Gynecologic Infections Part 2 Flashcards
Symptoms of cervicitis?
- purulent/mucopurulent discharge
- Intermenstrual or post sex bleeding
- +/- dysuria
- dyspareunia, vulvovaginal irritiation
Possible pathogens for cervicitis?
- Chlamydia and Gonorrhea are most common
- Trichomonas
- Mycoplasma genitalium
- HSV
N. gonorrhea describe the micro, growth, and virulence factors.
- Facultative anaerobic intracellar gram - diplococcus
- Grows on thayer martin chocolate agar
- Pili for adherence, IgA1 protease, Opa proteins
C. trachomatis micro?
- Gram - tiny obligate intracellular bacteria
- Often doesn’t appear on gram stain because it is so small, so PCR is usually for diagnosis of chlamydia
Mycoplasm genitalium micro?
- bacteria without cell walls
- mycoplasma bacteria are smallest free living bacteria
- cause of non gonoccal urethritis
How do you treat gonorrhea and chlamydia?
- IM Ceftriaxone and oral Azithromycin
- if allergic to azithromycin use doxycycline
What family of abx do the following fall under:
- ceftriaxone
- azithromycin
- doxycycline
- Ceftriaxone: 3rd gen cephalosporin
- Azithromycin: macrolide
- Doxycycline: tetracycline
How does Ceftriaxone work?
Inhibits cell wall synthesis
Azithromycin MOA and AE’s? What type of bacteria is it used on?
- 50s ribosome inhibitor
- GI upset and abd. pain
- Bacteria lacking cell walls such as mycoplasma, legionella and chlamydia and some anaerobes
Ceftriaxone (IM) pharmacokinetics and AE’s?
- IM penetrates CSF
- assoc. with acalculous cholestasis and bilirubin displacement from albumin
- use caution with neonates and avoid in jaundiced ones
How does Doxycycline work, pregnancy use?
- 30s ribiosome inhibitor
- Teratogenic
Chandelier sign?
Cervical motion tenderness
Key features of PID? Initial work up?
- fever
- lower abdominal or pelvic pain
- significant cervical motion tenderness
- Same workup as cervicitis but +/- pelvic US
Most common cause of PID?
N. gonorrhea and C.trachomatis
Where does PID begin and spread to?
- begins in vulva or vagina and spreas up through genital tract
What is considered a late stage of PID and how does it present?
- Tubo-ovarian abscess
- presents with adnexal mass, fever, increased WBC’s, abdominal pelvic pain
Waht is Fitz-Hugh CUrtis syndrome?
- Peritoneal inflammation/perihepatitis with sudden onset of sevefre abdominal pain, +/- fever, N/V
- can occur when tubo-ovarian abscess infection from PID spreads beyond ovary
What are the long term effects of PID?
Infertility, ectopic pregnancy
What are the complications in infants from gonorrhea and chlamydia?
- Both cause conjunctivitis via vertical transmission, this can lead to blindness
- presents with swelling of eye surface membranes erythema and discharge
In a patient with PID what would necessitate an inpatient treatment?
- high fever and severe pain with N/V
- complications such as pelvic or tubo-ovarian abscess
- Need for surgery
- Pregnancy
Outpatient PID treatment?
- Ceftriaxone and Doxycycline
- if complicated (abscess or recent gynecologic instrumentation) consider adding metronidazole
Inpatient PID treatment?
- Doxycycline plus Cefoxitin or Cefotetan
Inpatient PID treatment in a pregnant patient?
- Clindamycin and Gentamicin
Cefoxitin and Cefotetan MOA and class?
- 2nd gen Cephalosporins, Beta lactams
- Inhibit cell wall synthesis
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What are 2 main advantages of Cefoxitin and Cefotetan to penicillins?
- More resistant to beta lactamases
- New R group adds chemcial versatility for future dev of new abx
AE’s of Cefoxitin and Cefotetan (2nd Gen Cephaosporins)
- GI issues
- Neurotoxicity
- Nephrotoxicity
- Hepatic enzyme abnormalities
- Hematologic issues
Spectrum for 2nd gen cephalosporins?
- less activity for Gram + compared to first gens
- Covers Neisseria gonorrhea
Gentamycin MOA and class?
- Inhibtis 30s subunit
- Aminoglycoside
What bacterira are resistant to Gentamicin and why?
- Anaerobic bacteria are resistant bc transport of gentamicin into bacteria is oxygen dependent
Pharmacokineteics of Gentamicin
Ecreted unchanged in keidney so reduce dose if patient has renal impairments
AE Gentamicin?
- Nephrotoxicity
- Ototoxicity (usu. irreversible)
- Complete neuromuscular blockade (BBW) very rare
