Gynecologic And Pregnancy Related Infections Dr. Straudinger Flashcards
Thin white discharge coming from vagina + no itching
Bacterial Vaginosis, + check preg and chlamydia/ Gonorrhea
How to test for BV, candida, Trichomonasis
Wet Mount, checking pH = Vaginitis
How to test for Chlamydia, Gonorrhea, Trichomonasis
NAAT, PCR (endocervical swab, vaginal swab, urine)
Trichomonasis best seen on Vaginal swab or urine
Saline wet mount, vaginal epithelial cells with clue cells
+ vaginal discharge placed on slide and add KOH = smells fishy
Ph = over 4.5 (high)
BV
BV 3 of the 4 must be present
- Homogenous thin grey/white discharge
- Ph over 4.5
- Whiff test
- Clue cells
BV increased by and how common
Sexual activity (can come with STIs) = the MOST common in child bearing age
Douching is what
Vaginal rented with antiseptic or vinegar = increase BV risk
BV is seen in who
minorities and smoking
Normal bacteria in vagina and BV bacteria
- Lactobacilli = make lower pH, aerotolorant, gram- bacilli
2. Coccobacilli = like higher pH made form sex, gram + (clue cells) = Gardnerella Vaginalis
Gardenerella Vaginalis does what in the vagina
Creates BV
= makes biofilm for other bacteria to grow
= all the bacteria combined make the malodorous amine smells
BV 3 tx
- Metronidazole 2 x day, 7 days (500mg) = inhibit dna synthesis, deplete thiols
- Tinidazole = inhibits dna synthesis
- Clindamycin = inhibit 50s ribosome translation
Metronidazole and Tinidazole are activated by and their active form kills what
Nitroreductase , kills Bacteria BV, Trichomonasis
Metronidazole + Tinidazole side effects
- V, flushing, HA (with alcohol)
- Seizures, ataxia, Dizziness
- General : N, anorexia, Bloating, Cramping
= majority of drug eliminated in urine
Clindamycin (Lincosamine)
- Used for
- Kills what
- Used for
- Allergic to penicillin
- Gram + and Anaerobes + Group A strep (Strep throat) —-> B-lactamase making
- Toxic shock syndrome, PID, decrease PROM in women with BV**, tx MERSA also
Clindamycin side effects
- C. Diff overgrowth (Psudomembranous colitis)
2. Actively transported to Abscesses (not penetrating CSF though) = goood thing
Candida look like what on the external
Red and itchy vagina , thick cottage discharge, no redness on cervix
Candida have what tests
- KOH whiff test is negative however on wet mount + KOH= make final elements more visible, pseudohyphae
- PH is normal and low (under 4.5)
Normal pH in vagina
3.8-4.5
Risk of Candida
DM, Imunosuppressed, High Estrogen, ABs used
Candida albicans is most common what is another candida that can infect
Candida Glabrata
Candida can do what after long overgrowth
Invasion of squamous cells causing symptomatic disease
3 over the counter topical creams for Candidiasis
- Clotrimazole
- Miconazole
- Tioconazole
3 prescriptions topical creams for Candidiasis
- Terconazole
2. Butoconazole
1 oral 3 prescription for Candidiasis
Fluconazole
Fluconazole
- MOA
- Warnings
- Destroy fungi by inhibiting lanosterol —> Esgosterol by stickign to the 14a- demethylasa (disrupts the cell membrane*)
- Serious birth defects in pregnancy + AVIOD with Erythromycin = cardiotoxicity
Fluconazole and other azoles can cause what side effects
- Prolongation of QT interval (tornado de pointes) (if taken with Amiodarone or other QT prolongation drugs)*
- Cardio toxic if taken with erythromycin *
- Renal dysfunction should be with caution*
- Not in pregnancy*
Fluconazole inhibits
CYP3A4
Trichomonasis sx
- Sx
- Tests you see
- Bleeding after sex, itching, dysuria, pain with sex, thin green foul smelling discharge
- Cervix is strawberry (punctuate hemorrhage), red vulva and vagina,
= saline wet mount —> flagellated Protozoa, motile (oval shape), pH if over 4.5, KOH whiff test is +, many WBCs
Trichomonasis increases risk of what and associated with and how common
Most common NONVIRAL STI
= HIV and HPV
= increased risk of HIV due to cervical hemorrhages , can lead to carcinoma
Trichomonasis is how big and survival NTD likes infecting what
2 RBCs, only in humans (pear shaped with flagella) protozoan
= infects Squamous cells especially in urinary tracts , and eats bacteria
= does not for cysts
TX Trichomonasis how 2 drugs
+ what do you need to do when treating
1.Metronidazole ** 1st
2. Tinidazole
= must treat all sexual partners
= test 2weeks to 3 months after tx for cure
When taking metronidazole and trinidazole for Trichomonasis what do you need to tell patient
Avoid alcohol
Neisseria Gonorrhea and Chlamydia
- SX
- Tests you see what
- Thick mucoid discharge, pain sex, vaginal bleeding after sex
+ Normal external genitalia, cervix is RED + purulent discharge
2.
Cervicitis
- Sx and things you see
- Cervix is
- Most common
- Redness, mucopurulent discharge from cervix
- Spotting or bleeding after sex, dysuria
- Chlamydia Gonorrhea, Trichomonasis, HSV, Mycoplasma
Neisseria Gonorrhea
- What type of bacteria
- Grows on
- virulence factor
- gram - diplococcus
- Chocolate agar
- Pili adherence
Chlamydia Trachomatis
1, what type of bacteria
2. Dx how
- Gram - tiny obligate intracellular
2. Not on gram stain, NEED PCR ( Elementary body and Reticulate Body_
Mycoplasma Genitalia
- What type
- Causes what
- NO cell wall bacteria
- Non-gonococcal urethritis , cervicitis
= SMALLEST SIZE
How to treat Gonorrhea + Chlamydia when PCR results have not come back
- Ceftriaxone IM injection
2. Azithromycin oral (Doxycycline can be used if allergy to Azithromycin)
Cervicitis 3 drugs used to treat and their MOA
- Ceftriaxone (3rd gen, Cell wall synthesis, inhibit B-lactam) IM
- Azithromycin (Macrolide AB, 50S ribosome inhibitor)
- Doxycycline (Tetracycline AB, 30S ribosome inhibitor)
Ceftriaxone
1. Given how
2, excreted how + good thing about it
3. Side effects
- IM going through the CSF
- Bile + longest HL
- Cholestasis + bilirubin displacement, jaundice in neonates
Azithromycin
- MOA
- Given how
- Side effects
- 50s ribosome inhibitor
- IM And oral with empty stomach, excreted in bile
- GI upset, ABD pain
Doxycycline
1MOA
2. Given how
3. Side effects *
- 30S ribosome inhibition
- oral
- NOT IN PREGNANCY*, category D drug
PID
- SX
- Tests say what
- Thick mucoid discharge + Pain sex, bleeding after sex, FEVER, lower PELVIC PAIN moderate to severe
- Normal external genitalia, red cervix with purulent discharge + Cervical Motion Tenderness = CHANDELIER SIGN
CHANDELIER SIGN, is done how, means what, do what then
Cervical motion tenderness 2 fingers palpating Cervix and other hand above pubic bone palpating down = pt lifts butt off in the air in pain
= PID
= order US
What causes PID
Gonorrhea or chlamydia or other STIs + BV
PID can cause what inflammation
Inflammation of Pyrosalpinx + tube-ovarian abscess (fallopiana and ovarian both sides)
Tubo-ovarian abscess is what and sx, can spread to cause what
- Adenexal mass, fever, high WBCs, ABD-pelvic pain (complication of PID)
2 can causes many adhesions all over ovaries and Fallopian tubes - Fitz-Hugh- Curtis Syndrome
Fitz-Hugh- Curtis Syndrome
- SX
- Happens from
- Can lead to
Peritoneal inflammation, perihepatitis, Acute severe ABD pain, fever, N/V,
= disseminated infection , gonococcal septic arthritis
= infertility, ectopic, GI obstruction
Gonorrhea and chlamydia can cause what to neonates
- Gonococcal ophthalmia neonatorum (blindness + redness + discharge)
- Chlamydia : Neonatal inclusion conjunctivitis (blindness + redness + discharge)
PID tx 2 + tx if complicated with abscess or other problem OUTPATIENT
- Ceftriaxone + Doxycycline
2. Add Metronidazole if complicated
PID tx 2 + if pregnant INPATIENT
- Doxycycline + Cefoxitin OR Doxycycline + Cefotetan
2. Clindamycin + Gentamicin (pregnant)
Cefoxitin + Cefotetan
- MOA
- Advantage over PNC
- Side effects
- 2 gen cephalosporin, inhibit cell wall
- More resistance to B-lactam, chemical versatility , broad spec
- GI probs, renal toxic, hepatotoxic, thrombocytopenia, neurotoxic
Cephalosporin gen1, gen2, gen3
- Gen1 : gram + , strep pneumonia
- Gen2 : broad spec
- Gen3 : gram - , strep pneumonia
Gentamycin
- MOA
- Side effects
- Not go to
- 30S Ribosome inhibitor
- Category D , NOT good for pregnancy unless needed, renal toxic, ototoxic, NMJ toxic* BLACK BOX
- Does it go to CNS or eyes
Genital Herpes
- SX of
- PE
- Cause of this
- Types of lesions
- Genital sores (painful stinging + Itchy) fevers HA, dysuria ,
- Vulva scattered small shallow vesicles + ulceration , tender + LAD bilaterally
- HSV
- Early = vesicles red, Later = shallow raised edges
Chancroid
- Caused by
- Lesions
- Pain or no and how many + LAD
- Other sx
- H. Ducreyi
- clerks purulent base, no indurated, ragged edges
- Painful, many, LAD boboes
- No other constitutional sx
Syphilis
- Caused by
- Lesions
- Pain or no and how many + LAD
- Other sx
- T. Pallidum
- Ulcer/chancre, indurated, demarcated edges
- NO pain, only 1 + LAD in late primary stage
- Secondary syphilis has constitutional sx
LGV (Lymphogranuloma Venereum)
- Caused by
- Lesions
- Pain or no and how many + LAD
- Other sx
- C. Trachomatis L1, L2, L3
- Early = papule, Late = ulcer small shallow
- NO PAIN + only 1, LAD present
- Constitutional sx in secondary LGV
Granuloma Inguinale (Donovanosis)
- Caused by
- Lesions
- Pain or no and how many + LAD
- Other sx
- K. Granulomais
- Highly vascular ulcer beefy red
- NO Pain, + variable number of them, NO LADs,
- No constitutional sx
HSV can also present as and latency
Latency on sacral ganglia
= left LAD and left labia vesicles
HSV
- Type of virus
- 2 types
- Pap smear shows
- TR
- DNA virus
- Orofacial HSV1, Genital HSV2
- Molding, Multinucleated, Margination = Pap smear
- Vertical transmission + by fluids
HSV TX
- Acyclovir = stopes DNA lengthening, STOP replications , resistance = low viral thymidine kinase
- Famciclovir
- Valacyclovir
= within 72 hr of lesions
Primary syphilis sx
Secondary syphilis sx
Tertiary syphilis sx
- Primary = PAINLESS chancre, after 3-6weeks
- Secondary = 6 weeks after Condyloma Lata + macular red rash (palms + soles), patchy hair loss, LAD, organ probs
- 6 years after, Gummatous Lesions skin and bone (forehead, onside mouth….) , Thoracic Aoritc Aneurysm
Neuro syphilis sx
Loss of vibration and pain and temperature sense below lesion + - Rombergs,
Staying and how syphilis looks
Corkscrew organism on silver stain, spinning moving , lymphoplasmacytic infiltrate, GRAM -
TESTIG for syphilis
- Non-Treponemal screeenign test : VDRL, RPR
- Treponemal DX Test : FTA-ABS, if above is +
- Direct Specimen from tissue = PCR*, or silver stain
TX Syphilis 2 + Neurosyphillis tx
- Penicillin G = Beta-Lactam AB (Benzathine PNC) = safe in preg , gram - and gram + ( Amoxicillin + Flucoxicillin , inhibit cell call bacterial)
- Doxycycline if PNC allergy
- Aqueous crystalline PNC G + Procaine PNC G / probenecid
Chancroid is found where
Africa, Latin America, Southeast Asia , PAINFUL
LGV is found where
Tropical subtropical locations
= PAINLESS ulcer then, 2-6 weeks buboes painful unilateral inginal LAD (bilateral men, unilateral women)
LGV TX
- Doxycycline
2. Azithromycin or erythromycin (Macrolides) = if pregnant
Granuloma Inguinale is found where + TX + biopsy shows
India, Papua New Guinea, Caribbean, South Africa, PAINLESS,
- Donovan Bodies on bx
- Azithromycin (inhibit 50s ribosome)
50 S inhibitors
- Azithromycin
- Erythromycin
- Clarithromycin
- Clindamycin
- Lincomycin
30 S inhibitors
- Doxycycline
- Tetracycline
- Tigercycline
- Demeclocyclin
Toxic Shock Syndrome SX
+PE + from what
- RAPID Fever, macular rash on palms of hand abd pain, watery D, hypotension, Fever,
- Conjunctiva erythema, sunburn like rash
- Staph. Aureus
Staph aureus is what type of bacteria
Catalase + (Staph) , coagulase + , GRAM + , cluster cocci
= lipase, staphylkinase (clot destroying), Hyaluranidase ( CT destroying ) , Hemolysins Leukocidins, PNCase, Protein A
TSST-1 moa
Crosslinks T-cells and M (MHC2) = release of cytokines
TSS tx
- Remove tampons
- Vasopressin
- Empirical AB until culture, + Cephalosporin + Tazolactam, Vancomycin *
= Pipercillin / Tazobactam (Zosyn, PID also)
= Cefepime (4 gen, used for Enterobacteriaceae infections)
= Meropenem ( can cause C diff, preg safe)
= Imipenem / Cilastatin (not MRSA, only Pseudomonas, others + GIVE with CILASTATIN to prevent renal degradation )
Vancomycin used when and moa
Glycopeptide AB, made of non ribosome peptides = inhibit cell wall synthesis , needs Lactate
= MRSA
Enzyme bacteria make for resistance
Beta Lactamase enzyme (PNC resistance bacteria)
How to bind B-lactamase enzymes more efficiently to prevent resistance
PNC + Tazobactam
TORCH infections
Toxoplasmosis, Other (Parvovirus B19, syphilis, VZV), Rubella, CMV, HSV/HIV
= all are dna except rubella and hiv and toxo is a parasite
Toxoplasmosis SX
+ and does what to baby
- Asymptomatic usually
- LAD, Chorioretinitis (eye pain and blurry), intracranial calcifications
- Neuro probs, stillbirth
DX toxoplasmosis
- IgG and IgM serology
2. Spiramycin, Pytimethamine to tx
Syphilis in newborn SX EARLY
1.mucous membranes involvement + Rhinitis (Snuffles), RASH (palms, soles, genitals), LAD, lymphadenopathy
Syphilis in newborn SX LATE 3
- Gamma formation
- CN 8 effects = hearing loss
3 bone and teeth = saber shins, saddle noise, Hutchinsons teeth, frontal bossing
= after 2yo
DX Syphilis + TX
- RPR+ VDRL ——> FTA-ABS
2. PNC
Varicella Zoster Virus
- Sx
- Congenital varicella syndrome
- Peripartum VZV tx
- Various stages of healing vesicles rash
- Limb hypoplasia, cicatricial skin lesions, eye probs
- Acyclovir
Parvovirus B19
- Sx
- Risk of fetus
- Virus does what
- Slapped Cheeks red
- Fetal loss, fetal anemia, hydrops fetalis , high fetal death
- Viral DNA Attacks RBCs
Rubella
- SX
- Fetal causes
- What usually happens in born infant with this
- Mild fever, face —> truck = head to toe rash, Soft palate petechia (Forchheimer spots)
- Congenital Rubella Syndrome = Hearing loss, congenital heart disease PDA, cataracts,
- Blueberry muffin baby
Rubella DX
Serum IgG
CMV
- How common + fetal cause what
- Sx
- Most common viral congenital infection, Fetal hearing loss, Chorioretinitis (eye)
- Asymptomatic usually , mono life sx (fever, HA, pharyngitis)
CMV cells seen + tx
Owen eye inclusions (with inclusions around)
+ Supportive care
HSV
- Sx in fetus
- Tx
- Usually during birth (vertical TR)
- Skin, eye, mouth probs, CNS probs
- Acyclovir
Pregnant women screened for Group B strep when
35-37 weeks , vaginal + rectal swab
Group B strep can cause what to fetus
Sepsis, meningitis, Pneumonia (up to 3 month after birth)
Strep Agalactiae ( Group B strep)
- What type
- Group on it
- Virulence factor
- Gram + Cocci, chains
- Lancefield group B
- Anti-Phagocytic Capsule
Group B strep TX
- PNC G or Amoxicillin , cephalosporin, clindamycin (if allergic to pnc) during preg or during labor
Post Partum Endometritis
- Sx
- Risk of getting this
- TX
- fever, uterine tenderness , tachy, midline lower ABD pain
- Group B strep colonization , C-sections delivery
- Group A and Group B strep = Gentamicin + Clindamycin **, OR ampicillin/Sulbactam
IUD infection that is common
- Associated with
- Sx
- Bx seen
Actinomyces = Gram + filamentous bacteria
- Long term IUD
- Vagina discharge, Pelvic pain
- Sulfur granule on bx
Mastitis
- Sx sore/cracked nipples, fever, myalgia, redness, swollen, and tender breast
- Most common infection
- TX
- Sx sore/cracked nipples, fever, myalgia, redness, swollen, and tender breast
- Staph. Aureus
- Regularly empty breast* + (Cephalexin/Diclocacillin/ amoxicillin/clavulanate = MSSA) (Clindamycin / Trimethoprim/sulfamethoxazole = MRSA)
Prevent resistance
- Tazobactam + PNC (inhibit b-lactamase enzyme)
2. Amoxicillin + Clavulanate ( inhibit penicillinase )
Bacteria that resistant to PNC make
- BACTRIM MOA
- Side effects of bactrim
Penicillinase
- Block TH4 synthesis = Sulfamethoxazole + Trimethoprim **
- Kernicterus in neonate (high bilirubin in CNS)
