Lower Genital Tract Infections

Question 1

MOST contagious of all STI

vulvar pruritus confined to hairy areas of vulva

Answer 1

PEDICULOSIS
Phthirus pubis (crab louse)

Treatment:
Permethrin
Pyrethrin
Malathion
Ivermectin

Question 2

Widespread over hairy parts of the body

Severe intermittent itching at night

PATHOGNOMONIC - “burrow in the skin”

Answer 2

SCABIES
Sarcoptic scabei

Treatment:
Permethrin
Lindane

Question 3

Flesh colored, dome shaped papules with an umbilicated center

Self limiting

Answer 3

MOLLUSCUM CONTAGIOSUS
Pox virus

Treatment:
Self limiting
Monsel solution
TCA

Question 4

Genital, venereal or anogenital warts

MC STD of the vulva, vagina, rectum and cervix

Answer 4

CONDYLOMA ACUMINATUM
HPV 6, 11

Treatment:
Chemical, Cautery, Immunologic
Therapy, Surgery

Question 5

Chronic complex systemic disease caused by Treponema pallidum

Answer 5

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

Question 6

Screening for Syphilis

Answer 6

Venereal Disease Research Laboratories (VDRL) or Rapid Plasma Reagin (RPR)

Question 7

Treatment of Syphilis

Answer 7

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

Question 8

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

Answer 8

HERPES

Question 9

Definitive diagnosis for Herpes

Answer 9

PCR - most sensitive and accurate

Western Blot Assay for antibodies of HSV - for recurrent, unrecognized or subclinical herpes

Question 10

Treatment for Herpes Infection

Answer 10

Valacyclovir
Acyclovir
Famciclovir

Question 11

Sexually transmitted, acute, ulcerative disease of the vulva

Painful and tender ulcer

Buboes - tender suppurative inguinal adenopathy

Answer 11

CHANCROID
Haemophilus ducreyi

“school of fish” in microscopy

Question 12

Treatment for Chancroid

Answer 12

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

Question 13

Chronic infection of lymphatic tissue mostly affecting the vulva

Primary infection
Secondary infection
Tertiary infection

Answer 13

LYMPHOGRANULOMA VENEREUM (LGV)
Chlamydia trachomatis

BUBO - painful adenopathy in inguinal and perirectal areas

GROOVE SIGN - enlarged lymph node, tender and matted

Question 14

Treatment of Chlamydia trachomatis

Answer 14

Doxycycline 100 mg BID for at least 21 days

Erythromycin base 500 mg QID for 21 days

Question 15

Increased discharge
WHITE, THIN
increased odor

Answer 15

Bacterial vaginosis

>4.5

Question 16

Risk factors of Bacterial Vaginosis

Answer 16

new or multiple sexual partners
women who have sex with women
douching at least monthly or within the prior 7 days
social stressors

Question 17

Diagnosis of Bacterial Vaginosis

Answer 17

GRAM STAIN - gold standard
“clue cells”
decreased number of lactobacilli (Nugent criteria0

Question 18

Amsel’s Criteria (Bacterial Vaginosis)

Answer 18

homogenous vaginal discharge
ph >4.5
amine like odor when mixed with KOH (whiff test)
wet smear - clue cells

Question 19

Treatment of Bacterial Vaginosis

Answer 19

METRONIDAZOLE - 500 mg BID x 7 days

Clindamycin - 300 mg BID x 7 days

Question 20

Increased discharge
YELLOW FROTHY
Increased odor
Dysuria
Pruritis
"strawberry cervix"

Answer 20

TRICHOMONIASIAS

Trichomonas vaginalis

Question 21

Diagnosis of Trichomoniasis

Answer 21

NSS smear/ Wet smear

Question 22

Treatment of Trichomoniasis

Answer 22

METRONIDAZOLE - 500 mg BID x 7 days
Tinidazole 2 g SD

Metronidazole 2 g SD

Question 23

Increased discharge
white THICK
Dysuria
Pruritis
Burning
"WHITE CHEESY DISCHARGE"

Answer 23

CANDIDIASIS

Candida albicans

Question 24

Diagnosis of Candidiasis

Answer 24

KOH (10-20%) smear - filamentous forms, mycelia, hyphae, pseudohyphae

Question 25

Treatment of Candidiasis

Answer 25

INTRAVAGINAL
Butoconazole
Clotrimazole
Miconazole
Nystatin
Tioconazole
Terconazole

ORAL
Fluconazole 150 mg in a SD

Question 26

Inflammatory process associated with trauma, inflammatory systemic disease, neoplasia and infection

Answer 26

CERVICITIS

Question 27

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

Answer 27

MUCUPURULENT CERVICITIS
Chlamydia trachomatis
Neisseria gonorrhea

hypertrophic and edematous cervix
vaginal discharge
deep dyspareunia
postcoital bleeding

Question 28

Gram (-) diplococci found in the epithelium of the GUT, rectum, pharynx or the eye

Answer 28

MUCUPURULENT CERVICITIS
Neisseria gonorrhea

NAAT - GOLD STANDARD OF DIAGNOSIS

Question 29

Treatment for Mucopurulent Cervicitis caused by N. gonorrhea

Answer 29

Ceftriaxone 250 mg IM
OR
Cefixime 400 mg PO PLUS Chlamydia therapy if not ruled out

Question 30

Obligatory intracellular organism

Answer 30

MUCUPURULENT CERVICITIS
Chlamydia trachomatis

NAAT - GOLD STANDARD OF DIAGNOSIS

Question 31

Treatment of Chlamydia trachomatis

Answer 31

Azithromycin 1 g SD

Doxycycline 100 mg BID x 7 days