Infections/STDs part 2 Flashcards
what HPV types are MC associated w anogenital warts
types 6 and 11
tubo-ovarian abscess (TOA)
an inflammatory mass involving the fallopian tubes, ovaries, or occasionally other pelvic organs
most occur as a complication to PID
typically polymicrobial with mixtures of aerobic and anaerobic organisms
sx TOA
acute lower abdominal pain, vaginal discharge, and systemic symptoms, such as fever and chills
similar to PID
when is TOA thought to have ruptured
it is leaking contents into the abdominal cavity. Most patients with a ruptured TOA present with an acute abdomen and sepsis, which requires immediate surgical exploration.
dx TOA
made clinically based on hx and an exam suggestive of PID and the presence of an inflammatory adnexal mass on pelvic imaging
MC imaging modality for TOA
TVUS
Tx TOA
admit for IV abx - Cefoxitin and doxy or cefotetan and doxy
what pts w TOA should be treated initially w abx ALONE
hemodynamically stable, no signs of an acute abdomen, abscess size < 7 cm in diameter, and premenopausal status
Postmenopausal women w TOA
higher risk for malignancy –> surgical intervention is recommended for dx and therapeutic purposes
sx vulvovaginal atrophy
vulvovaginal dryness, burning, and irritation; urinary symptoms, such as dysuria, urinary frequency, and recurrent urinary tract infections; and reduced lubrication during sexual intercourse causing dyspareunia
PE vulvovaginal atrophy
tissue fragility or fissures, vulvovaginal pallor, vulvovaginal erythema, loss of vaginal rugae, and decreased vulvovaginal secretions
initial tx vulvovaginal atrophy
vaginal moisturizers (two or three times per week) and lubricants (during intercourse)
C/I vaginal estrogen
prior or current estrogen-dependent tumors
How does the normal vaginal pH compare to the vaginal pH in postmenopausal women?
Postmenopausal pH is more basic. The normal pH in reproductive-aged women is 3.5–5.0, and the pH in postmenopausal women is often 5.5–6.8
how long should ppl abstain from sexual activities for gonorrhea
abstain from sexual activities until at least 7 days after the initiation of therapy and they no longer have symptoms
cardiovascular syphilis
develops 10 years after primary
causes aneurysm formation in the aorta
neurosyphilis
damage to brain and spinal cord at any stage of disease causing gait abnormalities, disruption in pain and temp sensations, memory and speech impairment, psychosis and progressive dementia
nontreponemal testing for syphilis
venereal disease research laboratory (VDRL)
rapid plasma reagin (RPR)
Toluidine Red Unheated Serum Test (TRUST)
treponema test for syphilis
fluorescent treponema antibody absorption (FTA-ABS)
Microhemagglutination test for antibodies to T pallidum (MHA-TP)
T pallidum particle agglutination assay (TPPA)
T pallidum enzyme immunoassay (TP-EIA)
chemiluminescence immunoassay (CIA)
How often should ppl w syphilis be monitored
repeat RPR or VDRL at 6 and 12 month intervals to ensure treatment success
What is the nickname for syphilis?
the great imposter
strawberry cervix int rich is also called
colpitis macular (punctate macular hemorrhages on the cervix)
dx trich
wet mount is MC used
wet mount for trich
flagellated protozoa moving in corkscrew patterns, shaking, or rotating
if wet mount is negative but still suspicious of trich, what next
nucleic acid amplification testing
tx trich
oral metronidazole 500 mg by mouth twice a day for 7 days
all sexual partners should receive tx as well
repeat testing for trich
repeat testing should be performed 2 weeks to 3 months after abx completion to ensure curative therapy
sexual abstinence is strongly encouraged during this time
complications women trich
urethritis
cystitis
PID
infertility
complications men trich
prostatitis
epididymitis
infertility
prostate CA
sx Vulvovaginal candidiasis
most common symptom is vulvar pruritus and other common symptoms include vulvar burning, soreness, or irritation. Patients may have dysuria or dyspareunia
PE vulvovaginal candidiasis
erythema, excoriations, or fissures of the vulva and the vagina
may have discharge - white, thick, and clumpy discharge
sx may be worse the week prior to menses
dx vulvovaginal candidiasis
detecting Candida on a wet mount, Gram stain, or culture of vaginal discharge
dx should not be made solely based on clinical findings
tx vulvovaginal candidiasis
asx - no tx
sx - oral fluconazole administered as a single oral dose
if vulvovaginal candidiasis and uncontrolled diabetes mellitus = complicated; tx = two doses of oral fluconazole administered as oral doses 3 days apart
Vulvovaginal candidiasis is caused by an overgrowth of
C. albicans (MC)
C. glabrata
challenge of C. glabrata
resistance to azole therapy
what lesions are common w vulvovaginal candidiasis infxn
Satellite lesions (small, erythematous, well-demarcated patches with scalloped edges)
does discharge have an odor in vulvovaginal candidiasis
no
is pH abnormal in vulvovaginal candidiasis
no
The microscopic evaluation of a vaginal sample using either saline or potassium hydroxide for vulvovaginal candidiasis
hyphae and spores
sometimes referred to as spaghetti and meatballs for the shape and distribution of the fungal components.
tx chlamydia
azithromycin 1 gram PO as a single dose, doxycycline 100 mg PO twice daily for 7 days plus ceftriaxone 500 mg IM as a single dose, or cefixime 400 mg PO as a single dose
tx chlamydia in pregnancy
amoxicillin 500 mg PO three times per day for 7 days with repeat testing 3–4 weeks after therapy
