is used for culturing N. gonorrhoeae?

Answer 55

Thayer Martin medium.

Question 56

What is the recommended treatment for gonorrhea per CDC 2020?

Answer 56

Ceftriaxone 250 mg IM single dose plus doxycycline or azithromycin.

Question 57

What is the recommended treatment for chlamydia per CDC 2015?

Answer 57

Azithromycin 1g PO SD or doxycycline 100 mg PO BID x 7 days.

Question 58

What should patients abstain from after chlamydia or gonorrhea treatment?

Answer 58

Sexual intercourse for 7 days after single dose or until completing 7-day regimen.

Question 59

How long should past sexual partners be treated for chlamydia or gonorrhea?

Answer 59

Partners from the past 60 days.

Question 60

When should test of cure be done for chlamydia?

Answer 60

3-4 weeks after completing treatment.

Question 61

Who should undergo annual screening for chlamydia?

Answer 61

Sexually active women 25 years or younger, and older women with risk factors.

Question 62

What condition should be ruled out in all women with MPC?

Answer 62

Pelvic Inflammatory Disease (PID).