STD and Related Flashcards
It is a predisposing factor in salpingitis, PID, abortion, PTL, PPROM, chorioamnionitis
Bacterial vaginosis
Disease that can cause ishy, foul-smelling discharge with pooling at the posterior fornix
Bacterial vaginosis
Physiologic ovulation
- Thin,
- clear,
- mucoid,
- stretchable
- stringy
Physiologic discharge before menstruation
thick, whitish, viscous
Vulvar erythema, edema, excoriations, abnormal color, amount and consistency type of discharge
Pathologic
Diagnosis of Bacterial vaginosis
AMSEL Criteria
Gram Stain
Gold standard for Diagnosing Bacterial vaginosis
Gram Stain
Yellow green, purulent frothy, may have vaginal erythema, strawberry cervix with a high pH and + of Trichomoniads
Trichomoniasis
Diagnosis: Thin, whitish discharge Amine: + Clue cells: + Mycelia: - pH: 6 Trichomoniads: -
Bacterial vaginosis
Diagnosis: White, floccular, milky, creamy discharge Amine: - Clue cells: - Mycelia: - pH: 4 Trichomoniads: -
Normal
Diagnosis Thick, whitish, curdy cheesy attached to vaginal wall discharge Amine: - Clue cells: - Mycelia: + pH: 3 Trichomoniads: -
Candidiasis
Cause of musty smell or the pH of Bacterial vaginosis
Anaerobes produce aminopeptidases and decarboxylases that degrade CHON and A Atoamines increasing pH
NUGENT Scoring System in Gram Stain
0-3:
4-6:
7-10:
0-3: predominantly lactobacilli (normal flora)
4-6: intermediate flora w/ gradual disappearance of LB
7-10: flora other than LB(BV)
Treatment fo BV for Pregnant
Metronidazole 500mgBIDx7days
Metronidazole 250mgTIDx7days
Clindamycin 300mgBIDx7days
Management/ Tx of Sexual partner in BV
Not recommended
Can vulvo vaginal candidiasis acquire thru sexual contact
No
Risk factor of VULVO VAGINAL CANDIDIASIS
- Pregnancy
- DM
- antibiotic/immunosuppressive Tx
- OCPs
- Obesity
- tight clothing
- hyperhidrosis
Ssx of VULVO VAGINAL CANDIDIASIS
- pruritus,
- erythema,
- edema,
- excoriation,
- tenderness
Diagnosis of VULVO VAGINAL CANDIDIASIS
WET MOUNT with 10%KOH or NSS: mycelia/pseudo hyphae
Management for VULVO VAGINAL CANDIDIASIS
Miconazole100mg vagsup OD x7days Miconazole200mg vagsup ODx3days Miconazole1200mgvagsup SD Terconazole80mgvagsupODx3days Fluconazole150mgPOSD
Management for Pregnant and Sex partner for Volvu vaginal Candidiasis
- only topicalazoles x7days
* not recommended for sexual partner
Causative agent of TRICHOMONIASIS
T. vaginalis
Classified as STI so further evaluation for other STIs is important
TRICHOMONIASIS
Anaerobic protozoan parasite, proliferates during menstruation and frequently associated with leukocytosis
T. vaginalis
Ssx in TRICHOMONIASIS infection
- dysuria,
- urinary frequency,
- vaginal pruritus,
- dyspareunia,
- offensive odor,
- low back pain,
- urethral discharge,
- involvement of Bartholin and Skene’s glands
mc dx test employed in TRICHOMONIASIS
Wet mount mx
Most specific and sensitive test for TRICHOMONIASIS
Nucleic acid amplification test (NAAT)
Management for TRICHOMONIASIS and for sexual partner
• Metronidazole or Tinidazole 2g POSD
Alternative: Metronidazole 500mg BIDx7days
• recommended
Associated of TRICHOMONIASIS in Pregnancy and Lactation
- Preterm premature rupture of the membranes (PPROM)
- Pulmonary tuberculosis (PTB)
- low BW (birth weight)
Treatment for TRICHOMONIASIS in Pregnancy and Lactation
Metronidazole (CatB) no longer restricted in 2nd and 3rd trimester
Tinidazole (CatC) no safety profile established
Breast feeding withheld during treatment up to 24hrs (metronidazole SD), 3days (Tinidazole) after last dose
Flushing, throbbing in head and neck, headache, breathing difficulty, nausea, copious vomiting, sweating, thirst, chest pain, palpitations, tachycardia, hypotension, syncope, uneasiness, weakness, vertigo, confusion upon alcohol intake while ongoing treatment with Metronidazole and Tinidazole up to 1 and 3 days, respectively.
Disulfiram reaction
2nd mc bacterial STI which cause by N. gonorrheae
GONOCOCCAL INFECTION
Incubation period of N. gonorrheae
3-5 days
Ssx of GONOCOCCAL INFECTION
- vaginal discharge,
- urethral discharge,
- dysuria,
- AUB (Abnormal uterine bleeding)
- pelvic discomfort
Hallmark of GONOCOCCAL INFECTION
mucopurulent cervicitis
Patients must be screened for chlamydia, syphilis and HIV if the patient have GONOCOCCAL INFECTION
TRUE
Greenish, abudant, thick vaginal discharge
GONOCOCCAL INFECTION
CLINICAL PRESENTATION of GONOCOCCAL INFECTION
- Raise suspicion: increased leukocytes in endocervical gram stain (>10/hpf) in the absence of trichomoniasis
- Non-pregnant: may result to urethritis, cervicitis and PID
- Pregnancy: may result to Gonorrhea ophthalmic neonatorum
Mc systemic complication of GONOCOCCAL INFECTION. (Early and Late)
Disseminated Gonococcal Infection
Early: migratory arthritis, tenosynovitis, dermatitis
Late: arthritis, perihepatitis, endocarditis, meningitis pericarditis, osteomyelitis
Gold Standard in diagnosing GONOCOCCAL INFECTION
- Culture media - Mod Thayer Martin Medium
* Gram Stain- Gram (-) intracellular diplococcici
Management for GONOCOCCAL INFECTION
• Ceftriaxone250mg IMSD+
• (1g for DGI/conjunctivitis) +
- Azithromycin1g SD or
- Doxycycline 100mg BID Pox 7days
• Ceftriaxone not available: Cefixime 400mg POSD +
- Azithromycin1gSDor - Doxycycline100mg BIDPOx7days
Guidelines for mgt: PREGNANT in GONOCOCCAL INFECTION and the sexual partner
• Ceftriaxone 250mgIMSD+ Azithromycin1g SD
• Spectinomycin 2gIM
–if can’t tolerate cephalosporins
• Azithromycin 2gPO (if no spectinomycin)
• Management of sexual partner: recommended (preceding 60days)
MC sexually transmitted bacterial pathogen
CHLAMYDIAL INFECTION
Major cause of mucopurulent discharge and its Incubation period: long (1-3weeks)
CHLAMYDIAL INFECTION
Serotpye of C trachomatis that cause LGV
L1, L2, L3
Management for VULVO VAGINAL CANDIDIASIS
Miconazole100mg vagsup OD x7days (Daily) Miconazole200mg vagsup ODx3days Miconazole1200mg vagsup SD Terconazole80mg vagsup ODx3days Fluconazole150mg POSD
Diagnosis of CHLAMYDIAL INFECTION
• Endocervical discharge: yellow/green mucus
~ >10pmn/OIF of gram stain
~ friable, erythematous, edematous, cervical ectopy
- Associated with sterile pyuria (no bacteriuria)
- Ascending infection is common:
- Acute Salpingitis (mc complication)
- FitzHugh Curtis Syndrome
Gold std in diagnosing CHLAMYDIAL INFECTION
NAAT
Management for CHLAMYDIAL INFECTION and sexual partner
Azithromycin 1g POSD
Doxycycline 100mg POBIDx7days
Management of sexual partner: recommended with abstinence for 7days post treatment
Management for CHLAMYDIAL INFECTION for pregnant
Azithromycin 1gPOSD
Amoxicillin 500mg POTIDx 7days