Gynecologic Infections Flashcards
vaginal discharge that is white or yellow; without erythema, edema, burning, itching, cervical tenderness
Physiologic Leukorrhea
Dx with 3+ of the following:
- thin, white discharge
- amine “fishy” odor with KOH whiff test
- pH greater than 4.5
- clue cells (epithelial cells with adherent coccobacilli
Tx? (2 abx)
Bacterial Vaginosis
Tx: metronidazole or clindamycin
Dx:
- -yellow, grey, or green thin malodorous discharge
- -vaginal pH = 6-7
- -“strawberry cervix” with erythematous, punctate appearance
- -vulvar erythema, pruritus
- -motile pear-shaped organisms on wet mount
Tx?
What should be avoided in this tx? Why?
Trichomonas Vaginalis
Tx: metronidazole
*Avoid alcohol intake due to risk of disulfram-like reaction (flushing, n/v, hypotension)
Dx:
- -pruritus, burning, dysuria, dyspareunia
- -cottage-cheese like discharge
- -KOH prep shows branching hyphae and spores
Tx?
Candidiasis
Tx: azole therapy
- -miconazole (topical)
- -terconazole (topical)
- -oral fluconazole
1) painless, red, round, firm ulcer with raised edges; 1-3m later, maculopapular rash on skin and mucous membranes on palms and soles; painless inguinal adenopathy
2) painful vesicles that ulcerate; vesicles follow prodrome of vulvar burning and pruritus; Tzanck smear shows multinucleated giant cells
3) painful, demarcated, non-indurated ulcer in anogenital region
4) painful inflammation and enlargement of inguinal nodes
1) Syphilis
2) Genital herpes (HSV-2)
3) Chancroid
4) Lymphogranuloma Venereum
1) Screening tests for syphilis? (2)
2) Type of confirmation test for syphilis? (re: antibody)
1) VDRL, RPR
- -nontreponemal anticardiolipin antibodies
2) Specific treponemal antibody
- -eg, FTA-ABS, TPPA
- -can also use darkfield microscopy
Pelvic Inflammatory Disease
- -pelvic/adnexal pain, unilateral or bilateral
- -abnormal discharge, odor, bleeding
- -GI disturbances, urinary tract symptoms
Cultures: Chlamydia and N. gonorrhoeae often present, but infection is polymicrobial.
Tx?
- -broad spectrum category
- -tx for Chlamydia
Syndrome featuring PID with perihepatitis from ascending infection? S/s include RUQ pain, LFT elevations
PID
Tx: cephalosporin, doxycycline
Fitzhugh-Curtis Syndrome
–PID with perihepatitis from ascending infection? S/s include RUQ pain, LFT elevations
Low risk HPV strains? (2)
High risk HPV strains? (5)?
Begin pap smear at what age?
Repeat at what frequency in ages 21-29?
–cytology, HPV testing, or both?
Repeat at what frequency in ages 30-65?
–cytology, HPV testing, or both?
Low risk HPV strains: 6, 11
–condylomata accuminata
High risk HPV strains: 16, 18, 31, 33, 45
Begin pap smear at age 21
Ages 21-29: repeat every 3 years with cytology, but no HPV testing
Ages 30-65: repeat every 5 years with cytology and HPV testing
If pap smear reveals ASC-US, next step?
- in patient age 21-24
- in patient age 25+
Management of Pap smear showing ASC-US
Age 21-24
–repeat pap smear in 1 year
Age 25+
- -proceed to HPV testing
- -if (+), then colposcopy
- -if (-), then repeat pap and HPV test in 3 years
HPV vaccine recommended for what age group in females?
HPV vaccine recommended for what age group in males?
HPV Vaccine
- -females: age 9-26
- *not indicated in pregnant women
- -males: age 9-21
- *except in MSM: age 9-26
DDx:
- thin, off-white discharge; fishy odor; pH > 4.5; clue cells; amine odor with KOH
- thin, yellow-green, malodorous frothy discharge; pH > 4.5; motile pear-shaped organisms; vaginal inflammation with “strawberry cervix”
- thick, cottage-cheese discharge; pH: 3.8-4.2; pseudohyphae
- vulvar burning and pruritus precede vesicular rash; vesicles become painful ulcers; Tzanck smear shows multinucleated giant cells
- mucopurulent discharge; erythematous and friable cervix
- Bacterial Vaginosis
- -thin, off-white discharge; fishy odor; pH > 4.5; clue cells; amine odor with KOH - Trichomonas Vaginalis
- -thin, yellow-green, malodorous frothy discharge; pH > 4.5; motile pear-shaped organisms - Candida Vaginitis
- -thick, cottage-cheese discharge; pH: 3.8-4.2; pseudohyphae - Genital Herpes
- Chlamydia or Gonorrhea
- -need NAAT to distinguish
- *Vulvovaginitis
- -BV, Trichomonas, Candida
- *Cervicitis
- -Chlamydia, Gonorrhea
Tx:
- Bacterial Vaginosis
- Trichomoniasis
- Candida
- Chlamydia (2)
- Gonorrhea
- Genital Herpes (2)
Tx:
- Bacterial vaginosis
- -oral metronidazole - Trichomoniasis (tx partner too)
- -oral metronidazole - Candida
- -oral fluconazole - Chlamydia (tx partner too)
- -azithromycin (single dose)
- -OR doxycycline (7d course) - Gonorrhea
- -ceftriaxone
- -plus azithromycin or doxycycline! - Genital Herpes
- -acyclovir or valacyclovir
Management of Abnormal Pap Smear
- ASC-US, HPV(-)
- ASC-US, HPV(+)
- ASC-H (cannot exclude high-grade lesion)
- LSIL
- HSIL
- SCC
- AGC
Management of Abnormal Pap Smear in Adult Women
- ASC-US, HPV(-)
- -repeat Pap smear in 1 year - ASC-US, HPV(+)
- ASC-H
- LSIL
- HSIL
- -colposcopy, cervical biopsy - SCC
- -colposcopy, cervical biopsy
- -cold-knife conization - AGC
- -colposcopy, cervical biopsy
- -endometrial biopsy (if age 35+ or high risk for endometrial hyperplasia)
3 topical treatments for genital warts?
Genital Warts
-HPV 6, 11
Tx: trichloroacetic acid, podophyllin, 5-fluorouracil cream
HSV: natural history
–painful and itchy, vesicular, ulcerating lesions that resolve after 2-3 weeks
–vesicular and ulcerating lesions that resolve in 7-10 days
HSV
Primary Genital Infection
- -painful and itchy, vesicular, ulcerating lesions that resolve after 2-3 weeks
- -systemic symptoms
Recurrent Genital Infection
- -vesicular and ulcerating lesions that resolve in 7-10 days
- -less painful
