Gynecologic and Pregnancy-Related Infections Flashcards
What is the criteria used to diagnose bacterial vaginosis?
Amsel Criteria: at least 3 of the 4:
- discharge
- vaginal pH >4.5
- Positive Whiff test
- Clue cells saline wet mount
What is BV strongly associated with?
increased sexual activity and concomitant sexually transmitted infections
What is the shift in flora seen in cases of BV?
lactobacilli (normal) –> coccobacilli
What type of organism is gardnerella vaginalis?
virulent anaerobic coccobacilli that creates a biofilm
What 3 drugs can be used to treat BV?
metronidazole, tinidazole, or clindamycin
What is the MOA of metronidazole and Tinidazole?
DNA damage
What are the SEs of metronidazole and tinidazole?
Disulfram-like reaction with alcohol: flushing, vomiting, and headache
What class does clindamycin belong to?
lincosamides
When can clindamycin be used?
TSS, PID, and to decrease the risk of premature births in women with BV
what is the MOA of clindamycin?
inhibits protein synthesis at the 50S subunit
What does clindamycin cover?
gram positive bacteria and most anaerobes
what is a high yield adverse effect of clindamycin?
c.diff is resistant to clindamycin -> overgrowth leads to toxin release
What are the pharmacokinetics of clindamycin?
does not penetrate the CSF, actively transported to abscesses
What is the MOA of “azoles” anti-fungals?
destroy fungi by inhibiting conversion of lanosterol to ergosterol by the CYP450 enzyme system
what is the big warning that comes with fluconazole?
potential for fetal harm if pregnant
What cardiac abnormality are “azoles” like fluconazole associated with?
prolongation of the QT interval (torsade de pointes)
What is the most common nonviral sexually transmitted disease?
trichomoniasis
What are the features of T. vaginalis?
flagellated, pear-shaped protozoan
humans are only natural host
How do you treat trichomoniasis?
metronidazole or tinidazole
orally not vaginally
What are the signs of cervicitis?
purulent/mucopurulent discharge
intermenstrual or postcoital bleeding
dysuria, dysparunia, or vulvovaginal irritation
What type of organism is neisseria gonorrhea?
What is it’s virulence factor?
intracellular gram negative diplococcus
pili
what type of organism is chylamydia trachomatis?
gram negative, tiny obligate intracellular bacteria- often does not appear on gram stain
what type of organism is mycoplasma genitalium?
what do they cause?
bacteria without cell walls
cause non-gonococcal urethritis
How do you treat cervicitis?
empirically treat for gonorrhea and chlamydia using:
Ceftriaxone- IM
or
Azithromycin- PO
how do you treat cervicitis if the patient is allergic to azithromycin?
use doxycycline
azithromycin is a member of what drug family?
macrolide
doxycycline is a member of what drug family?
tetracycline family
what is the MOA of ceftriaxone?
it is a cell wall synthesis inhibitor
what is the MOA of azithromycin?
protein synthesis inhibitor (50S)
what is the MOA of doxycycline?
When should you not use it?
protein synthesis inhibitor (30S)
avoid during pregnancy- it is a class D drug
what are the two most common causative organisms of PID?
neisseria gonorrhea and chlamydia trachomatis
What is tubo-ovarian abscess?
adnexal mass, fever, increased WBCs, and abdominal-pelvic pain
what is Fitz-Hugh-Curtis syndrome?
if the PID infection spreads beyond the ovary to involve the peritoneum, inflammation around the liver capsule and diaphragm can occur
sudden onset of severe abdominal pain, +/- fever, nausea, vomiting
how can gonorrhea affect the neonatal eyes?
gonococcal ophthalmia neonatorum
how can chlamydia affect the neonatal eyes?
neonatal inclusion conjunctivitis
when would you hospitalize a patient for PID?
high fever, severe pain, n w/ v, pelvic or tubo-ovarian abscess
how do you treat PID as outpatient?
ceftriaxone AND doxycycline
*if the case is complicated, consider adding metronidazole
how do you treat PID inpatient?
doxycycline PLUS either cefoxitin or cefotetan
clindamycin AND gentamicin (recommended during pregnancy)
what is the MOA of cefoxitin and cefotetan?
they are cephalosporins: cell wall synthesis inhibitors
what is the MOA of gentamicin?
DNA topoisomerase inhibitor (inhibits protein synthesis at 30S)
what is the black box warning associated with gentamicin?
nephrotoxic/neurotoxic
