Genitourinary Infections Flashcards
What kinds of organisms are common in bacterial vaginosis?
Anaerobes:
Gardnerella vaginalis, Mycoplasma hominis, Mobiluncus species, Bacteroides species (other than Bacteroides fragilis)
What kinds of organisms are common in VVC?
Candida species
The most common pathogen in VVC is…
Candida albicans
Risk factors of VVC include:
Impaired immune status Broad-spectrum abx Inhibition of normal bacterial flora 30% test + after 2-3 week course of TETRACYCLINE Post treatment for trichomoniasis or BV CORTICOSTEROID medications Pregnancy Diabetes Changes in glycogen
Which GU infection has thick and curdy (“cottage cheese-like” discharge?
VVC
Which GU infection has normal vaginal pH, a negative “Whiff” test, and the presence of pseudohyphae on wet mounts?
VVC
A recurrent VVC is considered ____ or more episodes of symptomatic VVC in
3 or more episodes in <1 year
Women with these conditions are considered to have complicated VVCs:
Diabetes, Immunocompromising conditions (HIV), underlying immunodeficiency, or immunosuppressive therapy (corticosteroids)
Uncomplicated VVC treatment
OTC intravaginal agents:
Clotrimazole 1% or 2% cream, Miconazole 2% or 4$ cream [5g intravaginally daily ranging from 3-14 days], miconazole 100 mg or 200 mg vaginal suppository for 3-7 days
Oral agent:
Fluconazole 150 mg orally in a single dose
What is the treatment for severe vaginitis (complicated)?
Fluconazole 100, 150, or 200 mg PO q___h for ___ doses
OR
Topical antifungal therapy daily for _____ days
q72h for 3 doses [3 doses total, 9 days to complete]
OR
topical therapy daily for 7-14 days
What is the treatment for recurrent VVC (complicated) - maybe no longer albicans but a different species of candida?
Induction:
___ days of oral or topical therapy
Maintenance:
Fluconazole 100, 150, 200 mg ______ for _____ months
Induction: 7-14 days of oral or topical therapy
Maintenance: weekly for 6 months
Treatment for treatment failure/non-albicans candida vaginitis:
C. glabrata - intravaginal ____ acid _____ mg daily for ____ days
C. krusei - intravaginal ____ acid ____ mg daily for ____ days OR non-fluconazole (oral or topical) azole for _____ days
C. glabrata: boric acid 600 mg daily for 21 days
C. krusei: boric acid 600 mg daily for 21 days or non-fluconazole (oral or topical) azole for 7-14 days
New treatment approved for adult and post-menarchal pediatric females with VVC
Brexafemme (ibrexafungerp)
Oral VVC drug that is contraindicated during pregnany and a strong CYP3A4 inducer
Brexafemme (ibrexafungerp)
Which GU infection has an elevated vaginal pH (~5), a positive “Whiff” test, and thin, white discharge?
Bacterial vaginosis
Treatment of sexual partners is usually not needed for bacterial vaginosis: True or False
True
Recommended regimens for BV:
_______ 500 mg PO BID for 7days OR
_______ gel 0.75% one full applicator (5g) intravaginally once daily for 5 days OR
______ cream 2% one full applicator (5g) intravaginally at bedtime for 7 days
Metronidazole, metronidazole, clindamycin
Alternative regimen for BV:
_____ 300 mg orally BID for 7 days
Clindamycin *but anaerobic coverage has declined from before
Clindamycin ovules for BV treatment weaken ___ and ___ products.
Latex and rubber products. Patients should abstain from sex until treatment is complete
BV treatment in pregnant women:
_____ 500 mg PO ___ for 7 days OR
_____ 250 mg PO ___ for 7 days OR
____ 300 mg PO BID for 7 days
Trichomonas treatment in pregnant women:
Metronidazole ___ g PO _____
BV:
Metronidazole 500 mg PO BID for 7 days OR
Metronidazole 250 mg PO TID for 7 days OR
Clindamycin 300 mg PO BID for 7 days
Trichomonas:
Metronidazole 2 g PO ONCE
Which GU infection has a pH ~5, a positive “Whiff” test, and white to greenish , frothy discharge?
Trichomonas vaginitis
The incubation period for Trichomonas vaginitis is short/long?
Long, 3-28 days, so can take a while for symptoms to show, if any
___% of patients are asymptomatic for trichomonas vaginitis
50%
Treatment of sexual partners is usually not needed for trichomonas vaginitis: True or False
False, you must treat all sexual partners because trichomonas is an STI
Distinct findings for trichomonas include ____ spots and ___-shaped flagellate
Strawberry spots, pear-shaped flagellate
Trichomonas Treatment:
Women - Metronidazole ____ mg BID for __ day(s)
Men - Metronidazole ___ g for ____ day(s)
Alternative - Tinidazole 2 g in a ___ dose
Women - Metronidazole 500 mg BID for 7 days
Men - Metronidazole 2 g for 1 days (single dose)
Alternative - Tinidazole 2 g in a single dose
A lot of women will not know they have PID until they try to get pregnant (True/False)
TRUE
BV, VVC, STIs, and parasite infections are all common causes of PID (True/False)
True
PID treatment:
3 drugs - _____ + doxycycline + metronidazole OR
2 drugs - _____ + doxycycline OR
2 drugs - ____ + doxycycline
3 drugs - CEFTRIAXONE (1g IV q24h) + doxycycline (100 mg PO/IV q12h) + metronidazole (500 mg PO/IV q12h) (added for anaerobic coverage)
2 drugs - CEFOTETAN (2g IV q12h) + doxycycline (100 mg PO/IV q12h)
2 drugs - CEFOXITIN (2g IV q6h) + doxycycline (100 mg PO/IV q12h)
cephalosporin + doxycycline partially covers for N. gonorrhea and chlamydia
Pregnant women with PID can be treated as an outpatient procedure (True/False)
False, pregnancy needs automatic admission
For PID, you should generally start with IV and deescalate to PO. (True/False)
True
Oral therapy for PID after clinical improvement:
Doxycyline 100 BID + Metronidazole 500 mg BID for ___ days
14 days!
Alternative regimen for PID:
______ + doxycycline OR
______ + gentamicin
Ampicillin-sulbactam (3g IV q6h) + Doxycycline (100 mg PO/IV q12h) OR
Clindamycin (900 mg IV q8h) + Gentamicin (loading dose + maintenance dose)
If not in an hospital/ER settings for PID, there are IM or oral options for treatment (True/False)
True
PO Probenacid is given with ____ to increase the half-life but can _____
Given with cefoxitin IM to increase its half-life but can also change the half-life of other drugs
Ways to prevent PID
Control of STDs Promotion of condoms Use of oral contraceptives Avoidance of vaginal douching Chlamydia screening Early diagnosis and completed treatment
