infectious disorders of the female GU

Question 1

vaginitis

Answer 1

inflammation or infection of the vaginal canal, often in conjuction with vulvar irritation.

Question 2

normal values

Answer 2

discharge: 1.5 gm
pH: 3.5-4.5
group B strep. lactobacillus predominant

Question 3

sxs of vaginitis

Answer 3

change in flora, change in pH, change in discharge, inflammation. itching, burning, irritation, contact with dc is uncomfortable. odor, color/consistency

Question 4

candidiasis

Answer 4

yeast infection. predisposed by: DM, recent abx use, OCPs, pg, coricosteroid therapy, occulusive clothing.

Question 5

sxs candidiasis

Answer 5

white, thick dc. intense itching, dysuria (as flow touches labia). signs: vulvar/labial erythema, excoriation, edema, white dc often without odor

Question 6

dx of candidiasis

Answer 6

characteristic signs and symptoms, normal pH, hyphae/spores on KOH, wet prep or culture

Question 7

tx yeast infection

Answer 7

antifungal therapy-topicals (miconazole) qhs for 7 days. oral (fluconazole) 150 mg PO 1 dose. Resistant terconazole qhs 3-7 days. OTC

Question 8

bacterial vaginosis

Answer 8

common cause vaginal dc in women of childbearing age.

Question 9

etiology of BV

Answer 9

overgrowth of largely anaerobic bacteria, decrease or absence of lactobacillus. increased gardnerella. STI, douching, vag irritants, smoking

Question 10

sxs of BV

Answer 10

non-irritating dc-multimicrobial. thin gray-white/yellow dc; foul fishy odor.

Question 11

dx of BV Amsel criteria must have 3

Answer 11

abnormal dc, abnormal pH (>4.5), + whiff test with KOH, wet prep shows clue cells, DNA probe

Question 12

tx of BV

Answer 12

antibacterial (anaerobic) metronidazole either vaginally o PO. oral or topical clindamycin

Question 13

Trichomoniasis

Answer 13

wet mount shows increased PMNs with motile flagellate. KOH: whiff. pH >4.5. DNA probe. strawberry spots on cervix. Screen for other STIs

Question 14

tx of trichomoniasis

Answer 14

systemic metronidazole for both pt and partner. screen for other stis.

Question 15

wet prep

Answer 15

normal saline added to dc on a slide. visualize trichomonas, clue cells, yeast

Question 16

whiff test

Answer 16

KOH added to dc on slide. if anaerobic bacteria present , foul odor occurs. often not necessary, as odor is apparent.

Question 17

sxs of chlamydia

Answer 17

mucopurulent dc with cervicitis, dysuria, postcoital bleeding, pelvic pain, fever, urethritis.

Question 18

complications of chlamydia

Answer 18

PID. tubal occlusion/damage, infertility, ectopic pg risk, increases with each infection

Question 19

tx of chlamydia

Answer 19

PO abx. Azithro1 gm x 1with doxy 100 mg BID x 7 days. treat pt and partner. report to MDH. screen other STIs. rescreen in 3 mos.

Question 20

gonorrea presentation

Answer 20

copious mucopurulent dc, dysuria/frequency, pelvic pain, fever, urethritis, oropharyngeal.

Question 21

complications with gon.

Answer 21

PID. disseminated purulent arthritis, tenosynovitis, dermatitis, polyarthralgia

Question 22

dx of gon

Answer 22

DNA assay (urine or cervical swab).

Question 23

tx of gon

Answer 23

ceftriaxone 250 mg 1 IM and azithro 1 gm x 1. concurrent tx of chlamydia, treat pt and partner, report to MDH, screen for other STIs, rescreen in 3 mos

Question 24

primary syphilis

Answer 24

painless, hard, indurated ulcer forms at site of inoculation-chancre. usually solitary and hidden. LAD develops within 1-2 wks. chancre heals within 3-6 wks with no scar.

Question 25

secondary syph

Answer 25

skin rash, palms and soles, flu-like illness. condyloma lata, systemic: hepatitis, GI, musculoskeletal, renal, neuro. resolves 2-6 weeks to latent infection

Question 26

latent syph

Answer 26

positive serology and asymptomatic

Question 27

tertiary syph

Answer 27

CNS, CV, skin/subcutaneous sxs. Congenital birth defects and still birth

Question 28

dx of syph

Answer 28

spirochete seen on dark field miscroscopy.

Question 29

tx of syph

Answer 29

repeat titers at 3, 6, 12, and 24 mos post tx to ensure eradication. Benzathine Pen G 2.4 million units IMx1

Question 30

PID

Answer 30

acute ascending pelvic infection involving the upper genital tract. potential serious sequlea.

Question 31

risk factors for PID

Answer 31

adolescents, non-whites, multiple partners, previous PID/STI, recent IUD insertion, cigarette use, sex during menses.

Question 32

presentation of PID

Answer 32

low abdnominal pain, vaginal dc with or without odor, dysuria, dyspareunia, N/V, F/C, irregular bleeding.

Question 33

physical exam of PID

Answer 33

fever, abdominal tenderness, lower quadrants rebound and guarding, pelvic exam will show endocervical changes, CMT, adnexal tenderness, unterine tenderness

Question 34

DX of PID

Answer 34

clinical. ab and adnexal tenderness, CMT, dc, fever, WBC increased along with ESR and CRP, increased WBC on vag smear. definitive: imaging, laparascopy

Question 35

labs for PID

Answer 35

UPT, UA, CBC, microscopy on vag dc, STI testing

Question 36

tx PID

Answer 36

inpatient: high fever, sig abdomen findings, toxic, can’t tolerate PO, uncertainty, pregnancy. Doxy 100 mg POq 12 hrs + cefoxitin 2 gm IV Q 6 hours. or clindamycin + gent. IV therapy until sx free for 24 hours then doxy 100 mg po bid for 14 days

Question 37

Outpt tx PID

Answer 37

low, no fever, minimal abd, not toxic, good f/u. ceftriaxone 250 mg IM x 1 + doxy 100 mg po bid +/- metro 500 mg po bid to cover anaerobes. tx for 14 days.

Question 38

complications of PID

Answer 38

permanent reproductive damage. chronic pelvic pain, abscess formation, intestinal adhesions/obstructions