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Women's Health EOR > Infections > Flashcards

Infections Flashcards

1
Q

What is gonorrhea cervicitis?

A

mucopurulent vaginal dischage gram-negative intracellular diplococci

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2
Q

What are the characteristics of gonorrhea cervicitis?

A
  • women are often asymptomatic, a prolonged infection can results in pelvic inflammatory disease when the bacterium travels into the pelvic peritoneum
  • can infect any mucocutaneous surface (oral, urethral, vaginal, cervical, and anal)
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3
Q

How is gonorrhea cervicitis dx?

A

nucleic acid amplification test (NAAT) of discharge or urine

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4
Q

What is the tx of gonorrhea cervicitis?

A

ceftriaxone 250 mg IM in a single dose PLUS treatment for chlamydia (azithromycin 1 g PO single dose or doxycycline 100 mg PO BID for 7 days)

  • if ceftriaxone is unavailable - cefixime 400 mg PO single dose + azithromycin (to treat chlamydia)
  • check for other STIs
  • treat partners and educate to refrain from sex until the infection is treated
  • make sure to think of gonococcal pharyngitis in anyone with persistent pharyngitis and take samples for cultures
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5
Q

What is chlamydia cervicitis?

A

urethritis, vulvovaginitis (vulvar and vaginal discomfort, pain, pruritus), and inflation of the cervix, clear vaginal discharge

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6
Q

What is the most common sexually transmitted infection?

A

Chlamydia

-urethra, cervix, and rectum caused by the bacteria Chlamydia trachoma’s = serotypes D-K cause chlamydia

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7
Q

What are the symptoms of chlamydia?

A

Women: presenting with urethritis, bartholinitis, cervicitis characterized by dysuria, abnormal vaginal discharge, or post-coital bleeding
-may also present with upper genital tract infections (PID, endometriosis or sapling-oophoritis)

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8
Q

What occurs if a chlamydia infection is unnoticed or untreated in women?

A

these infections can results infertility, miscarriage, and an increased risk of mislocated pregnancy
-neontal conjunctivitis and neonatal pneumonia

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9
Q

How is the dx of chlamydia cervicitis made?

A

nucleic acid amplification test (NAAT) is the gold standard

-sensitivity 80-90% with a specificity of 95-100%

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10
Q

What is the treatment of chlamydia cervicitis?

A

azithromycin 1 g PO single doe or doxycycline 100 mg PO BID x seven days + ceftriaxone 250 mg IM + 1 to cover for gonorrhea

  • check for other STIs
  • treat partners and educate to refrain from sex until the infection is treated
  • in pregnancy azithromycin 1 gm x 1 dose or amoxicillin TID x 7 days
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11
Q

What is herpes simplex cervicitis?

A

herpes simplex virus 2 = enveloped linear double-stranded DNA virus = latent in sacral ganglia; herpes simplex virus 1 (less common)

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12
Q

What are the symptoms of herpes simplex cervicitis?

A
  • with genital herpes, primary infection can cause symptoms like ulcers and pustules which form on the labia majora, labia minor, mons pubis, vaginal mucosa, and cervix in women
  • prodrome of burning, tingling, and pruritus before the appearance of lesions
  • the classic presentation of vesicles on an erythematous base
  • reactivation often does not cause symptoms
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13
Q

How is herpes simplex cervicitis dx?

A

herpes can usually be diagnosed clinically based on how the skin or mucous membrane lesions look

  • the classical presentation with multiple vesicles on an erythematous base is often absent in many patients
  • thus, it is important to confirm the diagnosis of herpes simplex virus infection with either of the following techniques: viral culture (gold standard), polymerase chain reaction (PCR), direct fluorescence antibody, and type-specify serologic tests
  • Tzanck prep from skin scrapings = multinucleate giant cells
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14
Q

What is the tx of herpes simplex cervicitis?

A

acyclovir, valacyclovir, or famciclovir

  • valacyclovir (1000 mg twice daily for 7 to 10 days) rather than oral acyclovir or famciclovir due to BID dosing
  • parenteral therapy should be reserved for patients with severe clinical manifestations/complications (sacral nerve involvement leading to urinary retaining, meningitis)
  • suppression therapy for those with severe or frequent (>6 recurrent episodes per year) recurrences
  • valacyclovir 500 mg once daily for most patients; however, for patients with >10 recurrences annually, use valacyclovir 1000 mg once daily
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15
Q

What is human papilloma virus?

A

-genital warts caused by HPV type 6 and 11

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16
Q

What does the HPV 9-valent vaccine protect against?

A

nine subtypes, including sever types that cause cancer and is indicated for females and males ages 9-45 years old

  • > 90% of cervical cancer associated with HPV types 16, 18, 31, 33, and 35
  • condylomata acuminate are soft, skin-colored, fleshy lesions caused by HPV subtypes 6, 11, 18, 31, 33, and 35
  • subtypes 6 and 11 accounts for >90% of genital warts
  • trichomonas is commonly seen in combination with condylomata acuminata
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17
Q

What is the dx of human papilloma virus?

A

shave or punch biopsy confirms the diagnosis, only if necessary - uncertain diagnosis, poor response to therapy, atypical appearance, immunocompromised

  • Koilocytic squamous epithelia cells in clumps are found on Pap smear and are typical of cervical warts
  • HPV DNA can be detected on cervical swabs
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18
Q

What is the tx of human papilloma virus?

A

spontaneous remission in months to years is typical of skin warts

  • treat to improve symptoms and remove warts
  • the provider may apply podophyllin or trichloroacetic acid (TCA)
  • topical imiquimod (aldara) cream can be applied by the patient
  • surgery: cryotherapy with liquid nitrogen, surgical excision, electrocautery, laser, intralesional interferon
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19
Q

What does Gardasil protect against?

A

(quadrivalent) against HPV types 6 and 11 (genital warts) and 16 and 18 (cervical cancer) is available
- the vaccine is given in a series of three shots and is recommended for males and females age 11 to 12 years and is approved for ages 9 thru 26

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20
Q

What is chancroid?

A

a sexually transmitted disease which results in painful genital ulcers

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21
Q

What is the causative pathogen of chancroid?

A

Haemophilus ducreyi, a gram-negative rode that is very contagious but rarely found in the developed world
-cases of chancroid in the developing world may be underreported due to the difficulty of definitive diagnosis

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22
Q

What are the symptoms of chancroid?

A

begins as one or several painful genital ulcers on an erythematous base, 1-2cm/0.39-0.79 in diameter with sharply demarcated borders, the base of ulcer covered with purulent exudate bleeds easily when scraped

  • areas of the genitals most susceptible to friction, such as the glans penis or the vaginal introitus
  • in about half of patients with chancroid, there will also be marked lymphadenopathy in the inguinal chain
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23
Q

How is chancroid dx?

A

serologic testing for syphilis - RPR/VDL
-gram stain, culture, and biopsy (used in combination because of the high false-negative rates) show the causative agent Haemophilus ducreyi

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24
Q

What is the tx of chancroid?

A

single-dose therapy with ceftriaxone 250 mg IM x 1 dose or azithromycin 1 g PO x one dose
-fluctuant lymphadenopathy - needle aspiration, drainage prevent spontaneous rupture

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25
Q

What is lymphogranuloma venereum?

A

an ulcerative disease of the genital area

26
Q

What are the characteristics of LGV?

A
  • it is an uncommon, sexually transmitted infection
  • it is transmittable by vaginal, oral, or anal sex
  • its cause is the gram-negative bacteria chlamydia trachomatis, especially serotypes L1, L2, and L3
  • primary infection of lymphatics and lymph nodea
  • RF: MSM (unprotected receptive anal intercourse), HIV, HCV
27
Q

What are the three stage s of LGV infection?

A

primary, secondary, and late

28
Q

What is primary stage characteristics?

A

characterized by the developmental of painless genital ulcer or papules

29
Q

What is the secondary stage characteristics?

A

with the developmental of unilateral or bilateral tender inguinal and/or femoral lymphadenopathy (also called buboes)

30
Q

What is the late-stage characteristics?

A

with strictures, fibrosis, and fistulae of the anogenital area

31
Q

How is LGV dx?

A

diagnosis is by clinical suspicion

  • other causes of genital ulceration and inguinal adenopathy should be excluded = serologic testing for syphilis - RPR/VDRL
  • the basic for a definitive diagnosis of LGV is on serology tests (complement fixation or micro-immunofluorescence) or identification of Chlamydia trachoma’s in genital, rectal and lymph node specimens
  • men who have sex with men who have signs and symptoms of proctocolitis should receive testing for LGV
  • in these patients testing of rectal specimens with nucleic acid amplification test is the preferred approach
  • HIV testing should be consideration in patients with sexually transmitted infection
32
Q

What is the tx of LGV?

A

the recommended treatment regimen is doxycycline 100 mg orally twice a day given for 21 days

  • an alternate regimen is erythromycin 500 mg orally four times a day given for 21 days
  • azithromycin 1 gram orally once weekly for three weeks is also an affective alternative regimen
  • all patients who are suspected of having LGV (either Genito-ulcerative disease with lymphadenopathy or proctocolitis) should be empirically treated for LGV before an official diagnosis is certain
  • pregnant patients can have treatment with erythromycin
  • doxycycline and other tetracyclines should be avoided in pregnancy due to the risk of disruption of bone and teeth development
  • patients who have fluctuant or pus-filled buboes can benefit from aspiration of the node, which provides symptomatic relief, although incision and drainage of the nodes are not recommended as it can delay the healing process
33
Q

What is pelvic inflammatory disease?

A

infection that ascends from the cervix or vagina to involve the endometrium and or the fallopian tubes

34
Q

What are the causative agents of pelvic inflammatory disease?

A

gonorrhea and chlamydia

35
Q

What are the common symptoms of pelvic inflammatory disease?

A 
chandelier sign (cervical motion tenderness) 
-common symptoms include: infertility, ectopic pregnancy, tubo-ovarian abscess (adnexal mass)
36
Q

What are the complications from pelvic inflammatory disease?

A

infertility, ectopic pregnancy, tubo-ovarivan abscess (adnexal mass)

37
Q

How is pelvic inflammatory disease dx?

A

clinical findings suggest by direct abdominal tenderness, cervical motion tenderness, and adnexal tenderness plus one or more of the following

  • Temperature >38 C
  • WBC count > 10,000/mm3
  • pelvic abscess found by manual examination or ultrasonography
38
Q

What is the outpatient tx for pelvic inflammatory disease?

A

ceftriaxone IM 250 mg once + PO doxycycline 100 mg BID x 14 d + PO Flagyl 500 mg BID x 14 d

39
Q

What is the inpatient tx of pelvic inflammatory disease?

A
  • severely ill or nausea and vomiting precludes outpatient management
  • consider hospitalization if the diagnosis is uncertain, ectopic and appendicitis cannot be tulles out, pregnancy, pelvic abscess suspected, HIV positive, unable to follow or tolerate outpatient regimen, or failed to respond to outpatient therapy
  • doxycycline + IV cefetetan or cefoxitin x 48 hours until the condition improves, then PO doxycycline 100 mg BID x 14 day
  • clindamycin + gentamicin daily, if normal renal function, x 48 h until the condition improves, then PO doxycycline 100 mg BID x 14 days
40
Q

What is syphilis caused by?

A

caused by the spirochete Treponema palladium and has increased in incidence over the last ten years

41
Q

What is syphilis associated with?

A

risk-taking behavior such as drug use

42
Q

How long is incubation period for syphilis?

A

about three weeks

43
Q

What are the characteristics of primary syphilis?

A

presents as a painless ulcer (chance) in the genital or groin region persisting 3 to 6 weeks

44
Q

What are the characteristics of secondary syphilis?

A

presents as an erythematous rash involving the plasma and soles or a condyloma late, which is similar to the lesions of primary syphilis in its infectivity but differs in appearance

45
Q

What are the characteristics of tertiary syphilis?

A

(latent)
affects about 30% and is a representation of widespread systemic involvement and can present with major vessel changes, such as in the aorta, permanent CNS changes (neurosyphilis) or even benign mucosal growths called gammas

46
Q

How is syphilis dx?

A

RPR/VDRL and confirmed by the treponema antibody-absorption test (FTA-ABS)
-lyme disease can cause a false positive

47
Q

What is the tx of syphilis?

A

Benzathine PCN G, 2.4 million units IM x one dose for primary and secondary disease

  • additional doses if the infection has been for >1 year or if the patient is pregnant
  • if the patient is penicillin-allergic, treat with doxycycline
  • IV penicillin G (for Gummas) for congenital and late disease
48
Q

What is most common cause of vaginitis?

A

candida vaginitis

49
Q

What are the symptoms of candida vaginitis?

A

clumpy or cheesy vaginal discharge, pruritus, dysuria, burning, dyspareunia, vaginal or vulvar edema, and erythema

50
Q

What are the predisposing factors of candida vaginitis?

A

diabetes, oral contraceptives, and antibiotics

51
Q

How is candida vaginitis dx?

A

KOH branching hyphae

-pH < 4.5 (acidic)

52
Q

What is the tx of candida vaginitis?

A

oral fluconazole (diflucan) 150 mg PO x 1 then repeat in 7 days

  • topical clotrimazole (gene-lotrimin)
  • topical trioconazole (monistat)
  • in severe infections (generally hospitalized patients), amphotericin B, caspofungin, or voriconazole may be used
53
Q

What is the causative agent of bacterial vaginosis?

A

Gardnerella (anaerobic bacteria)

54
Q

What are the physical examination findings of bacterial vaginosis?

A

a frothy, grayish-white, fishy-smelling vaginal discharge is noted

55
Q

How is bacterial vaginosis dx?

A

“clue cells”, which are epithelial cells with bacilli attached to their surfaces,

  • on saline wet mount adding 10% KOH of the discharge produces a fishy odor (+whiff test)
  • pH >4.5 (bacteria = basic)
56
Q

What is the tx of bacterial vaginosis?

A

first-line treatment is metronidazole (flagyl) either orally or vaginally

  • metronidzole oral 500 mg PO BID x 7 days
  • metronidazole gel 0.75%: 5 g intravaginally daily x 5 days
  • clindamycin 2% cream: 5 g intravaginally QHS x 7 days
  • second-line treatment
  • clindamycin
  • tablets: 300 mg PO BID x 7 days
  • vaginal suppositories 100 g intravaginally QHS x 3 days
  • bioadhesive cream 2%: 5 g x 1 dose

-drug therapy with metronidazole, alcohol should not be consumed

57
Q

What are the symptoms of Trichomonas Vaginitis?

A
  • greenish gray frothy vaginal discharge with mild itching

- sexual active women

58
Q

How is Trichomonas Vaginitis dx?

A

hallmark pelvic exam finding in 20% of trichomonas infections is petechiae on the cervix (also known as a “strawberry cervix”)
-the presence of mobile and pear-shaped protozoa with flagella on wet mount

59
Q

What is the tx of Trichomonas Vaginitis?

A

metronidazole 2 g PO x 1 dose

-sexually transmitted, therefore the partner must also be treated

60
Q

What are the symptoms of atrophic vaginitis?

A
  • irritation, dryness, painful intercourse, increased UTIs, urinary intercourse
  • recurrent UTI despite treatment
61
Q

How is atrophic vaginitis dx?

A

can diagnose on vaginal exam - thin, pale appearing mucosa - diagnosis of exclusion in postmenopausal women

62
Q

What is the tx of atrophic vaginitis?

A

with topical estrogen creams

  • conjugated estrogens vaginal creams (0.625 mg/g) 0.5 - 2 g vaginally daily for three weeks, then tapered to lowest effective dose twice weekly, administer cyclically (3 weeks on, one week off)
  • can give oral HRT if no contraindication
  • non-hormonal vaginal moistures

Women's Health EOR (10 decks)

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