Gynecologic Infection Part 3 Flashcards
Genital Herpes:
- agent
- lesion
- painful/painless
- lymphadenopathy
- constitutional sx
- Caused by HSV 2
- Early on lesion is vesicles and erythematous, later on lesions are ulcerated shallow and have raised edges
- Multiple Painful lesions
- Inguinal lymphadenopathy present
- constitutional sx present
Chancroid:
- agent
- lesion
- painful/painless
- lymphadenopathy
- constitutional sx
- H. ducreyi
- Purulent base, non indurated ulcer with ragged edges
- Multiple Painful lesions
- Inguinal lymphadenopathy present and buboes
- no constitutional sx
Syphillis:
- agent
- lesion
- painful/painless
- lymphadenopathy
- constitutional sx
- T. pallidum
- Ulcer/chancre that isindurated with demarcated edges
- Painless singular lesion
- Lymphadenopathy present in late primary syphilis
- constitutional sx in secondary syphilis
LGV:
- agent
- lesion
- painful/painless
- lymphadenopathy
- const. sx
- C. trachomatis L1, L2, L3
- Early on papule later small shallow ulcer
- painless singular lesion
- painful lymphadenopathy in secondary see buboes
- secondary see constitutional sx
Where does herpes remain latent?
Sacral ganglia
How is Herpes simplex transmitted and what are the usual sites of involvement?
- transmitted via saliva, vaginal secretions and direct contact with an ulcerative lesion
- HSV 1: orofacial
- HSV 2: genital
Herpes cytology?
Infects squamous cells, has “Three M’s”:
nuclear Molding, multinucleated and margination
How do you treat genital herpes? When are they most effective
- Acyclovir or Famciclovir or Valacyclovir
- Most effective if started within 72 hours
Acyclovir MOA?
Targets thymidine kinase specific to herpes virus, leads to inhibition of replication
How does resistance to Acyclovir occur?
- Decreased or absent production of viral thymidine kinase
- This prevents acyclovir from reaching activated triphosphate state
30 yo woman 2 weeks of a singular genital lesion. It started witha bump and is now an open painless wound. 1-2 cm ulcer on inferior vulva with a raised and indurated border, not tender to palpation. Mild inguinal lymphadenopathy is present. She has had one new partner over the last 3 months.
What is this?
- Syphilis, the lesion is a chancre
- it is painless and develops 3-6 weeks after contact
- after 6 weeks of primary infection secondary syphillis can occur
Secondayry syphils?
- Macular rash
- formation of wart like lesion called condyloma lata
- rash involves palms and soles
What are the sixes of syphilis?
- Chancre develops after 6 weeks of inital contact
- 6 weeks after primary infection secondary syphilis develops
- 6 months after secondary tertiary syphilis develops
Tertiary syphilis?
- Gummatous lesions in the skin and bones
- CV syphilis: thoracic aortic aneurysm
What happens if syphilis involves the posterior columns and dorsal root ganglia?
- loss of coordination
- loss of pain/temp sensation
- diminished proprioceptive and vibratory sensation
What happens if syphilis involves the midbrain>
Argyll Robertson pupils, pupils do NOT constrict when exposed to light, but DO constrict when an object is brought close
What causes syphilis, what does histo show, what is on silver stain?
- T. pallidum
- spinning motility to invade tissues
- Histo shows lymphoplasmacytic infiltrate
- Corckscrew organism on silver stain
How is syphilis diagnosed?
- Non treponemal screening tests such as VDRL & RPR
- after positive screen treponemal diagnostic tests are done, FTA-ABS
Syphilis treatment if primary secondary or early latent phase?
- Benzathine Penicillin
- if allergic use doxycycline
Neurosyphilis treatment? Occular syphilis tx?
Aqueous crystalline penicillin G
Procaine penicillin G and Probenecid
Is benzathine penicillin safe for pregnancy?
Generally safe
What is Benzathine penicillin active against?
- Gram positive beta hemolytic streptococci
- Gram negative T. pallidum and T. carateum
Benzathine penicillin MOA?
- Inhibition of cell wall synthesis
- AE’s:
- allergic reactions, minor like rashes itching or flushing
- small fraction have serious reaction
what locations is chancroid common to?
- resource poor areas:
- Sub Saharan Africa
- Latin America
- Southeast Asia
Chancroid treatment?
- Azithromycin (macrolide)
- Ceftriaxone (3rd gen)
- Ciprofloxacin (flouroquinolone)
- Eruthromycin (macrolide)
Where is Lymphogranuloma venerum commonly found?
- Mostly in tropical/subtropical locations
- east and west africa, india, southeast asia, caribbean
LGM treatment?
- Doxycyline (tetracycline) (if not pregnant)
- Azithromycin or Erythromycin
Granuloma Inguinale:
- agent
- lesion
- painful/painless
- lymphadenopathy
- constitutional sx
- K. granulomatis
- beefy red ulcer
- painless
- psuedobuboes
- no constitutional sx
Where is Granuloma Inguinale commonly found?
- It is not common
- can be found in india, papa new guinea, caribbean, and southern africa
What genital lesion shows Donovan bodies?
Granuloma inguinale
Treatment for Granuloma inguinale?
Azithromycin
MOA of azithromycin?
50s ribiosome inhibition
22 yo with 1-2 days diffuse red rash on palms and soles of feet. Assoc. fever abdomen pain and watery diarrhea. On period for last 5 days using tampons.
- BP: 85/50 T:103.5
- General: appears ill slightly disoriented
- Skin: rash involves soles and palms, diffusly erythematous macular rahs looks like sunburn
- Conjunctival erythema
- Pelvic exam shows tampon
What is this?
- Staphylococcal TSS
Toxic Shock Syndrome presentation?
- rapid fever onset
- diffuse macular rash erythematous and involves hands/feet
- desquamation of rash 1-2 wks later
- hypotension
- signs of multiorgan involvement
S. aureus microbiology?
- Gram positive
- Catalase positive
- Coagulase positive
- cocci in clusters “grape like”
What are the tissue destroying proteins that S. aureus has?
- Hyaluronidase (CT destroyer)
- Staphylokinase (clot destroyer)
- Lipase
MOA of TSS?
- TSST-1 acts as super antigen and crosslinks T cells and macrophages (via MHC II) inducing release of cytokines
*
Treatment of TSS?
- removal of tampon or other source of infection
- supportive care for shock
- empiric abx until culture
In a patient with TSS with suspected Methicillin resistant S. aureus what should be sued to treat it?
Vancomycin
What type of drug is vancomycin?
- Glycopeptide, a drug of last resort that inhibits cell wall biosynthesis
How does resistance to vancomycin occur?
Resistant strains produce D-ala: D-lac or D-ala: D-ser instead of D-ala:D-ala at the C terminal, and vancomycin doesn’t have high affinity for those
What drug extend Beta lactam spectrum of abx activity to prevent antimicrobial resistance?
- Tazobactam
Pipercillin/Tazobactam?
Used to treat toxic shock syndrome and PID and others… covers gram + and gram - including psuedomonas
given IV
Cefepime?
- 4th gen cephalosporin
- active against psuedomonas, s. aureus, MDR strep pneumoniae
TSS treatment?
- Cefepime
- Pipericillin/Tazobactam
- Meropenem
- Imipenem/Cilastatin
When is cefepime a first line agent?
WHen infection is with enterobacteriaceae
What are the serious side effects of meropenem?
- C.diff infection
- seizure
- allergic rxn
- anaphylaxis
Meropenem use in pregnancy and how does resistance arise?
- safe
- resistance due to mutations in penicillin binding proteins
What bugs are Imipenem/Cilastatin active against?
- Psuedomonas and Enterococci
- NOT MRSA
How is Imipenem metabolized?
Renal enzyme dehydropeptidaase 1 (DHP1), so it is co administered with cilastatin (DHP1 inhibitor) to prevent this
