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EOR OB/GYN > Infections/STDs > Flashcards

Infections/STDs Flashcards

1
Q

Lab testing for PID

A

pregnancy test, microscopic examination of vaginal discharge, nucleic acid amplification testing for C. trachomatis and N. gonorrhoeae, HIV screening, and syphilis screening

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2
Q

TVUS for PID

A

used to evaluate for a tubo-ovarian abscess, especially if there is unilateral adnexal tenderness

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3
Q

Outpatient treatment for PID

A

empiric antibiotic coverage with ceftriaxone 500 mg IM in a single dose (1,000 mg if the patient is ≥ 150 kg), doxycycline 100 mg PO bid for 14 days, and metronidazole 500 mg PO bid for 14 days with follow-up in 72 hours

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4
Q

Indications for hospitalization PID

A

Patients with PID with high fever, inability to tolerate oral fluid intake, severe abdominal pain, or suspected abscess or pregnancy should be hospitalized

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5
Q

Tx for hospitalized pt w PID

A

cefoxitin 2 g IV every 6 hours (or cefotetan 2 g IV every 12 hours) and doxycycline 100 mg PO or IV every 12 hours. Patients with PID should refrain from sexual activity until therapy is completed, and all partners should be evaluated and treated

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6
Q

Major complications of PID

A

tubo-ovarian abscess, chronic pelvic pain, infertility, and ectopic pregnancy

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7
Q

the most common bacterial cause of sexually transmitted infections

A

Chlamydia trachomatis

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8
Q

what type of bacteria is Chlamydia trachomatis

A

gram-negative

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9
Q

sx Chlamydia trachomatis

A

asymptomatic = MC
changes in vaginal discharge, bleeding between menses, and postcoital bleeding

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10
Q

PE chlamydia trachomatis

A

mucopurulent endocervical discharge, endocervical bleeding, or edematous ectopy

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11
Q

discharge comparison btwn chlamydia and gonorrhea

A

the discharge associated with chlamydial infections is less painful, less purulent, and more watery

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12
Q

UA for chlamydia

A

pyuria with no organisms on Gram stain (chlamydia is hard to stain)

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13
Q

best test for dx of chlamydia

A

nucleic acid amplification test

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14
Q

Complications of C. trachomatis

A

pelvic inflammatory disease, ectopic pregnancy, and infertility

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15
Q

Bacterial vaginosis is due to

A

a shift in the vaginal flora that causes a rise in the vaginal pH

the shift is typically due to a decrease in hydrogen peroxide- and lactic acid-producing lactobacilli and an increase in anaerobic bacteria

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16
Q

RF for BV

A

sexual activity, douching, and cigarette smoking

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17
Q

sx BV

A

asx = MC
vaginal discharge or vaginal odor. The discharge is classically thin, white, and homogeneous.

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18
Q

BV does not typically cause

A

Bacterial vaginosis does not typically cause vaginal erythema or edema, dysuria, dyspareunia, vaginal pruritus, or vaginal burning

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19
Q

dx BV

A

at least three of the four Amsel criteria: homogeneous, thin, grayish-white discharge; vaginal pH > 4.5; positive whiff-amine testing; and clue cells on saline wet mount

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20
Q

tx BV

A

metronidazole or clindamycin (oral or topical)

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21
Q

Patient ed for tx for BV

A

educate patients to not consume alcohol while taking metronidazole and to not use latex condoms when using clindamycin cream

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22
Q

Rxn for patients drinking alcohol when taking Metronidazole

A

disulfiram-like reaction, including nausea and vomiting

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23
Q

clindamycin cream and condoms patient ed

A

Clindamycin cream can reduce the efficacy of latex condoms

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24
Q

tx BV for frequent recurrences

A

preventive therapy, either oral metronidazole or oral tinidazole daily for 1 week and vaginal boric acid daily for 3 weeks. Patients who are in remission after this regimen can then use metronidazole gel twice weekly for 4–6 months

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25
Q

anogenital warts are also called

A

Condylomata acuminata

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26
Q

MC cause of Condylomata acuminata

A

HPV 6 and 11

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27
Q

what is the most common sexually transmitted infection in the world

A

HPV

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28
Q

appearance of condyloma acuminata

A

soft to palpation and appear as flat, dome-shaped, verrucous, and cauliflower-shaped

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29
Q

sx condyloma acuminata

A

usually ASX
may have itching

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30
Q

dx anogenital warts

A

based on clinical appearance

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31
Q

self therapy at home for anogenital warts

A

miquimod, podophyllotoxin, sinecatechins

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32
Q

office based therapy for anogenital warts

A

trichloroacetic acid, cryotherapy, or surgical removal

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33
Q

Lymphogranuloma venereum

A

genital ulcer disease caused by specific serotypes of Chlamydia trachomatis

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34
Q

where is Lymphogranuloma venereum MC

A

most common in tropical and subtropical climates, such as West and East Africa, India, parts of Southeast Asia, and the Caribbean

Increased prevalence in US and Europe in men who have sex with men

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35
Q

stages of Lymphogranuloma venereum

A

primary infection, secondary infection, and late lymphogranuloma venereum

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36
Q

primary infection of Lymphogranuloma venereum

A

painless and small genital ulcer at the site of inoculation. The painless ulcer resolves spontaneously within a few days and thus often goes unnoticed

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37
Q

secondary infection of Lymphogranuloma venereum

A

occurs 2 to 6 weeks following the primary infection. The secondary stage is due to inflammation from direct extension to the superficial and deep inguinal or femoral lymph nodes. The secondary stage may manifest as an inguinal syndrome or as anorectal symptoms.

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38
Q

sx in secondary infection of Lymphogranuloma venereum

A

unilateral painful inguinal lymph nodes associated with lymphogranuloma venereum are often called buboes. The inguinal syndrome of lymphogranuloma venereum is less common in women because the vaginal and cervical lymph nodes drain predominantly to the retroperitoneal area. The secondary stage of lymphogranuloma venereum may lead to severe inflammation, causing systemic symptoms. Anorectal symptoms due to lymphogranuloma venereum include rectal discharge, tenesmus, anal pain, and constipation

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39
Q

late lymphogranuloma venereum

A

(typically in untreated cases) include strictures or fibrosis of the genitourinary tract, infertility, genital elephantiasis, and esthiomene, which is defined as destruction of the genitalia

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40
Q

dx lymphogranuloma venereum

A

Lymphogranuloma diagnosis is difficult but can be confirmed with laboratory testing, which may include cultures, serology, or nucleic acid amplification testing (most accurate)

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41
Q

tx lymphogranuloma venereum

A

21-day course of doxycycline. The buboes are sometimes drained for symptomatic relief

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42
Q

what should occur in all sexual partners of the patient with lymphogranuloma venereum

A

all sexual partners of the patient evaluated and treated and to have the patient tested for hepatitis B, hepatitis C, and HIV infection

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43
Q

what type of bacteria is gonorrhea

A

gram negative diplococcus

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44
Q

sx gonorrhea

A

mucopurulent vaginal discharge and vaginal pruritus

MC asx

45
Q

PE gonorrhea

A

May be normal

vaginal discharge
friable cervix

46
Q

complications gonorrhea

A

pelvic inflammatory disease, infertility, ectopic pregnancy, and chronic pelvic pain

47
Q

best diagnostic test gonorrhea

A

nucleic acid amplification testing

48
Q

tx gonorrhea in a pregnant woman

A

Combo of ceftriaxone 500 mg IM + azithromycin 1 g orally

49
Q

when should you repeat testing for gonorrhea

A

3 months

50
Q

should sexual partners of pts w gonorrhea be treated

A

yes

51
Q

cause of trichomoniasis

A

parasite trichomans vaginalis
pear-shaped protozoan with four polar flagella

52
Q

sx trichomoniasis

A

vaginal pruritus or discomfort
dysuria
lower abdominal pain
malodorous, yellow-green, frothy discharge and punctate hemorrhages on the cervix (strawberry cervix)

53
Q

tx trichomoniasis

A

single dose of metronidazole 2 g PO
avoid alcohol for 48 hours after

54
Q

other ADE of metronidazole

A

metallic taste

55
Q

cause of syphilis

A

spirochete treponema pallidum

56
Q

4 types of syphilis

A

primary
secondary
latent
tertiary

57
Q

when do sx begin for syphilis after initial infection

A

~3 weeks

58
Q

primary syphilis

A

a single, erythematous, painless genital ulcer (called a chancre) appears and usually lasts for 4 weeks.

highly infectious ulcer

they are solitary, erythematous, raised and firm to the touch and will ulcerate over time, creating a surrounding crater w elevated edges (usually heal within 3-6 weeks)

may have associated regional lymphadenopathy

59
Q

secondary syphilis

A

ay occur weeks to months after resolution of the chancre
A maculopapular rash on the palms of the hands and soles of the feet is the most recognized physical exam finding in secondary syphilis - rash is nonpruritic

condyloma lata (highly infectious) may appear near the site of the original chancre. These appear as small, verrucous lesions in mucocutaneous areas.

moth-eaten alopecia

Additional symptoms associated with secondary syphilis are fever and lymphadenopathy.

develops 4-10 weeks after chancre appears

60
Q

Latent stage syphilis

A

can persist for 25 years. This is an asymptomatic stage of disease.

pts are seroreactive

61
Q

Tertiary syphilis

A

characterized by gummatas, or small, benign growths found throughout various tissues. The patient may also have focal neurologic findings, including hearing and vision loss. Additional findings as a result of syphilis infection include congenital and neurosyphilis

slowly progressive

mainly affects the cardiovascular system and central nervous system - but can affect any organ

62
Q

Having syphilis increases the transmissibility of

A

HIV

63
Q

nontreponomal test for syphilis dx

A

Venereal Disease Research Laboratory (VDRL)

64
Q

treponema test for syphilis

A

fluorescent treponemal antibody absorption (FTA-ABS) or T. pallidum enzyme immunoassay

65
Q

tx of choice regardless of stage of syphilis

A

IM PCN G

66
Q

what does the stage of syphilis determine in terms of treatment

A

the dose of IM PCN G

67
Q

What is the name of the physical exam finding common in neurosyphilis where small pupils will accommodate near objects but do not react to bright light?

A

Argyll Robertson pupil.

68
Q

Chancroid

A

sexually transmitted infection that is caused by Haemophilus ducreyi

69
Q

what type of bacteria is haemophilus ducreyi

A

gram negative fastidious rod that clumps in long parallel strands producing the so called “school of fish” or “railroad track” appearance

70
Q

btwn what ages is haemophilus ducreyi MC

A

15-19

71
Q

sx chancroid/haemophilus ducreyi

A

painful genital ulcer that has a ragged border and a purulent base. The ulcer starts initially as a papule that progresses into a pustule and then into an ulcer within a few weeks. Patients may also report dysuria and dyspareunia, particularly in women

72
Q

PE chancroid/haemophilus ducreyi

A

unilateral tender inguinal lymphadenopathy (buboes) that appears 1 to 2 weeks after onset of the ulcer.

73
Q

does a serologic test exist for haemophilus ducreyi

A

no

74
Q

is culture of haemophilus ducreyi practical

A

no bc it is fastidious and requires a special medium that is not readily available

75
Q

what testing should be obtained when you suspect haemophilus ducreyi

A

Serologic tests (rapid plasma reagin, venereal disease research lab) should be obtained to exclude syphilis

76
Q

tx chancroi

A

drainage of a fluctuant inguinal lymph node
abx - azithromycin, ceftriaxone, erythromycin

77
Q

inpatient tx PID

A

parenteral therapy with a second-generation cephalosporin, such as cefoxitin or cefotetan, and doxycycline.

Metronidazole is added for anaerobic coverage in patients with a pelvic abscess or recent gynecologic instrumentation

78
Q

Indications for admission PID

A

severe illness (high fever, nausea and vomiting, or severe abdominal pain), suspected pelvic abscess, or pelvic inflammatory disease occurring in pregnancy

79
Q

what structures are involved in PID infection

A

uterus and fallopian tubes caused by ascending infection from the vagina and cervix

80
Q

another causative agent of PID that is not gonorrhea or chlamydia

A

mycoplasma genitalium

81
Q

Laparoscopic findings in PID

A

tubal wall edema and presence of exudates and visible hyperemia on the tubal surfaces

82
Q

MC cause BV - and describe it

A

facultative anaerobe Gardnerella vaginalis

83
Q

what are clue cells in BV

A

epithelial cells that have a stippled appearance due to coccobacilli that adhere to the edge of the cell

84
Q

gold standard dx BV

A

gram stain of vaginal discharge demonstrating the presence of gardnerella vaginalis

85
Q

sx herpes simples virus (HSV)

A

painful vesicular lesions on an erythematous base that eventually rupture and form ulcers

individuals w genital ulcers often have recurrent outbreaks

86
Q

types of infection for HSV

A

primary
nonprimary first episode
recurrent infection

87
Q

primary infection HSV

A

lab testing confirms genital herpes but the pt has no antibodies to HSV-1 or HSV-2

indicates that this is the first infection

88
Q

which type of HSV infection causes the most severe sx

A

primary infection

89
Q

sx primary HSV

A

painful genital fluid-filled vesicular lesions that ulcerate, dysuria, tender local lymphadenopathy, and systemic manifestations, such as fever, malaise, and headache

90
Q

nonprimary first episode HSV

A

lab evidence confirms genital herpes but the individual has antibodies to the other HSV subtype

91
Q

sx nonprimary first episode HSV

A

The manifestations of nonprimary first episode are less severe compared to primary infection. There are fewer lesions and less systemic symptoms.

92
Q

recurrent HSV infection

A

individual has HSV infection confirmed w lab testing and also has serum antibodies to the same subtype

it is possible for an individual to have a recurrent infection without prior sx

93
Q

sx recurrent HSV infection

A

less severe than primary or nonprimary first episode

systemic sx are absent
lesions tend to heal quicker

94
Q

dx HSV

A

viral culture or polymerase chain rxn testing

95
Q

tx HSV

A

acyclovir or Valacyclovir

acyclovir (400 mg tid for 7–10 days), famciclovir (250 mg tid for 7–10 days), and valacyclovir (1,000 mg bid for 7–10 days)

96
Q

low risk types of HPV

A

6, 11, 42

97
Q

high risk types of HPV

A

16
18
31
33

98
Q

why are high risk types of HPV more likely to progress to carcinoma

A

they produce E6 and E7 proteins that result in the destruction of p53 and RB genes, genes that are important in tumor suppressor pathways

99
Q

cervical intraepithelial neoplasia (CIN) is characterized by

A

koilocytic change, disordered cellular maturation, nuclear atypia, and increased mitotic activity within the cervical epithelium

100
Q

CIN1

A

involving 1/3 of the epithelium

101
Q

CIN2

A

involving 2/3 of the epithelium

102
Q

CIN3

A

involving more than 2/3 of the epithelium

103
Q

carcinoma in situ

A

involving the entire thickness of the epithelium

104
Q

dx HPV

A

HPV viral typing

105
Q

USPSTF recs for cervical CA screening

A

women between the ages of 21 and 29 years should undergo screening for cervical cancer every 3 years with cervical cytology alone. In women ages 30 and 65 years, screening should be done every 3 years with cervical cytology alone, every 5 years with high-risk HPV testing alone, or every 5 years with high-risk HPV testing in combination with cytology (cotesting)

106
Q

what can be used to treat genital warts caused by HPV

A

Podophyllin, trichloroacetic acid, or podofilox

107
Q

what HPV types does the recombinant human papilloma virus 9-valent vaccine cover

A

covers HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58

108
Q

What are some side effects of imiquimod?

A

Dermal ulcer, abrasion, edema, application site reaction, skin erosion, and erythema of the skin.

109
Q
A

EOR OB/GYN (18 decks)

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