Pelvic Infections and STIs Flashcards
what is the #1 cause of vaginal discharge
bacterial vaginosis (BV)
what is the #1 cause of symptomatic bacterial infection in reproductive age women
bacterial vaginosis (BV)
what are risk factors of BV
Multiple male partners
female partners
>1 partner
new parner
not using condoms
douching
HSV+
Menses
copper IUD
if symptomatic, what is the presentation of BV
vaginal discharge
milky with ‘fishy’ odor (after addition of KOH prep)
worse after unprotected intercourse
non-irritating
how is BV diagnosed
Amsel’s criteria or Nugent score (more sensitive and specific)
what is seen on miscroscopy with BV
Clue cells - secondary to Gardnerella vaginalis infection
what is the first line treatment for BV
Metronidazole PO x 7 days
Metrinidazole intravaginal gel
clindamycin intravaginal gel
what are alternative treatment for BV
oral clindamycin
clindamycin ovules
what are risks of untreated BV infection
increased risk for STI’s, including HIV
increased risk of preterm delivery
risk of candidiasis infection after treatment
what is Gonorrhea
gram negative intracellular diplococci
infects mucous membranes
highest incidence in ages 15-24
common co-infection with chlamydia
what are the presenting symptoms of gonorrhea
dysuria (urethritis)
purulent discharge (white, green, yellow)
increased vaginal discharge
friable cervix
vaginal bleeding
scrotal pain (epididymitis)
what are the possible extra-genital infections associated with gonorrhea
conjunctivitis
arthritis
disseminated
how is gonorrhea diagnosed
Nucleic acid amplification test (NAAT) - urine or swab
screening recommended regardless of symptoms
what is the treatment of gonorrhea
ceftriaxone IM single dose PLUS azithromycin or dyoxycycline
no intercourse for 7 days
treat partners
re-test at 3 months after treatment
what are the complications of gonorrhea
PID - infertility, abscess, chronic pain, ectopic pregnancy
epididymitis - infertility (rare)
mom-to-baby transmission - blindness, joint infection, sepsis
what is chlamydia
intracellular gram negative bacterium
common co-infection with gonorrhea
highest in ages 15-24
what are the symptoms of chlamydia
dysuria (urethritis)
pyruia
increased urinary frequency
purulent discharge (mucopurulent, mucoid, watery)
increased vaginal discharge
friable cervix
vaginal bleeding
scrotal pain, tenderness, edema
how is chlamydia diagnosed
Nucleic acid amplification test - swab or urine
screen recommended in sexually active pts regardless of symptoms
what is the treatment of chlamydia
Doxycycline BID for 7 days (Drug of choice)
alternative: azythromycin or levofloxacin
consider addition of ceftriaxone IM single dose
what are the complications of chlamydia
PID
Mom-to-baby transmission: conjunctivitis and PNA
preterm labor
reactive arthritis
What is Trichomonas Vaginitis
most preventable non-bacterial STI (flagellate protozoan)
prevented with condom use
what are the risk factors for trich
incarceration
2+ partners in one year
less than a HS education
poverty
BV
douching
what is the clinical manifestations of Trich
males: urethritis, epidydmitis, prostatitis
females: produce, malodorous, frothy, yellow or greenish discharge
“Strawberry cervix”
how is Trich diagnosed
Microscopy / wet mount (POC) - must do immediately after sampling
Nucleic acid type testing
culture
what is the treatment of Trich
first line: metronidazole PO x 7 days (women)
MetroPO x 1 for males
Tindazole PO alternative
NO GELS
what are complications of Trich
1.5x increased risk for preterm labor
PROM
small for gestational age infants
2x increased risk for cervical CA
some evidence for increased prostate CA risk
HIV infection
What is candidiasis
aka vulvovaginal candidiasis
primarily caused by C. albicans
not a true STI
what are risk factors for candidiasis
DM
obesity
HIV+
pregnancy
antibiotic use
steroid use
OCP use
debilitation
moist vaginal environment
what is uncomplicated candidiasis
sporadic or infrequent
mild to moderate ssx
likely c. albicans
immunocompetent
what is complicated candidiasis
recurrent
severe
likely non c.albicans spp.
DM
immunocompromised
immunosuppressant tx
How is candidiasis diagnosed
presence of budding yeast and hyphae on KOH wet mount
if negative or complicated: culture (gold standard)
what is the treatment of candidiasis
OTC: clitrimazole, miconazole
Rx: butoconazole cream, terconazole cream/suppository, PO fluconazole
what is syphilis
caused by treponema pallidum (spirochete)
can cause infection of virtually any tissue/organ
infection via oral/vaginal/anal intercourse, placenta, non-sexual blood contact
what are risk factors of syphilis
MSM, SUD, lack of condom use
-condoms dont eliminate risk- exposed areas can be infectious
what are the categories of syphilis
primary, secondary and tertiary syphilis
what is primary syphilis
single painless ulcer (chancre)
nontender, non purulent, indurated
3-4 weeks after infection
may have multiple lesions, atypical lesions, painful
appear on genitals, breast, oropharynx or others
what is secondary syphilis
skin rash, mucocutaneous lesions, lymphadenopathy
what is tertiary syphilis
many pts remain latent and dont develop dertiary manifestation
cardiac manifestations, gummas (soft granulomas), bone lesions, liver lesions, paresis
can occur 10-30 years
non-infectious lesions
what is neurosyphilis
can occur at any stage; meningitis, AMS, stroke, cranial nerve dysfunction
what is ocular syphilis
can occur at any stage; conjunctivitis, uveitis, keratitis, optic neuropathy, vision loss
what is auditory syphilis
can occur at any stage; tinnitus, vertigo, SN HL
how is syphilis diagnosed
darkfield microscopy or molecular testing (early)
later stages requires two testing methods: non-treponemal test and treponemal test
what is the treatment of syphilis
parenteral penicillin G - first line for all stages
Doxy-2nd line
no intercourse for 7-10 days
reportable disease
what is a Jarisch-Herxheimer reaction
fever and worsening clinical ssx
starts within hours of treatment
lysis of spirochetes - release of endotoxin
What is a Chancroid
rare STI
m/c age 21-30
sex workers and younger men
caused by Haemophilus ducreyi (gram negative bacilli)
incubation period 3-5 days
what is the presentation of chancroid
ulcerations: painful, pustule, papule, soft, irregular boarders, necrotic base with yellow-grey exudates, erythematous halo
what is the gold standard for diagnoisng chancroid
lesion culture (requires special medium)
what is the treatment of chancroid
azithry 1gPO x1
ceftriaxone 250mg IM x1
what is herpes simplex
very common STI
m/c cause of genital ulcers
HSV type 1 or 2
what is the presentation of herpes simplex
+/- tingling prodrome
macular or papular lesions - vesicles on an erythematous base - ulcerations
ulcerations are shallow and severely painful
associated with edema, burning, itching, dysuria, vaginal/urethral discharge
tender lymphadenopathy
how is HSV diagnosed
clinical if vesicles present
swab of lesion for HSV PCR
HSV serology (antibodies)
HSV serum PCR
Tzank smear
what is the treatment of HSV
lifelong infection
acute treatment to decrease length of sx
prophylactic tx decreases # of recurrences
what are the risks with HSV
HIV, meningitis, acute retinal necrosis
what is another name for genital warts
condyloma acuminata
related to HPV types 6 or 11
what is the presentation of condyloma acuminata
many infections are asymptomatic
characterized by flat, papular or pedunculated lesions
lesions occur near introitus, under foreskin or penile shaft
+/- pain
+/- puritis
how are genital warts diagnosed
primarily clinica
definitive dx with biopsy of lesion
what is the treatment of genital warts
no gold standard - shared dx making
cryotherapy, surgical removal, TCA or BCA
what are patient applied options for the treatment of genital warts
imiquimod cream
podofilox gel
sinecatechins ointment
what is imiquimod cream
tx for genital warts
stimulates interferon and cytokines
tx 8-16weeks once daily or once 3x/week
what are the sx of imiquimod cream
primarily skin irritation, hypopigmentation
what is podofilox gel
tx for genital warts
antimitotic - wart ecrosis
BID for 3 days then 4 days off, repeat max 4x
limited by size
when is podofilox gel contraindicated
pregnancy
what is sinecatechins ointment
tx of genital warts
green tea extract + catechins
3x/day for no more than 16 weeks
what are the SE of sinecatechins
skin irritation
unknown pregnancy risk
what is the inflammation of the upper genital tract
PID
what are risk factors for PID
multiple partners
age
previous PID
IUD
tubal ligation
what is the presentation of PID
abd and lower pelvic pain
vaginal discharge
dyspareunia
abnormal vaginal bleeding
what is seen on exam with PID
cervical discharge
cervical motion tenderness (chandelier sign)
uterine tenderness
adnexal tenderness
+/- pelvic mass
how is PID diagnosed
dx is primarily clinical
reliable dx if 3 clinical criteria present:
*cervical motion tenderness
*uterine tenderness
*adnexal tenderness
what is the definitive dx test for PID
laparoscopic endometrial biopsy
-wont ID any organisms, shows scarring
what is the treatment of PID
IV or PO abx
first line: ceftriaxone IM/IV PLUS Doxy PO/IV PLUS Metronidazole PO/IV
what are the three clinical criteria for PID dx
*cervical motion tenderness
*uterine tenderness
*adnexal tenderness
what are the indication for admission with PID
need to r/o other surgical emergency
presence of tubo-ovarian abscess
pt is pregnant
severe infection (+n/v, temp >101)
pt cant tolerate PO tx
no response to PO tx
what are complications of PID
tubo-ovarian abscess
pelvic abscess
ectopic pregnancy (d/t scaring in fallopian tubes)
infertility (5x increased risk)
adhesions
what is the duration of acute pelvic pain
< 3 months duration
what is chronic pelvic pain
presistent, noncyclic pain perceived to be in structure related to the pelvis and lasting more than six months
often no etiology identified - CRPS or somatic syndrome
