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Women's Health Rotation > Infections > Flashcards

Infections Flashcards

1
Q

Cause of candidiasis

A

MC after abx which destroy the nl vaginal flora

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2
Q

When should one suspect HIV/AIDS or diabetes with candidiasis?

A

Multiple episodes, esp without antibiotic insult

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3
Q

Confirmation of candidiasis

A

Wet prep- will see budding and hyphae

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4
Q

Tx of chronic candidiasis

A

Diflucan 150 mg weekly for 6 mos

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5
Q

Tx of candidiasis

A

Oral Diflucan or topical agents

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6
Q

Cause of atrophic vaginitis

A

Lack of estrogen support either d/t menopause or surgical removal of the ovaries or other hypoestrogenic states
Significant cause of dyspareunia

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7
Q

Tx of atrophic vaginitis

A

Oral hormone therapy if no contraindications or estrogen replacement cream or Osphena (similar CIs to oral estrogens)

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8
Q

Organism of trichomoniasis

A

Trichomonas vaginalis

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9
Q

S/sx of trichomoniasis

A

Frothy, yellow-green vaginal d/c with strong odor
May cause discomfort during intercourse and urination and itching of the female genital area
Rarely, lower abdominal pain

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10
Q

PE of trichomoniasis

A

Vaginal walls and cervix may appear red and irritated

Cervix may have surface hemorrhages or petechiae causing a “strawberry” appearance

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11
Q

Tx for trichomoniasis

A

Metronidazole 2 gm PO x 1 (or 500 mg BID x 7) is commonly used
Alcohol while taking the med and for 48 hrs afterwards is contraindicated
Avoid sexual intercourse until tx is completed
Treat sexual partners

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12
Q

What is the MC vaginal infection in women of childbearing age?

A

Bacterial vaginosis

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13
Q

S/sx of bacterial baginosis

A

Some women have no sx
Others complain of a foul fishy odor, particularly during their period or after intercourse
D/c may be white or gray.
May cause burning and/or itching

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14
Q

Dx of bacterial vaginosis

A

Wet prep/KOH whiff test

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15
Q

Tx of bacterial vaginosis

A

May treat with topical or oral meds (metronidazole tablets or gel, Clindamycin gel)

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16
Q

RFs for BV

A 
Abx
Douching
Vaginal lubricants
Some spermicides
Anal sex
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17
Q

What is the second most commonly reported notifiable dz in the US?

A

Gonorrhea

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18
Q

Sx of gonorrhea

A

In women, the sx of gonorrhea are often mild and can be mistaken for bladder or vaginal infection
Initial sx may include a painful or burning sensation when urinating
Increased vaginal d/c
Vaginal bleeding between periods

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19
Q

Complications of gonorrhea

A

Left untreated:

  • Sepsis
  • Gonococcal arthritis
  • Fitz-Hugh-Curtis syndrome
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20
Q

Details of septic arthritis

A

Fever, joint pain, limited ROM, purulent aspirate
CBC, ESR or CRP, admit
Tx requires 2 wks of IV abx

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21
Q

Fitz-Hugh-Curtis syndrome

A

AKA perihepatitis
Severe RUQ pain in addition to PID sx
Caused by violin string adhesions under liver

22
Q

Dx of gonorrhea

A

Through culture of pharynx, vagina, penis or rectum

Wet prep will show TNTC (too numerous to count) WBCs

23
Q

Tx of gonorrhea

A

Ceftriaxone 250 mg IM single dose
PLUS
Azithromycin 1 g orally x 1
Once tx is completed, the woman should be retested to ensure complete cure (test of cure) in 3 mos or if she returns for clinic for any reason within 12 mos post-tx

24
Q

What is the most frequently reported bacterial STI in the US?

A

Chlamydia

25
Q

When should chlamydia be suspected?

A

Frequently has no sx or has very mild sx
If pt has deep internal pain with intercourse. With bimanual exam she will experience intense pain with manipulation of the cervix (chandelier sign)

26
Q

Dx of chlamydia

A

Urine (high false-neg) or culture taken from the ectocervix or vagina

27
Q

Complications of chlamydia

A 
Cervicitis
Endometritis
PID
Urethritis
Epididymitis
Neonatal conjunctivitis
Pediatric PNA
Reiter syndrome
28
Q

Tx of chlamydia

A

Azithromycin 1 g PO in single dose
OR
Doxycycline 100 mg PO BID x 7 days (not OK in pregnancy)

29
Q

What anatomic locations are included with PID?

A 
Endometrium
Oviducts
Ovaries
Uterine wall
Uterine serosa and broad ligaments
Pelvic peritoneum
Also, a TOA may form
30
Q

Dx of PID

A

Difficult to diagnose bc of the wide variation in s/sx
Many women have subtle or mild signs
Usually based on clinical findings
Delay in dx and tx probably contributes to inflammatory sequelae in the upper reproductive tract

31
Q

When should empiric tx of PID be initiated?

A

Sexually active young women and other women at risk for STIs if they are experiencing;

  1. Pelvic or lower abd pain
  2. If no cause for illness other than PID can be Id-ed
  3. AND if one or more of the following minimum criteria are present on pelvic exam:
    - Cervical motion tenderness
    - Uterine tenderness
    - Adnexal tenderness
32
Q

What additional criteria can be used to support a dx of PID?

A

Oral temp >101 F
Abnl cervical or vaginal mucopurulent d/c
Presence of abundant numbers of WBC on wet prep
Elevated ESR
Elevated CRP
Lab documentation of cervical infection with N. gonorrhea or C. trachomatis

33
Q

MC organisms of PID

A

MC are gonorrhea and chlamydia

Usually polymicrobial in nature

34
Q

Other organisms of PID

A

Ureaplasma urealyticum
Mycoplasma genitalium
Trichomonas vaginalis
Gardnerella vaginalis

35
Q

Long-term consequences of PID

A 
MC and serious are tubal factor infertility and ectopic pregnancy
Other sequelae:
Chronic pelvic pain
Dyspareunia
Menstrual disturbances
Pelvic adhesions
36
Q

Outpatient tx for PID

A

Ceftriaxone 250 mg IM PLUS doxycycline 100 mg PO BID x 14 days with or without metronidazole 500 mg PO BID x 14 days
OR
Cefoxitin 2 g IM single dose and probenecid 1 g orally administered concurrently in a single dose plus doxycycline 100 mg PO BID x 14 days with or without metronidazole 500 mg PO BID x 14 days
OR
other parenteral third-gen cephalosporine plus doxycycline 100 mg PO BID x 14 days with or without metronidazole 500 mg PO BID x 14 days

37
Q

When should PID pts be hospitalized?

A

Surgical emergencies
Pt is pregnant
Pt does not respond clinically to oral antimicrobial therapy
Pt is unable to follow or tolerate and outpatient oral regimen
Pt has severe illness, nausea and vomiting, or high fever
Pt has TOA

38
Q

PID inpatient tx

A

Regimen A:
Cefotetan 2 g IV q12h OR cefoxitin 2 g IV q6h plus doxycycline 100 mgm PO or IV q12 hrs
Regimen B:
Clindamycin 200 mg IV q8h plus gentamicin loading dose IV or IM (2 mg/kg of body wt) followed by a maintenance dose (1.5 mg/kg) q8h

39
Q

Ways to get a PID partner treated

A

Pt referral: ask pt to notify partner and ensure tx or have pt bring partner for concurrent tx
Expedited partner tx: pt delivered partner tx or health department field-delivered tx or call in Rx for him at pharmacy
Provider referral for partner
Health department referral for partner

40
Q

Genital HSV causative organisms

A

HSV-1 or HSV-2

41
Q

Presentation of genital HSV

A

Blisters and ulcerated sores around genitals and anus

42
Q

Dx of genital HSV

A

Can be confirmed by viral culture or Tzanck smear

43
Q

Tx of genital HSV

A

Acyclovir
Famiclovir
OR
Valacyclovir

44
Q

Transmission of syphilis

A

Passed through direct contact with a syphilis sore or contact with condylomata lata. Sores are generally on the external genitalia

45
Q

Presentation of primary syphilis

A

Initially presents as a firm, round, painless nodule, called a chancre, where the syphilis entered the body
Lasts 3-6 wks and will resolve with tx
If it is not treated it then proceeds to secondary syphilis

46
Q

Sx of secondary syphilis

A 
Condyloma lata lesions in moist areas
Rash usually on the palms of the hands and soles of the feet, but may be on other parts of the body. Often described as "copper penny" colored lesions
Fever
Swollen LNs
Sore throat
HAs
Muscle aches
Wt loss
Sx resolve with or without tx, but without tx will progress to latent or late stage syphilis
47
Q

Latent and late stage syphilis

A

Latent stage can last for years
Late stages can appear 10-20 years after infection was first acquired
In late stages, dz may subsequently damage internal organs, including brain, nerves, eyes, heart, blood vessels, liver, bones, and joints

48
Q

S/sx of late stage of syphilis

A 
Appearance of soft rubbery tumors called gummas
Difficulty coordinating muscle movements
Paralysis
Numbness
Blindness
Dementia
49
Q

Definitive dx of syphilis

A

Darkfield examinations and direct fluorescent antibody tests of lesion exudate or tissue

50
Q

Presumptive dx of syphilis

A 
Nontreponemal tests (VDRL and RPR) measured in titers
OR
Treponemal tests (FTA-ABS and TP-PA)
If one type is positive the lab should confirm with the other
51
Q

Tx of syphilis

A

PCN G 2.4 million units IM in a single dose is preferred for tx of primary, secondary and early latent stages
Late latent or unknown duration should be treated with 2.4 million units weekly x 3 doses
Neurosyphilis: aqueous crystalline PCN G 3-4 million units IV q4h for 10-14 days

52
Q

All pts with syphilis should be tested for what?

A

HIV

Women's Health Rotation (15 decks)

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