Gynecologic and Pregnancy-Related Infections

Question 1

What is the criteria used to diagnose bacterial vaginosis?

Answer 1

Amsel Criteria: at least 3 of the 4:

1. discharge
2. vaginal pH >4.5
3. Positive Whiff test
4. Clue cells saline wet mount

Question 2

What is BV strongly associated with?

Answer 2

increased sexual activity and concomitant sexually transmitted infections

Question 3

What is the shift in flora seen in cases of BV?

Answer 3

lactobacilli (normal) –> coccobacilli

Question 4

What type of organism is gardnerella vaginalis?

Answer 4

virulent anaerobic coccobacilli that creates a biofilm

Question 5

What 3 drugs can be used to treat BV?

Answer 5

metronidazole, tinidazole, or clindamycin

Question 6

What is the MOA of metronidazole and Tinidazole?

Answer 6

DNA damage

Question 7

What are the SEs of metronidazole and tinidazole?

Answer 7

Disulfram-like reaction with alcohol: flushing, vomiting, and headache

Question 8

What class does clindamycin belong to?

Answer 8

lincosamides

Question 9

When can clindamycin be used?

Answer 9

TSS, PID, and to decrease the risk of premature births in women with BV

Question 10

what is the MOA of clindamycin?

Answer 10

inhibits protein synthesis at the 50S subunit

Question 11

What does clindamycin cover?

Answer 11

gram positive bacteria and most anaerobes

Question 12

what is a high yield adverse effect of clindamycin?

Answer 12

c.diff is resistant to clindamycin -> overgrowth leads to toxin release

Question 13

What are the pharmacokinetics of clindamycin?

Answer 13

does not penetrate the CSF, actively transported to abscesses

Question 14

What is the MOA of “azoles” anti-fungals?

Answer 14

destroy fungi by inhibiting conversion of lanosterol to ergosterol by the CYP450 enzyme system

Question 15

what is the big warning that comes with fluconazole?

Answer 15

potential for fetal harm if pregnant

Question 16

What cardiac abnormality are “azoles” like fluconazole associated with?

Answer 16

prolongation of the QT interval (torsade de pointes)

Question 17

What is the most common nonviral sexually transmitted disease?

Answer 17

trichomoniasis

Question 18

What are the features of T. vaginalis?

Answer 18

flagellated, pear-shaped protozoan

humans are only natural host

Question 19

How do you treat trichomoniasis?

Answer 19

metronidazole or tinidazole

orally not vaginally

Question 20

What are the signs of cervicitis?

Answer 20

purulent/mucopurulent discharge
intermenstrual or postcoital bleeding
dysuria, dysparunia, or vulvovaginal irritation

Question 21

What type of organism is neisseria gonorrhea?

What is it’s virulence factor?

Answer 21

intracellular gram negative diplococcus

pili

Question 22

what type of organism is chylamydia trachomatis?

Answer 22

gram negative, tiny obligate intracellular bacteria- often does not appear on gram stain

Question 23

what type of organism is mycoplasma genitalium?

what do they cause?

Answer 23

bacteria without cell walls

cause non-gonococcal urethritis

Question 24

How do you treat cervicitis?

Answer 24

empirically treat for gonorrhea and chlamydia using:
Ceftriaxone- IM
or
Azithromycin- PO

Question 25

how do you treat cervicitis if the patient is allergic to azithromycin?

Answer 25

use doxycycline

Question 26

azithromycin is a member of what drug family?

Answer 26

macrolide

Question 27

doxycycline is a member of what drug family?

Answer 27

tetracycline family

Question 28

what is the MOA of ceftriaxone?

Answer 28

it is a cell wall synthesis inhibitor

Question 29

what is the MOA of azithromycin?

Answer 29

protein synthesis inhibitor (50S)

Question 30

what is the MOA of doxycycline?

When should you not use it?

Answer 30

protein synthesis inhibitor (30S)

avoid during pregnancy- it is a class D drug

Question 31

what are the two most common causative organisms of PID?

Answer 31

neisseria gonorrhea and chlamydia trachomatis

Question 32

What is tubo-ovarian abscess?

Answer 32

adnexal mass, fever, increased WBCs, and abdominal-pelvic pain

Question 33

what is Fitz-Hugh-Curtis syndrome?

Answer 33

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

Question 34

how can gonorrhea affect the neonatal eyes?

Answer 34

gonococcal ophthalmia neonatorum

Question 35

how can chlamydia affect the neonatal eyes?

Answer 35

neonatal inclusion conjunctivitis

Question 36

when would you hospitalize a patient for PID?

Answer 36

high fever, severe pain, n w/ v, pelvic or tubo-ovarian abscess

Question 37

how do you treat PID as outpatient?

Answer 37

ceftriaxone AND doxycycline

*if the case is complicated, consider adding metronidazole

Question 38

how do you treat PID inpatient?

Answer 38

doxycycline PLUS either cefoxitin or cefotetan

clindamycin AND gentamicin (recommended during pregnancy)

Question 39

what is the MOA of cefoxitin and cefotetan?

Answer 39

they are cephalosporins: cell wall synthesis inhibitors

Question 40

what is the MOA of gentamicin?

Answer 40

DNA topoisomerase inhibitor (inhibits protein synthesis at 30S)

Question 41

what is the black box warning associated with gentamicin?

Answer 41

nephrotoxic/neurotoxic