Management of gynecological infections

Question 1

What are three main categories for infection of the female pelvis

Answer 1

Pregnancy, post-surgical infections, pelvic inflammatory disease (PID)

Question 2

What are the three classifications of infections related to pregnancy

Answer 2

Intrapartum, postpartum, or postabortal infections

Question 3

What is an intrapartum infection, when does it usually occur

Answer 3

amniotic fluid/fetal membranes become infected due to normal flora ascending into the intrauterine cavity after membrane rupture, less than 37 weeks

Question 4

What are the organisms that usually cause intrapartum infections

Answer 4

Beta-Streptococci, E. coli, Mycoplasma spp. and Prevotella Spp

Question 5

T/F: Intrapartum infections should be treated before delivery to make sure the pathogen does not become systemic

Answer 5

True

Question 6

What antibiotics are given to treat a intrapartum infection

Answer 6

Ampicillin and gentamicin

Question 7

What part of the uterus in infected after birth causing a postpartum infection

Answer 7

The endometrium is infected by normal flora

Question 8

What are the risk factors for endomyometritis

Answer 8

Duration of labor or rupture of membranes, bacterial vaginosis, number of vaginal exams, internal fetal monitoring

Question 9

What organisms cause endomyometritis

Answer 9

E. coli, Beta-stretococcous, C. vagininalis, prevotella

Question 10

What are the first line antibiotics used to treat endomyometritis, alternatives

Answer 10

Clindamycin and gentamicin, amp/sulb, pip/tazo, cefoxitin. carbapenenms

Question 11

What causes surgical site infections in women

Answer 11

Surgical site is contaminated with vaginal flora

Question 12

What organisms usually cause a surgical site infection in women

Answer 12

beta-strep, E. coli, prevotella, G. vaginalis

Question 13

What are classifications for surgical site infections in women

Answer 13

cuff cellulitis, pelvic cellulitis and pelvic abscess

Question 14

What are key diffenences in the 3 types of surgical site infections

Answer 14

Cuff cellultis: minimal discahe with lower abdominal pain
Pelvic cellultiis: Fever tenderness with patients appearing sick
Pelvic Abscess: spread of infection deep into abdominal tissue that may require antibiotics and surgical drainage

Question 15

What is a key way to prevent a surgical site infection

Answer 15

use chlorhexidine or providone iodine around the skin and vagina area

Question 16

What are other risk factors for getting a surgical site infection

Answer 16

Not using systemic antimicrobial prophylaxis, blood loss, prolonged surgery (greater than 2 hours), blood transfusion, using staples instead of sutures

Question 17

What are the antibiotics that are suggested if a patient has cuff cellulitis

Answer 17

Augmentin 875 mg BID OR Cirprofloxacin 500 mg BID plus Flagyl 500 mg BID

Question 18

T/F: For pelvic cellulitis and pelvic abscess the length of treatment should only be 7 days with a start of IV antibiotics

Answer 18

False: For pelvic cellulitis and pelvic abscess the length of treatment should be 14 days with IV antibiotics starting off

Question 19

If a patient has pelvic abscess what will determine whether or not there is drainage of a mass

Answer 19

Abscess is greater than 8 cm or abscess is less than 8 cm but there is not improvement after using antibiotic therapy

Question 20

What is the most common cause of vaginal discharge, what causes this

Answer 20

Bacterial vaginosis. due to alteration of normal vaginal flora

Question 21

What organism works to keep normal flora in check, what can cause their decline

Answer 21

Lactobacillus, G. vaginalis predomniates, vaginal anaerobes (prevotella, bacterocides, peptosteptococcus)

Question 22

What are symptoms of bacterial vaginosis

Answer 22

Homogenous gray- white discharge, pH greater than 4.5, coccobacillary cells adhered to vaginal epithelium

Question 23

What are risk factors of bacterial vaginosis

Answer 23

Douching, smoking, early age sexual intercours, multiple sex partners, woman/woman sex

Question 24

T/F: Bacterial vaginosis is NOT and STD/STI

Answer 24

True

Question 25

What are the treatment options for baterial vaginosis

Answer 25

Metronidazole 500 mg BID for 7 days, Metronidazole 0.75 gel every day for 5 days, Clindamycin 300 mg BID for 7 days

Question 26

What is pelvic inflammatory disease

Answer 26

Infection/ inflammation of the upper genital tract (reproductive) and pelvic organs

Question 27

What are two pathogens that MUST be covered if pelvic inflammatory disease is present

Answer 27

Gonorrheae and chlamydia

Question 28

What are the risk factors for PID

Answer 28

Young females from early teens to early 20s, multiple sex partners, substance abuse, douching

Question 29

When do symptoms for PID develop

Answer 29

During or after the menstrual cycle

Question 30

How long are patient with PID treated, if given IV antibiotics when should a switch to oral happen

Answer 30

14 days, 24 to 48 hours