Gynecology Flashcards
What bacteria cause vaginal infections in prepubertal females?
Shigella
Strep pyogènes
In what populations is trichomonas found?
Infants
Sexually active people
What is the most common vaginal pathogen?
Candida albicans
What is the treatment for bacterial vaginosis?
Metronidazole
500 mg orally bid for 7 days
Metronidazole gel 0.75%
One full applicator vaginally daily for 5 days
Clindamycin 300 mg PO BID x 7: days
What is the treatment of vulvovaginal candidiasis?
Clotrimazole 1% cream
5 g intravaginally for 7–14 days
Clotrimazole 100-mg vaginal tablet
One vaginally daily for 7 days
Or 2 tablets vaginally for 3 days
Oral agent: fluconazole 150 mg
Once orally
What is the treatment of trichomoniasis?
Metronidazole
2 g orally as single dose
Tinidazole
2 g orally as single dose
How is trichomoniasis transmitted?
Vertically or by sexual contact
What is the presentation of trichomoniasis (postpubertal)?
pruritic, frothy, and yellowish discharge
“strawberry cervix” with multiple punctate areas of hemorrhage is pathognomonic
How is trichomoniasis found?
Antigen testing (NAAT)
What is the treatment of infant trichomoniasis?
PO metronidazole 15 mg/kg/day orally in two to three divided doses for 7 days
What are the characteristics of bacterial vaginosis?
(i) a homogeneous, white adherent vaginal discharge; (ii) vaginal pH above 4.5; (iii) a fishy, amine-like odor released when 10% potassium hydroxide solution is added to a sample of the discharge; and (iv) the presence of clue cells (Amsel criteria)
What are the bacteria that are overgrown in bacterial vaginosis?
Gardnerella vaginalis, Mobiluncus species, other anaerobes, and Mycoplasma hominis
What symptoms go AGAINST the diagnosis of bacterial vaginosis?
Dysuria
Pruritis
What are clue cells?
epithelial cells that are studded with large numbers of small bacteria giving them a granular appearance with shaggy borders
What are the most common causes of cervicitis?
Neisseria gonorrhoeae and Chlamydia trachomatis and potentially Mycoplasma genitalium
What are the symptoms of cervicitis
purulent vaginal discharge, intermenstrual bleeding, postcoital bleeding, and dyspareunia
Treatment of cervicitis
empiric therapy for gonorrhea and chlamydia while awaiting test results. This can be treated with ceftriaxone (250 mg intramuscularly or intravenously + azithromycin (1 g orally), or doxycycline (100 mg orally twice a day for 7 days)
What are the minimum diagnostic criteria for PID?
Sexually active patient with pelvic or lower abdominal pain, no cause other than PID identified, and one of the following:
Cervical motion tenderness or
Uterine tenderness or
Adnexal tenderness
What is perihepatitis Fitz-Hugh–Curtis syndrome
right upper quadrant pain and tenderness produced by inflammation of the liver capsule in association with PID
What is the treatment of PID?
- Mild
CTX 250mg IM + doxycycline 100mg PO BID X 14 days - Moderate-severe (abscess, systemically unwell, not responding to tx)
CTX 1-2g daily + doxycycline 100mg BID + metronidazole 500mg BID
OR
Cefoxitin + doxycycline
Treatment for primary HSV infection
Acyclovir 400 mg po tid for 7–10 days
OR
Acyclovir 200 mg po five times daily for 7–10 days
OR
Famciclovir 250 mg po tid for 7–10 days
OR
Valacyclovir 1 g po bid for 7–10 days
Treatment for suppression of HSV infection
Acyclovir 400 mg po bid
OR
Famciclovir 250 mg po bid
OR
Valacyclovir 500 mg po once a day
OR
Valacyclovir 1 g po once a day
Treatment of recurrent HSV infection
Acyclovir 400 mg po tid for 5 days
OR
Acyclovir 800 mg po bid for 5 days
OR
Acyclovir 800 mg po tid for 2 days
OR
Famciclovir 1,000 mg po bid for 1 day
OR
Valacyclovir 500 mg po bid for 3 days
OR
Valacyclovir 1 g po once daily for 5 days
How should OCP be prescribed for abnormal uterine bleeding?
On a taper from q6h to once daily
What are contraindications to estrogen therapies
migraine with aura, deep venous thromboembolism or pulmonary embolism, inherited prothrombotic disorders, systemic lupus erythematosus with positive or unknown antiphospholipid antibodies, hypertension (SBP >160 mm Hg or DBP >100 mm Hg), certain heart conditions (ischemic heart disease, complicated valvular heart disease, peripartum cardiomyopathy), certain liver conditions (hepatocellular adenoma, liver malignancy, severe cirrhosis), postpartum <21 days, stroke, current diagnosis of breast cancer, or history of complicated solid organ transplant
Treatment of lichen sclerosis
topical, high-potency corticosteroids (clobetasol 0.05% ointment) applied to the affected area twice daily for 2 weeks. Patients should be reexamined at 2 weeks to assess for response. Patients usually require 6 to 12 weeks of treatment with topical steroids until symptoms and visible findings have resolved.
What is the definition of oligomenorrhea?
an interval of more than 6 weeks between two menstrual periods.
What is the definition of infrequent menstrual bleeding
one to two episodes of menstrual bleeding in a 90-day period
What are the reportable STIs in canada?
Chlamydia
Gonorrhea
Syphilis
Risk factors for ectopic pregnancy
- Previous ectopic
- Tubal surgeries
- PID
- Tubal abnormalities
- Assisted reproduction
- IUD
Risk factors for PID
young age
large number of sexual partners
nonbarrier contraceptive methods
cigarette smoking
recent douching
bacterial vaginosis
previous gynecologic surgery
HIV infection
What are the serious potential complications of PID?
tuboovarian abscess
infertility
chronic pelvic pain
ectopic pregnancy
Specific/definitive criteria for PID
endometrial biopsy with evidence of endometritis
Laparoscopic abnormalities consistent with PID
Transvaginal US or MRI showing thickened, fluid-filled tubes or tuboovarian complex
Doppler studies showing tubal hyperemia
Which has higher risk of infertility in PID - chlamydia or gonorrhea?
chlamydia
Non STI bugs that can cause PID
anaerobes, Gardnerella vaginalis, Gram-negative rods, cytomegalovirus (CMV), M. genitalium
Ddx vaginal bleeding pre-pubertal
- trauma
- Foreign body
- Genital warts
- Vulvovaginitis
- Lichen sclerosis
- Shigella vaginitis* (but can also happen with GAS, gonorrhea and chlamydia vaginitis)
- Tumour – endodermal sinus tumor, rhabdomyosarcomas, sarcoma botryoides)
- Vascular anomalies/malformations – eg. Infantile hemangioma
- Urethral prolapse with irritation
What is a sarcoma botryoides?
presents as a polypoid, “grape-like” mass protruding from the introitus and often has metastasized to the lungs, pericardium, liver, kidney, and bones when initially diagnosed. Peak incidence is 2 years of age but this can present between 1 and 5 years old.
