Gynecology - Supurative Cervicitis, genital warts, Ulcerative genital infections

Question 1

What can cause cervicitis?

Answer 1

Gonorrheal infection
Chlamydial infection
Trichomoniasis

Question 2

Can you differentiate gonorrheal and clamydial infections on clinical examination?

Answer 2

No.

Both can present with:

• Vaginal discharge
• Erythema of cervix and surrounding tissue
• Dysuria
• Lower abdominal pain
• Both can be asymptomatic
• Both can cause congenital infection
• Both can cause pelvic inflammatory disease if left untreated.

Question 3

Symptoms of gonorrhea?

Answer 3

May present as vaginitis or cervicitis, profuse, odorless, white-yellow vaginal discharge

• May infect Bartholin and/or Skene’s glands
• May infect urethral epithelium
• May ascend reproductive tract -> PID.

Question 4

Diagnosing gonorrhea

Answer 4

NAAT of first-void urine, cervical or vaginal secretions

• Cultures should be optained if testing for rectal or pharyngeal involvement
• All patients tested for gonorrhea should be simultaneously testedfor other STDs, including chlamydia and trichomoniasis.

Question 5

Treating gonorrhea?

Answer 5

Ceftriaxone AND azithromycin

• Refer sex-partners or EPT
• Abstinence until pt and sexual partners are treated

Question 6

Complications of gonorrhea?

Answer 6

1. Disseminated gonococcal infection: joint/tendon pain; septic arthritis (knee is most common site; conjuctivitis
2. PID in females, acute epidydimitis in males
3. Congenital gonorrhea: bilateral conjuctivitis w/purulent discharge (ophtalmia neonatorum)

Question 7

Symptoms of chlamydia?

Answer 7

Endocervical, mucopurulent discharge; hyperemic, edematous endocervical tissue; dysuria

Question 8

Diagnosing Chlamydia:

Answer 8

NAAT of first-void urine,cervical or vaginal secretions:

• ELISA for endocervical specimens
• Cultures should be obtained if testing for rectal or pharygeal involvement
• All pts. tested for chlamydia should be simultaneously tested for other STDs including gonorrhea and trichomoniasis.

Question 9

Treating chlamydia?

Answer 9

Azitromycin

• refer sexual partners or ept
• abstinence until pt and sex partners are treated
• anorectal chlamydia: use doxycycline.

Question 10

Complications of chlamydia

Answer 10

1. Reactive arthritis (Reiter’s syndrome): dysuria, monoarthritis of large joints, conjuctivitis/uveitis
2. PID in females; acute epididymitis in males
3. Congenital chlamydia: bilateral conjuctvitis w/watery to purulent discharge 5-14 d after birth.

Question 11

Which warts does HPV-infection cause?

Answer 11

Condyloma acuminata

Question 12

Which warts does Poxvirus infection cause?

Answer 12

Molluscum contagiosum

Question 13

What is the most common sexually transmitted disease?

Answer 13

Condyloma Acuminatum (HPV)

Question 14

Which strands of HPV typically causes condyloma acuminatum?

Answer 14

Especially types 6, 11

Question 15

Which strands of HPV typically causes cervical cancer?

Answer 15

Especially types 16, 18

Question 16

Treating condyloma accuminatum?

Answer 16

Optional, lesions will usually spontaneously resolve. 
Surgical:
- Electrosurgical excision 
- Cryotherapy 
- Laser ablation 

Medical:

• Imiquimod
• Podofilox
• Trichloracetic acid

Question 17

Condyloma acuminata vs condyloma lata?

Answer 17

Condyloma acuminata - caused by HPV. Usually more verrucous/cauliflower like in appearance, though they may coalesce.

Condyloma lata - Manifestation of secondary syphilis. Usually occur on anogenital region skinfolds but may also occur elsewhere or be disseminated. Warts tend to be smooth, flat-topped, larger.
- Look for recent hx of primary chancre (past few mos.)
- May be accompaniedby other signs of secondary syphilis, i.e., constitutional sx (malaise, fever, H/A, nausea), lymphadenopathy.
Dx: RPR/VDRL
Tx: Benzathine Penicillin