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
