Lower Genital Tract Infections Flashcards
MOST contagious of all STI
vulvar pruritus confined to hairy areas of vulva
PEDICULOSIS Phthirus pubis (crab louse)
Treatment: Permethrin Pyrethrin Malathion Ivermectin
Widespread over hairy parts of the body
Severe intermittent itching at night
PATHOGNOMONIC - “burrow in the skin”
SCABIES
Sarcoptic scabei
Treatment:
Permethrin
Lindane
Flesh colored, dome shaped papules with an umbilicated center
Self limiting
MOLLUSCUM CONTAGIOSUS
Pox virus
Treatment:
Self limiting
Monsel solution
TCA
Genital, venereal or anogenital warts
MC STD of the vulva, vagina, rectum and cervix
CONDYLOMA ACUMINATUM
HPV 6, 11
Treatment:
Chemical, Cautery, Immunologic
Therapy, Surgery
Chronic complex systemic disease caused by Treponema pallidum
SYPHILIS
Primary - chancre - solitary painless
Secondary - systemic disease; condyloma latum
Latent
Tertiary - CNS, cardio and musculoskeletal
Late - optic atrophy, tabes dorsalis, generalized paresis, aortic aneurysm, gummas
Screening for Syphilis
Venereal Disease Research Laboratories (VDRL) or Rapid Plasma Reagin (RPR)
Treatment of Syphilis
Primary, Secondary and Latent - BENZATHINE PENICILLIN G 2.4 million units IM
Late Latent - BENZATHINE PENICILLIN G 2.4 million units IM at one week intervals x 3 doses
Neurosyphilis - AQUEOUS CRYSTALLINE PENICILLIN G, 18-24 million units administered 3-4 million units IV every 4 hours for 10-14 days
Recurrent, incurable highly contagious
Flu-like symptoms - malaise, myalgias, nausea, diarrhea and fever
Vulvar burning and pruritus precede the multiple vesicles that appear next and remain intact for 24-36 hrs before evolving into PAINFUL genital ulcers
HERPES
Definitive diagnosis for Herpes
PCR - most sensitive and accurate
Western Blot Assay for antibodies of HSV - for recurrent, unrecognized or subclinical herpes
Treatment for Herpes Infection
Valacyclovir
Acyclovir
Famciclovir
Sexually transmitted, acute, ulcerative disease of the vulva
Painful and tender ulcer
Buboes - tender suppurative inguinal adenopathy
CHANCROID
Haemophilus ducreyi
“school of fish” in microscopy
Treatment for Chancroid
Azithromycin 1 g orally
Ceftriaxone 250 mg IM in a single dose
Ciprofloxacin 500 mg twice daily for 3 days
Erythromycin base 500 mg TID x 7 days
Chronic infection of lymphatic tissue mostly affecting the vulva
Primary infection
Secondary infection
Tertiary infection
LYMPHOGRANULOMA VENEREUM (LGV) Chlamydia trachomatis
BUBO - painful adenopathy in inguinal and perirectal areas
GROOVE SIGN - enlarged lymph node, tender and matted
Treatment of Chlamydia trachomatis
Doxycycline 100 mg BID for at least 21 days
Erythromycin base 500 mg QID for 21 days
Increased discharge
WHITE, THIN
increased odor
Bacterial vaginosis
>4.5
Risk factors of Bacterial Vaginosis
new or multiple sexual partners
women who have sex with women
douching at least monthly or within the prior 7 days
social stressors
Diagnosis of Bacterial Vaginosis
GRAM STAIN - gold standard
“clue cells”
decreased number of lactobacilli (Nugent criteria0
Amsel’s Criteria (Bacterial Vaginosis)
homogenous vaginal discharge
ph >4.5
amine like odor when mixed with KOH (whiff test)
wet smear - clue cells
Treatment of Bacterial Vaginosis
METRONIDAZOLE - 500 mg BID x 7 days
Clindamycin - 300 mg BID x 7 days
Increased discharge YELLOW FROTHY Increased odor Dysuria Pruritis "strawberry cervix"
TRICHOMONIASIAS
Trichomonas vaginalis
Diagnosis of Trichomoniasis
NSS smear/ Wet smear
Treatment of Trichomoniasis
METRONIDAZOLE - 500 mg BID x 7 days
Tinidazole 2 g SD
Metronidazole 2 g SD
Increased discharge white THICK Dysuria Pruritis Burning "WHITE CHEESY DISCHARGE"
CANDIDIASIS
Candida albicans
Diagnosis of Candidiasis
KOH (10-20%) smear - filamentous forms, mycelia, hyphae, pseudohyphae
Treatment of Candidiasis
INTRAVAGINAL Butoconazole Clotrimazole Miconazole Nystatin Tioconazole Terconazole
ORAL
Fluconazole 150 mg in a SD
Inflammatory process associated with trauma, inflammatory systemic disease, neoplasia and infection
CERVICITIS
Gross visualizations of yellow mucopurulent material on a white cotton swab
(+) 10 or more PMN leukocytes per hpf on gram stained smears obtained from endocervix
MUCUPURULENT CERVICITIS
Chlamydia trachomatis
Neisseria gonorrhea
hypertrophic and edematous cervix
vaginal discharge
deep dyspareunia
postcoital bleeding
Gram (-) diplococci found in the epithelium of the GUT, rectum, pharynx or the eye
MUCUPURULENT CERVICITIS
Neisseria gonorrhea
NAAT - GOLD STANDARD OF DIAGNOSIS
Treatment for Mucopurulent Cervicitis caused by N. gonorrhea
Ceftriaxone 250 mg IM
OR
Cefixime 400 mg PO PLUS Chlamydia therapy if not ruled out
Obligatory intracellular organism
MUCUPURULENT CERVICITIS
Chlamydia trachomatis
NAAT - GOLD STANDARD OF DIAGNOSIS
Treatment of Chlamydia trachomatis
Azithromycin 1 g SD
Doxycycline 100 mg BID x 7 days
