Lower Genital Tract Infections Flashcards

1
Q

What must be ruled out in patients over 40 with multiple recurrences of bartholin’s gland ABSCESSES?

A

Adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

MOST contagious STI

A

Lice (pediculosis pubis, crab louse, pthirus pubis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Primary sx of lice (pediculosis pubis, crab louse, pthirus pubis)

A

Constant itching (2/2 allergic sensitization)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Tx for Lice (pediculosis pubis, crab louse, pthirus pubis)

A

Permethrin (Nix)

Lindane (Kwell)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Primary sx of scabies (itch mite), sarcoptes scabei

A

Severe intermittent itching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What populations cannot take Lindane (Kwell)?

A

Pregnant or lactating women

Children under 2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Tx for Primary sx of scabies (itch mite), sarcoptes scabei

A

Permethrin (Nix)

Lindane (Kwell)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Aka “water wart”

A

Molluscum contagiosum, pox virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How contagious is Molluscum contagiosum, pox virus?

A

Mildly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the nodules of Molluscum contagiosum, pox virus

A

“Water wart”

The more mature nodules have an umbilicated center

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is Molluscum contagiosum (pox virus) diagnosed?

A

Intracytoplasmic molluscum bodies with WRIGHT’s or GIEMSA STAIN confirm the diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is a major complication of Molluscum contagiosum (pox virus)?

A

Bacterial superinfection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Tx of Molluscum contagiosum (pox virus)

A

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 well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How contagious is condyloma acuminatum (HPV)?

A

Highly, 25-65%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

High risk HPV strains

A

16 and 18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

HPV types that are found in benign lesions

A

HPV 6 and 11

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How is HPV spread?

A

Sexually or auto-inoculation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Incubation period for HPV

A

Long, 1-8 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Where is genital HPV found?

A

Cervix - 70%

Vulva - 25%

Anus - 20%

Vagina - 10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Where does the herpes virus reside during the latent phase?

A

The dorsal root ganglia of S2-4

21
Q

How contagious is genital herpes?

A

Highly, 75%

22
Q

What is the recurrence rate of HSV 1?

A

55% recurrence within 12 months

23
Q

What is the recurrence rate of HSV II?

A

80% within 12 months

24
Q

Dx of HSV

A

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)

25
Q

Bacterial infections, common in tropics, AKA Donovanosis

A

Granuloma inguinale (gram neg calymmatobacterium granulomatosis)

26
Q

What is the rate of Granuloma inguinale (gram neg calymmatobacterium granulomatosis) in the US?

A

<199 cases/year

27
Q

Tx of Granuloma inguinale (gram neg calymmatobacterium granulomatosis)

A

Azithromycin

28
Q

Dx of Granuloma inguinale (gram neg calymmatobacterium granulomatosis)

A

Finding Donovan bodies in specimens and smears

29
Q

Classic clinical sign is the “Groove sign” (double genitocrural fold)

A

Lymphogranuloma venereum (LGV), Chlamydia trachamotis

30
Q

How is Lymphogranuloma venereum (LGV)/Chlamydia trachamotis dx?

A

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)

31
Q

Tx of Lymphogranuloma venereum (LGV)/Chlamydia trachamotis

A

***CDC - Doxycycline 100mg BID at least 21 days

Tetracycline, Erythromycin, Sulfasoxazole

32
Q

Is chancroid (H. ducreyi) more common in males or females?

A

Males

33
Q

Describe the lesions of chancroid (H. ducreyi)

A

Soft chancre that is painful and tender

34
Q

How is chancroid (H. ducreyi) diagnosed?

A

Gram stain/culture revealing “school of fish” pattern on gram stain

35
Q

Tx of chancroid (H. ducreyi)

A

CDC - erythromycin base x 7 days

36
Q

How is syphilis dx?

A

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

37
Q

If a patient is found to have syphilis, they should be tested for HIV infection. What is the treatment in an HIV positive pt?

A

Desensitize and then PCN G 2.4 million units IM

38
Q

Describe primary syphilis

A

Hard, painless chancre that develops in 3 weeks and heals within 2-6 weeks

39
Q

Describe secondary syphilis

A

SYSTEMIC disease that develops from 6 weeks to 6 months after primary chancre with a rash and vulvar condyloma latum

40
Q

Describe the rash associated with secondary syphilis

A

Red macules and papules over the palms and soles

41
Q

Is the lymphadenopathy associated with secondary syphilis painful or painless?

A

Painless

42
Q

How long does it take for latent stage secondary syphilis to develop?

A

20 years

43
Q

When is the majority of females diagnosed with syphilis?

A

During the latent stage

44
Q

What percentage of patients develop tertiary syphilis?

A

33% of untreated patients

45
Q

Manifestations of tertiary syphilis

A

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

46
Q

Treatment of primary, secondary, and 1st year of latent syphilis

A

Benzathine PCN G 2.4 million units IM (if allergic, then give tetracycline)

47
Q

Treatment of syphilis in pregnancy

A

Desensitize then PCN G 2.4 million units IM

48
Q

Treatment of late latent or tertiary syphilis (gummas and CV syphilis)

A

Benzathine PCN G 7.2 million units IM