infections part 2 Flashcards
What is the causative pathogen for a Chancroid?
Haemophilus ducreyi- Gram negative rod
What PE finding will you see in about half of patients with chancroid?
There will also be marked lymphadenopathy in the inguinal chain
Dx of chancroid?
Gram stain, Culture and biopsy used in combination because of the high false negative rates
Tx for chancroid in the genital area?
Ceftriaxone 250mg IM x 1dose
If someone has a chancroid and a fluctuant lymphadenopathy what should you do?
Needle aspiration to prevent spontaneous rupture
What is lymphogranuloma venereum (LGV)
This is an ulcerative disease of the genital area
What pathogen causes LGV?
Chlamydia trachomatis especially serotypes L1, L2, and L3
What are some risk factor for contracting LGV?
MSM
HIV
HCV
How many stages are there with LGV? Describe them.
3 stages
Stage 1- development of painless genital ulcer or papules
Stage 2- Development of unilateral or bilateral tender inguinal and/or femoral lymphadenopathy
Stage 3- strictures, fibrosis, and fistulae of the anogenital area
How do you diagnose LGV?
Really made by clinical suspicion but should do serological testing to rule out syphilis
What is the Tx for LGV?
Doxycycline 100mg orally twice a day given for 21 days
What are some other options for tx LGV other than doxy?
An alternate regimen is erythromycin 500 mg orally four times a day given for 21 days
Azithromycin 1 gm orally once weekly for three weeks is also an effective alternative regimen
If a woman is pregnant and has LGV how should you tx her?
well dont give doxy, she can be given erythromycin
Where does the infection that causes PID usually come from, like what gets infected first?
Infection usually ascend from the cervix or vagina to involve the endometrium and or the fallopian tubes
What are two primary causative agents of PID?
Gonorrhea and Chlamydia
If someone has tenderness with motion of the cervix this is called what sign?
Chandelier sign
If a women who is sexually active reports fever, pelvic pain and vaginal discharge what should you think and want to rule out?
PID
What is the main/worst complication with PID
Infertility
List some clinical findings with PID?
abdominal tenderness, cervical motion tenderness, and adnexal tenderness plus one or more of the following:
Temperature > 38°C
WBC count > 10,000/mm3
Pelvic abscess found by manual examination or ultrasonography
What is the tx for PID?
outpatient: Ceftriaxone IM 250mg once along with doxycyline 100mg x 14days can add flagyl is she is prone to yeast infections with antibiotic use
For inpatient treatment for PID what are your two options?
Doxycycline + IV cefotetan or cefoxitin × 48 h until the condition improves, then PO doxycycline 100 mg BID × 14 d
Clindamycin + gentamicin daily, if normal renal function, ×48 h until the condition improves, then PO doxycycline 100 mg BID × 14 days
What is the Tx for syphilis?
Benzathine PCN G, 2.4 million units IM × one dose for primary and secondary disease
How do you diagnose syphilis?
RPR/VDRL and confirmed by the treponemal antibody-absorption test (FTA-ABS).
What can cause a false positive while testing for syphilis?
Lyme disease
if someone is penicillin allergic but has syphilis and needs to be treated what can you use?
doxycycline
Clumpy or cheesy vaginal discharge, pruritus burning, vaginal or vulvar edema and erythema makes you think of what?
Candida vaginitis
How do you Dx candida vaginitis?
KOH showing budding hyphae, with PH <4.5 acidic
Tx for candida?
oral fluconazole 150mg po x1 then repeat in 7 days
if someone wants a topical cream to tx candida what can they use?
Topical clotrimazole (Gyne-Lotrimin) Topical tioconazole (Monistat)
This type of vagina grossness is caused by Gardnerella?
BV
What would you expect to see on PE with someone w/BV?
Frothy, grayish-white fishy-smelling vaginal discharge
When evaluating epithelial cells for someone you suspect to have BV what would you see?
Clue cells
What is the amine Criteria to dx BV?
Thin, homogenous vaginal discharge. Vaginal pH greater than 4.5. Positive whiff test (fishy amine odor when 10 percent potassium hydroxide solution is added)
What is the first line treatment for BV?
Metronidazole oral 500mg PO bid x 7days
What is second line tx for BV?
Clindamycin
Tablets: 300 mg PO b.i.d. × 7 days
Vaginal suppositories 100 g intravaginally QHS × 3 days
Bioadhesive cream 2%: 5 g × 1 dose
What should someone not do when being trated with the first line therapy for BV?
Not drink as single thing
Greenish gray frothy vaginal discharge with mild itching is suspicious for what?
Trichomonas
What would you see on microscopy for trich?
mobile and pear shaped protozoa with flagella
Tx for Trich?
Metronidazole 2g PO x 1 dose
Should the partner of someone with trich also be treated?
Yes yes they should
woman in her 50s presents with Irritation, dryness, painful intercourse, increased UTIs, urinary incontinence, what do you suspect
atrophic vaginitis
Tx for atrophic vaginitis?
Conjugated estrogens vaginal cream
