Infections of the Lower Female Reproductive Tract

Question 1

Common causes of UTIs:

Answer 1

• E. coli (85%)
• Staph saprophyticus
• Klebsiella
• Enterococcus
• Proteus

Question 2

Initial treatment of uncomplicated UTI (3):

Answer 2

oral antibiotics, 3-7 days

• Bactrim
• Nitrofurantoin
• Fluoroquinolones

Question 3

Most common cause of vulvitis:

Answer 3

Candidiasis

Question 4

Presentation of primary syphilis:

Answer 4

Painless, red, round, firm ulcer with raised edges (chancre); self-resolving

Question 5

Presentation of secondary syphilis:

Answer 5

• Develops 1-3 months after 1’ syphilis resolves
• Flu-like symptoms (fever, myalgias)
• Maculopapular rash on palms and soles

Question 6

Presentation of tertiary syphilis:

Answer 6

• Granulomas (gumma) of skin and bones
• Cardiovascular syphilis (aortitis)
• Neurosyphilis

Question 7

Testing for syphilis:

Answer 7

• Initial: nontreponemal cardiolipin Ab (VDRL/RPR)

- Confirmation: fluorscent treponemal Ab absorption (FTA-ABS), T. pallidum particle agglutination assay (TPPA)

Question 8

Treatment of syphilis:

Answer 8

• 1’/2’/early latent: Benzathine penicillin G IM once
• Late latent: Benzathine penicillin G IM weekly x 3 weeks
• Neurosyphilis: PCN IV q4 10-14d
• Alternatives: doxy, tet, ceftriaxone, azithro

Question 9

Best method for testing for HSV:

Answer 9

Type-specific Ab for HSV1/HSV2 IgG

Question 10

Manifestations of stages of LGV (chlamydia):

Answer 10

• 1’: local lesion (papule or shallow ulcer)
• 2’: painful inflammation and enlargement of inguinal nodes
• 3’: protocolitis, rectal stricture, rectovaginal fistula

Question 11

Treatment for LGV (c. trach L1/L2/L3):

Answer 11

doxycycline, erythromycin