Infections of the Genital Tract Flashcards
3 common causes of vaginitis
- bacterial vaginosis*
- vulvovaginal candidiasis*
- trichomoniasis
*=not sex transmit
In repro age women, predominant organism within vagina?
lactobacilli
dec vaginal pH: 3.5-4.5
pH < 4.5 (normal range) suggests
yeast infection
pH >4.7
bacterial vaginosis*
amine “whiff” test
- fishy odor that results when a drop of KOH is mixed in with discharge
- suggests dx of BV
Wet mount
slide of discharge mixed w/ saline and on other side mixed w/ KOH
Clue cells
bacteria studded w/ squamous epithelial cells –> BV
motile protozoa
trichomoniasis
spaghetti and meatballs
hyphae and budding yeast –> candidiasis
vulvovaginal candidiasis tx
topical antifungals
bacterial vaginosis
polymicrobial infection, lack of H2O2-producing lactobacilli –>overgrowth of anaerobic organisms
gardneraella vaginalis found w/ greater freq
thin, watery discharge
fishy odor
Amsel’s criteria
for bacterial vaginosis (need 3/4)
- abnormal gray discharge
- vaginal pH > 4.5
- positive amine “whiff” test
- more than 20% of epithelial cells being clue cells
Nucleic acid amplifcation tests (NAAT)
high sensitivity for bacterial vaginosis, chlamydia
bacterial vaginosis tx
5 – night course of intravaginal metronidazole or clindamycin
or
7-day course of oral metronidazole
Vaginal trichomoniasis sx
discharge, itching, burning, or postcoital bleeding
Vaginal trichomoniasis transmission
sexually transmitted infection caused by parasitic protozoan, Trichomonas vaginalis
Vaginal trichomoniasis dx
based on seeing the moving trichomonads on saline microscopy
based on seeing the moving trichomonads on saline microscopy. tx
oral metronidazole
TX PARTNER TOO
metronidazole can cause a ____-like effect
disulfram-like (Antabuse) effect when alcohol is ingested resulting in nausea, vomiting, headaches, and sweating
most comm bacterial STI in US
Chlamydia
Most non-gonococcal urethritis (NGU) in a male patient is caused by
Chlamydia trachomatis
chlamydia
vaginal discharge, post-coital bleeding, or dyspareunia
majority=ASYMPTOMATIC
untreated chlamydia puts women at high risk for
pelvic inflammatory disease
high risk of recurrence/reinfection
BV
chlamydia
many polymorphonuclear cells with gram negative intracellular diplococci which looks like a pair of kidney beans
Neisseria gonorrhea
Gonorrhea primary affects the mucous membranes of the
lower genital tract
gonorrhea in men, main sx
urethritis
gonorrhea in women, main sx
often asymptomatic
polymigratory arthralgias in knees or elbows
Disseminated gonococcal infection (DGI)
occurs in untreated chlamydia pt
pelvic inflammatory disease (PID) etiology
-female repro tract, begins in cervix –> peritoneal cavity –> peritonitis –> agglutination –> pelvic adhesive disease –> chronic pain, infertility, ectopic preg
known etiologic agents of PID
Neisseria gonorrhea and Chlamydia trachomatis
PID presumptive dx
should be made and the patient treated for PID for any sexually active women presenting with…
- abdominal or pelvic pain
- either cervical motion tenderness, fundal tenderness and/or adnexal tenderness on exam
- if no other cause for her pain is found.
lymphogranuloma venereum (LGV)
- caused by type “serovars of Chlamydia trachomatis”
- genital ulcer which progresses into a lymphatic infection with associated inguinal abscesses (buboes) and systemic illness
groove sign
lympgranuloma venereum (LGV)
regional inguinal lymph nodes become exquisitely tender/erythematous
fevers/chills/malaise/HA/weight loss
late lymphogranuloma venereum (LGV)
genital elephanitsis
lymphogranuloma venereum (LGV) tx
3 week course of doxycycline
chancroid
- causes ulcerative genital disease
- low income
- erythema w halo
chancroid natural history
begins as tender papule –> ulcerates –> ragged with erythematous halo
ulcers can bleed easily, merge and form serpingious ulcers
no tx –> bubo formation –> sinus tract formation
chancroid dx
clinical dx
-painful genital ulcers, tender lymphadenopathy, and negative testing for HSV or syphilis
large numbers of gram negative coccobacilli in a “school of fsh” pattern
Hemophilus ducreyi –> CHANCROID
chancroid
azithromycin or cefriaxone (single dose therapy)
granuloma inguinale
Donovanosis
- chronic, progressive, ulcerative
- painless papule –> ulcerates to form an exuberant, beefy red ulcer w/ satin-like surface and easy bleeding
-cliniical + histo of Donovan bodies
lymphogranuloma venereum vs Granuloma inguinale
both can lead to elephantiasis
constitutional sx absent in Granuloma inguinale
Donovan bodies
gold standard for Granuloma inguinale
Granuloma inguinale tx
doxycycline
HSV-1 transmission
oral
HSV-2
contact with genital secretions
HSV lesion
painful, thin-walled vesicle on an ingammatory base
primary HSV sx
fever, malaise, anorexia, and tender bilateral inguinal adenopathy
HSV maintained in a repressed state in neurons
“latency”
- transcription of only a few proteins
- activ of entire genome can occur –> full transcription, viral release, etc
recurrence of HSV?
common
recurrent episodes are usually associated with less severe symptoms than the primary infection and can even be asymptomatic
dx of HSV
PCR
culture (1 vs 2)
serology
Tzanck prep
Tzanck prep
The presence of multinucleated giant cells indicates infection with a herpes virus (“ground glass” appearance)
low sensitivity
no 1 vs 2 distinguish
multinucleated giant cells indicates infection with a ____ virus (“ground glass” appearance)
herpes
HSV tx
acyclovir for outbreaks
-need to tx recurrences EARLY ON
HSV and pregnancy
neonatal HSV –> sepsis, encephalitis, DIC
spontaneous abortion, congenital HSV manifestations
If the pregnancy patient has no symptoms suggestive of HSV outbreak or lesions on exam, ____________ is recommended to avoid neonatal exposure.
cesarean delivery
high risk HPV
cervical dysplasia and cervical cancer
low-risk HPV
condyloma acuminata
condyloma tx
excisional or ablative techniques (TCA)
Treponema pallidum
tight coil spirochete
–> SYPHILIS (variety of system affected)
highly infectious stage of syphillis
primary syphilus
painless ulcer and painless lymphadenopathy
90% secondary syphilis patients develop
a rash
punched out tissue
made up of granulation and yellow slough
tertiary syphilis
Findings of neurosyphilis include:
meningovascular syphilis
tabes dorsalis
general paresis
syphilitic otitis
syphilis dx
RPR
VDRL
primary and secondary syphilis tx
benzathine penicillin
scabies transmission
intimate personal contact, often sexual in nature, but casual contact or contact with fomites may be adequate for transmission. Institutional epidemics can occur.
public louse
- pediculosis pubis
- highly infectious
- severe itching/low-grade fever/constitutional
- dx on inspection
tertiary/neurosyphilis tx
IV penicillin
molluscum contagiosum
caused by moderately infectious DNA pox virus
diffuse papule distinguished by central umbilication
Henderson-Patterson bodies
Henderson-Patterson bodies
molluscum contagiosum
scabies
- Sarcoptes Scabiei
- itching most severe at night
- worldwide, all rases/SES
- erythematous papules/excoriations classically seen in webbed spaces of fingers
scabies tx
Permethrin cream
Ivermectin oral
pubic louse tx
Permethrin cream
similar to scabies
