Infections Flashcards
1
Q
Chlamydia etiology and sxs
A
- Most common bacterial STD
- RF: lack of condom use, lower socioeconomic status, living in an urban area, having multiple sex partners
- most common in F 15-19, then 20-24
- independent risk factor for cervical cancer
- Sxs:
- men: dysuria, purulent urethral discharge, itching, scrotal pain and swelling, fever
- women: puruelnt urethral discharge, intermenstrual or post-coital bleeding, dysuria
- mucopurulent discharge from cervical os, friable cervix
2
Q
chlamydia diagnostics and tx
A
- Tx: NAAT, wet mount (leukorrhea >10 WBC), culture, enzyme immunoassay, PCR
3
Q
Gonorrhea etiology and sxs
A
- transmitted sexually or neonatally
- 30% coinfected with chlamydia
- Sxs: asymptomatic in women, symptomatic in men
- Cervicitis or urethritis (purulent discharge, dysuria, intermenstrual bleeding)
- Disseminated: fever, arthralgias, tenosynovitis, septic arthritis, endocarditis, meningitis, skin rash (distal extremities)
4
Q
Gonorrhea dx and tx
A
- dx: NAAT, gram stain (leukocytes, gram neg intracell. diplococci), cultures (men from urethra, women from endocervix)
- tx: tx empirically because cultures take 1-2d
- Ceftriaxone x1, add Azithromycin or doxy to cover chlamydia
- if disseminated, hospitalize and IV or IM ceftriaxone
- Complications of dz: PID, infertility, epididymitis, prostatitis, salpingitis, tubo-ovarian abscess, Fitz-Hugh-Curtis syndrome
5
Q
lymphogranuloma venereum
A
- MCC: chlamydia trachomatis - primary infxn of lymphatics and lymph nodes
- Sx: hx of proctitis with or without anal lesions
- first stage = painless genital ulcer 3-12d after infxn
- second stage = unilateral lymphadenitis or lymphangitis with tender inguinal or femoral LAD
- Enlarged bubos, which are painful
- Tender lymphadenopathy at the femoral and inguinal lymph nodes, separated by a groove made by poupart ligament (“sign of the groove”)
- dx: serologic testing for syphilis - RPR/VDRL
- Tx: drainage of buboes, doxy 100mg BID x 21d
6
Q
chancroid
A
- etiology: haemophilus ducreyi (G-)
- sxs: PAINFUL chancre
- PAINFUL lymphadenopathy - leads to bubo formation
- dysuria and dyspareunia in Fs
- multiple painful punched out ulcer with undermined borders
- dx: serologic testing for syphilis - RPR/VDRL
- culture and gram stain of fluctuant lymph node or ulcer for H ducreyi
- Tx: 1 g azithromycin
- fluctuant inguinal lymph nodes should be incised and drained
7
Q
HPV
A
- etiology: MC - condylomata acuminatum
- Low-risk types: 6, 11
- anogenital warts - most common viral STD in US
- Causes nearly 100% of cervical cancers - most significant RF for cervical CA
- Low-risk types: 6, 11
- sxs and signs: most asymptomatic
- flesh-colored papillary exophytic lesions on genitalia
- dx: RPR/VDRL - r/o syphilis
- HIV, HPV viral typing not recommended daily
- Shave or punch bx confirms - hyperplastic prickle cells, koilocytotic or vacuolated squamous epithelial cells in clumps on pap (cervical warts)
- tx: most resolve spontaneously
- podophyllin or trichloroacetic acid
- surgery (cryotherapy, excision, electrocautery, intralesional interferon
- guarasil
- 6, 11 = warts
- 16, 18 = cervical CA
- condoms reduce transmission of warts
8
Q
Herpes simplex virus (herpes labialis), HSV-1
A
- transmission: kissing, resides in trigeminal ganglion
- signs and sxs: fever, malaise, vesiculopustular oral lesions in groups
- herpes labialis (cold sores): most common on lips, painful, heal in 2-6 wks
- bell palsy
- herpetic whitlow
- dx: clinical dx with lesions dewdrop on a rose petal
- tzanck smear - multinucleated giant cells
- culture of HSV
- ELISA
- PCR
- tx: acyclovir
- complications: herpes encephalitis, HSV keratitis
9
Q
Genital herpes, HSV-2
A
- resides in sacral ganglion
- prior HSV-1 infxn confers partial immunty to HSV2
- signs and sxs: severe, prolonged sxs
- fever, HA, malaise
- painful vesicles on genitals (itching, dysuria, multiple, bilateral)
- tender inguinal lymph nodes
- dx: HSV1 and HSV2 Ab negative
- PCR, culture if active lesion present
- tx: acyclovir, sitz baths, topical xylocaine
- complications: aseptic meningitis, keratitis, blepharitis, keratoconjunctivitis
- C section recommended for pregnant women with active infxn
10
Q
Pelvic Inflammatory disease etiology and sxs
A
- etiology: infxn ascends from cervix to involve endometrium and/or fallopian tubes
- MCC = gonorrhea, chlamydia, genital mycoplasmas
- RF: endocervical infxn, BV, hx of PID, vaginal douching, IUD insertion, D&C or C-section
- signs and sxs:
- mucopurulent malodorous vaginal discharge
- abd pain
- abnl vaginal bleeding
- bilateral lower abdominal and pelvic pain
- N/V
- urethritis, proctitis
- Fever
- yellow endocervical discharge, easily induced bleeding
- uterine or adnexal tenderness and swelling, CMT
- rebound/guarding
11
Q
Pelvic inflammatory disease dx and tx
A
- Dx: ESR elevated, leukocytosis, B-hCG, NAATs, gram stain
- US: enlarged fallopian tubes with fluid in cul-de-sac
- laparoscopy - last line, rule out appy, ectopic, tumor
- endometrial bx
- outpt: ceftriaxone IM and doxy PO x14d
- +/- flagyl BID x 14d
- inpt: hosp if: dx uncertain, pregnant, abscess suspected, severely ill or N/V preclude outpt management, HIV pos
- Doxy + IV cefotetan or cefoxitin x 48h, then PO doxy BID x14d
- clindamycin + gentamicin qh x48h, then PO doxy BID x14d
12
Q
trichomoniasis
A
- signs, sxs: increased d/c and odor, dysuria, frequency, dyspareunia, itching, irritation
- thin yellow-green to gray, adherent frothy discharge in vagina
- malodorous, musty (amine)
- hyperemic mucosa, friable cervix, strawberry cervix (petechiae)
- dx: wet mount, ph 5-6.5 (basic)
- tx: 2 g metronidazole PO x1, no ETOH 48h, TREAT PARTNER
13
Q
bacterial vaginosis
A
- MCC vaginitis
- RF: new partner, smoking, IUD, douching, pregnancy
- signs, sxs: mostly asx
- increased vag d/c
- dysuria, frequency, dyspareunia
- noticeable fishy discharge after menses or intercourse, no itching
- thin ivory/gray d/c
- dx: amsel criteria (3 of 4)
- thin, gray, homogenous d/c
- positive whiff
- clue cells
- elevated pH >4.5 (basic)
- tx: metronidazole BID x7d
- Or vaginal metronidazole
14
Q
atrophic vaginitis
A
- postmenopausal women, thinning of vag epithelium
- signs, sxs: dyspareunia, thin vag d/c, vag pruritis, burning, soreness
- atrophic vulvar changes (smooth, shiny, pale, dry, thin), scattered vag petechia, thin clear or brown d/c (leukorrhea)
- UTI, urge incontinence may be associated
- Dx: clinical dx
- vaginal cytology (greater % of parabasal cells)
- vaginal pH: 5-7
- tx: H2O soluble lubes, topical vaginal estrogens, oral estrogens
15
Q
candidiasis
A
- 2nd MCC vaginitis
- RF: high dose OCP, diaphragm use, DM, abx, pregnant, immune suppression, tight clothes
- signs, sxs: vulvar or vag itching, burning, external dysuria, dyspareunia, odorless thick cottage cheese curd-like d/c
- erythema of vulva, excoriations from scratching
- dx: wet mount - budding yeast
- gram stain - pseudohyphae
- vaginal culture (+) for yeast
- pH <4.7 (acidic)
- tx: fluconazole 150 PO once
- tx uncircumcised partners
- short-course topical azole
- recurrent: weekly topical /PO
- resistant: boric acid TID x7d
