Genitourinary and Gynecological Issues and Disorders Flashcards
Enuresis defintion and types
involuntary urination occurs at any age when voluntary control should be present
Types:
primary: children who have never established control
secondary: dry for more than 6-12 months and begin wetting
nocturnal: incontinence during sleep
diurinal: occurs during waking hours
Incidence of enuresis
40% in 3 yr olds
10% in 5 yr olds
3% in 10 yr olds
95% of all case are functional
Management of enuresis
enuresis alarm, positive reinforcement chart
bladder control training–teach bladder to hold more
hypnosis/self hypnosis
medications:
imipramine–one hour before bedtime x1 week
DDAVP
oxubutynin–if less than 6 years old for detrusor muscle hyperactivity associated with neurological disorders
UTI causative organisms
e coli 80-90%
staphylococcus aureus
S/sx of UTI in infants
may be asymptomatic
weight loss, FTT
dehydration
irritability
S/sx of UTI in children/adolescents
dysuria frequency urgency nocturia suprapubic, lower abdominal discomfort hematuria fever
Management of UTI
oral antibiotics for 10-14 days:
trimethoprim/sulfmethoxazole
cephalosporins
amoxicillin
- *follow up in 2 days and change antibiotic if not improvement
- *Follow up in 1-2 week, then every 1-3 months for a year for a UA
Children less than 2 months of age with a UTI should be hospitalized for IV antibiotics
When to do a renal US and/or VCUG?
Renal US after first UTI in children 2-24 months and/or febrile infants
VCUG is indicated if US is abnormal
**antimicrobial prophylaxis is not indicated
Hypospadias
common congenital abnormality in which urethral opening is on the ventral surface of the penis
**if baby has this, may have other GU abnormalities (undescended testes, inguinal hernia, hydrocele)
S/sx of hypospadias
dorsally hooded foreskin **classic finding
urinary stream that aims downward
chordee (ventral bowing of the penis)
Management of hypospadias
referrals to urologist at birth
circ must not be done bc foreskin is used in repair
surgery best around 6-12 months
Cryptorchidism
undescended testes
very common in premature infants as descent typically happens in 3rd trimester
If doesn’t happen by 1 year–refer to urology
teach testicular self exam bc higher risk of testicular cancer
Testicular torsion
twisting and strangulation of the spermatic cord characterized by acute pain; constitutes a surgical emergency to prevent necrotic testicle and infertility
- most often happens in the 10-20 age group
Signs and symptoms of testicular torsion
acute onset of pain
affected testes may lie high
pain not relieved by elevating scrotum
Phren’s sign
pain not relieved by elevating scrotum with testicular torsion
Phren–Penis
Dysmenorrhea
pain and cramping with menstruation
Primary:absence of any pelvic abnormality, typically begin 6-12 months after menarche, with symptoms increasing until mid 20s
Secondary: underlying cause–pregnancy, PID, endometriosis
Why does ibuprofen work for dysmenorrhea and how should you prescribe someone to take it?
400 mg every 4-6 hours beginning at the onset of the menstrual cycle and continuing for 24-72 hours
Take 2 days before and after
ibuprofen decreases prostaglandin release, which causes muscle cramps
Chlamydia
parasitic STD
most common cause of cervicitis and urethritis in adolescents
most common in those 18-24 years old
Female s/sx of chlamydia
often asymptomatic dysuria intermenstrual spotting postcoital bleeding (after intercourse) dyspareunia (painful intercourse) vaginal discharge lower abdominal/pelvic pain
Males s/sx of chlamydia
often asymptomatic
dysuria
thick, cloudy penile discharge
testicular pain
What test is used to check for chlamydia?
enzyme immunoassay for screening–results in 30-120 min, cheap
culture is most definitive but takes 3-9 days
Management of chlamydia
azithromycin– 1 gram in single oral dose
doxycycline 100 mg orally twice a day x 7 days
report to health department
Gonorrhea
bacterial STD–can be cultured from GU tract, oropharynx, conjunctiva, and anorectum
leading cause of infertility in females
S/sx of gonorrhea in females
80% asymptomatic dysuria urinary frequency mucopurulent discharge labial pain/swelling lower abdominal pain fever dysmenorrhea nasuea and vomiting
S/sx of gonorrhea in males
dysuria
frequency
white/yellow, green penile discharge
testicular pain
Lab tests for gonorrhea
gram stain of discharge shows gram-negative diplococci and WBCs
cervical culture using thayer-martin or transgrow media
Management of gonorrhea
ceftriaxone IM one dose
azithromycin 1 gram orally x 1 dose (covers chlamydia)
doxycycline 100 mg orally x 2 daily x 7 days
co-treat for chlamydia
report to health dept
Syphilis
STD caused by treponema palladium, a spirochete–which can be transmitted across the placenta
What is the primary diagnosis of syphilis, secondary and latent diagnosis of syphilis?
primary: typical lesion or newly positive syphilis screen–dark filed microscopy shows treponemes in 95% of chancres
secondary: clinical presentation with strongly reactive syphilis screen
latent/tertiary: serologic evidence of untreated syphilis
Primary stages of syphilis
chancre present at site of inoculation 2-6 weeks after exposure
chancre indurated and painless
regional lymphadenopathy
Secondary stages of syphilis
occurs 6-8 weeks later
flu-like symptoms
generalized lymphadenopathy
generalized maculopapular rash, especially on palms/soles
Latent and tertiary stages of syphilis
latent: seropositive, but asymptomatic , about 1/3 untreated cases develop tertiary
tertiary: leukoplakia, cardiac insufficiency, infiltrative tumors of skin, bones, liver, and CNS involvement
Serologic tests of syphilis
general disease research lab (VDRL) and/or rapid plasma reagin
Confirmed with treponema tests
Management of syphilis
penicillin G
or doxycycline or erythromycin in those allergic to penicillin
report all cases to health department
Bacterial Vaginosis
a vaginal infection to which several species of bacteria interact to alter the vaginal flora
most prevalent vaginal infection in women of reproductive age
not considered an STD/STI, but seen more often in sexually active women
Symptoms of bacterial vaginosis
increased milky discharge
may have pruritus
malodorous “fishy” discharge most evident after sexual intercourse
Wet mouth of bacterial vaginosis
clue cells–epithelial cells covered with bacteria
decreased/absent lactobacilli
few or absent WBC
post amine whiff test–fishy odor with KOH added to slide
Treatment of bacterial vaginosis
metronidazole PO
clindamycin PO
**or intravaginal of either
Herpes
recurrent, viral STD associated with painful lesions that you have for rest of life caused by HSV
type 1: lips, face, mucosa
type 2: genitalia
Transmission by direct contact with active lesion or by virus containing fluid
Signs and symptoms of herpes
initial: fever, malaise, dysuria, painful/pruritic ulcers for 12 days
recurrent: less painful/pruritic ulcers for 5 days
lab diagnosis of herpes
papanicolaou or tzanck stain
viral culture is most definitive
Management of herpes
no curative treatment
symptomatic treatment with drying and antipruritic agents
treatment options:
acyclovir: topical, oral, IV
valacyclovir: especially useful for asymptotic viral shredding of HSV-2
AIDS epidemiology
characterized as the result of infections by HIV
modes of transmission typically maternal infant perinatal transmission
breastfeeding is primary positional vertical route (contraindicated)
Signs and symptoms of AIDS
low birth weight and falling ratio of head circumference to height/weight
recurrent infections
diminishing activity
developmental delay
hepatosplenomegaly, generalized lympahdenopathy
Screening and confirmatory testing for AIDS
in infants: HIV PCR testing
in older children: ELISA screening is used
western blot test is confirmatory
Progress towards AIDS
absolute CD4 lymphocyte count: normal >800
CD4 lymphocyte percentage of WBC–risk for progression of AIDS is high when
Prevention of opportunistic infections in those with HIV
trying to prevent from HIV turning into AIDS
bactrim for pneumocystitis pneumonia prevention
monitor for CMV
Antiretroviral treatment in those with HIV
combination treatment–with antiretroviral therapy
start no later than when the patient has a CD4 of 350
drug resistance develops readily–take meds exactly as prescribed at same time each day
