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RGU 1 > STIs involving discharges - vulvovaginitis > Flashcards

STIs involving discharges - vulvovaginitis Flashcards

1
Q

What is sexual health?

A
  • a state of physical, emotional, mental, and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction, or infirmity.
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2
Q

What are the 5 P’s related to sexual hx?

A
  • Partners
  • Practices
  • Prevention
  • Pregnancy
  • Protection
  • Past Hx of STIs
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3
Q

What are the STIs of concern that cause “drips” (discharges)?

A
  • gonorrhea
  • Chlamydia
  • nongonococcal urethritis/mucopurulent cervicitis
  • Trirchomonas vaginitis/urethritis
  • Candidiasis
  • bacterial vaginosis
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4
Q

What is vulvovaginitis?

A

the spectrum of conditions that cause symptoms such as vulvovaginal itching, burning, irritation, and abnormal discharge.

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5
Q

What is used to treat trichomoniasis?

A

metronidazole (can be used in pregnancy)

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6
Q

What is trichamonis vaginitis?

A
  • sexually transmitted parasite that causes vaginitis and cervicitis (STRAWBERRY CERVIX due to inflammation from capillary dilation).
  • causes burning, itching, dyspareunia (painful sex) and malodorous yellow/green discharge.
  • causes pH greater than 4.5 in vaginosis
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7
Q

How do we diagnose trichamonis vaginosis?

A
  • well show MOTILE trophozoites under wet mount
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8
Q

What is important to remember about treatment for trichamonis vaginosis?

A

treat BOTH partners

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9
Q

What is Candidiasis?

A
  • fungus that causes “cottage cheese” like discharge, vulvar/vaginal pruritus along with burning, irritation, dyspareunia (painful sex), and burning with urination.
  • will see PSEUDOHYPHAE on saline wet mount of vaginal discharge.
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10
Q

How do you treat candidiasis?

A
  • fluconazole
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11
Q

What will bacterial overgrowth of Gardnerella vaginalis do to the protective H2O2-producing Lactobacilli (aka disturbance of natural flora)?

A

allow for increase in pH and growth of other bacteria or candida species (greater than 4.5).
*normal vaginal pH= 3.8-4.2

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12
Q

What factors can adversely affect the normal vaginal flora?

A
  • douching
  • antibiotics
  • hormonal changes
  • use of oral contraceptives
  • foreign bodies (tampons, IUD…)
  • semen
  • menses
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13
Q

What is the KOH “whiff” test?

A
  • place sample of vaginal secretions in a test tube with KOH and if bacterial vaginosis infection, you will smell a sharp “fishy” odor, indicative of Gardnerella vaginalis.
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14
Q

Where should you take a sample when testing for vaginal pH?

A
  • from the mid portion of vaginal wall; NOT cervix, which has a pH of 7.
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15
Q

What are some general problems associated with Gardnerella vaginalis (aka bacterial vaginosis; BV)?

A
  • PID, preterm birth, chorioamnionitis…
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16
Q

What should we do when pts present with Gardnerella vaginalis; bacterial vaginosis (BV)?

A
  • treat al symptomatic patients.

- screen and treat all “high risk” its (i.e. prior preterm labor/delivery).

17
Q

Is chronic UTI associated with BV?

A

YES

18
Q

Does BV cause elevated pH?

A

YES

19
Q

How do you treat Gardnerella vaginalis (aka bacterial vaginosis)?

A
  • metronidazole or clindamycin
20
Q

What discharge will you see with Gardnerella vaginalis?

A

grayish-white discharge

21
Q

** What specific cells will you see with Gardnerella vaginalis?

A

clue cells= epithelial cells coated with bacteria

22
Q

How is Gardnerella vaginalis (BV) transmitted?

A

sexually

23
Q

What is pelvic inflammatory disease (PID)?

A
  • the acute clinical manifestation of ascending genital-tract infection involving the endometrium, fallopian tubes, and/or adjacent pelvic structures.
  • usually due to gonnorhea, chlamydia, or mycoplasma
24
Q

*** What are the minimum criteria for PID?

A
  • uterine tenderness

- adnexal tenderness +/- cervical motion tenderness

25
Q

What is chandelier sign?

A

cervical motion tenderness during painful pelvic exam, indicating PID

26
Q

What are some additional criteria associated with PID?

A
  • temp greater than 101 (38.3 celsius).
  • elevated WBC count
  • elevated ESR/CRP
  • aka normal markers of inflammation
27
Q

What are the sequelae of PID?

A
  • tubal infertility
  • ectopic pregnancy
  • chronic pelvic pain
28
Q

*** What is Fitz-Hugh Curtis syndrome?

A
  • RUQ pain due to perihepatic adhesions “violin strings” between liver capsule and peritoneum
29
Q

What is the pathway to PID?

A
  • cervicitis leading to endometritis, which leads to salpingitis/oophoritis/tuboovarian abscess, which leads to peritonitis.
30
Q

What is the classic symptom of PID?

A
  • abrupt onset of severe lower abdominal pain during or shortly after menses.
31
Q

Does risk for ectopic pregnancy increase significantly after one episode of PID?

A

YES

RGU 1 (17 decks)

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