PID and Abuse Case Flashcards
A complication of PID causes RUQ pain?
Fitz-Hugh-Curtis Syndrome
What is the cause of the RUQ pain is FHCS?
Inflammation of the liver capsule and peritoneal surfaces of the anterior RUQ.
What would you see in laparoscopy or a liver biopsy in patients with FHCS?
Violin string like adhesions of the liver capsule
Classic finding in PID?
Chandelier sign
What two infections are most commonly associated with FHCS?
Gonorrhea and chlamydia.
T/F? Chancres are typically very painful.
False - painless although they look painful
A single chancre and regional adenopathy is suggestive of what type of syphilis?
Primary
Preferred treatment of primary syphilis?
Pen G benzathine 2.4 million units IM once
Secondary syphilis includes what symptoms?
Systemic illness, rash involving hands and soles, fever, malaise.
Treatment for secondary syphilis?
Pen G benzathine 2.4 million units IM once
What is latent syphilis?
+ treponema pallidum testing w/o symptoms.
Difference between early and late latent syphilis?
Early < 1 year from initial infection
Latent >1 year from initial infection
Treatment for early latent syphilis?
Pen G benzathine 2.4 million units IM once
Tertiary syphilis presents with what symptoms?
Late syphilis with manifestations involving the cardiovascular system or gummatous disease (disease of skin, subq tissues, bones, or viscera)
Treatment for tertiary syphilis and late latent syphilis?
Pen G benzathine 2.4 million units IM once weekly for 3 weeks.
T/F? Neurosyphilis only occurs with late syphilis.
False - can occur any time during course of infection
Early neurosyphilis includes what manifestations?
Asymptomatic/symptomatic meningitis, stroke, vision or hearing loss.
Late neurosyphilis includes what manifestations?
Involves brain and spinal cord - dementia, paresis, tabes dorsalis.
Treatment for neurosyphilis?
Aqueous pen G 3-4 million units IV every 4 hours for 10-14 days.
Syphilis infections of the ___ or ___ should always be treated as neurosyphilis.
eye or ear
What are the options for the first test you would do if you suspect syphilis?
VDRL ( venereal disease research lab test)
OR
RPR (rapid plasma reagin test)
If you got a positive test, what do you do next?
Confirmatory treponemal test
What are the options for confirmatory treponemal tests?
TP-PA
FTA-ABS
TP-EIA
CIA
Testing for gonorrhea?
NAAT preferred - vaginal swab in women, urine in men.
Tx for gonorrhea?
Ceftriaxone 500mg IM
If a patient needs to be treated for gonorrhea, and chlamydia has not been ruled out, does it change your treatment?
Yes - treat with ceftriaxone 500mg IV + doxy 100mg BID x 7 days
Testing for chlamydia?
NAAT - vaginal swab in women, urine sample for men.
Treatment for chlamydia?
Two first line options,
Azithromycin 1g PO
OR
Doxy 100mg PO BID x 7 days
T/F? Herpes infections can cause constitutional symptoms.
True - but they don’t always cause constitutional symptoms.
Recurrent herpes infections present with what type of lesions?
Small vesicular or ulcerative lesions. Vulvar irritation or fissures possible.
T/F? If your patient is diagnosed with herpes, it is important to tell them it is a lifelong infection.
True
What test is most commonly done to test for herpes?
Viral culture from vesicle fluid
What is the most sensitive and specific test for herpes?
PCR
What is the gold standard for herpes testing?
Tzank smear
What findings on a Tzank smear indicate herpes infection?
Multinucleated giant cells
Treatment for herpes?
Acyclovir or valacyclovir for flares and suppression if 6+ flares per year
Describe the discharge of BV.
Thin off white vaginal discharge with a fishy odor
What criteria can you use to diagnose BV?
Amsel criteria
List the Amsel criteria.
Homogenous thin white/grey discharge that coats vaginal wall
Vaginal pH > 4.5
Positive whiff amine test with 10% KOH solution
Clue cells on saline mount, at least 20% epithelial cells
How many of the Amsel must be met to dx BV?
3/4
Tx for BV?
Metronidazole or clindamycin
Describe the discharge of candidiasis.
Cottage cheese like thick, white.
What are some associated symptoms with the discharge in candidiasis?
Intense pruritis, could have excoriations with bleeding.
Dysuria
Dyspareunia
What do you need to diagnose candidiasis?
Went mount with budding yeast and hyphae on KOH prep
Tx for candidiasis?
Oral fluconazole or topical clotrimazole or miconazole.
Why do you need to exercise caution when prescribing fluconazole?
A lot of DDIs
Describe the discharge with trichomoniasis
Malodorous greenish-yellow thin discharge.
Cervical appearance with trichomoniasis?
Strawberry cervix
Gold standard trich testing?
NAAT
Wet mount of trichomonas shows?
Flagellated trichomonads
Tx for trich?
Metronidazole or tinidazole x 7 days
