infections (non pregnancy) Flashcards
indications for hospitalization for PID
- Pregnancy
- failed outpatient treatment
- inability to tolerate oral medications
- non compliant
- severe presentation (high fever, vomiting
- complications (eg. tubo-ovarian abscess, perihepatitis)
outpatient regimen fof PID
- IM ceftriaxone + oral doxycycline
inpatients regimen for PID
IV cefoxitin or cefotetan plus oral doxycycline or parental IV clincamycin plus gentamicin
Septic pelvic trombophlebitis - RF
- cesarean
- pelvic surgery
- endometritis
- PID
- pregnancy
- Malignancy
Septic pelvic trombophlebitis - pathophys
hypercoagulability
pelvic venous dilation
vascular trauma
infection
Septic pelvic trombophlebitis - presentation
- fever unresponsive to antibiotics
- no localised signs/symptoms
- negative infectious evaluation
- diagnosis of exclusion
Septic pelvic trombophlebitis - treatment
anticoagulation
broad spectrum antibiotics
Gonococcal pharyngitis
fever, and lower abdominal pain (associated with PID)
–> non tender cervical lymphadenopathy
infectious genital ulcer - ddx
painful: HSV, H. ducreyi (chancroid)
painless: syphylis, Chlamydia trachomatis L1-L3)
how to confirm genital HSV
PCR
2nd line: culture or Tzank smear
genital hsv vs H. ducrey on presentation
HSV –> small vesicles or ulcers on erythematous base, Mild lymphadenopathy
ducrey –> larger, deep ulcers with gray/yellow exudare, well demarcated, SEVERE lymphadenopathy that may suppurate
HPV infection - vaccination?
yes –> do the vaccine
non pregant women with syphilis and allergy to penicillin
doxicycline
staph toxic shock syndrome - risks
tampon use
nasal packing
surgical/postpartum wound infection
staph toxic shock syndrome - mechanism
S. aureus –> exotoxin (superantigen)
staph toxic shock syndrome - clinical features
- fever (39 or more)
- HYPOTENSION
- DIffuse macular rash (palms + soles)
- desquamation 1-3 wks after disease onset
- vomiting diarrhea
- altered mental status (no focal signs)
staph toxic shock syndrome - treatment
supportive therapy
removal of foreign body
antibiotic (eg. clindamycin + vanco
chlamydia and gonorr - treatment
empiric: azytthro + ceftriaxone
confirmed chlamy only: azythromycin
confirmed gonorh only: azith + ceftriaxone (due to increasing resistance to cephalosp)
condylomata acuminata - etiology / prevention
HPV 6, 11
vaccination, barrier contraception
condylomata acuminata - clinical features
multiple pink or skin-colored lesions
lesions ranigng from smooth, flattened papules to exophytic/cauliflower like growths
condylomata acuminata - treatment
chemical: podophyllin resin, trichloroacetic acid
immunologic: imiquimod
surgical: cryotherapy, laser, excision
condylomata lata - how to differentiate them from acuminata
lata are flat, velvety lesions –> broader base and flatter surface and are lobulated or plaque-like
characteristics of ulcerative STD - diseases and agents
Chancroid - h. ducreyi
Genital herpes - HSV 1 + 2
Granuloma inguinale (donovanosis) - Klebsiella granulomatis
syphilis - Treponema pallidume
Lymphogranuloma venereum - C. trachomatis
syphilis - features of primary lesion
single, indurated welll circumscribed ulcer
clean base
Lymphogranuloma venereum - features of primary lesion
small shallow ulcers
large painful coalsesced inguinal lumph nodes (buboes)
Granuloma inguinale - features of primary lesion
extensive + progressive ulcerative lesions without lymphadenopathy
base may have granulation like tissue
gram negative intracytoplasmic cysts (donovan bodies)
chancroid - features of primary lesion
multiple + deep ulcers
base may have gray to yellow exudate
organism often clump in long parallel strands
genital herpes - features of primary lesion
multiple small grouped ulcers
shallow with erythematous base
sms often clumg in long parallel stands
syphilis - treponemal vs nontreponemal
- nontreponemal (RPR, VDRL: anti-cardiolipine, quantitive, decreased titers confirm treatment, possbile FN in early infection
- Treponemal (FTA-ABS): anti-treponemal, qualitive, greater sensitivity in early, positive after treatment
recommendations for chlamydia and neisseria screening fo women
anual in all sexually active women age under 25 and 25 or older with risk factors
a risk factor for bacterial vaginosis
douching
tubo-varian abscess (complication of PID) - presentation
fever, abd pain, COMPLEX MULTILOCULATED ADXENAL MASS WITH THICK WALLS AND INTERNAL DEBRIS ON u/s, ELEVATED LEUKOCYTOES, ELEVATED ca125 + crp
