Infection (Gynae): TSS, Trichomonas vaginalis Flashcards
What is TSS?
TSS is a toxin-mediated acute life-threatening illness, usually precipitated by infection with
· Staph aureus (producing Staph Enterotoxin B).
· Group A Strep (GAS), (Streptococcus pyogenes, producing TSST1).
What is the aetiology of TSS?
· Diabetes, alcoholism, varicella infection and surgical procedures increase risk.
· Staph aureus: tampon use -> Only occurs in those without serum Ab to staphylococcal toxin.
Severe GAS infections can cause Nec Fasciitis and gangrenous myositis.
What is the epidemiology of TSS?
5/100k per year.
What would you find in the history/ exam of TSS?
Hx: sore throat, fever, myalgia, D&V, headache, and nonfocal neurologic abnormalities. Enquire about active infections, and tampon use (peak incidence 5d after period onset)
O/E: High fever, rash, hypotension, multiorgan failure (involving at least 3 organ systems). Desquamation, typically of the palms and soles, 1-2 weeks after acute illness.
What Ix would you do for TSS?
Bloods: FBC and high WCC, Ck may be high. High creat, low glucose, high LFT. CULTURE (blood and/or tampon).
Urine: sterily pyuria, Hburia. Mburia.
High HR and low BP. Septic, Oliguric.
What is the management of TSS?
Early recognition and treatment.
Debriedment of wound, removal of tampon or foreign object.
Empirical IV abx (B lactams -> Clyndamycin most recommended) ,
Tight BP control and haemodynamic resusc. Tight glycaemic control. Fluid resuscitation (can require up to 10-15L/d)
What are the complications/ prognosis of TSS?
Hypovolaemic shock causing AKI and hypoxia of brain
Bacteraemia, DIC, ARDS, Electrolyte imbalance.
Mortality 5-15%.
What is Trichomonas Vaginalis?
Trichomoniasis is a sexually transmitted infection (STI) caused by the motile parasitic protozoan Trichomonas vaginalis.
What is the aetiology of Trichomonas Vaginalis?
Transmitted by sexual contact. RF : new or multiple martenrs, hx of STI, current STI, sex contact with infected partner, drugs/prostitution, no barrier use.
What is the epidemiology of Trichomonas Vaginalis?
One of the most common STIs.
What would you find in the history/ exam of Trichomonas Vaginalis?
Nonspecific symptoms. Mat be asymptomatic.
Frothyyellow-green PV discharge. Vulvar irritation. Cervicitis (Frailty and pain) and vaginitis (discharge, itching, irritation and odor). Dyspareunia.
O/E speculumL PV discharge, vulval/vaignal erythema, Strawberry cervix (diffues macular erythromatous lesions).
What Ix would you do for Trichomonas Vaginalis?
Micobiology: Wet mount microscopy testing (flagellated protozoa).
HVS, full STI screen (common coninfection).
What is the management of Trichomonas Vaginalis?
Abx: Oral metronidazole (Flagyl).
Abstain from sex until the end of treatment regime. Contact tracing and testing/tx partner.
What are the complications/ prognosis of Trichomonas Vaginalis?
Strong association with other Sti presence. PID, infertility, high HIV transmission due ton inflammation, Pregnancy: PTL, PPROM.
95% cure rate with oral metronidazole.
