Gynecological and Pregnancy Infections Part 1 (Staudinger)

Question 1

A 42-year-old female presents to the clinic with a thin, off-white vaginal discharge. Vaginal pH is elevated. There is a positive Whiff test, and clue cells are seen on a saline mount. Which of the following is not a risk factor for her condition?

a. Diabetes Mellitus
b. Sexually Transmitted Infections
c. Douching
d. Cigarette smoking
e. Sexual Activity

Answer 1

A. Diabetes Mellitus; Pt has Bacterial Vaginosis; #1 cause of vaginal discharge in childbearing women; associated with increased sexual activity and sexually transmitted infection; NOT considered a sexually transmitted disease

Question 2

Amsel Criteria for Bacterial Vaginosis

Answer 2

Diagnosis for BV; 3 of the 4 have to present:
1. Homogenous, thin, grayish-white discharge
2. Vaginal pH >4.5
3. Positive Whiff test
4. Clue cells on saline wet mount

Question 3

Explain the shift in flora in bacterial vaginosis

Answer 3

Normal flora = lactobacilli (thrive in LOW pH)
Shift in flora to Coccobacilli (thrive in higher pH) created by increased sexual activity

Question 4

What is the most common organism that causes Bacterial vaginosis?

Answer 4

Garnerella vaginalis; conglomerate and create a variety of volatile, malodorous amines resulting in a “fishy” smell

Question 5

What are the three common drugs used to treat bacterial vaginosis?

Answer 5

1. Metronidazole
2. Tinidazole
3. Clindamycinn

Question 6

MOA of Metronidazole

Answer 6

treatment for BV (Gardnerella vaginalis) and Trichomoniasis (Trichomonas vaginalis); inhibits DNA synthesis by loss of helical DNA structure; inhibits protein synthesis by interacting with DNA; bactericidal

Question 7

MOA of Tinidazole

Answer 7

treatment for BV (Gardnerella vaginalis) and Trichomoniasis (Trichomonas vaginalis); inhibits DNA synthesis by loss of helical DNA structure; inhibits protein synthesis by interacting with DNA; bactericidal

Question 8

What are some undesirable side effects of Metronidazole and Tinidazole (Nitroimidazoles)?

Answer 8

Disulfuram-like reaction with alcohol: flushing, vomiting, and headaches

Question 9

Drugs in the Nitroimidazoles family

Answer 9

Metronidazole and Tinidazole; treatment for BV (Gardnerella vaginalis) and Trichomoniasis (Trichomonas vaginalis); inhibits DNA synthesis by loss of helical DNA structure

Question 10

Drug in the Lincosamide family used to treat Bacterial Vaginosis?

Answer 10

Clindamycin; is preferred in pregnant BV pt due to decreased risk of premature births; also used to tx Toxic Shock Syndrome and PID; not used to treat Trichomoniasis

Question 11

MOA of Clindamycin

Answer 11

inhibits protein synthesis by binding to bacterial 50S subunit; inhibits peptide chain elongation (transpeptidation)

Question 12

High yield adverse effect of clindamycin

Answer 12

Pseudomembranous colitis - C. diff is resistant to clindamycin and overgrowth leads to toxin release

Question 13

A 35-year-old female with Bacterial Vaginosis is allergic to metronidazole, so an alternate antibiotic is prescribed. What is the MOA for the most likely prescribed antibiotic?

Answer 13

Clindamycin; Binds to the 50S ribosomal subunit to inhibit peptide chain elongation

Question 14

A 30-year-old sexually active female presents with yellowish-green frothy vaginal discharge. Her exam shows punctate hemorrhages on her cervix. What finding on wet mount would confirm your suspicion for the most likely diagnosis?

a. Budding yeast
b. Pear-shaped, flagellated protozoa
c. White Blood Cells absent
d. Squamous epithelial cells covered with coccobacilli (clue cells)
e. Pseudohyphae

Answer 14

b. Pear-shaped, flagellated protozoa; Trichomoniasis caused by trichomonas vaginalis; single-celled parasite

Question 15

Trichomoniasis

Answer 15

most common non-viral sexually transmitted infection in females; can last for months to years; associated with other STI (HIV and HPV - lead to carcinoma); multiple sexual partners increases the risk; caused by trichomonas vaginalis

Question 16

What other sexually transmitted infections are associated with Trichomoniasis?

Answer 16

HIV and HPV - can lead to carcinoma

Question 17

Trichomonas vaginalis

Answer 17

causes Trichomoniasis; pear-shaped, flagellated protozoa; single celled parasite; reproduces by binary fission; humans are the ONLY natural host

Question 18

What are the two drugs used to treat Trichomoniasis?

Answer 18

1. Metronidazole
2. Tinidazole

***avoid Tinidazole in pregnancy
must treat ALL sexual partners
retest patient with PCR 2 weeks - 3 months after completing treatment

Question 19

A woman has a sexually transmitted infection, and the decision is made to treat her with antibiotics as an outpatient. She is warned that unpleasant reactions may occur if she consumes alcoholic beverages while taking this drug. The antibiotic can be identified as which of the following?

a. Ceftriaxone
b. Ofloxacillin
c. Penicillin
d. Metronidazole
e. Doxycycline

Answer 19

d. Metronidazole; Disulfuram-like reaction with alcohol: flushing, vomiting, and headaches

Question 20

A 54-year-old woman is complaining of vaginal itching with a thick white discharge. Her KOH wet mount shows pseudohyphae and budding yeast. She is prescribed an oral medication. What serious complication can occur when this medication is taken with certain other medications that interact with it?

Answer 20

Pt has Candidiasis (Candida albicans); treated with Fluconazole; inhibits conversion of lanosterol to ergosterol; watch for QT interval prolongation and torsades de points

Question 21

Fluconazole

Answer 21

oral drug used to treat Candidiasis caused by Candida albicans; MOA inhibits conversion of lanosterol to ergosterol; LOTS of drug interactions - watch for:

-fetal harm in pregnancy
-prolongation of QT interval (torsade de pointes)
-should NOT be used with erythromycin - cardiotoxicity leading to sudden cardiac death
-caution w patients with renal dysfunction