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OB/GYN > Infection and Pelvic Pain > Flashcards

Infection and Pelvic Pain Flashcards

1
Q

Inflammation/Irritation of the Vagina

S/s, Dx, Tx

A

vaginitis / vaginosis

  • S/s
    • copious, maodorous, or irritating discharge
  • Dx
    • wet mount prep to analyze vaginal secretions
  • Tx
    • maintain protective acidic environment
    • relieve symptoms (usually pruritis)
    • antimicrobial/antifungal meds
    • probiotic supplements
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2
Q
  • sexually associate (not always STI)
  • Gardnerella vaginalis or other anaerobe
  • grey vaginal discharge, fishy odor

S/s, Dx, Tx

A

Bacterial Vaginosis (BV)

  • Dx
    • clue cells on wet mount (vaginal epithelial cells covered w/ bacteria)
  • Tx**
    • Metronidazole (Flagyl) 500mg PO bid 7d
    • Tx of partners NOT necessary
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3
Q
  • copious, frothy, malodorous, yellow/gray-green discharge**
  • internal pruritis**

S/s, Dx, Tx

A

Trichomoniasis (Trichomonas vaginalis)

anaerobic, unicellular flagellated protozoan that adheres to urethra, vagina, skene/bartholin glands

  • Dx
    • strawberry cervix**
  • Tx
    • Metronidazole (Flagyl) or Tinidazole
    • MUST tx partners
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4
Q

BV vs. Trich

A
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5
Q
  • vulvar/vaginal pruritis, burning, dysuria, dyspareunia, vaginal discharge
  • scant vaginal discharge (20% thick, curdy)

S/s, Dx, Tx

A

Candidiasis (Candida albicans)

  • Dx**
    • antibiotics, diabetes, immuno
    • 10% KOH prep of vag. discharge
      • branching hyphae and spores
    • culture on sabouraud’s agar if negative
  • Tx**
    • Fluconazole (Diflucan) 150mg PO 1 dose
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6
Q
  • inflammation of cervix
  • yellow-green mucopurulent discharge from cervix
  • chandelier sign

Cause

A

cervicitis / mucopurulent cervicitis (MPC)

  • typically STI - gonorrhea/chlamydia MC
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7
Q
  • inflammation of external genetalia
  • soaps, detergents, lotions, shaving, pads, tight clothing
  • vaginal infections spread to labia

Treatment

A

vulvodynia

(vulvitis, vestibulitis, vulvovestibulitis)

  • Tx
    • avoid irritants, wear loose clothing
    • behavioral tx
    • topical xylocaine
    • topical or systemic antidressants
    • botox of affected nerve
    • vestibulectomy
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8
Q
  • reddened/painful cyst +/- puss at vaginal opening to ducts

Treatment

A

Bartholinitis or Bartholin Cyst

(bartholin or greater vestibular glands)

  • Tx
    • broad-spetrum antibiotics
    • drain cyst w/ hot soaks, needle aspiration, catheter, or marsupialization of gland
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9
Q

STI definition

A

Sexually Transmitted Infection

  • spread by intimate/sexual contact
  • includes hepatitis and TB
  • prevalent in ALL socioeconomic, racial, ethnic groups
  • adolescents at greatest risk of exposure/infection
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10
Q

Gonorrhea

Cause, S/s, Dx, Complications, Tx

A

Bacterial: Neisseria gonorrhoeae

  • S/s
    • endocervical canal MC site
    • asymptomatic
    • dysuria, vag. discharge, dysmenorrhea, lower abdominal/pelvic pain
    • fever, mucopurulent discharge from OS
  • Dx
    • gram stain microscopy
    • N. gonorrhoeae cultured (mainstay)
    • NAAT is new norm
  • Complications
    • PID, sterility, disseminated infection (joints- polyarthralgia)
    • pass from mother to fetus/infant
  • Tx**
    • Ceftriaxone (Recephin) 250mg IM

AND

  • Azithromycin 1g orally (chlamydia coverage)
  • MUST tx partners
  • no sex until infection resolved
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11
Q

Syphilis

Cause, S/s, Dx, Complications, Tx

REPORTABLE

A

Bacterial: Treponema pallidum

(corkscrew spirochete, anaerobic bacteria)

screen in pregnancy: TORCH

  • S/s- Stages
    • Primary (local manifestations)
      • granulomatous rxn: hard, painless chancre w/ yellowish discharge
      • firm, large, nontender regional lymph nodes
    • Secondary (systemic)
      • 6w after chancre appears
      • low fever, malaise, sore throat
      • anorexia, gen. adenopathy, HA, joint pain, skin/mucous membrane rash
      • condylomata lata
    • Latent
      • 1y - lifetime, asymptomatic but medical evidence
    • Tertiary
      • most severe, after latent
      • gummus formation: destructive skin, bone, soft-tissue lesions
      • neurosyphilis- reversible dementia
  • Dx
    • Darkfield microscopy and serologic tests
      • VRDL antigen and RPR tests
      • FTA-ABS if RPR postitive
  • Tx
    • Benzathine Pen G parenteral injection
    • MUST tx partners
    • condoms until tx verified
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12
Q

Chancroid

Cause, S/s, Dx, Complications, Tx

A

Bacterial: Haemophilus ducreyi (G- bacillus)

  • S/s
    • painful, tender, soft chancre
    • women: asymptomatic, dysuria, dyspareunia, vag. discharge, painful defecation, rectal bleeding
  • Tx
    • 3rd gen cephalosporin
    • MUST tx partners
    • condom use
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13
Q

Granuloma inguinale (donovanosis)

Cause, S/s, Dx, Complications, Tx

A

Bacterial: Klebsiella granulomatis

(G-, non-spore forming, encapsulated bacteria)

  • S/s
    • commonly concurrent w/ syphilis
    • rare in US
    • painful nodule w/ itching, ulcers on labia
  • Dx
    • donovan bodies- bacteria filled vacuoles within white cells of ulcer smear
  • Tx
    • Abx for at least 3 weeks
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14
Q

Chlamydia

Cause, S/s, Dx, Complications, Tx

A

Bacteria: Chlamydia trachomatis

MC STI in U.S.**

  • S/s
    • can be asymptomatic
    • acute urethral syndrome (dysuria, frequency, sterile pus in urine)
    • mimics UTI
  • Dx
    • NAATs of genital swab recommended
  • Complication
    • leading cause of tubal infertility
    • C. trachomatis MCC cervicitis
    • infects:
      • cervix, urethra, rectum, conjuntiva***
  • Tx
    • Azithromycin 1 dose
    • MUST tx all sexual contacts
    • abstinence/condoms during tx + 7 days
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15
Q

Lymphogranuloma venereum

Cause, S/s, Dx, Complications, Tx

A

Chlamydial Infection

  • S/s
    • skin lesion spreading to lymphatic tissue
    • inflammation, necrosis, abscesses
    • buboes- pus draining lymph node
    • 1’: cervix, vaginal wall, labia
    • 2’: large buboes that rupture and drain
  • Tx
    • Doxycycline or Erythromycin PO 21d
    • MUST tx partners
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16
Q

Nongonococcal / Nonspecific Urethritis

Cause, S/s, Dx, Complications, Tx

(Nonreportable STI)

A

Chlamydial infection MCC

  • S/s
    • asymptomatic
    • dysuria w/ mild to moderate white or clear urethral discharge
  • Tx
    • Azithromycin 1 dose or Doxycycline 7d
17
Q

Genital Herpes

S/s, Dx, Tx

(non-reportable disease)

A

HSV Type 1 and HSV Type 2

(Type 2 is 80% of initial and 98% or recurrent)

  • S/s
    • vesicles that progress to ulceration w/ pain, lymphadenopathy, fever
    • persists in latent stages
    • recurrent infections milder
  • Dx
    • serum PCR test
  • Tx
    • no cure- symptom management
    • Acyclovir
18
Q

Human Papillomavirus (HPV)

S/s, Dx, Tx

A

Viral STD

  • S/s
    • condylomata acuminata (genital warts) - soft, skin-colored, whitish pink-to-reddish brown benign cauliflower painless growths
  • Dx
    • Papanicolaou test (Pap smear)
  • Tx
    • patient applied
      • Podofilox, Imiquimod, Sinecathechin
    • provider applied
      • cryotherapy, Podophyllin resin, Trichloroacetic acid (TCA), Bichloroacetic acid (BCA), surgery
    • vaginal/urethral/anal warts
      • TCA, BCA, cryotherapy, surgery
19
Q

Molluscum Contagiosum

S/s, Dx, Tx

A
  • S/s
    • benign viral infection of skin of face, hands, lower abdomen, genitalia
    • taken into epithelial cells by phagocytosis
  • Dx - clinical
  • Tx
    • spontaneous healing after months - but contageous until then
    • curettage, liquid nitrogen (cryotherapy), silver nitrate, topical creams
    • lifetime immunity once lesions heal
20
Q

Human Immunodeficiency Virus (HIV)

Approach During Pregnancy

A

retrovirus that infects CD4 (helper) T cells - destroys T and B cell function

  • perinatal transmission around L&D MCC of HIV infection in children
  • HAART: highly active antiretroviral therapy
    • initiated if viral load > 1,000 copies/mL
    • undetectable load is the goal
  • C-section and NO breastfeeding
  • screen all pregnant patients w/ consent
21
Q

Pediculosis Pubis

S/s, Dx, Tx

A

Parasite - Phthirus pubis (the crab louse)

  • S/s
    • mild to severe itching
    • allergic sensations
    • 2’ infections from scratching
  • Dx - clinical
  • Tx
    • creme rinse
    • shampoo
    • lotion
    • tx of clothes and bedding
22
Q

Pelvic Inflammatory Disease (PID)

S/s, Complications, Tx

A

accute inflammation caused by infection -

possibly migrated STI (untreated C/G MCC)

  • S/s
    • sudden, severe ab pain w/ fever or no sx
    • cervical motion, uterine, adnexial tenderness
    • salpingitis- inflammation of fallopian tubes
    • oophoritis- inflammation of ovaries
  • Complications
    • infertility, ectopic pregancies
  • Tx
    • Admit if failed PO, questionable compliance, severe systemic illness, tubo-ovarian abscess (TOA)
      • IV Cefotetan or Cefoxitin + Doxy
      • IV Clindamycin + Gentamycin
      • 25% require drainage
    • MUST tx partners
23
Q

Urinary Tract Infection (UTI)

Classifications, Pathogens, Protective

A

inflammation of urinary epithelium after colonization

  • Classification
    • complicated vs. uncomplicated
    • cycstitis- bladder inflammation
    • pyeloneprhitis- upper urinary tract
  • MC pathogens
    • E. coli, Staph. saprophyticus
    • virulence: evade/overwhelm defense, adherance to uroepithelium (pili, fimbriae), resist defense (biofilms)
  • Protective mechanisms
    • washed out during micturition
    • low pH, high osmolality of urea
    • Tamm-Horsfall proteins
    • uroepithelium secretions
    • ureterovesical junction
    • women: mucus-secreting glands
24
Q

Acute Pyelonephritis

S/s, Dx, Tx

A

infection of ureter, renal pelvis and/or parenchyma

  • S/s
    • flank pain
    • fever, chills
    • CVA tenderness
    • purulent urine
  • Dx
    • WBC casts
  • Tx
    • antibiotics
25
Q

Cystitis

S/s, Dx, Tx

A

acute/chronic inflammation of bladder

  • S/s
    • asymptomatic
    • frequency, dysuria, urgency, low back/suprapubic pain
  • Dx
    • urine culture of specific organisms 10K+
  • Tx
    • antimicrobial therapy
26
Q

Painful Bladder Syndrome (aka Interstitial Cystitis)

3 Causes, S/s, Dx, Tx

A

non-bacterial infectious, noninfectious cystitis (radiation, chemical)

interstitial cystitis (autoimmune, hypersensitivity)

  • S/s and Dx
    • sx of cystitis for 6+ weeks w/ negative urine culture and no other know cause
  • Tx
    • oral and intravesical therapies
    • sacral nerve stimulation
    • Onabotulinum toxin A
    • surgery
27
Q

Chorioamnionitis

Risk factors, S/s, Dx, Tx

A

intraamniotic infection syndrome - vaginal microorganisms ascend into uterine cavity after rupture of membranes

  • Risks
    • prolonged labor, rupture of membranes, mult. vaginal exams, young, low socioeconomics, nulliparity, BV
  • S/s and Dx
    • fever +2 other
      • maternal/fetal tachycardia
      • maternal leukocytosis
      • uterine tenderness
      • foul-smelling amniotic fluid (rare)
      • ruptured membranes
  • Tx
    • Ampicillin + Gentamicin intrapartum
    • delivery of fetus
28
Q

Postpartum Endometriosis

Risk factors, S/s, Dx, Tx

A

Endomyometriosis

  • Risks
    • prolonged labor, rupture of membranes, BV, frequent vaginal exams, internal fetal monitoring, polymicrobial infection, chlamydia trachomatis late form
  • S/s and Dx
    • 1st or 2nd post partum day fever
    • lower abdominal pain
    • uterine tenderness
    • leukocytosis
    • delayed bowel function
  • Tx
    • Clindamycin + Gentamicin until fever/WBC count resolve
    • if fever persists- consider wound or pelvic abscess
29
Q

Chronic Pelvic Pain

(2 types)

A
  1. Cyclic - dysmenorrhea
  2. Non-cyclic
    • LEAPING
      • Leiomyoma
      • Endometriosis (MC >30) / Endometritis
      • Adhesions/Adenomyosis
      • PID (MC <30)
      • Infections
      • Neoplasm
      • Gastrointestinal
    • also: psych, MSK, fibromyalgia, UTI, Mittelschmerz
30
Q

Chronic Pelvic Pain

(workup)

A
  • detailed history (including prior surgeries)
  • PE
  • labs
  • imaging (laproscopic is conclusive)
  • referrals
31
Q

Chronic Pelvic Pain

(treatment)

A
  • multidisciplinary
    • ovulation or menstrual suppression
    • NSAIDs
    • surgery not effective w/out abnormal pathology
    • injections
32
Q

Chronic Pelvic Pain

(clinical pearls)

A
  • accounts for 12% hysterectomies, 20% laparoscopies, 40% repeat office visits
  • PID is MCC in women < 30
  • endometriosis MCC in women > 30
  • laparoscopy is GOLD standard for dx
    • ONLY done after psychogenic and GI evaluated

OB/GYN (7 decks)

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