Lower Genital Tract Infections Flashcards
What must be ruled out in patients over 40 with multiple recurrences of bartholin’s gland ABSCESSES?
Adenocarcinoma
MOST contagious STI
Lice (pediculosis pubis, crab louse, pthirus pubis)
Primary sx of lice (pediculosis pubis, crab louse, pthirus pubis)
Constant itching (2/2 allergic sensitization)
Tx for Lice (pediculosis pubis, crab louse, pthirus pubis)
Permethrin (Nix)
Lindane (Kwell)
Primary sx of scabies (itch mite), sarcoptes scabei
Severe intermittent itching
What populations cannot take Lindane (Kwell)?
Pregnant or lactating women
Children under 2 years
Tx for Primary sx of scabies (itch mite), sarcoptes scabei
Permethrin (Nix)
Lindane (Kwell)
Aka “water wart”
Molluscum contagiosum, pox virus
How contagious is Molluscum contagiosum, pox virus?
Mildly
Describe the nodules of Molluscum contagiosum, pox virus
“Water wart”
The more mature nodules have an umbilicated center
How is Molluscum contagiosum (pox virus) diagnosed?
Intracytoplasmic molluscum bodies with WRIGHT’s or GIEMSA STAIN confirm the diagnosis
What is a major complication of Molluscum contagiosum (pox virus)?
Bacterial superinfection
Tx of Molluscum contagiosum (pox virus)
Local anesthesia injection followed by evacuation of the caseous material and excise the nodule with a sharp dermal curet
Treat the base with Monsel’s or 885% TCA
Also use electrocautery or cyrosurgery
How contagious is condyloma acuminatum (HPV)?
Highly, 25-65%
High risk HPV strains
16 and 18
HPV types that are found in benign lesions
HPV 6 and 11
How is HPV spread?
Sexually or auto-inoculation
Incubation period for HPV
Long, 1-8 months
Where is genital HPV found?
Cervix - 70%
Vulva - 25%
Anus - 20%
Vagina - 10%
Where does the herpes virus reside during the latent phase?
The dorsal root ganglia of S2-4
How contagious is genital herpes?
Highly, 75%
What is the recurrence rate of HSV 1?
55% recurrence within 12 months
What is the recurrence rate of HSV II?
80% within 12 months
Dx of HSV
Viral cultures (rapid monoclonal antibody tests or cytology can studies are less reliable than viral cultures)
PCR (MOST accurate and newest test)
Western blot (most specific method to dx recurrent herpes or recent unrecognized or sub clinical infection)
Bacterial infections, common in tropics, AKA Donovanosis
Granuloma inguinale (gram neg calymmatobacterium granulomatosis)
What is the rate of Granuloma inguinale (gram neg calymmatobacterium granulomatosis) in the US?
<199 cases/year
Tx of Granuloma inguinale (gram neg calymmatobacterium granulomatosis)
Azithromycin
Dx of Granuloma inguinale (gram neg calymmatobacterium granulomatosis)
Finding Donovan bodies in specimens and smears
Classic clinical sign is the “Groove sign” (double genitocrural fold)
Lymphogranuloma venereum (LGV), Chlamydia trachamotis
How is Lymphogranuloma venereum (LGV)/Chlamydia trachamotis dx?
Culture (of purulent drainage with monoclonal antibodies for chlamydia)
Complement fixation antibody titer (most frequent serum method; antibodies tigers > 1 in 64 indicate active infection). Don’t use Frei Skin Test (low sensitivity)
Tx of Lymphogranuloma venereum (LGV)/Chlamydia trachamotis
***CDC - Doxycycline 100mg BID at least 21 days
Tetracycline, Erythromycin, Sulfasoxazole
Is chancroid (H. ducreyi) more common in males or females?
Males
Describe the lesions of chancroid (H. ducreyi)
Soft chancre that is painful and tender
How is chancroid (H. ducreyi) diagnosed?
Gram stain/culture revealing “school of fish” pattern on gram stain
Tx of chancroid (H. ducreyi)
CDC - erythromycin base x 7 days
How is syphilis dx?
Serologic tests - 2 types (becomes positive 4-6 weeks after exposure)
SCREENING either nonspecific, nontreponemal antibody tests (VDRL, RPR) or specific, antitreponemal antibody tests (FTA-ABS, MHA-TP)
If a patient has a positive treponemal test, they will usually remain positive for life
If a patient is found to have syphilis, they should be tested for HIV infection. What is the treatment in an HIV positive pt?
Desensitize and then PCN G 2.4 million units IM
Describe primary syphilis
Hard, painless chancre that develops in 3 weeks and heals within 2-6 weeks
Describe secondary syphilis
SYSTEMIC disease that develops from 6 weeks to 6 months after primary chancre with a rash and vulvar condyloma latum
Describe the rash associated with secondary syphilis
Red macules and papules over the palms and soles
Is the lymphadenopathy associated with secondary syphilis painful or painless?
Painless
How long does it take for latent stage secondary syphilis to develop?
20 years
When is the majority of females diagnosed with syphilis?
During the latent stage
What percentage of patients develop tertiary syphilis?
33% of untreated patients
Manifestations of tertiary syphilis
Potentially destructive effects on the central nervous, cardiovascular, and musculoskeletal systems
Optic atrophy, Tabes dorsalis, generalized paresis, aortic aneurysm, gummas of the skin and bones
Treatment of primary, secondary, and 1st year of latent syphilis
Benzathine PCN G 2.4 million units IM (if allergic, then give tetracycline)
Treatment of syphilis in pregnancy
Desensitize then PCN G 2.4 million units IM
Treatment of late latent or tertiary syphilis (gummas and CV syphilis)
Benzathine PCN G 7.2 million units IM
