Gynecologic infections

Question 1

The bartholin duct is capable of having a cyst or abscess. What are the general symptoms as well as treatment

Answer 1

General symptoms: Painful swelling with dyspareunia

Treatment

1. ) Asymptomatic cyst - no therapy or warm soaks
2. ) Abscess - incisions and drainage, culture for chlamydia

Question 2

All vaginitis has the same symptoms, what are they

Answer 2

Vulvovaginitis such as itching, burning, irritation, and abnormal discharge

Question 3

What must you not confuse vaginitis symptoms with

Answer 3

1. ) Midcycle estrogen surge which has mucoid secretions
2. ) Luteal phase/pregnancy which has thick and white secretions

If many WBC’s but no organism - suspect chlamidya

Question 4

What’s in your differential and screened for in vaginitis

Answer 4

1. ) Trichomonas, candidiasis, and bacterial vaginosis

2. ) If purulent discharge - get N-Gonorrhea and chlamydia trachomatis to rule out cervicitis

Question 5

What are the risk factors for bacterial vaginosis vs. trichomonas vs. yeast

Answer 5

Bacterial vaginosis: More than one pregnancy, female sexual partner

Trichomoniasis: Unprotected sex with multiple partners

Yeast: Diabetes and broad spectrum antibiotics

Question 6

What are the pearls for bacterial vaginosis, trichomonas, and yeast

Answer 6

Bacterial vaginosis: Homogenous grayish white fishy discharge
Trichomonas: Yellow-green, frothy with strawberry petechiae in upper vagina/cervix

Question 7

What is the treatment for bacterial vaginosis and trichomonas

Answer 7

Metronidazole or vaginal clindamycin

If trichomonas, treat like STD and treat partners too

Question 8

What are the complications of bacterial vaginosis

Answer 8

1. ) Chorioamniotis/endometritis
2. ) Infection
3. ) Preterm delivery
4. ) Miscarriage
5. ) PID

Question 9

What is cervicitis

Answer 9

Inflammation of uterine cervix from chlamidya, gonococcus, trichomonas, HSV, or HPV

Presents with yellow green mucopurulent discharge with cervical motion tenderness but no other signs of PID

Question 10

What is pelvic inflammatory disease

Answer 10

POLYMICROBIAL infection of upper genital tract. Either N gonorrhea, chlamydya, and aerobes/anaerobes

Question 11

What are the symptoms of pelvic inflammatory disease

Answer 11

1. ) Lower abdominal pain
2. ) This time, fever and cihlls
3. ) Purulent cervical discharge
4. ) Cervical motion tenderness (chandelier sign)
5. ) Adnexal tenderness

Question 12

If you were to do an ultrasound for PID, what could you potentially see

Answer 12

Thickening or dilation of fallopian tubes, fluid in cul-de-sac, multicystic ovary, tuboovarian abscess

Question 13

What is the treatment of PID

Answer 13

Outpatient
Regimen 1: Fluoroquine + metronidazole
Regimen 2: Cephalosporin + probenecid + doxycycline

Inpatient
Clindamycin + gentamicin

Question 14

When is surgery indicated for PID

Answer 14

1.) Drainage of tuboovarian pelvic abscess if mass persists after abx, greater than 4 to 6 cm, mass is in cul-de-sac in midline and drainable through vagina

Question 15

What are the complications of PID

Answer 15

1. ) Infertility

2. ) Fitz-hugh-curtis syndrome - perihepatitis, RUQ pain, abnormal liver function tests

Question 16

What is toxic shock syndrome

Answer 16

Caused by staph aereus toxin within 5 days of tampon use with abrupt fever, vomiting, watery diarrhea

May also see macular erythematous rash, nonpurulent conjunctivitis, and desquamation during recovery

Question 17

What is the diagnosis and treatment of toxic shock syndrome

Answer 17

Clinical because blood cultures negative

Treatment: Rapid rehydration, anti-staph drugs

Corticosteroids can reduce severity o illness and fever

Question 18

What are causes of death from toxic shock syndrome

Answer 18

1. ) ARDS
2. ) Hypotension
3. ) Hemorrhage secondary to DIC