Infections of the Lower Female Reproductive Tract Flashcards
Top diagnosis of dysuria, urinary urgency, and frequency?
UTI
What UA findings are seen with with UTI
Hematuria, leukokcytes, leukocyte esterase, or nitrates in absence of vaginal infection
What organisms cause UTIs
E coli (80-85%) Staph saprophyticus klebsiella proteus mirabilis enterococcus
Treatment for UTI
Oral antibiotics and f/u culture sensis
initial - bactrim, nitrofurantoin, fluoroquinolone for 3-7 days
for Pyelo, treat inpatient with IV abx, or 14 days outpatient
Most common cause of vulvitis (and often vulvar pruritis)
Candidiasis
What are the typical causes of primary vulvar ulcers?
STIs such as herpes, syphilis, chancroid, and lymphogranulosum venereum
What is syphilis caused by and what are the stages?
Treponema pallidum (spirochete)
Primary: Painless, red, round, firm 1 cm ulcer = chancre
Secondary: Systemic, 1-3 months after primary resolves, flu-like with fevers/myalgias. Classic maculopapular rash on palms/soles
Latent
Tertiary: granulomas (gumma) of skin and bones, syphilitic aortitis, neurosyphilis with meningovascular, paresis, tabes dorsalis
Diagnostic tests for syphilis?
VDRL, RPR, FTA-ABS
Treatment for syphilis?
Penicillin G, 2.4 mil units IM one time
For late latent, Pen G once a week for 3 weeks
If allergic, can give 14 days doxy, 100 mg bid
For tertiary (neurosyphilis) need IV Pen G, 3-4 mil u q4 hr for 10-14 days (if allergic, requires desensitization)
What complication can occur after syphilis treatment?
Jarisch-Herxheimer rxn = acute febrile
fevers, chills, myalgia, pharyngitis, rash 24 hours after treatment
Presentation of herpes?
Initial flu-like symptoms, vaginal burning and pruritis, then multiple clear vesicles that evolve into painful genital ulcers
Complications of herpes
Shedding occurs in first 6 months after primary infection, and immediately before or after recurrences
Neonatal herpes is devastating, vaginal exam must be done before delivery and if lesions are present then do c-section
Testing for herpes?
Tzanck smear showing multinucleated giant cells
Viral cultures
HSV DNA PCR
Treatment for herpes?
Primary: acyclovir, famciclovir, valacyclovir for 7-10 days
Severe = IV acyclovir
can use acyclovir for prophylaxis
What organism causes chancroid lesions?
Haemophilus ducreyi
What must you also test for if you see chancroid lesions?
HIV because chancroid is a cofactor for HIV transmission
Presentation of chancroid?
Painful, demarcated, nonindurated ulcure often with painful suppurative infuinal lymphadenopathy
How is chancroid diagnosed?
Clinically because testing is poor
R/o other sources of infection
Treatment of chancroid
ceftriaxone 240 mg IM once
azithromycin 1 g PO once
cipro 500 mg PO bid for 3 days
erythromycin 500 mg qid for 7 days
What is lymphogranuloma venereum caused by?
chlamydia (c tracomatis)
What are the stages of LGV?
Primary - painless local lesion
Secondary (inguinal syndrome) = painful inflammation and enlargement of inguinal nodes
Tertiatry = rectal involvement, anal pruritis and mucous anal discharge, elephantitis, RV fistula
Treatment of LGV?
Doxy 100 mg bid 21 days
What are the causes of nonulcerative lesions
Condyloma acuminata Molluscum cantagiosum Phthirus pubis Sarcoptes saciei Folluculitis (staph aureus)
Treatment for condylomas
Caused by HPV
Local excision, cryotherapy, topical trichloroacetic acid, topical 25% podophyllin, 5-FU cream
CO2 laser or surgical excision
Pox virus causes what kind of skin lesion?
Molluscum contagiosum
Molluscum contagiosum has what characteristic appearance?
Small, domed lesion with umbilicated center
Diagnosis and treatment of molluscum?
Wright stain or Giemsa stain, biopsy
local excision or trichloroacetic acid
Phthirus pubis (crab louse) and sarcoptes scabiei (itch mite) have what differences?
P pubis = pediculosis, usually confined to pubic hair
scabies = spread throughout body
What is the treatment for pediculosis and scabies?
pediculosis = Site specific topical permethrin cream scabies = whole body permethrin cream or ivermectin
What is the cause, diagnosis,and treatment of BV?
Loss of lactobacillus dominance –> Gardnerella vaginalis
increased vaginal discharge with “fishy amine odor”
Diagnosis (3 of the following): whiff test (10% KOH), thin white coating discharge, pH>4.5, presence of clue cells
Treatment = metronidazole (avoid alcohol) or clinda
Yeast infections: cause, diagnosis, treatment
Candidiasis (candida albicans)
Vulvar edema and erythema with scant discharge
White adherent plaques
Diagnosis = visualization of branching hyphae in KOH
Treatment: azoles (miconazole, terconazole), nystatin suppositories, oral fluconazole
600 mb boric acid capsules in vagina for non candica albicans species
What is the most common protozoan causing vaginal infection?
Trichomonas vaginalis
How to diagnosis and treat T vaginalis?
Profuse yellow, gray, or green discharge with unpleasant odor
Characteristic strawberry cervix
diagnosis: wet prep showing protozoan, culture is most s/s study
treatment: metronidazole 3 g orally
Most common organisms causing cervicitis?
Gonorrhea and chlamydia
What is cervicitis?
CMT without other symptoms of PID
Gonorrhea diagnosis and treatment?
Gram-negative diplococci
NAAT (nucleic acid amplification test)
Treatment: ceftriaxone or cefixime once
Gonorrhea in neonates can cause what?
Conjunctivitis
Chlamydia characteristics?
Can cause ocular, respiratory, and repro tract infections
Typically asymptomatic
Annual screening recommended
Treatment: azithro once, or 7 days doxy
