Gynecological Issues and Disorders Flashcards
Parasitic sexually transmitted disease; intracellular obligate which closely resembles a gram-negative bacterium
Chlamydia
Most common bacterial STI in the US between ages 14-24 years
Chlamydia
The most common cause of cervicitis and urethritis in adolescence
Chlamydia
Dysuria Intermenstrual spotting Postcoital bleeding Dyspareunia (painful intercourse) Vaginal discharge Lower abdominal/pelvic pain Rectal tenesmus
Signs and symptoms of chlamydia in females
Dysuria
Thick, cloudy, penile discharge
Testicular pain
Rectal tenesmus
Signs and symptoms of chlamydia in males
What is rectal tenesmus?
The feeling of being unable to empty the large bowel of stool
What is the management for chlamydia?
Azithromycin [Zithromax] 1 g orally in a single dose
Doxycycline [Vibramycin] 100 mg orally twice a day x 7 days
Azithromycin, Erythromycin, or Amoxicillin if pregnant
Bacterial STD caused by Neisseria gonorrhoeae (gram-negative diplococci) that can be cultured from genitourinary tract, oropharynx, conjunctiva, and/or anorectum
Gonorrhea
Most are asymptomatic Dysuria Urinary frequency Mucopurulent vaginal discharge Labial pain/swelling Lower abdominal pain Fever Dysmenorrhea Nausea/vomiting
Signs and symptoms of gonorrhea in females
What is the leading cause of infertility among females?
Gonorrhea
Most are asymptomatic Dysuria Frequency White/yellow-green penile discharge Testicular pain
Signs and symptoms of gonorrhea in males
What will diagnostics show for gonorrhea?
Gram-negative diplococci and white blood cells
Cervical culture for N. gonorrohoeae using Thayer-Martin or Transgrow media
What is the treatment for gonorrhea?
Ceftriaxone [Rocephin] 500 mg IM x 1 dose + Doxycycline 100 mg orally twice daily for 7 days for chlamydia
All contacts should be treated
REPORT TO HEALTH DEPARTMENT
How do you treat gonorrhea in pregnancy?
Ceftriaxone 500 mg in a single IM dose and azithromycin [Zithromax] 1 gram PO as a single dose
What illnesses must be reported to the state health department?
Gonorrhea, Syphillis, Chlamydia
Sexually transmitted disease involving multiple organ systems and caused by Treponema pallidum
Syphilis
Chancre present at the site of inoculation 2-6 weeks after exposure
Chancre indurated and painless
Regional lymphadenopathy
Primary stage of syphilis
Occurs 6-8 weeks later
Flu-like symptoms
Generalized lymphadenopathy
Generalized maculopapular rash (especially on palms and soles)
Secondary stage of syphilis
Seropositive, but asymptomatic
About 1/3 of untreated cases develop tertiary syphilis
Latent stage of syphilis?
Leukoplakia
Cardiac insufficiency–aortitis, aneurysms, aortic regurgitation
Infiltrative tumors of skin, bones, liver
CNS involvement–meningitis, hemiparesis, hemiplegia, others
Tertiary stage of syphilis
What are the diagnostic tests for syphilis?
Venereal Disease Research Laboratory (VDRL)
Rapid plasma reagin (RPR)
Confirmed with treponemal tests
What is the management of syphilis?
Benzathine penicillin G
What do you treat syphilis with a penicillin allergy?
Doxycycline
Erythromycin
Vaginal infection in which several species of bacteria interact to alter the vaginal flora
Bacterial vaginosis
What is the most prevalent vaginal infection in women of reproductive age?
Bacterial vaginosis
Increased milky discharge
May have pruritis
Malodorous “fishy” discharge most evident after sexual intercourse
Signs and symptoms of bacterial vaginosis
How do you treat bacterial vaginosis?
Metronidazole PO
Clindamycin PO
Intravaginal metronidazole or clindamycin
What do diagnostics show for bacterial vaginosis?
Wet shows clue cells (epithelial cells covered with bacteria appear stippled with poorly defined borders); decreased/absent lactobacilli; few or absent WBC
Positive amine “whiff’ test
Recurrent, viral sexually transmitted disease that is associated with painful lesions
Herpes
How is herpes transmitted?
Direct contact with active lesions or by virus-containing fluid (saliva, cervical secretions)
Fever, malaise, dysuria, painful/pruritic ulcers for 12 days
Initial herpes reaction
What are the signs and symptoms of recurrent herpes reaction?
Less painful/pruritic ulcers for 5 days
Recurrent herpes reaction
What are the diagnostics for herpes?
Papanicolaou or Tzanck stain
Viral culture is the most definitive
What is the treatment options with herpes?
Acyclovir [Zovirax] for topical, oral, IV routes
Valacyclovir is usually for asymptomatic viral shedding of HSV-2
Characterized by immunodeficiency as the result of infections by human immunodeficiency virus (HIV)
Acquired Immune Deficiency Syndrome (AIDS)
What is the primary postnatal vertical route for HIV transmission?
Breastfeeding
Low birth weight and the falling ratio of head circumference to height/weight Recurrent infections Diminishing activity Developmental delay Hepatosplenomegaly Generalized lymphadenopathy
Signs and symptoms of AIDS
In infants what diagnostic screening should be used for HIV?
HIV polymerase chain reactions (PCR)
In older children what diagnostic screening should be used for HIV?
Enzyme-linked immunosorbent assay (ELISA) screening
What is confirmatory testing for HIV?
Western blot test
What shows progression to AIDS?
Absolute CD4 lymphocyte count (normal > 800)
CD4 lymphocyte percentage of WBC (at risk when higher than <20%)
Viral load (should be < 5,000 copies or “zero/undetectable”
What is used for prevention against opportunistic infections in HIV/AIDS?
Bactrim for PJP prevention
Monitor for cytomegalovirus
What is the treatment for HIV/AIDS?
Usually started at diagnosis of HIV positivity irrespective of CD4 count
Drug resistance develops rapidly so stress importance of taking medication exactly as prescribed
