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Women's Health > Infectious Disorders of the Female Genital Tract > Flashcards

Infectious Disorders of the Female Genital Tract Flashcards

1
Q

Vaginitis

Definition and types of

A

Inflammation of the vaginal canal

Often with vulvar irritation

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2
Q

Normal vaginal conditions

A

Normal flora:

  • staph, strep, anaerobic bacteria
  • Group B Strep (bad if pg)
  • Lactobacillus

Lactobacillus predominate and maintain pH at 3.5-4.5, they are supported by glycogen and estrogen

Normal amount of discharge = 1.5g/day

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3
Q

Infectious causes of vaginitis

A
  • candidiasis
  • bacterial vaginosis
  • trichomoniasis
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4
Q

Noninfectious causes of vaginitis

A

atrophic (less estrogen ==> less discharge)
chemical (dyes, perfumes, etc.)
allergic
foreign body

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5
Q

General sxs of vaginitis

A

inflammation
change in discharge - leukorrhea

asymptomatic to significant discomfort

  • pruritis, burning, irritation
  • vulvovaginitis common when contact with d/c
fishy odor (amines are broken down by anaerobes)
color/consistency/volume of discharge changes
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6
Q

Candidiasis Risk Factors

A 
DM
recent antibiotic use
OCPs
pregnancy (change in estrogen)
corticosteroid therapy 
occlusive clothing
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7
Q

Candidiasis Sxs and Signs

A

White, thick discharge
Intense pruritis
dysuria (as flow touches labia)

Vulvar/labial erythema, excoriation, edema
white d/c, often without odor

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8
Q

Candidiasis Etiology

A

Candida albicans MC

Candida glabrata at increasing rates; harder to tx

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9
Q

Candidiasis Dx

A

Characteristics signs and sxs
Normal pH
Hyphae/spores on wet prep or culture

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10
Q

Candidiasis Tx

A

Antifungal Therapy

  • topicals (miconazole, butoconazole, etc.) qhs x 7days
  • fluconazole 150mg PO x 1 dose

OTC therapies are the same, but only topicals are available

Vaginal hygiene

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11
Q

Vaginal hygiene

A

cotton/no underwear to improve airflow
wipe front to back
avoid occlusive/wet clothing, douching or any vaginal FB’s, baths, or perfumes/dyes, etc.

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12
Q

Bacterial Vaginosis Etiology

A

Overgrowth of normal anaerobic bacteria:

  • decrease of lactobacillus
  • increase gardnerella, mobiluncus, mycoplasma, bacteroides

Overgrowth may be caused by douching and vaginal irritants

Common cause of vaginal discharge in women of childbearing age

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13
Q

Bacterial vaginosis d/c

A

Non-irritating d/c that is thin, grey-white/yellow with a foul/fishy odor

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14
Q

Bacterial Vaginosis Dx

A

Amsel Criteria: (must have 3)

  • abnormal d/c with foul odor
  • abnormal pH (>4.5)
  • positive “whiff” test with KOH
  • wet prep shows clue cells

in the future can use DNA probe to determine high gardenerella

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15
Q

Clue cells

A

squamous cells are surrounded by anaerobic bacteria

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16
Q

Bacterial Vaginosis Tx

A

Vaginal hygeine
pelvic rest x 1 week after tx

Topical or PO metronidazole or clindamycin x 7 days

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17
Q

STI’s

A 
Trichomoniasis 
Human Papilloma Virus 
Herpes Simplex Virus 
Chlamydia 
Gonorrhea 
Trichomonas vaginalis 
Syphilis

Always screen for comorbid STIs!!

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18
Q

Trichomoniasis Etiology

A

unicellular, flagellate protozoan: trichomonas vaginalis

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19
Q

Trichomoniasis Risk Factors

A

Multiple sexual partners
Hx of STIs
Lack of condom use
Lower SES

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20
Q

Trichomoniasis S&S

A

Persistent, profuse frothy d/c
Vulvar pruritis/foul odor
Dysuria

Inflamed labia, perineum, vagina
Small petechiae on cervix/vaginal wall
(STRAWBERRY SPOTS)

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21
Q

Trichomoniasis Dx

A

Wet mount shows increased PMNs and motile flagellate
pH >5
KOH wiff

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22
Q

Trichomoniasis Tx

A

Metronidazole PO 2gm x1 for pt and partner

23
Q

HPV Etiology and Transmission

A

Warts, condyloma acuminata, types 6 and 11

Transmission - skin to skin contact, but spreads more quickly over mucous membranes
Incubation 1-6 months
Viral shedding can occur even when warts are not present

24
Q

HPV S&S

A

Signs - numerous, discrete, fleshy lumps with a smooth, velvety surface; can be hidden in anus or vaginal canal

Symptoms - mass (MC); pruritis, bleeding, burning, tender, discharge, pain

25
HPV Dx
Visual inspection | Sometimes requires acetic acid wash to visual skin
26
HPV Tx
Often difficult, requiring multiple visits Tx like any other wart - destruction with cryotherapy, electrocautery/curettage, TCA acid, etc.
27
HPV Vaccines
Gardasil - quadrivalent for strains 6 and 11 (CA), 16 and 18 (warts) - boys and girls 6-26 Cervarix - bivalent: 6,11 - girls only
28
HSV Transmission and Incubation
Transmitted through viral shedding through sex (oral, anal, vaginal) and skin to skin contact Incubation 2-20 days
29
HSV S&S
Primary Outbreak: - most severe - small, painful, grouped vesicles develop at the site of contact -> pustules -> ulcers/erosions-> crust over and heal in 2-4 weeks - dysuria, regional lymphadenopathy, flu like sxs Secondary Outbreak - less severe with fewer lesions - prodrome likely with tingling/pain - heal faster (1-2 weeks) Recurrence can happen with any trigger
30
HSV Dx
Clinical presentation Tzanck smear Serology - PCR (takes a long time)
31
HSV Tx
PO acyclovir, valacyclovir within 24-72 hours of onset
32
Chlamydia Characteristics
Chalmydia trachomatis Transmission: sexual contact Incubation 7-14 days Risks: women <20yrs, multiple partners, lower SES
33
Chlamydia S&S
``` Often asymptomatic With active infections: - clear, mucopurulent d/c with cervicitis - dysuria - postcoital bleeding - pelvic pain - fever ```
34
Chlamydia Dx
DNA Assay - (urine test) MC | Cervical culture
35
Chlamydia Tx
REPORT TO MDH PO azithro x 1 or doxy x 7 days Tx partner Rescreen in 3-4 mos for reinfection
36
Chlamydia Complications
PID - tubal occlusion/damage - infertility - ectopic pg risk - increases with each infection
37
Gonorrhea Characteristics
Neisseria gonorrheae | transmitted through sexual contact
38
Gonorrhea S&S
``` Can be asymptomatic in early disease With active disease: - copious mucopurulent d/c - dysuria/frequency - pelvic pain - fever ```
39
Gonorrhea Dx
DNA assay | culture
40
Gonorrhea Tx
PO ceftriaxone 250mg IM x 1 + azithromycin 1gm or doxy 100mg po bid x 7 days
41
Gonorrhea complications
PID | Disseminated - tenosynovitis, arthritis
42
Syphilis etiology
treponema pallidum transmitted through sex incubation 1-12 weeks
43
Syphilis RF
AA the South Urban areas
44
Primary Syphillis
Painless, hard indurated ulcer forms at site of inoculation - chancre - Usually solitary, but can go unnoticed; heals in 306 weeks without scar Lymphadenopathy develops within 1-2 weeks Bacteria remain in blood stream Cha
45
Secondary and Tertiary Syphilis
Rash affecting palms and soles Flu like illness *Condyloma lata* Systemic, hepatitis, GI, MS, renal, neuro Resolves in 2-6 weeks to latent infection Tertiary - CNS, CV (aortic aneurysms), derm Congenital -> birth defects, still births
46
Syphilis Dx and Screening
Dx- Spirochete seen on dark field microscopy | Screening - RPR/VDRL serology, then confirm with serology (fluorescent treponemal antibody absorption test (FTA))
47
Syphilis Tx
Report to MDH Pen G IM Repeat titers at 3, 6, 12 and 24 months to ensure eradication
48
PID Definition
acute ascending pelvic infection involving the upper genital tract with potential serious sequelae
49
PID etiology
Gonorrhea MC Chlamydia 10-20% of women who get GC/CT get PID Can also result from procedures/surgery
50
PID RF
``` Adolescents Non-whites Multiple partners Previous PID/STI Recent IUD insertion Smoking Sex during menses ```
51
PID S&S
Often asymptomatic Crampy, bilateral low abdominal pain MC Others: vaginal d/c, dysuria, dyspareunia, N/V, irregular bleeding
52
PID Dx
``` **Cervical motion tenderness** adnexal tenderness, abdominal tenderness +/- rebound, discharge, fever WBC >10,000 US Tx with any suspicion ```
53
PID tx
Outpt if low/no fever, minimal abd findings and not toxic appearing Ceftriaxone IM + doxy PO +/- metro PO x 14 days
54
PID complications
permanent reproductive damage - infertility, ectopic pg risk Chronic pelvic pain1` abscess formation intestinal adhesions/obstructions

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