Infections of the Lower female reproductive tract Flashcards
how to ID a contaminated urine sample?
high amts of bacteria but no pyuria
what are the 5 most common organisms causing UTIs
E. coli S. saprophyticus Proteus Klebsiella Enterococcus
what dx should you consider if pt has dysuria & urinary frequency but a negative urine cx?
interstitial cystitis
what are the initial abx chosen for UTI?
ampicillin
TMP-SMX
macrodantin
cephalexin
what is most common cause of vulvitis?
candidiasis
how can Crohn’s disease present on vulva?
kinfe-cut ulcers
syphillis vs. herpes vs. chancroid vs. LGV - painful or not?
syphilis & LGV are not painful
HSV and chancroid are.
syphillis vs. herpes vs. chancroid vs. LGV - # of lesions?
syphilis & LGV are a single papule
HSV is multiple vesicles
chancroid is 1-3 papules/pustules
causative organism for syphilis?
Treponema pallidum
initial test for syphilis?
dark field microscopy of material expressed from lesion.
RPR/VDRL
primary vs. secondary vs. tertiary syphilis:
primary = painless, red, round, firm ulcer on genitals
secondary = maculopapular rash on skin, mucous mems, palms & soles
tertiary syphilis = gummas (granulomas of skin & bones), aortitis, neurosyphilis, tabes dorsalis (degradation of dorsal columns)
when does the latent period of syphils happen?
after the second stage. Can remain latent for years.
tx for syphilis?
benzathine PCN
IV if its neurosyphillis
what can occur a few hours after tx of syphilis?
Jarisch-Herxheimer rxn - malaise, fever, HA, pharyngitis, rash
(also occurs w/tx of other spirochete infections - Lyme)
CP of genital herpes:
first flu-like sx’s, nausea, diarrhea, fever
vulvar burning & pruritis, then painful vesicles which ulcerate
mgt of pg women w/HSV?
if active outbreak, deliver via c/s
dx of HSV?
Tzanck smear, look for multinucleated giant cells
viral cultures
tx of HSV
acyclovir to decrease length of infection & viral shedding. But no definitive “cure.”
causative organism of chancroid
Haemophilus ducreyi
CP of chancroid:
a single or multiple painful, demarcated, non-indurated ulcer
painful inguinal LAD
how to dx chancroid:
hard to cx. R/o other causes
tx of chancroid:
ceftriaxone, or azithromycin/erythromycin, or ciprofloxacin, or TMP-SMX. Treat partners.
causative organism of lymphogranuloma vereneum?
Chlamydia trachomatis (L-serotypes)
stages of LGV?
primary - painless, transient papule or shallow ulcer
secondary = painful inguinal LAD, fever, HA, malaise, anorexia
Tertiary = anal pruritis, rectal discharge, proctocolitis, rectal stricture, rectovag fistula, elaphantiasis
tx of LGV
doxycycline
ddx of non-ulcerative genital lesions:
folliculitis (S. aureus)
condyloma
MC
tx of condylomas
local excision cryotherapy trichloroacetic acid podophyllin 5-FU cream
repeated weekly until gone
imiquimod
podofilox
CO2 laser to vaporize
diff b/w scabies & crabs
scabies can spread anywhere. crabs (pediculosis) is confined to pubic hair
why is the vagina acidic?
b/c lactobacillus produces acid, maintains pH < 4
how does BV happen?
a shift in bacterial flora in vagina => pH change. Gardnerella vaginalis is most common org found in cx.
how does BV affect pg’y?
ass’d w/preterm birth
dx of BV
fishy odor wet prep shows elevated pH (5-6) clue cells whiff test (addition of KOH) cx for Gardnerella, Bacteroides, other anaerobes
tx of BV
metronidazole or clindamycin
don’t take alcohol when using metronidazole (disulfiram reaction - makes acetaldehyde accumulate)
CP of candidiasis
vulvar edema & erythema
scant discharge
some pts have char’ic white plaques or cottage cheese discharge
tx for trichomoniasis
metronidazole once PO
general transmission rates of gonococcal infection?
much easier for men to give it to women than for women to give it to men
tx of gonococcal infection?
ceftriaxone + doxycycline or azithromycin (cover chlamydia)
why is prevalence of chlamydia so high?
earlier age of first sexual encounter, greater # sexual partners
both sexes can be asx’c carriers (bad for women…can => undx’d PID)
tx of chlamydia
doxycycline or azithromycin
if pregnant, erythromycin
