Gynecological and Pregnancy Related Infections Part 1 Flashcards
what is the differential diagnosis of vaginal discharge
pathologies that lead to vaginal discharge
Bacterial Vaginosis, Candida, Trichomoniasis, Gonorrhea, and Chlamydia
to help narrow the differential diagnosis of vaginal discharge we would utilize?
additional tests used
Wet mount, pH, PCR/NAAT and pregnancy teset
PCR is utilize to identify gonorrhea, trichmonasis and chlamydia, what kind of PCR for all 3 is used?
endocervical swab, vaginal swab or urine for gonorrhea and chlamydia
vaginal or first voided urine for trichomoniasis
dont forget to check a ____ test when evaluating gynecological complaints because our treatment might be altered
pregnancy
what is a clue cell
vaginal epithelial cells with bacteria obscuring its borders
what is a postassium hydroxide whiff test
when we swab the vaginal place the discharge on a slide and drop postassium hydroxide onto the discharge
what are the three common causes of vaginitis
bacterial vaginosis, candidiasis, trichmonasis
bacterial, fungal, parasitic
what are the signs of bacterial vaginosis
discharge, bacterial pH, whiff test, NaCL wet mount
homogenous think off white foul smelling discharge
pH >4.5
positive whiff test
clue cells with few RBCs
what is the criteria for diagonsis bacterial vaginosis
amsel criteria with 3/4 present
- discharge
- vaginal pH >4.5
- posititve whiff test
- clue cells on saline wet mount
what is the pathology of bacterial vaginosis
overgrowth of anerobic bateria which replaces normal bacterial flora
bacterial vaginosis is not a sexually transmitted disease BUT is associated with ?
2 things
increased sexual activity and concomittant secually transmitted diseases
what concomitant secually transmitted infections are associated with BV
HIV, gonorrhea, chlamydia, herpes, HPV
____ has a slight anti-estrogenic effect wich can predispose you to changes in the vaginal flora
smoking
normal vaginal flora consits of ______
bacteria
lactobacilli
lactobacilli are ____ anaerobic gram _____ bacilli that predominate in the vagina shortly after menses
aerotolerant
gram negative
lactobacilli create ____ and ____ which lowers the pH
hydrogen peroxide and lactic acid
pH of the vagina rises when there is contraceptive devices implanted, secual intercourse etc. and there is a shift in bacteria to ?
anerobic coccobacilli (clue cells, cover squamous cells)
what are the typical microorganisms that cause bacterial vaginosis?
anerobic and facultative anerobic coccobaccili like** gardnerlla vaginalis**, prevotella species, and atopbium vaginae
gardnerella vaginalis plays a pivotal role in creating a ____ that allows other bacteria to create a bacterial mass
biofilm
what causes the fishy smell in BV
the anerobes and facultative anerobes merge together to create volatile, malodorous amines
what are the choice of drugs to treat BV?
metronidazole, tinidazole, clindamycin
all in PO or vaginal cream formations
what is the MOA of nitroidazoles (metronidazole and tinidazole)
causes DNA damage by first being acitvated by nitroreductase and releasing free radicals that causes loss of DNA helical structure, strand breakage, and inhibits protein synthesis (DNA replication is lost)
mtronidazole and tinidazole causes cell death in susceptible organisms like
trichomonas
what are the side effects of nitroimidazoles
Disulfuram-like reaction with alcohol (flushing, vomiting, headache), CNS distubances, nausea/bloating/cramping
metabolism of nitroimidazoles is through?
glucuronidation
nitroimidazoles are eliminated how?
through the urine unchanged
does nitroimadizoles penetrate the CSF
yes, and abcessess too
clindamycin is a ________ that is used when there is a patient allergic to ____
lincosamide
allergic to penicillin
clindamycin covers?
what type of bacteria
gram positives and anaerobes
clindamycin is used to treat ____ and to decrease the risk of premature births in women with BV
toxic shock syndrome
**pelvic inflammatory disease too
MOA of clindamycin
binds to the 50s bacterial subunit to inhibit transpeptidation
transpeptidation is peptide chain elongation
adverse affect of clindamycin
C.diff which can lead to overgrowth and release of toxins
does clindamycin penetrate the csf?
no but does penetrate abcesses
what are the presentations of candidiasis
pH, discharge, NaCL wet mount, whiff test, KOH wet mount
ph<4.5
thick clumpy cottage cheese discharge
negative whiff test
KOH wet mount has psuedohyphae
no cervitis
erythema on vulva
to better assess candidia on wet mount we should use?
KOH (postassium hydroxide rather than NACL)
is candadiasis a sexually transmitted disease
no
Risk factor for vulvovaginal candidiasis ?
diabetes, high estrogen states, immunosuppresion, antibiotics (fluroquinolones)
in diabetes candidia can thrive in ____ glucose environments
higher
HIV and immunosuppresion both decrease ____ response to infection by candida
immune
pregnancy and post-menopausal estrogen therapy can increase the risk of candida due to ____ states
increased estrogen
antibiotics can cause candida because they ?
inhibit normal flora and favor the growth of candidia species
symptomatic infection with candida is only seen with?
invasion of the squamous cells (massive overgrowth)
________ is the most common cause of vulvovaginal infections
candida albicans (also could be candida glabrata due to fungal drugs being used to being target albicans)
over the counter azoles that treats candiasis
clotrimazole, miconazole, ticonazole
all vaginal suppositories
prescription vaginal suppositories for candidiasis
terconazole and butoconazole
oral prescription drug to treat candidiasis?
flucanazole
MOA of azoles (anti-fungal)
inhibit conversion of lanosterol to ergosterol by CYP450 system
cant form fungal cell wall, cell membrane disruption
bind to active site of 14a demethylase CYP450 enzyme
flucanazole side effects
azoles
potential for fetal harm/birth defects, prolong QT interval (torsades)
QT prolongation caused by other medicines may be amplified via the flucanazole-mediated inhibition of ?
cytochrome P450/(CYP3A4)
flucanazole given with erythromycin can cause?
cardiotoxicity, sudden heart death
flucanazole should be adminsitered with caution to patients with ____ dysfunction
renal dysnfunction
azole antifungals are ____ and ____ of the CYP3A4 family
inhbitors and substrates
increases the serum concentrations of numerous drugs and can lead to potentially serious and lethal drug-drug interactions
what is the primary route of excretion for flucanzole
azole (antifungal)
renal excretion
patients with liver or renal failure are at increased risk for drug drug interactions due to not being able to metabolize the drug
dyspurina
pain with sex
vaginitis tests
wet mount, pH
cervitis tests
PCR/NAAT
what are the presentations of trichmoniasis
discharge, cervix findings, pH, whiff test, NACL wet mount
green/yellow malodorous discharge
cervical petichiae (strawberry cervix)
pH>4.5
positive whiff test
NaCl wet mount with motle flagellated protazoa
trichomoniasis is the most common ________ sexually tranmitted disease
nonviral
trichomonasis is associated with other sexually transmitted diseases like ?
HIV and HPV
what increases the risk for trichomoniasis
multiple sexual partners
trichmonas vaginalis is a flagellated pear shaped ________
protazoan
no cyst formation so it does not survive outside the body
____ are the only natural hosts of trichomonas vaginalis
humans
T. vaginalis reproduces through
binary fission
asexual replication where the organism splits in half*** infect squamous epithelium
treatment of trichmoniasis
treat any sexual partners to present reinfection
metroidazole and tinidazole
use mitronidazole in pregnancy
you should retest patients with trichomoniasis when ?
2 weeks to 3 months after completing treatment
