Gynecologic Infections Part 1 Flashcards
26 yo female with 1 week vaginal discharge:
- sexuallly active monogamous
- fishy discharge
- thin and white discharge
- no irritation or itching
Cervix is normal with moderate thin white discharge on PE. What is the ddx? How to narrow?
Vaginitis, Wet Mount, pH:
- Bacterial Vaginosis
- Candida
- Trichomoniasis
Cervicitis, NAAT/PCR
- Gonorrhea
- Chlymadia
- also includes trichomoniasis
26 yo female with 1 week vaginal discharge:
- sexuallly active monogamous
- fishy discharge
- thin and white discharge
- no irritation or itching
DDx:
- Bacterial Vaginosis,Candida, Trichomoniasis, Gonorrhea, Chlamydia
What is indicated if KOH Whiff Test is positive (fishy smell) and pH is >4.5
Bacterial vaginosis
Bacterial Vaginosis symptoms, pH, KOH Whiff test results, NaCl wet mount results?
- odor and thin milky white fishy smelling discharge
- >4.5
- positive KOH whiff test
- Clue cells and no/few WBC’s
What is bacterial vaginosis associated with?
Increased sexual activity and STI’s
What is the #1 cause of vaginal discharge in childbearing women?
Bacterial vaginosis
What is considered normal vaginal flora?
Lactobacilli which trive in low pH environments and they create it
What organism is most common cause bacterial vaginosis?
- Gardnerella vaginalis
- creates biofilm allowing other species to adhere
What should bacterial vaginosis due to Gardnerella vaginalis be treated with?
- Metronidazole
- Tinidazole
- Clindamycin
all are available in cream or oral pills
MOA for Metronidazole and Tinidazole?
- Disrupts DNA synthesis
- causes formation of free radicals
- Bactericidal
Clindamycin MOA? What type of bacteria does this cover?
- Inihibits 50s ribosomal
- gram positive bacteria and most anaerobes are covered
Metronidazole and Tinidazole AE’s?
- Disulfiram like reaction with alcohol
- flushing
- vomiting
- headache
- CNS:
- seizures, ataxia, dizzy
- Nausea, anorexia, bloating
45 yo with female 3 days discharge, she is sexually active and recently finished abx for a UTI. She has thick white cottage cheese like discharge with vaginal irritation, itchiness, and inflammation.
- PE shows external genitalia and vaginal erythema/edema, thick white discharge, and cervix is w/o erythema
- DDx?
Vaginitis, Wet Mount, pH:
- Bacterial Vaginosis
- Candida
- Trichomoniasis
Cervicitis is not indicated
45 yo with female 3 days discharge, she is sexually active and recently finished abx for a UTI. She has thick white cottage cheese like discharge with vaginal irritation, itchiness, and inflammation.
- PE shows external genitalia and vaginal erythema/edema, thick white discharge, and cervix is w/o erythema
- KOH wet mount shows psuedohyphae and budding, pH is 4.0 (normal)
- What is the diagnosis?
Vaginal Candidiasis
Vaginal Candidiasis symptoms, pH, KOH whiff test, wet mount
- Itchy discomfort dysuria thick clumpy white “cottage cheese” discharge
- Inflammation and erythema noted
- ph usually less than 4.5
- negative KOH whiff test
- NaCl wet mount has few to many WBC’s
- Psuedohyphae ( spores if not candidia)
Risks to developing candidia?
- DM
- Immunosuppression
- genetic susceptibility
- Increased estrogen states
- Broad spectrum abx like fluoroquinolones,cephalosporins, azithromycin
What causes majority of fungal vulvovaginal infections
C. albicans
C. glabrata is most common cause of non albicans infection
WHat are the Azoles used for vulvovaginal candidiasis?
OTC: all topical
- Clotrimazole
- Miconazole
- Tioconazole
Rx:
- Terconazole (topical)
- Butoconazole (topical)
- Fluconazole (oral)
How do Azoles destroy fungi?
Inhibiting conversion of lanosterol to ergosterol by CYP450 enzyme
Fluconazole use during pregnancy?
Do not use, could cause serious and specific birth defects
Fluconazole warnings?
- Azoles are assoc. with QT prolongation possibly due to inhibition of CYP3A4
- Use of fluconazole and erythromycin increaes risk of cardiotoxicity and can cause s_udden cardiac death_
- Caution in patients with renal issues
What CYP do Azoles inhbit?
CYP3A4
26 yo female vaginal discharge 2 weeks. Sexually active 3 partners past year. Thin frothy green foul smelling discharge with va ginal irritation, dysuria, dyspareunia and bleeding after sex.
- PE: erythema vulva/vagina, punctate hemorrhage on cervix (strawberry)
- What is ddx?
- BV, candidia and trichomoniasis requiring a wet mount
- There are signs of cervicitis so testing for Gonorrhea and chlamydia with PCR
26 yo female vaginal discharge 2 weeks. Sexually active 3 partners past year. Thin frothy green foul smelling discharge with va ginal irritation, dysuria, dyspareunia and bleeding after sex.
- PE: erythema vulva/vagina, punctate hemorrhage on cervix (strawberry)
- Wet mount shows flagellated protozoa and mobile on microscope
- what is this?
- Trichomoniasis vaginitis
Trichomoniasis vaginitis sx?
- Itchy, frothy grey or yellow green malodorous discharge (70% asx)
- Cervical petechiae (strawberry cervix)
- pH >4.5
- KOH whiff usually positive
- NaCl wet mount shows motile flagellated protozoa with WBC’s
What is the most common non-viral STI?
Trichomoniasis
T. vaginalis features microscopically?
- Flagellated pear shaped protozoan
- no cysts only trophozoite and doesn’t survive well outside body
- Humans are only natural host
How do you treat Trichomoniasis?
- Metronidazole or Tinidazole
- both of these are oral
In a pregnant patient with Trichomoniasis, what treatement should be avoided?
Tinidazole
Trichomoniaisis management after treatement?
- Test that it is cured after 2 weeks to 3 months of completing treatment
- also make sure any partners have been treated
