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Womens health > Infections > Flashcards

Infections Flashcards

1
Q

PID definition and causes

A

Spectrum of inflammatory disorders of the upper female genital tract including endometritis, salpingitis, Tubo-ovarian abscess & pelvic peritonitis.

Pathogens: chlamydia, gonorrhea, mycoplasma, normal flora (not always an STI)

infection is often poly microbial -> requires broad spectrum antibiotics

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2
Q

PID SX and EX

A 
pelvic pain 
fever, rigors, sweats
dyspareunia
AUB
D/C

Chronic: low grade fever, LOW, abdominal pain

peritonitis: tachy, hypotension, fever

Pelvic examination: adnexal tenderness, cervical motion tenderness

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3
Q

PID IX

A

FPU, BHCG

Endocervical swab or high vaginal swab for STIs

FBE/CRP/ESR, blood cultures

TVUS to exclude other causes of pain

Laparoscopy: best for diagnosis

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4
Q

MX of Mild PID

A

young, mild SX, !!hemodynamicaly stable!!, non ATSI, no CX

outpatient MX: IM Ceftriaxone stat + Doxycycline/Azithromycin PO + Metronidazole PO for 14d
monash EMQ: Azitho, doxy, metro

mild ->CDM or Monash DAM

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5
Q

MX of severe PID

A

Pregnant, hemodynamically unstable, septic, high fever (>38), tubo ovarian abscess suspect

in patient ABX with IV: ceftriaxone, azithromycin, metronidazole

IV CAM severe
oral DAM mild or IM ceftriaxone + oral D/A + oral M

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6
Q

PID other MX

A

educate, condom use, one partner, immunizations, notify to DHHS, screen and treat partners with 1 dose of Azithromycin, follow up with GP for test of cure

no sex for during and for 7 days after treatment ideal. if not possible, please use barrier protection.

Analgesia

abscess -> surgical workup
NBM/NGT, antiemetic, analgesia, surgical referral -> laparoscopy

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7
Q

PID CX

A

Tubo-ovarian abscess (TOA). If no improvement after ABX. Can present like appendicitis.

infertility and ectopic pregnancy due to adhesions

chronic pelvic pain: >6mo of pain due to permanent damage to reproductive tract.

Fitz-hugh-curtis syndrome: RUQ pain in the context of PID. due to peri-hepatitis (violin string perihepatic adhesions)

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8
Q

Genital Herpes

A

HSV2 (1 possible too),

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9
Q

Genital Herpes

A

HSV2 (1 possible too)

can acquire from asymptomatic or symptomatic. oral or genital sexual contact

SX: painful vesicular lesions (recurrent, painful, itchy)

IX: NAAT swab base of lesion or unroofed lesion + HSV serology
concurrent STI screen

MX:Do not need to confirm HSV with IX prior to starting IX
acyclovir -> valaciclovir

lignocaine gel, paracetamol/codeine for pain relief

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10
Q

Chlamydia Trachomatis SX

A

Asymptomatic

Men: urethritis, D/C, proctitis, dysuria
Women: cervicitis, D/C, PCB, proctitis

D/C is thick, foul smelling

oral SX: painless sores in mouth, tonsilitis, strep throat

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10
Q

Chlamydia Trachomatis IX

A

NAAT w endocervical swab ideally or self collected high vaginal swab

FPU if swabs cannot be taken

Oral, anoerectal swab if indicated based on sexual practices

Swab discharge where possible

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11
Q

Chlamydia trachomatis MX

A

Notify DHHS, contact trace 6mo

encourage to tell partner (let them know app)

Avoid sex during ABX and 7d after TX

encourage barrier protection

Uncomplicated or pharyngeal infection -> oral Doxycycline 100mg BD for 7days or oral Azithromycin 1g Stat (non compliance)
Pregnant -> doxy CI -> azithromycin 1g PO stat and test of cure in 4wk (pregnancy)

Repeat test in 3mo to exclude re infection (probably means contact tracing not done properly)

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11
Q

Neisseria Gonorrhoea SX

A

Asymptomatic
urethritis, cervicitis
D/C -> thicker and more purulent than C
Pharyngitis: sore throat, pharyngeal exudate, cervical lymphadenitis

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12
Q

N. Gonorrhea IX

A

NAAT with endocervical swab. if not possible self collected high vaginal swab
FBU if above not possible
anorectal/oral swab if appropriate

If gonorrhoea NAAT is positive then a cervical swab for gonorrhoea culture should be obtained antimicrobial susceptibility testing
Start on empirical ABX though: IM ceft + PO Azithromycin Stat

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13
Q

N. Gonorrhea MX

A

Uncomplicated genital or anorectal gonorrhoea: ceftriaxone IM stat + azithromycin oral stat (azithromycin to cover for chlamydia)

Pharyngeal Gonorrhea: Ceftriaxone IM and PO Azithromycin

Start ABX empirically. then also need return of sensitivities

For pharyngeal, anal or cervical infection, a test of cure by NAAT should be performed 2 weeks after Tx (test of cure in everyone in 2wk due to high ABX resistant). Then re test in 3mo for re infection

contact tracing: 2months
no sex during or 7days after

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14
Q

N. Gonorrhea CX

A

Conjunctival infection can occur in neonates born to infected mothers & in adults via exposure to infected genital secretions

Disseminated gonococcal infection, characterized by arthritis & skin lesions is rare

15
Q

Candidiasis (Candida albicans)

A

Proliferation of endogenous vaginal yeasts
Candidiasis does not occur in non-estrogenized vaginal environment i.e., prepubertal or post menopausal (not on estrogen Tx)

16
Q

Candidiasis SX

A

intense itching
Thick white curd like odourless D/C

excoriation, fissures, edema on examination

Chronic presentation (4 or more symptomatic episodes/year)

- Signs are cyclical, increasing pre-menses. Can present with vaginal dryness rather than D/C . 
- Sex aggravates signs -> burning, superficial dyspareunia, vulvar dysuria
17
Q

Candidiasis IX

A
  • Microscopy with pH evaluation on vaginal swab -> low PH + budding yeasts
18
Q

Candidiasis MX

A

Acute candida: clotrimazole/ niacin vaginal cream or pessary for 3-6 nights or single dose oral fluconazole (second line)
○ + topical 1% hydrocort if severe vulvitis
○ Warn pts all PV Tx can weaken latex condoms)
- Chronic/ recurrent: induction Tx followed by suppression w different doses of fluconazole & antifungal cream
NB fluconazole should not be taken during pregnancy

19
Q

Bacterial Vaginosis Cause

A

Polymicrobial syndrome characterized by profound change in vaginal microbiota from lactobacilli dominant state to high diversity & quantities of anaerobic bacilli including Gardnerella vaginalis.
Not an STI because it does not colonize the male reproductive tract. Thought to be an imbalance of the female reproductive system

20
Q

Bacterial Vaginosis RX

A

Copper IUD, increased vaginal PH, increased sex partners, ABX, decreased estrogen

21
Q

BV Sx

A

thin, white/grey, fishy malodourous discharge (Whiff Test)

Associated w increased risk of spontaneous abortion, premature labour, chorioamnionitis, post partum endometritis & PID

22
Q

BV IX

A

Amsel’s criteria
Vaginal swab -> DX with 3 of
-Clinician observed vaginal discharge, thin, white or grey often adherent homogenous appearance
-Vaginal pH > 4.5
-Clue cells on gram stain or wet preparation of high vaginal secretions (vaginal epithelial cells that have coccobacilli on their edges)
- Positive amine (whiff) test - if you can smell the malodor (fishy) on examination this is a positive test

23
Q

BV MX

A

Metronidazole 400mg PO BD for 7d
Refrain from sex or use condoms during Tx
no treatment for males
Avoid douching & intravaginal cleaning - associated w non-optimal vaginal microbiota

CX of untreated -> Miscarriage, chorioamnionitis, endometritis, PID, increased RX of STIs

BV in the first trimester can lead to late second trimester miscarriages & preterm labour w it associated Cx (oral clindamycin to reduce risk)

24
Q

Trichomoniasis SX

A

STI caused by protozoan parasite

must odour
pale green frothy D/C
Cervicitis: strawberry cervix due punctate hemorrhages)
tenderness, dysuria, dysparaunia, pruritis

25
Q

Trichomoniasis IX

A

Wet prep & micro of vaginal or urethral swab: Visualize motile flagellated organism

NAAT high vaginal, cervical swab

26
Q

Trichomoniasis MX

A

Metronidazole 400mg BD for 7d

TX partners too

27
Q

Molluscum Contagiosum

A

benign spontaneously resolving, painless infection lasting 3mo
kids lesions anywhere on body. aduts STI affecting genitals, pubic region, abdomen, thighs

poxvirus of skin. skin to skin contact

SX: lesion in cluster presenting as smooth surfaced firm shaped dome with central umbilication

IX: clinical

Resolves in 3mo, can use iquimod cream or cryotherapy

28
Q

STI screen

A

Asymptomatic MSM

  1. First pass urine: C and G
  2. Serology: HIV, syphilis, Hep B/C
  3. Rectal swab: C G
  4. Throat swab: C G

if symptomatic swab D/C

Asymptomatic women

  1. Endocervical swab (ideally)
  2. self collected high vaginal swab
  3. First pass urine same sensitivity as endocervical if pregnant
  4. Serology
  5. Rectal
  6. Oral swab as above

if symptomatic swab D/C

All tests at NAAT

29
Q

Syphilis Cause and SX

A

Spirochete Treponema Pallidum (G-ve)

Primary
- Painless, singular ulcer on genital => swab
Secondary
- Flu like illness, generalized macular papular rash
Tertiary
- years after untreated infection
- Gummatous (internal ulcers on organs)
- Neurosyphilis: vision, hearing loss, meingism

30
Q

Syphilis IX

A

Swab lesion NAAT first line IX!!
Serology

EIA/CMIA -> if positive -> syphilis serology
need trep and non trep for + diagnosis (values are positive for life

Treponemal test
- TPHA, TPPA

non Treponemal test

  • VDRL, RPR
  • values change with treatment
31
Q

syphilis MX

A

infectious 1,2, early latent-> IM benzathine penicillin G
non infectious -> 3 doses spaced weekly apart
- primary or secondary infectious
- tertiary non infectious
- secondary latent: no rash -> non infectious

Abstain from sex until d7 after both have received Tx

1o contact trace 3mo -> test of cure in 3mo
2o contact treat 6mo -> test of cure 6mo
3o IV Benzathine pen -> contact 12mo -> test of cure 12
Re-test in 6mo
Notify DHHS

32
Q

Jarisch-Herxheimer reaction

A

possible ADR to Tx, occurs 1-12h after injection.
Presents w malaise, pyrexia, headache, vasodilation tachycardia, leukocytosis
If have these symptoms present to hospital

33
Q

Sexual contacts of syphilis

A

Individuals who report sexual contact w a person w syphilis: single dose benzathine penicillin w/o waiting for serology results

34
Q

Syphilis in pregnancy

A

Vertical transmission from mother to fetus can occur during pregnancy
Screening at first pregnancy appt w treponema pallidum antibody (TPA) enzyme immunoassay
Congenital syphilis may result in premature birth, low birth weight, FDIU or neonatal death & severe infant morbidity

Early (primary): benzathine penicillin 1.8g IM single dose

Late (>2yrs) or indeterminate duration: benzathine penicillin 1.8g IM once per week for 3wks

35
Q

Asymptomatic STI is always?

A

Chlamydia -> treat with Azithromycin

Womens health (8 decks)

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