infections Flashcards
what increases discharge normally
estrogen
vaginal discharge is abnormal if
i. Increased volume, especially if soiling the clothes
ii. Bad odor
iii. Change in consistency or color
iv. Irritation or pruritis, pain, burning
v. Dyspareunia or dysuria
BV tx in pregnant woman
Flagyl or clinda orally best
tx for batholin’s abscess
when would you follow up
Clindamycin 300mg po tid x 7 days or Ceftriaxone 250mg IM
FU in 2 weeks
primary HSV infection
Valacyclovir 1g po bid x 10 days for primary HSV infection
RPR reactive
syphillis
, 1:16; MHA-TP positive
what decrease in titers fo you need to see when treating syphillis
Need to see 4-fold decrease in RPR titer over 6 months (1:16 to 1:4 or less) and stays low at 12 and 24 months post-tx
HPV warts-provider tx
Cryotherapy
Podophyllin
TCA
Surgical destruction/removal
hpv warts home tx
Podofilox
Imiquimod
what goes on a KOH smear
- 10% potassium hydroxide solution on a slide
Mycoplasma hominis and Ureaplasma urealyticum
dx and tx
- Diagnosis by vaginal culture or PCR for identification
2. Treatment is Doxycycline 100mg po bid x 10 days
marsupilization would be used for a cyst of abscess
CYST
when would you see a decreased in vaginal pH
candidiasis
what are non hormonal options for the treatment of hot flashes
clonidine
SSRI
neurotin
anbx for bartholon’s abscess
i. Ceftriaxone 250mg IM or Cefixime 400m po
ii. Clindamycin 300mg po x 7 days
iii. Add azithromycin 1gm po if C. trachomatis
follow up care for bartholin’s abscess
a. Wear peripad to absorb drainage
b. Pelvic rest (no sex)
c. Sitz baths and mild analgesics 48 hrs
d. Catheter in place 2-4 wks (poss 6 wks)
e. Call for any increase in pain, swelling, fever or unusual vaginal discharge
i. Acute salpingitis-peritonitis
PID
labs for PID
ix. WBC > 10K and/or elevated CRP
x. Inflammatory mass on exam or US
xi. Gram negative intracellular diplococci
xii. Purulent discharge on culdocentesis
xiii. Elevated ESR
who should be admitted for PID
a. Temp >102.2˚F, guarding or rebound tenderness, toxic patients; adolescents and pregnant women
i. Most common STD among women
chlamydia `
chlamydia tx in pregnant pt
a. Erythromycin 500mg po qid x 7 days or
b. Amoxicillin 500mg po tid x 7 days
chlamydia tx in non pregnant
a. Azithromycin 1g po x 1 dose or
b. Doxycycline 100mg po bid x 7 days
iii. Most common cause of genital ulcers
HSV
with syphilis Primary chancre develops ____ after infection and persists _____
10-90 days after infection,
persists 1-5 weeks and heals spontaneously
Cutaneous eruption of secondary syphilis occurs ____after initial lesion
iv. Cutaneous eruption of secondary syphilis occurs 2-6 months after initial lesion, heals spontaneously after 2-6 weeks
what does primary syphilis look like
Painless genital chancre: indurated, firm papule or ulcer with raised borders on labia, vulva, vagina, cervix, anus, lips or nipples
Painless, rubbery regional lymphadenopathy followed by generalized lymphadenopathy in the 3rd-6th week
positive serology for syphilis occurs in
d. Positive serologic tests in 1-4 weeks in 70% of pts
b. Condyloma lata
moist papules in perineum, darkfield microscopy positive
Viral-like syndrome, diffuse lymphadenopathy
is seen with primary, secondary or tertiary syphilis
secondary
when would you get a Lp for a pt with syphilis
neurologic symptoms, treatment failure, serum non-treponemal titer >1:32, evidence of tertiary syphilis, HIV+ patients
Early syphilis tx
Benzathine penicillin G, 2.4 million units IM once
Doxycycline 100mg po bid x 14 d if PCN allergic
b. Late syphilis or unknown duration tx
Benzathine penicillin G, 2.4 mU IM q wk x 3 wks
Doxycycline 100mg po bid x 28 d if PCN allergic
when do you repeat testing for pt with syphilis
b. Repeat RPR or VDRL at 0, 3, 6, 12, and 24 months after treatment
Condyloma Acuminata dx
- Biopsy of lesions for definitive diagnosis
labs for a pt with dysmenorrhea dyschezia and dysparuneia
FSH, CBC for anemia, Metabolic panel for PCOS, TSH, GC/Chlamydia (for underlying PID), HCG
pelvic pain think
ectopic pregnancy PID intersittial cystitis adenomyosis ovarian neoplasms pelvic adhesions IBS colon cancer diverticular disease
dx of endometriosis is most commonly made during
- 25-35 years old most common
Uncommon on pre/post monarchal girls
Rare in post menopausal women NOT taking estrogen
tall thin
asian
white
RF for endometriosis
mullerian anomlaies short menstrual cycles pronlonged menses nulliparity early menarche
What lowers risk of endometriosis
multiple births
extended intervals of lactation
late menarche
mild enometriosis, superficial implants less than 5 cm in aggreagte, scattered on the peritoneum and ovaries. no significant adhesions
ii. Stage 2
exhibits multiple implants, both superficial and invasive, Peritubal and periovarian adhesions
Stage 3:
VII. Endometriomas
Contains blood, fluid, menstrual debris
lined with endometrial epithelium, stroma and glands
how can you detect endometriomas
d. Detected on imaging (US, CT, MRI)
endometriomas are part of endometriosis?
stage 4
dysmenorrhea with endometriosis
Typically “dull or crampy that begins 1-2 days before menses and can persists during and a few days after, chronic
if infertile for ___ laproscopy is indicated
after 12 months surgery is indicated
laproscopy
MODERATE PAIN, no ultrasound evidence of endometrioma
TX
Treat symptomatically –>NSAIDS and monophasic combined hormonal contraceptives (pills, patch or ring, ?LNgIUD, ?Nexplanon)
when would you advise taking NSAIDS in a
Starting the NSAIDS a day before their symptoms typically starts seems to help (i.e. if they get cramping the day before their period then starting the NSAIDS 2 days before their period)
how do OCPs work for endometriosis
Suppress ovulation and menstruation through hyperestrogenic effect—-seems counter intuitive but it works!
Consider continuous regimen with pill free interval to allow for withdrawal bleed every 3-4 months
if OCP do not work for endometriosis
POP change to norethidrone acetate 5mg
Consider depot medroxyprogesterone acetate 150mg IM
MODERATE PAIN, or no response to previous therapies or recurrent symptoms
GnRH agonist with add-back (Depo-Lupron)
Add-back helps decrease hypoestrogenic effects (hot flashes, night sweats, vaginal dryness etc.) and preserves bone density
Aromatase inhibitors are reserved for women with endometriosis who
who continue to have refractory symptoms despite GnRH agonist treatment
when would you get a laproscopy
No response to treatment, refractory symptoms, endometrioma or masses seen on imaging or exam
reoccurence rates after laproscopy
- 10% in 3 years
2. 35% in 5 years
