Gynecologic and Pregnancy Related Infections Part 2

Question 1

What kind of organism is N. gonorrhea?

Answer 1

• Gram neg diplococcus

Question 2

What agar grows N. gonorrhea?

Answer 2

• Thayer martin chocolate agar

Question 3

What is the virulence factor of N. gonorrhea?

Answer 3

• Pili for adherance

Question 4

What is needed often for the diagnosis of N. gonorrhea?

Answer 4

• PCR since it does not stain with Gram stain

Question 5

What is mycoplasma genitalium?

Answer 5

• Bacterial without cell walls

- Cause of non-gonococcal urethritis

Question 6

What is the empirical treatment of Gonorrhea and chlamydia?

Answer 6

• Ceftriaxone – IM
• Azithromycin – PO
• Doxycycline

Question 7

What is the MOA of ceftiraxone?

Answer 7

• Penetrates CSF with a long half life

- Broad spectrum –> 3rd gen cephalosporin

Question 8

What is the spectrum for azithromycin?

Answer 8

• Bacteria lacking cell walls and some anaerobes

Question 9

What is the MOA of azithromycin?

Answer 9

• Binds 50s subunit

Question 10

What is the MOA of doxycyline?

Answer 10

• Binds 30S subunit

Question 11

Is doxycycline safe in pregnancy?

Answer 11

• NO

Question 12

What are the most common causes of PID?

Answer 12

• N. gonorrhea and chlamydia trachomatis

Question 13

Where does PID begin?

Answer 13

• Vulva or vagina and spreads through the genital tract

Question 14

What is a bad end result of PID?

Answer 14

• Pyrosalpinx and tubo-ovarian abscess

Question 15

What is seen in a tubo-ovarian abscess?

Answer 15

• Adnexal mass
• Fever
• Increased WBC
• Abdominal-pelvic pain

Question 16

What can occur in long term PID?

Answer 16

• Infertility
• Ectopic pregnancy
• Intestinal obstruction

Question 17

What is Fitz-Hugh-Curtis syndrome?

Answer 17

• Peritoneal inflammation
• Sudden onset of severe abdominal pain
• +/- fever
• N/V

Question 18

What two STIs can cause neonatal conjunctivitis?

Answer 18

• Gonorrhea – > gonococcal ophthalmia neonatorum

- Chlamydia –> neonatal inclusion conjunctivitis

Question 19

What is the outpatient treatment for PID?

Answer 19

• Ceftriaxone (3rd gen ceph) AND doxycycline (binds 30S)

- Could add metronidazole if serious (DNA breakage)

Question 20

What is the inpatient treatment for PID?

Answer 20

• Doxycycline (30S) PLUS either Cefoxitin OR cefotetan (2nd gen ceph)
• Clindamycin (bind 50S) AND gentamicin in pregnancy

Question 21

What are some undesirable side effects of 2nd gen cephalosporins?

Answer 21

• GI disturbances
• Neurotoxicity
• Nephrotoxicity
• Hepatic enzyme abnormalities
• Hematologic problems

Question 22

What is the MOA of gentamicin? Spectrum?

Answer 22

• Binds 30S

- Transport is oxygen dependent (cannot use in anaerobes)

Question 23

What are some undesirable side effects of gentamicin?

Answer 23

• Nephrotoxicity
• Ototoxicity
• Complete neuromuscular blockage

Question 24

What is the black box warning with gentamicin?

Answer 24

• Injection is potentially nephrotoxic/neurotoxic