Gynecologic Infections Flashcards
MCC od vaginal discharge
Bacterial Vaginosis (BV)
Pt has profuse grey/milky vaginal discharge w/ string fishy odor. you suspect?
bacterial vaginosis (BV)
What is included in the Amsel criteria to diagnose bacterial vaginosis (BV)
Homogeneous discharge
pH >4.5
+ “whiff” test
Clue cells on wet prep
Tx of Bacterial Vaginosis (BV)
Metronidazole- 500mg BID x 7 days
Metronodazole gel-5g intrvag QD x 5 days
Clindamycin cream- 5g intravag Q HS x 7 days
Tinidazole- 2g PO QD x 2days / 1g PO QD x 5 days
Clindamycin- 300mg PO BID x 7 days
Pt has Hx of recurrent BV & NO prior long term Tx
give PO Metronidazole or PO Tinidazole or vaginal Clindamycin x 2 weeks
Pt has Hx of recurrent BV w/Hx of prior long term Tx
same Tx x 2 wks;
add suppression–> 1x weekly metrogel or 2x weekly PO metro or Tinidazole x 6months
Pt presents w/ vaginal burning/itching, irritation, post-void dysuria, odorless thick white “cottage cheese” discharge
Vahinal Candidiasis (C. Albicans MC)
Diagnosis of vaginal candidiasis
Vulvovaginal erythema
pH < 4.5
budding yeast, pseudohyphae on KOH
Tx of single/isolated vaginal candidiasis infx
w/ “azole” or nystatin intravag 3-7 days;
single dose of PO Fluconazole
Risk factors of vaginal candidiasis
increased estrogen levels immunosuppression Environmental DM ABX use
Chonic vaginal candidiasis is associated w/?
decreased concentration in mannose binding lectin &
increased concentration of interleukin-4
definition of recurrent vulvovaginal candidiasis
> /= 4 episodes in 1 yr
recurrent vulvovaginal candidiasis evalutation
Revisit Pt Hx
speculum exam
NAAT & Wet Prep/KOH
fungal culture w/sensitivities
Tx for acute recurrent vulvovaginal candidiasis
local intravag therapy 7-14 days PO fluconazole (200mg) 1 pill q 72hrs x 3 doses --> days 1, 4, 7
Suppression Tx: PO Fluconazole 100-200mg weekly x 6 months
if non-albicans species is found on culture of recurrent vulvovaginal candidiasis Tx w/?
PO Fulconazole 150-200mg q 72 hrs x 3-4 dose (50% cure rate
Boric acid capsule intravag 600mg 1x QD for 2 weeks (60% cure rate)
Sx Tx of external irritation recurrent vulvovaginal candidiasis
Topical mid-potency steroids help
Pt presents w/ frothy green/yellowish discharge w/ “musty” odor dyspareunia and sometimes dysuria
Trichomoniasis
Diagnosis of Trichomoniasis
Frothy discharge Strawberry cervix pH > 4.5 Trichomonads on wet prep NAAT is GOLD STANDARD for Diagnosis
Tx of Trichomoniasis
Metronidazole 2g PO x 1 dose; or
500mg BID for 2 weeks (compliant Pts only)
Tinidazole 2g once
Tx BV if also co-infected
What is needed after Tx of Trichomoniasis if prolonged or recurrent infx @ 1month and 6 months
Tx of Cure
Most common STD infx
HSV
Pt presents w/ tingling / itching / burning /paresthesias w/ painful burning that later developed into grouped vesicles on genital area ?
HSV
Dx of HSV
Culture, PCR, Serum antibodies
W/ HSV what presents the greatest risk to fetus / neonate
initial infx; no antibodies to pass to fetus
What type of HSV when it is located on vulvovaginal area
HSV 2
Pt presents condylomata acuminatum on genital area you Dx ______; and _____ if doesn’t respond to Tx
Genital Warts (HPV); Biopsy
Tx of Genital Warts
Provider applied: Podophyllin, trichloroacetic acid (TCA), Bichloroacetic acid (BCA)
Pt applied: Podofilox or imiquimod (not during preg)
Surgical: tangential scissor excision, tangential shave excision, curettage, electrosurgery
Pt presents w/ isolated PAINLESS chancre hard smooth raised rounded borders found on cervix / vagina / vulva
Primary syphilis
Dx primary syphilis w/?
RPR or VDRL
confirm w/ FTA-ABS
Tx of primary syphilis
PCN 2.4 million units IM
Pt presents w/ maculopapular rash on palms / soles / mucous membranes, w/ fever malaise, lymphadenopathy, chondylomata lata
Secondary Syphilis
Tx of Secondary Syphilis
PCN 2.4 million units IM
Pt presents w/ fever malaise and HA 8 hours after Tx of primary / secondary Syphilis
Jarisch-Herxheimer Reaction
Tx of Late latent, tertiary, and cardiovascular syphilis
PCN 2.4 million units IM weekly x 3 doses
After Tx Pt should be _______ for serologic testing and clinical reeval; if Tx failure give _______
reeval @ 6month intervals;
PCN 2.4 million units IM weekly x 3 doses
Pt present w/ erythematous papule –> pustule –> w/in 48hrs ulceration red/glandular/soft;
edges irreg w/erythematous nonindurated, PAINFUL
Chancroid
Tx of Chancroid
Azithromycin 1g PO;
Ceftriaxone 250mg IM
Pt present w/ urethritis / cervicitis, on culture noted intracellular bacteria
Chlamydia trachomatis
Tx of Chlamydia
Azithromycin 1 g PO x 1 Doxy 100mg BID x 7 days Tx all sex partners test for other STI's Abstinence x 7 days on antibiotics No TOC needed rescreen in3-4 months
Primary Tx of Gonorrhea
Ceftriaxone 25mg IM + 1g Azithromycin PO
MC organisms cause PID
Chlamydia
gonorrhea
BV microflora (anaerobes)
Genital Mycoplasms (M. hominis, U. urealyticum, M. genitalium)
PID is
upper genital tract inflammation/infx
results most commonly from ascending lower tract infex; important due to sequelae
what are the sequelae of PID
infertility, ectopic pregnancy, chonic pelvic pain
Risk factor of PID
Douching single substance abuse multiple sex partners Low socioeconomic status recent new sex partner young other STI's sex partner w/ urethritis or gonorrhea previous Dx of PID
Diagnostic criteria of PID
Uterine/adnexal or CERVICAL MOTION TENDERNESS in sexually active / those w/ risks;
oral temp >101 F
Mucopurulent cervical discharge / friability
Elevated ESR / CRP
WBC in saline microscopy
Lab Dx of Chlamydia / gonorrhea
US/MRI/Laproscopic Most sensitive
Pt present w/ Lower ABD/pelvic pain / yellow vaginal discharge / heavy menstral flow/ fever chills / anorexia / N/V / Diarrhea / dysmenorrhea / Dyspareunia / UTI Sx that DEVELOPED DURING OR SOON AFTER MENSTRATION
PID
Inpatient Tx of PID
Cefoxitin IV or Cefotetan IV plus Doxy IV
Outpatient Tx of PIT
Ceftriaxone 250mg IM + Doxy 100mg BID x 2weeks
+/- metronidazole 500mg BID for 2 weeks if concomitant Trich infx or recent instrumentation
Pt noted to have tender inflamed adnexal mass, U/S noted 6 cm mass in Left adnexa
Tubo-ovarian Abscess (TOA)
Tx’d TOA w/ broad spectrum IV ABX, but there has been no response in 24-48 hours
need surgery
Triad of toxic shock syndrome
starts –> fever / malaise / diarrhea
diffuse macular rash –> red rash, not painful/itchy
orthostatic hypotension progressing to shock
Tx of Toxic shock syndrome
ABX while awaiting cultures
systemic support
Major criteria for Toxic Shock Syndrome
Hypotension Orthostatic syncopre SBP < 90 for adult diffuse macular erythroderma Temp >/=38.8C Late skin desquamation
