Infections Flashcards
When during the menstrual cycle would a PID typically develop?
Typically presents in week after cycle
Follicular phase
What is “Hydrosalpinx”?
Fallopian Tube damage
- distortion, dilatation, edema as a result of the immune reaction to infection
Chlamydia or Gonorrhea?
_____ invokes a strong immune/inflammatory response: Activation of complement and prostaglandin.
Chlamydia
Chlamydia or Gonorrhea?
_____ produces toxins that damage epithelial cells.
Gonorrhea
Chlamydia trachomatis is an intracellular organism that infects what type of cells?
Infects squamocolumnar and columnar epithelial cells
In females: Cervix (75-80%); Urethra (60-80)
In neonate: Conjunctiva
Characteristics of Gonorrhoeae?
• Gram negative diplococcus, in pairs
• Invades noncornified epithelial tissue; attaches to nonciliated cells
• Cervicitis; urethritis
– Anorectal; pharyngeal
• 50% of women may have no symptoms
• Usually more acute sxs– pain, discharge
Obstetric risks involved w/ PID?
Obstetric: Incr risk of premature delivery
- Premature rupture of membranes
Neonatal risks involved with PID?
Gonorrhea: blindness, sepsis
Chlamydia: eye infection, respiratory, pneumonia
PID - Diagnosis?
Physical Exam:
- Cervical motion tenderness
- Mucopurulent discharge;
- Diffuse lower abdominal tenderness/ tenderness on pelvic exam
(cervical culture/ urine for positive for gonorrhea/ chlamydia)
Laproscopy:
– Edematous tubes/ adnexa – purulent discharge
Perihepatic adhesions:
- Fitz Hugh Curtis syndrome = diagnostic of prior PID
– But most patients will NOT have symptoms –
When does the CDC recommend that women are screened for PID?
- Yearly screening of all females < 25 years
- or >25 if new partner or multiple partners
(Cervical culture or urine test)
PID - Age group w/ peak incidence?
Ethnicity w/ inc’d risk?
15-24 year olds
African-Americans have 2x rate of PID of whites
Cervicitis (mild PID) in a non-pregnant female positive for Chlamydia — Tx?
Azithromycin or Doxycycline x 7 days
also…
- Tetracyclines
- Erythromycin
Cervicitis (mild PID) in a pregnant female positive for Chlamydia - Tx?
Azithromycin or Erythromycin
**No doxycycline
Cervicitis (mild PID) in a pregnant female positive for Gonorrhoeae - Tx?
How about a non-pregnant female?
Ceftriaxone x1 IM
(Pregnant or Nonpregnant)
Alternative therapies:
- Gentamycin injection OR oral Gemifloxacin;
- AND azithromycin
PID Treatment in an acute infection?
Cefotetan or Cefoxitin PLUS Doxycycline
PID Treatment in an acute infection if the patient is allergic to Penicillin?
Clindamycin IV (8 hrs)
plus
Gentamycin
AEs of Doxycycline/Tetracycline during pregnancy?
- Accumulates in teeth and long bones. Permanent discoloration.
- Hepatic toxicity reported in pregnant women
What class of drugs are avoided during pregnancy due to concern in pediatric population for arthropathy and cartilage damage?
Quinolones
What is Chorioamnionitis? Ass’d complications?
Infection of amnion, usually intra-partum
May be associated w/:
- Preterm labor
- Rupture of membranes
- Prolonged labor
What Obstetrics-related infection has an increased risk with cesarean?
Endometritis
infection of endometrium/myometrium
_____ slows motility of smooth muscle of urinary tract, potentially leading to UTI/Pyelonephritis.
Progesterone
Routine screening as part of prenatal care?
- Hepatitis B
- Syphilis
- Rubella
- GC/CT (gonorrhoeae/chlamydia)
- Group B Strep (GBS)
Which of HSV’s can cause genital disease? Recurrent?
Both can cause genital disease & be recurrent
Describe “Primary” vs. “Non-primary” HSV infection.
Primary: Clinical infection – DNA culture of HSV-1 or HSV-2 virus in patient without Abs to HSV-1 or HSV-2.
Nonprimary: Genital infection with HSV-1 or HSV-2 with Abs to other HSV type.
Preferred mechanism of HSV diagnosis?
viral DNA culture from lesion or ulceration
positive is confirmatory; negative is not
T or F?
Transplacental passage of HSV-2 antibodies from mother to fetus offers fetus protection.
True
HSV - Morbidities?
- NO CURE
- Increased HIV transmission
- Recurrent genital ulceration
- Psychological impact
Pregnancy: Neonatal transmission & consequent disease
85% of HSV cases result from what form of transmission?
Vertical
even though 80% of cases have no Hx in mother
Where does the majority of neonatal HSV cases localize (location on infant’s body)?
Skin, eyes, & mouth
What is the Transmission risk @ time of delivery for a Primary HSV episode?
Non-primary HSV episode?
Primary = 30-60% risk
Non-primary = 33% risk
(recurrent HSV w/ Sx, no lesions = 0-2%;
less if no Sx)
When is a Cesarean delivery recommended in a pregnant woman w/ HSV?
Any pregnant women with active lesions or symptoms at time of labor
- It is NOT recommended for a history of HSV but no active lesions or symptoms
- It is NOT recommended for positive serology status of either HSV-2 or HSV-1
Tx for HSV+ pregnant mother undergoing vaginal delivery?
Acyclovir prophylaxis at 36 weeks (or Valacyclovir)
- Goal of decr viral load, shedding
- Decr outbreak potential / improve vaginal delivery
Is Cesarean section still beneficial if labor has started (i.e. membrane has ruptured)?
Yes
WHat is the leading cause of neonatal sepsis?
Group B Strep (GBS)
- Normal flora for up to 30% of women
- GI, GU colonization
- Intrapartum exposure, passage through vagina that is colonized with GBS.
GBS symptoms in a newborn?
Sepsis, Pneumonia, Meningitis
- Prior to current screening, newborn fatality rates as high as 50%
GBS infection in newborn - risk factors?
- Incr risk < 37 weeks
- Prolonged rupture of membranes ( 18+hrs)
- Chorioamnionitis
Obstetrics risk for mother w/ GBS?
Risk factor for:
- premature labor, premature rupture of membranes
- endometritis, chorionamnionitis
- Incr risk of genitourinary tract infections:
- Cystitis, pyelonephritis
Precautions taken for GBS during pregnancy - what are they & when do they occur?
Vaginal/Rectal Culture at 35-37 weeks
Positive: Antibiotic prophylaxis in labor
Negative: No treatment
If GBS status of a pregnant mother is unknown (no culture), what factors, if present, would merit treatment as if she was GBS positive?
- Gestational age < 37 weeks
- Intra-partum temperature > 100.4
- Membranes ruptured > 18 hours
