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OSD_Repro > Infections > Flashcards

Infections Flashcards

1
Q

When during the menstrual cycle would a PID typically develop?

A

Typically presents in week after cycle

Follicular phase

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2
Q

What is “Hydrosalpinx”?

A

Fallopian Tube damage

- distortion, dilatation, edema as a result of the immune reaction to infection

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3
Q

Chlamydia or Gonorrhea?

_____ invokes a strong immune/inflammatory response: Activation of complement and prostaglandin.

A

Chlamydia

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4
Q

Chlamydia or Gonorrhea?

_____ produces toxins that damage epithelial cells.

A

Gonorrhea

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5
Q

Chlamydia trachomatis is an intracellular organism that infects what type of cells?

A

Infects squamocolumnar and columnar epithelial cells

In females: Cervix (75-80%); Urethra (60-80)

In neonate: Conjunctiva

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6
Q

Characteristics of Gonorrhoeae?

A

• 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

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7
Q

Obstetric risks involved w/ PID?

A

Obstetric: Incr risk of premature delivery

- Premature rupture of membranes

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8
Q

Neonatal risks involved with PID?

A

Gonorrhea: blindness, sepsis

Chlamydia: eye infection, respiratory, pneumonia

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9
Q

PID - Diagnosis?

A

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 –

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10
Q

When does the CDC recommend that women are screened for PID?

A
  • Yearly screening of all females < 25 years
  • or >25 if new partner or multiple partners

(Cervical culture or urine test)

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11
Q

PID - Age group w/ peak incidence?

Ethnicity w/ inc’d risk?

A

15-24 year olds

African-Americans have 2x rate of PID of whites

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12
Q

Cervicitis (mild PID) in a non-pregnant female positive for Chlamydia — Tx?

A

Azithromycin or Doxycycline x 7 days

also…

  • Tetracyclines
  • Erythromycin
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13
Q

Cervicitis (mild PID) in a pregnant female positive for Chlamydia - Tx?

A

Azithromycin or Erythromycin

**No doxycycline

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14
Q

Cervicitis (mild PID) in a pregnant female positive for Gonorrhoeae - Tx?

How about a non-pregnant female?

A

Ceftriaxone x1 IM

(Pregnant or Nonpregnant)

Alternative therapies:

  • Gentamycin injection OR oral Gemifloxacin;
  • AND azithromycin
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15
Q

PID Treatment in an acute infection?

A

Cefotetan or Cefoxitin PLUS Doxycycline

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16
Q

PID Treatment in an acute infection if the patient is allergic to Penicillin?

A

Clindamycin IV (8 hrs)
plus
Gentamycin

17
Q

AEs of Doxycycline/Tetracycline during pregnancy?

A
  • Accumulates in teeth and long bones. Permanent discoloration.
  • Hepatic toxicity reported in pregnant women
18
Q

What class of drugs are avoided during pregnancy due to concern in pediatric population for arthropathy and cartilage damage?

A

Quinolones

19
Q

What is Chorioamnionitis? Ass’d complications?

A

Infection of amnion, usually intra-partum

May be associated w/:

  • Preterm labor
  • Rupture of membranes
  • Prolonged labor
20
Q

What Obstetrics-related infection has an increased risk with cesarean?

A

Endometritis

infection of endometrium/myometrium

21
Q

_____ slows motility of smooth muscle of urinary tract, potentially leading to UTI/Pyelonephritis.

A

Progesterone

22
Q

Routine screening as part of prenatal care?

A
  • Hepatitis B
  • Syphilis
  • Rubella
  • GC/CT (gonorrhoeae/chlamydia)
  • Group B Strep (GBS)
23
Q

Which of HSV’s can cause genital disease? Recurrent?

A

Both can cause genital disease & be recurrent

24
Q

Describe “Primary” vs. “Non-primary” HSV infection.

A

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.

25
Q

Preferred mechanism of HSV diagnosis?

A

viral DNA culture from lesion or ulceration

positive is confirmatory; negative is not

26
Q

T or F?

Transplacental passage of HSV-2 antibodies from mother to fetus offers fetus protection.

A

True

27
Q

HSV - Morbidities?

A
  • NO CURE
  • Increased HIV transmission
  • Recurrent genital ulceration
  • Psychological impact

Pregnancy: Neonatal transmission & consequent disease

28
Q

85% of HSV cases result from what form of transmission?

A

Vertical

even though 80% of cases have no Hx in mother

29
Q

Where does the majority of neonatal HSV cases localize (location on infant’s body)?

A

Skin, eyes, & mouth

30
Q

What is the Transmission risk @ time of delivery for a Primary HSV episode?
Non-primary HSV episode?

A

Primary = 30-60% risk

Non-primary = 33% risk

(recurrent HSV w/ Sx, no lesions = 0-2%;
less if no Sx)

31
Q

When is a Cesarean delivery recommended in a pregnant woman w/ HSV?

A

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
32
Q

Tx for HSV+ pregnant mother undergoing vaginal delivery?

A

Acyclovir prophylaxis at 36 weeks (or Valacyclovir)

  • Goal of decr viral load, shedding
  • Decr outbreak potential / improve vaginal delivery
33
Q

Is Cesarean section still beneficial if labor has started (i.e. membrane has ruptured)?

A

Yes

34
Q

WHat is the leading cause of neonatal sepsis?

A

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.
35
Q

GBS symptoms in a newborn?

A

Sepsis, Pneumonia, Meningitis

  • Prior to current screening, newborn fatality rates as high as 50%
36
Q

GBS infection in newborn - risk factors?

A
  • Incr risk < 37 weeks
  • Prolonged rupture of membranes ( 18+hrs)
  • Chorioamnionitis
37
Q

Obstetrics risk for mother w/ GBS?

A

Risk factor for:

  • premature labor, premature rupture of membranes
  • endometritis, chorionamnionitis
  • Incr risk of genitourinary tract infections:
    • Cystitis, pyelonephritis
38
Q

Precautions taken for GBS during pregnancy - what are they & when do they occur?

A

Vaginal/Rectal Culture at 35-37 weeks

Positive: Antibiotic prophylaxis in labor

Negative: No treatment

39
Q

If GBS status of a pregnant mother is unknown (no culture), what factors, if present, would merit treatment as if she was GBS positive?

A
  • Gestational age < 37 weeks
  • Intra-partum temperature > 100.4
  • Membranes ruptured > 18 hours

OSD_Repro (15 decks)

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