Gynecologic and Pregnancy Related Infections Part 2 Flashcards
What kind of organism is N. gonorrhea?
- Gram neg diplococcus
What agar grows N. gonorrhea?
- Thayer martin chocolate agar
What is the virulence factor of N. gonorrhea?
- Pili for adherance
What is needed often for the diagnosis of N. gonorrhea?
- PCR since it does not stain with Gram stain
What is mycoplasma genitalium?
- Bacterial without cell walls
- Cause of non-gonococcal urethritis
What is the empirical treatment of Gonorrhea and chlamydia?
- Ceftriaxone – IM
- Azithromycin – PO
- Doxycycline
What is the MOA of ceftiraxone?
- Penetrates CSF with a long half life
- Broad spectrum –> 3rd gen cephalosporin
What is the spectrum for azithromycin?
- Bacteria lacking cell walls and some anaerobes
What is the MOA of azithromycin?
- Binds 50s subunit
What is the MOA of doxycyline?
- Binds 30S subunit
Is doxycycline safe in pregnancy?
- NO
What are the most common causes of PID?
- N. gonorrhea and chlamydia trachomatis
Where does PID begin?
- Vulva or vagina and spreads through the genital tract
What is a bad end result of PID?
- Pyrosalpinx and tubo-ovarian abscess
What is seen in a tubo-ovarian abscess?
- Adnexal mass
- Fever
- Increased WBC
- Abdominal-pelvic pain
What can occur in long term PID?
- Infertility
- Ectopic pregnancy
- Intestinal obstruction
What is Fitz-Hugh-Curtis syndrome?
- Peritoneal inflammation
- Sudden onset of severe abdominal pain
- +/- fever
- N/V
What two STIs can cause neonatal conjunctivitis?
- Gonorrhea – > gonococcal ophthalmia neonatorum
- Chlamydia –> neonatal inclusion conjunctivitis
What is the outpatient treatment for PID?
- Ceftriaxone (3rd gen ceph) AND doxycycline (binds 30S)
- Could add metronidazole if serious (DNA breakage)
What is the inpatient treatment for PID?
- Doxycycline (30S) PLUS either Cefoxitin OR cefotetan (2nd gen ceph)
- Clindamycin (bind 50S) AND gentamicin in pregnancy
What are some undesirable side effects of 2nd gen cephalosporins?
- GI disturbances
- Neurotoxicity
- Nephrotoxicity
- Hepatic enzyme abnormalities
- Hematologic problems
What is the MOA of gentamicin? Spectrum?
- Binds 30S
- Transport is oxygen dependent (cannot use in anaerobes)
What are some undesirable side effects of gentamicin?
- Nephrotoxicity
- Ototoxicity
- Complete neuromuscular blockage
What is the black box warning with gentamicin?
- Injection is potentially nephrotoxic/neurotoxic
