infections part 2

Question 1

What is the causative pathogen for a Chancroid?

Answer 1

Haemophilus ducreyi- Gram negative rod

Question 2

What PE finding will you see in about half of patients with chancroid?

Answer 2

There will also be marked lymphadenopathy in the inguinal chain

Question 3

Dx of chancroid?

Answer 3

Gram stain, Culture and biopsy used in combination because of the high false negative rates

Question 4

Tx for chancroid in the genital area?

Answer 4

Ceftriaxone 250mg IM x 1dose

Question 5

If someone has a chancroid and a fluctuant lymphadenopathy what should you do?

Answer 5

Needle aspiration to prevent spontaneous rupture

Question 6

What is lymphogranuloma venereum (LGV)

Answer 6

This is an ulcerative disease of the genital area

Question 7

What pathogen causes LGV?

Answer 7

Chlamydia trachomatis especially serotypes L1, L2, and L3

Question 8

What are some risk factor for contracting LGV?

Answer 8

MSM
HIV
HCV

Question 9

How many stages are there with LGV? Describe them.

Answer 9

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

Question 10

How do you diagnose LGV?

Answer 10

Really made by clinical suspicion but should do serological testing to rule out syphilis

Question 11

What is the Tx for LGV?

Answer 11

Doxycycline 100mg orally twice a day given for 21 days

Question 12

What are some other options for tx LGV other than doxy?

Answer 12

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

Question 13

If a woman is pregnant and has LGV how should you tx her?

Answer 13

well dont give doxy, she can be given erythromycin

Question 14

Where does the infection that causes PID usually come from, like what gets infected first?

Answer 14

Infection usually ascend from the cervix or vagina to involve the endometrium and or the fallopian tubes

Question 15

What are two primary causative agents of PID?

Answer 15

Gonorrhea and Chlamydia

Question 16

If someone has tenderness with motion of the cervix this is called what sign?

Answer 16

Chandelier sign

Question 17

If a women who is sexually active reports fever, pelvic pain and vaginal discharge what should you think and want to rule out?

Answer 17

PID

Question 18

What is the main/worst complication with PID

Answer 18

Infertility

Question 19

List some clinical findings with PID?

Answer 19

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

Question 20

What is the tx for PID?

Answer 20

outpatient: Ceftriaxone IM 250mg once along with doxycyline 100mg x 14days can add flagyl is she is prone to yeast infections with antibiotic use

Question 21

For inpatient treatment for PID what are your two options?

Answer 21

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

Question 22

What is the Tx for syphilis?

Answer 22

Benzathine PCN G, 2.4 million units IM × one dose for primary and secondary disease

Question 23

How do you diagnose syphilis?

Answer 23

RPR/VDRL and confirmed by the treponemal antibody-absorption test (FTA-ABS).

Question 24

What can cause a false positive while testing for syphilis?

Answer 24

Lyme disease

Question 25

if someone is penicillin allergic but has syphilis and needs to be treated what can you use?

Answer 25

doxycycline

Question 26

Clumpy or cheesy vaginal discharge, pruritus burning, vaginal or vulvar edema and erythema makes you think of what?

Answer 26

Candida vaginitis

Question 27

How do you Dx candida vaginitis?

Answer 27

KOH showing budding hyphae, with PH <4.5 acidic

Question 28

Tx for candida?

Answer 28

oral fluconazole 150mg po x1 then repeat in 7 days

Question 29

if someone wants a topical cream to tx candida what can they use?

Answer 29

``` Topical clotrimazole (Gyne-Lotrimin) Topical tioconazole (Monistat) ```

Question 30

This type of vagina grossness is caused by Gardnerella?

Answer 30

BV

Question 31

What would you expect to see on PE with someone w/BV?

Answer 31

Frothy, grayish-white fishy-smelling vaginal discharge

Question 32

When evaluating epithelial cells for someone you suspect to have BV what would you see?

Answer 32

Clue cells

Question 33

What is the amine Criteria to dx BV?

Answer 33

Thin, homogenous vaginal discharge. Vaginal pH greater than 4.5. Positive whiff test (fishy amine odor when 10 percent potassium hydroxide solution is added)

Question 34

What is the first line treatment for BV?

Answer 34

Metronidazole oral 500mg PO bid x 7days

Question 35

What is second line tx for BV?

Answer 35

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

Question 36

What should someone not do when being trated with the first line therapy for BV?

Answer 36

Not drink as single thing

Question 37

Greenish gray frothy vaginal discharge with mild itching is suspicious for what?

Answer 37

Trichomonas

Question 38

What would you see on microscopy for trich?

Answer 38

mobile and pear shaped protozoa with flagella

Question 39

Tx for Trich?

Answer 39

Metronidazole 2g PO x 1 dose

Question 40

Should the partner of someone with trich also be treated?

Answer 40

Yes yes they should

Question 41

woman in her 50s presents with Irritation, dryness, painful intercourse, increased UTIs, urinary incontinence, what do you suspect

Answer 41

atrophic vaginitis

Question 42

Tx for atrophic vaginitis?

Answer 42

Conjugated estrogens vaginal cream