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MDCN 460: Course 6 > STIs, PID and Discharge > Flashcards

STIs, PID and Discharge Flashcards

1
Q

what is the predominant organism of the normal flora

A

lactovacilius

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2
Q

normal vaginal discharge is called ___ ____

A

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.

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3
Q

most common cause of abnormal vaginal discharge

A

bacterial vaginosis

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4
Q

presentation and management of bacterial vaginosis

A

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.

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5
Q

pathophysiology of bacterial vaginosis

A

overgrowth of certain organisms and depletion of lactobacillus

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6
Q

T/f treatment for bacterial vaginosis changes with pregnancy

A

false. the management is metronidazole and clindamycin. same treatment in pregnancy and in HIV

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7
Q

presentation and management of candidiasis

A

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.

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8
Q

T/F BV is an STI

A

false

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9
Q

T/F candidiasis is an STi

A

false

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10
Q

trichomonas is an STI?

A

true.

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11
Q

which age group is most affected by trichomonas

A

older?younger, women?men

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12
Q

presentation and symptoms and management of trichomonas

A

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.

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13
Q

gram stain results in bacterial vaginosis

A

glue cells, more gram negative curved vacilli and coccobacilli

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14
Q

gram stain results in VVC

A

budding years, hyphae

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15
Q

gram stain results in tricomona (TV)

A

PMN, trichonmonas

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16
Q

strawberry cervix and off-white yellow frothy appearance of discharge is an indication of ____

A

trichomonas (TV)

17
Q

how does the pH differ btween BV, VVC, and TV?

A

both BV and TV will be basic, and VVC would result in ACIDIC environment

18
Q

what type of condition would result in a positive whiff test with KOH?

A

bacterial vaginosis

19
Q

BV in pregnancy can lead to:

A

PROM, chorioamnionitis, preterm labour, pre-term birth, post C-section endometritis

20
Q

having BV while undergoing a procuedure like IUD, biopsy or curretage is associated with:

A

PID and vaginal cuff cellulitis

21
Q

T/F lichen sclerosis can cause dischage

A

false.

22
Q

Amsel Criteria for BV Diagnosis (B-C-D-W)

A

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.

23
Q

clinical presentation of chlamydia in males and females

A

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.

24
Q

diagnosing chlamydia

A

NAAT, consistent syndromes, partner with a positive test

25
Q

management of chlamydia

A

azithromycin first line in nonpregnant adults. Doxycycline second line.

  • if pregnant: azithromycin or amoxicillin
26
Q

outline the ages of males nad females most likely to be affected with gonorrhea

A

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.

27
Q

neonatal presentation of gonorrhea

A

opthalmia, conjunctivits, sepsis, disseminated gonoccal infection.

in chilrdren: urethritis, vagininitis, conjunctivits, pharyngeal infection, proctitis, disseminate gonoccal infection

28
Q

diagnosis and treament of gonorrhea

A

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)

29
Q

pelvic inflammatory disease definition and microbiology

A

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.

30
Q

minimum diagnostic criteria for pID

A

lower abdominal tenderness

adnexal tenderness

cervical motion tendeness

31
Q

gold standard definitive diagnostic criteria for PID

A

laparoscopy demonstrating abnormalities consistent with PID, such as fallopian tube erythema and/or mucopurulent exudates

32
Q

definitive diagnostic crtiera for PID

A
33
Q

management of PID

A

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.

34
Q

complications of chlamydia for males and females

A

Complications of Chlamydia

Female: PID, ectopic pregnancy, infertility, chronic pelvic pain, reiter syndrome

Males: epididymo-orchitis, reiter syndrome.

35
Q

complications of gonorrhea

A

Complications of Gonorrhea

Female: PID, infertility, ectopic, chronic pelvic pain, reactive arthritis, disseminated gonococcal infection

Males: epididymo-orchitis, infertility, disseminated gonococcal infection

36
Q
  1. List etiologies for non-infectious vaginal discharge.
A

Non-infectious causes with discharge:

  • Physiologic
  • Desquamative inflammatory vaginitis
  • Atrophic vaginitis
  • Foreign bodies
  • Cervical ectropion

MDCN 460: Course 6 (67 decks)

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