STIs, PID and Discharge Flashcards
what is the predominant organism of the normal flora
lactovacilius
normal vaginal discharge is called ___ ____
physiologic leukorrhea.
Transparent, mucousy, white-yellow, variable odor (none to some), can vary over time (cycles, pregnancy, medications), lactobacillus maintains acidity in discharge (H2O2 and lactic acid), pH 3.8 to 4.2, increased in low estrogen states.
most common cause of abnormal vaginal discharge
bacterial vaginosis
presentation and management of bacterial vaginosis
Presentation: up to 50% have no symptoms, some may have a fishy odor. Discharge may be white/grey, thin, copious.
Management: metronidazole, clindamycin. Same treatments in pregnancy or in HIV positive persons.
pathophysiology of bacterial vaginosis
overgrowth of certain organisms and depletion of lactobacillus
T/f treatment for bacterial vaginosis changes with pregnancy
false. the management is metronidazole and clindamycin. same treatment in pregnancy and in HIV
presentation and management of candidiasis
Presentation: 20% are asymptomatic. Others may have pruritus, dysuria, dyspareunia, discharge (white, clumpy, curd-like), erythema, edema of the vulva.
Management: fluconazole. Longer courses may be needed for immunocompromised hosts. Topical azoles for pregnancy.
T/F BV is an STI
false
T/F candidiasis is an STi
false
trichomonas is an STI?
true.
which age group is most affected by trichomonas
older?younger, women?men
presentation and symptoms and management of trichomonas
Sexually transmitted. Most curable STI.
Presentation: frequently asymptomatic, women>men; older>younger, mild to severe, symptoms lasting 5-28 days after being infection.
Symptoms: genital itching or burning, redness or soreness, burning with urination or ejaculation, discharge, possible dyspareunia. Discharge is off-white, yellow, frothy. Erythema of vulva and cervix.
Management: treatment regardless of symptoms. Metronidazole 2g PO 1 dose.
gram stain results in bacterial vaginosis
glue cells, more gram negative curved vacilli and coccobacilli
gram stain results in VVC
budding years, hyphae
gram stain results in tricomona (TV)
PMN, trichonmonas
strawberry cervix and off-white yellow frothy appearance of discharge is an indication of ____
trichomonas (TV)
how does the pH differ btween BV, VVC, and TV?
both BV and TV will be basic, and VVC would result in ACIDIC environment
what type of condition would result in a positive whiff test with KOH?
bacterial vaginosis
BV in pregnancy can lead to:
PROM, chorioamnionitis, preterm labour, pre-term birth, post C-section endometritis
having BV while undergoing a procuedure like IUD, biopsy or curretage is associated with:
PID and vaginal cuff cellulitis
T/F lichen sclerosis can cause dischage
false.
Amsel Criteria for BV Diagnosis (B-C-D-W)
Thin, white, yellow, homogenous discharge
Clue cells on wet mount microscopy
Vaginal fluid pH over 4.5 BASIC
Release of fishy ofor when adding 10% KOD (Whiff test positive). Need at least 3 criteria for positive result.
DO a BV TEST SWAB.
clinical presentation of chlamydia in males and females
Chlamydial Infections
- Incubation period 2-3 weeks (up to 6)
- Persists for months with no treatment.
- Co-infection with NG common (20-42%)
Diagnosis of Chlamydia: nucleic acid amplification testing (NAAT), consistent syndrome, partner with a positive test.
Management: azithromycin first line in non pregnant adults. Doxycycline second line.
If pregnant: azithromycin or amoxicillin.
diagnosing chlamydia
NAAT, consistent syndromes, partner with a positive test
management of chlamydia
azithromycin first line in nonpregnant adults. Doxycycline second line.
- if pregnant: azithromycin or amoxicillin
outline the ages of males nad females most likely to be affected with gonorrhea
Males 20-24 years and females 15-19 years most affected
Presentation: incubation period 2-7 days. Often asymptomatic in females, symptomatic in males.
Risk factors: sex, prior infection, other STIs, youth, number/multiple partners, vulnerable populations, HIV transmission is increased with GC.
neonatal presentation of gonorrhea
opthalmia, conjunctivits, sepsis, disseminated gonoccal infection.
in chilrdren: urethritis, vagininitis, conjunctivits, pharyngeal infection, proctitis, disseminate gonoccal infection
diagnosis and treament of gonorrhea
Diagnosis: NAAT, culture in select cases, urethral gram stain may be done in some contexts.
Management in both pregnant and heterosexual adults: cefixime or ceftriaxone PLUS azithromycin.
Or azithromycin + gentamicin or gemifloxacin.
Must NOTIFY. Also treat CT if GC+.
Test of cure in select situations (culture 3-7 after, NAAT 2-3 weeks after)
pelvic inflammatory disease definition and microbiology
Definition: infection of the female upper genital tract– any combination of anatomic structures (endometrium, fallopian tubes, pelvic peritoneum et al). Most common infectious cause of lower abdominal pain)
Micro: polymicrobial. can be categorized as STI vs endogenous pathogen causes
- stis: ct, gc, hsv is rare, Tv is rare
- genital tract organisms; mycoplasma genitalium, m. hominis
anaerobes; bacteroids spp., peptostrptococcus spp,
aerobes; ecoli, g. vaginallis, H.influenzae, strep.
minimum diagnostic criteria for pID
lower abdominal tenderness
adnexal tenderness
cervical motion tendeness
gold standard definitive diagnostic criteria for PID
laparoscopy demonstrating abnormalities consistent with PID, such as fallopian tube erythema and/or mucopurulent exudates
definitive diagnostic crtiera for PID
management of PID
Management: early diagnosis and treatment is crucial for fertility
PO or IV antibiotic treatment: poly microbial coverage
Cefoxitin + doxycyclin
Goals: prevent infertility, ectopic pregnancy, chronic pelvic pain.
complications of chlamydia for males and females
Complications of Chlamydia
Female: PID, ectopic pregnancy, infertility, chronic pelvic pain, reiter syndrome
Males: epididymo-orchitis, reiter syndrome.
complications of gonorrhea
Complications of Gonorrhea
Female: PID, infertility, ectopic, chronic pelvic pain, reactive arthritis, disseminated gonococcal infection
Males: epididymo-orchitis, infertility, disseminated gonococcal infection
- List etiologies for non-infectious vaginal discharge.
Non-infectious causes with discharge:
- Physiologic
- Desquamative inflammatory vaginitis
- Atrophic vaginitis
- Foreign bodies
- Cervical ectropion
