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LMCC Study - OBGYN > Infectious diseases of the female reproductive and urinary tract > Flashcards

Infectious diseases of the female reproductive and urinary tract Flashcards

1
Q

What triad of symptoms is classically associated with PID?

A

1) Pelvic pain
2) Cervical and Adnexal tenderness
3) Fever

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2
Q

What are clue cells? What are they associated with?

A
  • Superficial vaginal epithelial cells with adherent bacteria
  • Associated with bacterial vaginosis
  • Most commonly Gardnerella vaginalis *
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3
Q

What is bacterial vaginosis?

A
  • Alteration in the normal vaginal flora that results in a loss of hydrogen peroxide producing lactobacilli and an overgrowth of anaerobic bacteria
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4
Q

Which two anaerobic bacteria are found in much higher concentrations of women during bacterial vaginosis infection?

A

1) Gardnerella vaginalis
2) Mycoplasma hominis
* Note lactobacilli are usually absent

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5
Q

Women with BV are at increased risk of which gynecological problems?

A
  • Pelvic inflammatory disease
  • Postabortal PID
  • Postoperative cuff infections after hysterectomy
  • Abnormal cervical cytology
  • Due to change in flora making more suceptable to infection *
  • Also, although not an STI, increased sexual activity is a risk factor for BV (which also increases change of other STI and HPV)
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6
Q

Pregnanct women with BV have increased risk of what?

A
  • PROM
  • Pre-term labour
  • Chorioamnionitis
  • Postcesarean endometritis
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7
Q

What is the Whiff test?

A
  • Addition of potassium hydroxide to vaginal secretions releases a fishy odor
  • Associated with BV
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8
Q

How is BV diagnosed?

A
  • Clue cells of microscopy
  • Fishy smelling whiff test
  • pH testing
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9
Q

How would you treat a patient with BV? explain your choice

A

Metronidazole (vaginal gel or PO)

  • Antibiotic with excellent anaerobic coverage, but poor coverage of lactobacilli (kills anaerobes and allows lactobacilli to repopulate)
  • Clindamycin (gel) may also be used
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10
Q

What type of infection is trichomonas vaginitis?

A
  • Parasitic infection
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11
Q

Why is Trichomonas vaginitis commonly associated with BV?

A
  • Trichomonas creates an anaerobic environment which favors the development of BV
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12
Q

What are the clinical symptoms of Trichomonas?

A
  • Profuse, purulent, and malodorous vaginal discharge
  • Vulvar pruritis
  • Patchy vaginal erythema
  • Colpitis macularis (STRAWBERRY CERVIX)
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13
Q

Strawberry cervic is associated with which condition?

A
  • Trichomonas vaginitis
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14
Q

How may trichomonas vaginitis be diagnosed on microscopy?

A
  • Viewing motile trichomonads

- Cells with visible flagella (kind of look like kites)

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15
Q

How is trichomonas vaginitis treated?

A
  • Metronidazole
  • 2g PO once
  • or 500mg BID x 7d
  • Treat sexual partners to avoid reinfection
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16
Q

Which pathogen is most commonly responsible for vulvovaginal candidiasis?

A
  • Candida albicans (85-90%)
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17
Q

What are risk factors for the development of vulvovaginal candidiasis?

A
  • Antibiotic use
  • Pregnancy
  • Diabetes
  • Both are associated will decrease in cell mediated immunity (making immunocompromised)
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18
Q

What are the clinical features associated with vulvovaginal candidiasis?

A
  • Vulvar pruritis
  • Discharge (can be watery to homogenous and thick)
  • Vaginal pain, burning
  • dyspareunia
  • erythema or edema of labia and vulvar skin
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19
Q

What would candidiasis look like under microscope?

A
  • Budding yeast
20
Q

How is vulvovaginal candidiasis treated?

A

1) Topical “azole” drugs (typically 1-7 days)
- clotrimazole
- miconazole
- tioconazole

2) Oral “azole”
- fluconozole 150mg PO once

  • Note: Treatment will kill yeast quickly, but symptoms, from irritation, will last for 2-3 days *
21
Q

What is atrophic vaginitis?

A
  • Atrophy of the vaginal and vulvar epithelium
  • Due to lack of estrogen
  • Can result in post-coital bleeding, dyspareunia
22
Q

What is the treatment of atrophic vaginitis?

A
  • Topical vaginal estrogen cream
23
Q

What is your differential diagnosis for endocervicitis with discharge?

A
  • N. gonorrhoeae
  • C. trachomatis
  • Above 2 cause 50% of time
  • M. genitalium
  • Bacterial vaginosis
  • Birth control pill use
24
Q

Why is dual therapy recommended in the treatment of gonoccocal infection of the cervix, urethra or rectum? What therapy is recommended?

A
  • Dual therapy due to increasing rates of resistant gonoccocal infection
  • Dual therapy is
    1) IM ceftriaxone 250mg OR Cefixime 400-800mg single dose

2) 1g single dose of PO azithromycin OR Doxycycline 100mg BID for 7 days
* Note that the azithro is not presumtive treatment for chlamydia it is incase there is resistance to cephalosporins

25
Q

What is the treatment for chlamydial infection of the cervix, urethra or rectum?

A
  • Azithromycin 1g PO once
    OR
  • Doxycycline 100mg PO BID for 7 days
  • Note doxy has been shown to be more effective IF observed doses are possible, but this is not very practical
26
Q

What is pelvic inflammatory disease?

A
  • Microorganisms colonizing the endocervix and ascending to the endometrium and fallopian tubes
  • Upper genital tract infection
27
Q

Which STI’s are commonly implicated in PID infection (2)

A
  • N. gonorrheoeae
  • C. trachomatis

Less common

  • Mycoplasma genitalium
  • Respiratory pathogens
    1) Strep
    2) Pneumococci
28
Q

What does cervical motion tenderness suggest?

A

Peritoneal inflammation
- Pain when the peritoneum is stretched by moving the cervix

  • In PID you get pelvic organ tenderness (uterus, adnexa)
  • Ectopic pregnancy - bleeding into peritoneum causing cervical motion tenderness
29
Q

What would you expect to see on histology of vaginal and endocervical secretions in a patient with PID?

A
  • Increased polymorphonuclear leukocytes
30
Q

How would you treat a patient with pelvic inflammatory disease?

A 
- Ceftriaxone IM 250-500mg OR  Cefixime 800mg single dose
PLUS 
- Doxycycline 100mg BID for 14 days 
WITH OR WITHOUT 
- Metronidazole  500mg PO BID x14d
  • Need broad spectrum coverage for gonorrhea, chlamydia, M. genitalium, gram negative facultative bacteria, anaerobes and strep
31
Q

What is a tubo-ovarian abscess?

A
  • Endstage process of acute PID

- Diagnosed when a patient has a palpable pelvic mass on exam

32
Q

Which two infections would you suspect if a patient came in complaining of genital ulcers?

A

1) Herpes simplex virus

2) Syphilis

33
Q

A painless and minimally tender ulcer is most likely to be associated with what?

A
  • Syphilis
34
Q

What tests can be performed to investigate for possible T. pallidum infection?

A
  • nontreponemal rapid plasma reagin test (RPR)

- venereal diseas research laboratory (VRDL)

35
Q

A patient comes in with groups vesicles mixed with small ulcers and has had a history of these lesions previously. What do you suspect?

A
  • HSV
36
Q

A patient comes in with 1-3 extremely painful ulcers which is accompanied by tender inguial nodes. What do you suspect?

A
  • Chancroid
37
Q

How would you manage a patient with HSV?

A 
- Acyclovir
or
- Famciclovir 
or
- Valacyclovir
38
Q

How do you treat a patient with syphilis?

A
  • Penicillin G 2.4 million units IM

- Single dose

39
Q

What is Chancroid?

A
  • STI causing painful genital ulcers
  • Caused by Haemophilus ducreyi
  • NOT COMMON IN N.AMERICA
40
Q

What is the treatment of Chancroid?

A
  • Azithromycin 1g PO weekly for 3 weeks
41
Q

Genital warts are most commonly caused by which strains of HPV? Are they oncogenic?

A
  • 6 and 11
  • No they are non-oncogenic
  • 16 and 18 are responsible for most cervical cancers
42
Q

How contagious are genital warts?

A
  • Very

- 75% of sexual partners develop them when exposed

43
Q

What is the treatment for genital warts?

A

Removal of warts

-Irradication of the virus not possible

44
Q

What is intraamniotic infection syndrome?

A
  • AKA Chorioamnionitis
  • clinically detectable infection of the amniotic fluid and fetal membranes during pregnancy
  • Due to ascending vaginal microorganisms following rupture of membranes
45
Q

What are the two most common pathogens associated with Chorioamnionitis?

A
  • Group B Strep

- E. coli

46
Q

What are the criteria needed for diagnosis of chorioamnionitis? When would you treat the mother?

A

1) Fever > 38 degrees
2) 2+ of the following
- maternal or fetal tachycardia
- Maternal WBC > 15,000
- Uterine tenderness (usually unable to assess due to anesthesia)
- Foul smelling amniotic fluid (rare)

  • Due to impreision of the diagnosis - Any mother with a fever over 38 may be considered for antibiotic tx.
47
Q

Which antibiotics would you use in a patient with chorioamnionitis?

A
  • Ampicillin and gentamicin

Same bacteria as neonatal infections

LMCC Study - OBGYN (21 decks)

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