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GYN > INFECTIONS > Flashcards

INFECTIONS Flashcards

1
Q

UTI pathogens

A 
E coli 80-85%
Staph saprophyticus
Proteus mirabilis
Klebsiella pneumoniae
Enterococcus
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2
Q

UTI treatment?

A

TMP-SMX
Nitrofurantoin
Fluoroquinolone

3-7 days

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3
Q

Ulcerative lesion causes?

A

Herpes
Syphilius
Chancroid
Lymphogranuloma venerum

Crohn’s disease, Behcet’s disease

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4
Q

Syphilis lesions

A

1) Chancre- painless, round, firm ulcer with raised edges. Develops ~3 wks after inoculation. Regional adenopathy.
Material inside has motile spirochetes on dark-field microscopy
2) 1-3 months later has systemic flu-like symptoms with fever and myalgias. Maculopapular rash on palms and soles.

LATENT PHASE

3) GRANULOMAS (gummas) of skin and bones.
Cardiovascular/aortitis.
Neurosyph.

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5
Q

Syphilis treatment

A

Benzathine penicillin

IV penicillin for neurosyphilis

Could have the Jarisch-Herxheimer rxn (usu within 8-24 hours after starting treatment).
This is NOT A DRUG RXN. It’s endotoxin release that causes systemic release of cytokines.

Basically everyone gets penicillin. If this is truly a big problem then give:
Doxy tetra ceftriaxone azithromycin combo.

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6
Q

Syphilis tests? Do the antibodies disappear after treatment? False positive antibodies?

A

VDRL and RPR

Antibodies POSITIVE for 6-12 months after treatment with progressively dec titers.

False positives with autoimmune, other infections, malignancy, pregnancy, IVDU. Therefore, positive result must be confirmed with specific treponemal antibody studies like FTA-ABS and TPPA (particle agglutination assay).

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7
Q

What if they’re asymptomatic with a positive antibody titer?

A

Early latent or late latent stage.

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8
Q

Genital herpes pathogen?

A

HSV-2 but up to 80% of NEW cases are from HSV-1.

Recurrence more frequent with HSV-2

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9
Q

Genital herpes incubation period, symptoms.

A

2-10 days. Flu-like symptoms.
Vulvar burning and pruritis precede the multiple vesicles that appear, happens for 24-36 hours then evolves into painful genital ulcers. These ulcers req 10-22 days to heal.
Recurrence less severe than initial outbreak.

SUBCLINICAL ASYMPTOMATIC SHEDDING CAN OCCUR. IS MORE FREQUENT DURING THE FIRST 6 MONTHS AND IMMEDIATELY BEFORE OR AFTER RECURRENT OUTBREAKS.

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10
Q

Herpes diagnosis

A

Viral culture

Tzanck smear isn’t sensitive or specific

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11
Q

Herpes treatment

A

Acyclovir

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12
Q

Chancroid characteristics

A

Difficult to culture so we underestimate rates

Males&raquo_space; females

Is a COFACTOR for HIV transmission

Painful, nonindurated ulcer anywhere in the anogenital region, usually just one ulcer. Painful suppurative inguinal LAD.

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13
Q

Chancroid treatment

A

Ceftriaxone or azithromycin

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14
Q

Lymphogranuloma venereum pathogen

A

Chlamydia trachomatis L serotypes

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15
Q

LG stages

A

3-12 day incubation

Primary: Local lesion that’s a papule or shallow ulcer. Painless, transient, can go unnoticed.

Secondary: Inguinal syndrome. 2-6 wks later with PAINFUL inflammation and enlargement of inguinal nodes (usu unilateral).

Tertiary (Rectal exposure only): Anogenital syndrome with proctolitis, rectal structure, rectovaginal stricture, elephantiasis.

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16
Q

LG diagnosis

A

Clinical.

Genital/lymph node specimen culture, direct immunofluorecence, nucleic acid detection also possible.

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17
Q

LG treatment

A

Doxycycline

Erythromicin ok

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18
Q

Nonulcerative lesion causes?

A
  • Condyloma acuminata
  • Molluscum contagiosum
  • Phthirus pubis (crab louse)
  • Sarcoptes scabiei (itch mite)
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19
Q

Etiology of condyloma acuminatum

A

HPV 6 and 11

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20
Q

Warts diagnosis

A

Biopsy

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21
Q

Warts treatment? Recurrence rate?

A

Local excision- best for a large/bleeding lesion
Cryotherapy

Topical trichloroacetic acid
Topical 25% podophyllin- not recommended for extensive disease bc of toxicity (peripheral neuropathy)
5-FU cream- for intractable condyloma

The medicines require weeks or months to be effective!

Imiquimod and podoilox

Recurrence rate 20%

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22
Q

HPV vaccines and coverage

A

Cervarix 16, 18

Gardasil 6, 11, 16,18

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23
Q

Molluscum contagiosum

A

Pox virus

1-5mm domed papule with an umbilicated center

Wright or giemsa stain

Anywhere on skin except palms and soles.

Local excision, cryotherapy, or trichloroacetic acid.

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24
Q

Pediculosis

A

Confined to pubic hair (crabs)

Permethrin 1% cream, wash after 10min
Piperonyl butoxide, wash after 10min

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25
Q

Scabies

A

Permethrin cream to all areas of body, wash in 8-14 hrs

Ivermectin oral.

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26
Q

BV risk factors

A 
New or multiple sex partners
Lack of vaginal lactobacilli
Female sexual partners
Douching
Smoking
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27
Q

BV cause

A

Shift in predominant bacterial species in vagina.
POLYMICROBIAL
Most common organism is Gardnerella.

28
Q

BV diagnosis

A

KOH whiff test
pH greater than 4.5
Clue cells on microscope

Profuse nonirritating white milky discharge with malodorous fishy amine odor.
GRAM STAIN IS GOLD STANDARD.

29
Q

BV treatment

A

Metronidazole (avoid alcohol) 7 days

Clindamycin ok

Recurrence up to 30%

30
Q

Candidasis diagnosis

A

KOH prep

Gram stain and culture (for IDing non-albicans species that may be less responsive to azole therapy)

31
Q

Candidiasis treatment

A

Azoles for 1-3 days topical or suppository

Oral: fluconazole (especially for recurrent cases)

Non-albicans: boric acid capsules, intravaginally

32
Q

Trichomonas diagonsis

A
  • Frothy green-gray profuse malodorous discharge.
  • Strawberry mucosa (puncate epithelial papillae) in only 10%

WET PREP shows protozoan with flagella

33
Q

Trichomonas treatment

A

Metronidazole 2g SINGLE ORAL DOSE Tinidazole

Treat partner.

34
Q

Gonorrhea diagnosis

A

Thayer Martin chocolate agar of endocervical cultures

Nucleic amplification tests now more popular than cultures

35
Q

Gonorrhea treatment

A

IM ceftriaxone 125 mg 1x

Oral cefexime 400mg 1 dose

Cotreat for chlaymida with Doxycycline or azithromycin

36
Q

Gonorrhea and chlamydia rates of infections

A

Gonorrhea stable

Chlamydia increased

37
Q

Chlamydia symptoms

A

Up to 70% asymptomatic

38
Q

Chlamydia treatment

A

Azithromycin 1g oral single dose

Doxycycline 100mg oral 2x/day for 7 days

39
Q

Endometritis and Endomyometritis risk factors

A

POLYMICROBIAL.
STIs, retained products of conception, intrauterine foreign bodies or growths, instrumentation of the cavity

MC after C/S but possible after vaginal deliveries and surgical pregnancy terminations

40
Q

Endometritis is UNCOMMON in what? Therefore antibiotic prophylaxis not recommended

A

EMB, endometrial ablation, hysteroscopy, IUD placement

41
Q

When is antibiotic prophylaxis advised for prevention of endometritis?

A

C/S
Surgical terminations of pregnancy
HSG or sonohysterography in women with hx of PID or dilated tubes

42
Q

Chronic endometritis diagnosis

A

Clinically with uterine tenderness, fever, elevated WBC

EMB with plasma cells

43
Q

Rx of endometritis unrelated to pregnancy

A

Same as for PID (cephalosporin like cefoxitin or cefotetan)

44
Q

Rx of postpartum endometritis

A

Clindamycin gentamicin

Single agent: cephalosporins

45
Q

Rx of chronic endometritis

A

Doxycycline 10-14 days

46
Q

What is PID

A

Infection of the upper female genital tract including any combo of endometritis, salpingitis, tubo-ovarian access, pelvic peritonitis.

47
Q

Infertility risk with PID? Successive episodes?

A

Risk inc with # of episodes

40% with 3 or more

48
Q

Risk factors for PID

A 
Nonwhite nonasian
Multiple partners
Douching
Smoking
Prior hx of PID
49
Q

Minimum criteria for empiric treatment of PID?

A

Pelvic or lower abdominal pain in sexually active @ risk of STIs and ONE OR MORE OF:

  • Cervical motion tenderness
  • Uterine tenderness
  • Adnexal tenderness

Additional

  • Fever >38.3
  • Abnormal cervical or vaginal mucopurulent discharge
  • WBC inc
  • Elevated ESR and CRP
  • Gonorrhea or chlamydia on cultures
50
Q

Last resort for diagnosing PID

A

Laparoscopic only when appendicitis can’t be ruled out by clinical exam or if there’s a poor response to antibiotics.

51
Q

Fitzhugh-Curtis

A

Occasional complication fo PID with RUQ pain and LFT elevations from perihepatitis

52
Q

PID treatment

A

Often hospitalized

Broad-spectrum cephalosporin.
IV for 24 hrs until clinical improvement, then doxy 100mg orally for 2 weeks.

Allergic to cephalosporins: IV clinda and genta

Outpatient basis: Ceftriaxone IM

Pregnant: Clinda and genta

53
Q

Silver lining of a TOA?

A

It’s not walled off like a true abscess so it’s more responsive to antimicrobial therapy.

54
Q

TOA diagnosis

A

CLINICAL:

  • Pelvic pain
  • Fever/leukocytosis
  • Adnexal or posterior cul-de-sac mass or fullness

ULTRASOUND

Get endocervical swab and blood cultures to r/o sepsis

55
Q

TOA treatment

A

Trial of medical management with broad-spectrum antibiotics as inpatient

PARENTERAL Cefotetan or cefoxitin + Doxy

Clinda and genta

If responsive, patient can switch to oral

IF MORE SERIOUS NEED SURGERY

56
Q

Toxic shock syndrome. Nonmenstrual causes?

A

Vaginal infections, vaginal delivery, c/s, postpartum endometritis, miscarriage, laser treatment of condyloma

57
Q

TSS cause

A

Staph that produces TSST-1

Blood cultures often negative

58
Q

TSS physical and lab findings

A

High fever, hypotension, desquamation of palms and soles, GI disturbances, inc BUN and creatinine, platelet count less than 100,000

59
Q

TSS treatment

A

HOSPITALIZATION.

HYPOTENSION FIRST- IV fluids and pressors

Antibiotics not for toxin, but to dec recurrence chance.

Clinda + vanc (or linezolid), 10-14 days

60
Q

HIV diagnosis

A

Screening test: ELISA

If positive, confirm with WESTERN BLOT.

Viral loads and CD4 counts to monitor progression

61
Q

HIV pre-exposure prophylaxis?

A

New thing.

Tenofovir disoproxil fumarate _ emtricitabine (TDF/FTC).

62
Q

HIV treatment

A

Nucleoside analogs- inhibit reverse transcription and interfere with viral replication (zidovudine, lamivudine, abcavir, etc.)

Protease inhibitors- interfere with the synth of viral particles and inc CD4 counts while dec viral load.

HAART

63
Q

HIV vertical transmission %’s and modalities?

A

Intrapartum 50-80%
Intrauterine 20-50%
Postpartum 15%

GIVE IV ZIDOVUDINE DURING PREGNANCY AND LABOR.

ART in pregnancy started in 2nd trimester.

64
Q

Should you do a c/s for HIV pregnancy?

A

Only if viral loads are HIGH and she hasn’t been getting treated.

NO BENEFIT if viral load is < 1000 copies/mL

65
Q

Another thing to look out for in HIV

A

Cervical cancer!

Do routine pap smears at initial eval and 6 months later.

GYN (14 decks)

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