Gynecological and Pregnancy Related Infections Part 2 Flashcards
what are the common presentations of cervicitis
mucopurulent discharge, bleeding between menses, dysuria, urethritis
what are the most common pathogens that cause cervicitis?
chalmydia, gonhorrea, trichomonas, mycoplasma genitalium
neisseria gonorrhea is a (blank) gram ____ diplococcous that grows on?
intracellular
gram negative
grows on thayer-martin chocolate agar
what is a chocolate agar?
an antibiotic infused heated blood agar that releases hemin and NAD
what are the virulence factors for neisseria gonorrhea and what do they do
pili which allows it to adhere to cells throughout the gynecolgic tract
igA1 protease and OPa proteins which allow it to avoid immune protection
chlamydia trachomatis is a tiny ________ intracellular bacteria that does not appear on ?
obligate (gram negative)
does not appear on gram stain
chlamydia has an extracellular infectious particle termed?
it has an active parasitic form termed?
elementary body
reticulate body
what does the reticulate body of chlamydia do?
steals ADP and ATP energy from host cell
mycoplasma genitalium does not have what?
it can cause cervicitis and what else?
cell wall (very small)
non-gonoccoal urethritis
how do we treat cervicitis?
empirically at first to cover gonorrhea and chlamydia
intramuscular cftriazone and oral azirthomycin
in case of azithromycin allery use doxycylin
ceftriaxone is?
a third generation cephalsporin that includes a beta lactams and inhibits cell wall synthesis
1st gen- gram +
2nd gen- gram - and more resistant to beta lactamases
ceftriazone is adminsitered how? it penetrates what?
IM and penetrates the CSF
side effects of ceftriaxone
acalulous cholestasis and bilirubin displacment
azithromycin is?
macrolide that inhibits 50s subunit of ribosomes
azithromycin can treat what?
bacteria lacking cell walls (chlamydia, mycoplasma)
cause cervitis
how do you take azithromycin?
PO/IV
side effects of azithromycin
GI upset, abdominal pain
doxycycline is?
30s ribosome inhibitor to inibit protein synthesis (category D) - tetracycline
avoid in pregnancy
adverse affects of doxycycline
chelator dont give with milk, antacid, ca+ or fe+
Pelvic inflammtory disease key features
fever, lower abdominal pain, pelvic pain, cervical motion tenderness (chandelier sign)
workup of PID
same for cervitis and ultrasound to evaluate uterus, ovaries, and fallopian tubes
wet mount, pH, PCR/NAAT
what are the most common causes of PID
neisseria gonorrhea and chlamydia
mycoplasma genitalium , BV
Pelvic inflammatory disease begins in the _ and spreads up through the _
vagina/vulva
spreads up through the genital tract
acute infection in the cervix/ uterus is termed
infection of the fallopian tubes with abundant neutrophils is termed
acute infection of the tubes and the ovaries is termed that also incoporated pus in the fallopian tubes is termed?
cervicitis
acute suppurative salpingitis
pyrosalpinx and tubo-ovarian abcess
a tubo-ovarian abcess is what? and presents with what?
presents with 3 things
it is a late stage complication of pelvic inflammatory disease that results in a cystic mass with multiple lobulares (filled with inflammation)
there is an adnexal mass, fever, leukocytosis, and abdominal pelvic pain
if pelvic inflammtory disease spreads to the peritoneal cavity beyond the ovary this can cause
inflammtinon around the liver capsule and diapragm cauing fitz-hugh curtis syndrome
fitz-hugh curtis syndrome presents with the sudden onset of?
abdominal pain, fever, nausea, and vomiting
other complications of PID
disseminated infection through bactermia
septic arthritis
infertility and ectopic pregnancy through scarring of the fallopian tube
neonatal conjunctivitis/blindness through vertical transmission from gonohrrea and chlamydia
neonatal blindness caused by gonorrhea and chlamydia presents like?
swelling of the eye, erythema, discharge
when would we treat PID inpatient
if there is severe illness like high fever, severe pain, nausea, vomiting, abcess, surgery is needed or pregnancy
outpatient medication for PID
if complicated?
ceftriazone and doxycylcine
if complicated consider adding metronidazole
inpatient medication for PID
if pregnant?
doxycycline + cefoxitin or cefotetan
if pregnant clindamycin and gentamicin
cefoxitin and cefotetan are _____
beta lactam cell wall synthesis inhibitors
2nd generation cephalosporins
cephalosporins have 2 main advantages over penicilins which are?
more resistant to beta lactamases but more sensittive to cephalosporinases
more chemical versatility because of an new R group
second generation cephalosporins like cefoxitin and cefotetan cover?
nesiseria gonorrhea
side effects of cefoxitin and cefotetan
gi disturbances, neurotoxicity, nephrotoxicity, hepatic enzyme abnormalities, hematologic problems
gentamicin is a _
amino-glycoside, category D drug that inhibits protein synthesis that inhibits the 30s subunit
category D- positive evidenece of human fetal risk (benefit may outweigh the risk)
anerobic bacteria are resistant to getamicin because transport of gentamicin into bacteria is?
oxygen dependent
side effects of gentamicin
as well as other aminoglycosides
ototoxicity (irreversible) (BB warning)
nephrotoxicity (BB warning)
complete neuromuscular blockade
complications are higher in people with impaired renal function
