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OBGYN > Lower reproductive tract infections > Flashcards

Lower reproductive tract infections Flashcards

1
Q

UTIs

A

Need to r/o pyelo (no fever, no CVA tenderness)

Treat for E. coli, etc. with oral abx.

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2
Q

DDx of UTIs

A

Interstitial cystitis: chronic inflammation of bladder → recurrent irritative urinary sx (urgency, frequency) for long time w/o infection, also pelvic pain (dyspareunia, etc).

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3
Q

Vulvitis

A

Usually candidasis
If chronic, always rule out malignancy
Could also be 2/2 irritants, etc.

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4
Q

Syphilis (T. pallidum): primary

A

Primary = chancre on exposed mucosa, painless / red / round / firm / well circumscribed.

Develops 3wks after exposure; some LAD too.

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5
Q

Syphilis (T. pallidum): secondary

A

Disseminated. Maculopapular rash including palms / soles 1-3 mo after exposure

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6
Q

Syphilis (T. pallidum): latent

A

Early if < 1yr, late if > 1 yr

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7
Q

Syphilis (T. pallidum): tertiary

A

Uncommon, years later.

Granulomas / gummas of skin, cardiovascular syphilis (aortitis), neurosyphilis (tabes dorsalis, general paresis).

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8
Q

Diagnose syphilis

A

Dark field microscopy from chancre / granuloma is gold standard

RPR/STS → FTA-ABS for serology / screening.

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9
Q

Syphilis management

A

PCN G 2.4M units x 1; if late latent, do it weekly x 3 wks.

Alternatives: tetracycline PO 4x/day x 2wks, doxy 100mg PO BID x 2wks, or ceftriaxone 1gm IM/IV daily x 8-10d, but desensitize & give PCN, especially in pregnancy!

If neurosyphilis, need IV PCN G q4h x 10-13d.

Follow RPR / VRDL titers - should see decrease @ 6mo, nonreactive @ 12-24mo

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10
Q

Jarisch-herxheimer rxn

A

After starting PCN
From death of spirochetes
Fever, chills, H/A, myalgia,malaise, pharyngitis, rash w/in 24h
Shouldn’t prevent / delay therapy

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11
Q

HSV symptoms

A

Grouped vesicles / ulcers with burning, pruritis.

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12
Q

HSV Dx

A

DNA PCR, or Tzanck smear classically.

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13
Q

HSV management

A

Primary infection: acyclovir, famciclovir, valacyclovir
If severe or immunocompromised, IV acyclovir
If recurrent, oral acyclovir x 5d
Chronic infection: valacyclovir can lessen transmission, reduce outbreaks
If pregnant, C/S

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14
Q

Chancroid (H. ducreyi) symptoms

A

Painful, well-demarcated, non-indurated ulcer with painful supperative inguinal LAD
Very rare in USA

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15
Q

Chancroid (H. ducreyi) diagnosis

A

Dx with culture (chocolate agar), hard to do.

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16
Q

Chancroid (H. ducreyi) treatment

A

Tx with ceftriaxone IM x1, azithro PO x 1, or longer cipro / erythro regimens.
Treat partners too

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17
Q

LGV (C. trach L1-3): first stage

A

Painless, transient local lesion (papule / ulcer)

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18
Q

LGV (C. trach L1-3): second stage

A

Inguinal syndrome (painful enlargment / inflammation of inguinal nodes, fever / H/A / malaise, anorexia)

19
Q

LGV (C. trach L1-3): tertiary stage

A

Anogenital syndrome (proctocolitis, rectal stricture, rectovaginal stricture, elephantiasis.

20
Q

LGV (C. trach L1-3) diagnosis

A

Clinical suspicion, can also use cx / immunofluorescence / NAAT

21
Q

LGV (C. trach L1-3) treatment

A

Doxycycline 100 mg PO BID or erithroymycin x 21 days.

22
Q

Condyloma acuminata (genital warts)

A

Caused by HPV
Raised papillomatous wart → can grow to large pedunculated lesions
Bx if uncertain
Prevent with gardasil

23
Q

Condyloma acuminata (genital warts) treatment

A

Treat with local excision, cryo, topical TCA or 5FU

Can also use imiquimod or podofilox self-treatment if motivated

24
Q

Molluscum contagiosum (pox virus) symptoms/ dx

A

Small umbilicated “water warts”, anywhere except hands / feet. Clinical dx.

25
Q

Molluscum contagiosum (pox virus) treatment

A

Local excision or Trichloracetic acid (TCA) / cryotherapy

26
Q

Bacterial vaginosis:

A

shift from lactobacillis → other microorganisms, incl Gardnerella

27
Q

Dx of bacterial vaginosis

A

Dx: 3 of [whiff test, thin white homogenous discharge, > 20% clue cells, nitrazine pH > 4.5]

28
Q

Treatment of bacterial vaginosis

A

Metranidazole 500mg PO BID x 7d or clinda. PO > topical for efficacy. No EtOH with metro

29
Q

Candidiasis risk factors:

○ Dx: KOH prep showing branching hyphae & spores

A

A/w diabetes, recent abx, immunocompromise, intercourse, etc.

30
Q

Candidiasis signs and symptoms

A

Sx: Pruritis, burning, dysuria, dyspareunia, discharge

On exam: satellite lesions, cottage cheese-like discharge

31
Q

Treatment of candidiasis

A

Tx: azoles
■ Topical / suppository = miconazole, terconazole; Nystatin too
■ PO: fluconazole = Diflucan 150 mg PO x 1
■ If recurrent, consider non-albicans species (can be resistant to azoles); try longer duration and may need weekly PO fluconazole x 6mo

32
Q

Trichomonas vaginalis:

A

STD, unicellular anaerobic flagellated protozoa

33
Q

Trichmonas vaginalis symptoms

A

Profuse discharge (yellow / gray / green / frothy) with unpleasant odor, pruritis, worse just after menses 2/2 vaginal pH increase

34
Q

Trichomonas vaginalis examination

A

pH in 6-7 range, vulvar erythema / edema / pruritis, “strawberry cervix” (but only 10%)

35
Q

Trichomonas dx

A

Wet prep → trichomonads; NAAT is more sensitive, cx rarely done but most sensitive / specific

36
Q

Treatment of trichomonas

A

Metronidazole 2g PO x1 and treat partner as well

Vs BV tx, which is for 7d and no partner treatment needed

37
Q

Mucopurulent cervicitis:

A

Cervical motion tenderness without other PID sx

38
Q

Gonorrheal cervicitis:

A

Classically sx peak during & after menses. Can infect anal canal, urethra, oropharynx, bartholin glands too.
In neonates, can cause conjunctivitis. Disseminated = fevers, erythematous macular skin rash, arthritis, etc.

39
Q

Diagnosis of gonorrheal cervicitis

A

Gram negative dipplococcus; can gram stain or isolate with Thayer-Martin media, although
NAAT on urine / cervical specimens is now #1

40
Q

Treatment of gonorrheal cervicitis

A

Ceftriaxone 125 mg IM x 1 or cefixime 400mg PO x 1;

Also treat with azithro PO x1 for CT unless ruled out by NAAT

41
Q

Chlamydia trachomatis

A

Ocular, respiratory, reproductive tract infections. Urethritis, etc. too.

42
Q

Diagnosis of Chlamydia trachomatis

A

NAAT (intracellular, so gram stain / cx not good)

43
Q

Chlamydia trachomatis treatment

A

Azithromycin 1g PO x1 or BID doxy x 7d (but not in pregnancy)

OBGYN (32 decks)

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