Test 3 Deck 4 Flashcards
Stratifiied squamous epithelium produce __ that’s converted to __ __. In menopause __ production decreases.
Glycogen, lactic acid, decrease
Things that can offset the balance of vaginal microflora?
Abx Douching Semen Foreign bodies (tampons, diaphragm) Hypoestrogenized (atrophic): menopause, high progesterone relative to estrogen (pregnancy/contraception)
What is the MC cause of vaginal discharge?
Bacterial vaginosis
What are the diagnosis requirements for bacterial vaginosis?
3 of 4
- Homogenous discharge
- Ph >4.5
- Positive whiff test
- Clue cells on wet prep
Pt. Presents w/ homogenous, profuse grey milky discharge and strong fishy odor especially after intercourse. What is the treatment?
Metronidazole
Metronidazole gel
Clindamycin cream
What is the treatment for chronic/recurrent w/ no prior long term treatment?
Vaginosis metrogel/ or metronidazole, oral tinidazole, or vaginal clindamycin for 2 weeks
What is the treatment for recurrent infection with hx of long-term treatment?
Vaginal metrogel, oral metronidazole, oral tinidazole, vaginal clindamycin for 2 weeks, then SUPPRESSION 1x weekly metrogel or 2x weekly oral metronidazole, or tinidazole 6 months
What are some consequences w/ BV?
Adverse pregnancy outcomes
PROM, preterm delivery, intra-amniotic infection, post-partum endometritis
Pt presents w/ vaginal burning/itching, irritatoion, post-voiding dysuria, odorless thick white cottage cheese discharge. DX?
Vuvovaginal candidiasis
What is the diagnosis of candidiasis?
Vulvovaginal erythema
Ph <4.5
Budding yeast/pseudohyphae on KOH
What is the treatment for isolated candidiasis infection?
Azole or nystatin intravaginal 3-7 days, or single oral dose of fluconazole
Risk factors for candidiasis?
Increased estrogen,
DM
Immunosuppressive
Abx
What is the treatment for acute recurrent infection of candidiasis?
Local intravaginal thearpy 7-14 days, oral fluconazole 1 pill q 72 hrs x 3 doses, 1,4,7
Suppressive
Oral fluconazole weekly for 6 months
What is considered chronic vaginal candidiasis?
> = 4 episodes per year
What is the treatment for recurrent vulvaginal candidiasis non-albicans species?
Oral fluconazole
Boric acid
Patient presents w/ frothy green-yellow discharge, odor is strong and musty, they have pain w/ intercourse and sometimes pain w/ peeing. Dx?
Trichomoniasis
What is the diagnosis for trichomoniasis?
Frothy discharge, strawberry cervix, Ph >4.5 Trichomonads on wet prep, NAAT is gold standard Strawberry cervix Motile Protozoa w/ flagellum
What is the gold standard for dx of trichomoniasis?
NAAT
What is the treatment for trichomoniaisis?
Metronidzaole 500 mg 2 weeks
What else do you need to look and see is present if the patient has trichomoniasis?
BV and if you don’t treat for it it might not heal
What do yo need to do post treatment for trichomoniasis?
TOC if prolonged or recurrent infection at 1 month and 6 months
Which herpes virus causes more frequent recurrences?
HSV-2
Patient presents w/ prodrome of tingling, itching, burning, fever, HA , malaise and inguinal lymphadenopathy. DX__ advice for sexual contact
Herpes, do not have sex during prodrome
Genital warts are caused by what types of HPV?
6, 11
How is HPV transmitted?
Contact, inanimate objects, birth canal to larynx
Treatment for genital warts?
Provider: trichloroacetic acid, bichloracetic acid
Patient: podofilox or imiquimod
What is the dx for primary syphilis?
Screening: RPR or VDRL
Confirm: FTA-ABS
Pt presents w/ bacteremia 6 wks to 6 mos post painless chancre. The patient has maculopapular rash on palms, soles, mucous membranes. Complaining of fever, malaise. On PE you note lymphadenopathy and condylomata Lata. DX
Secondary syphilis
What is is considered early latent syphilis and late latent syphilis?
<1 yr or >1 year
Pt. Present w/ fever, malaise and HA after treatment w/ penicillin for syphilis.
Jarisch-Herxheimer Reaction w/ 8 hours of PCN treatment.
What is the treatment for syphilis <1 year?
Benzathine penicillin 2. 4 million units
What is the treatment for syphilis >1 year?
Pen G 2..4 million units IM weely x 3
What is the folllow up for syphilis and treatment if first fails?
Reevaluate at 6 mos intervals for serologic testing and clinical reevaluation. Weekly PCN injections for 3 weeks.
Pt. Presents w/ painful erythematous papules that becomes a pustule then ulcerated w/in 24 hours. The edges of the ulcer are erythematous. Dx__ trx__
Chancroid (haemophilus ducreyi)
Azithromycin 1 gym orally or ceftriaxone
What is the treatment for chlamydia, PCR testing?
Azithromycin or doxy
Treat other contacts and test for other STI’s. Abstinence for 7 days and rescreen in 3-4 months
What is the treatment for gonorrhea?
Ceftriaxone + azithromycin
Urethritis or cervicities are associated w/ what STIs?
Chlamydia and gonorrhea
Diagnostic criteria for PID?
Cervical motion tenderness in sexually active you women
Lower abdominal pain
Temp >101
Mucopurulent discharge
Elevated ESR or CRP
Diagnosed w/ chlamydia or gonnorhea
Patient presents w/ yellow vaginal discharge and lower abdominal/pelvic pain during/soon after mennstruation. DX__ trx__ concerns__
Cover for GC/chlamydia/anaerobes
Inpatient: cefoxitin IV or cefotetan IV plus Doxy IV
Outpatient: ceftrixaxone IM + doxy for 2 weeks +/- metronidazole 2 weeks if concomitant TRICH infection or recent instrumentation
Infertility,ectopic pregnancy, chronic pelvic pain
When to admit for PID?
Pregnant, adolescents, drug addicts, WBC >15,000
PT presents w/ tender inflammatory adnexal mass that results of complication of PID. DX __ treatment__
Turbo-ovarian abscess
Broad spectrum abx; surgical if no improvement in 24-48 hours
Pt. Presents w/ hx. Of fever, malaise, and diarrhea. This progresssed to a non-painful, non-pruritic rash, and orthostatic hypotension. DX__ trx__
Toxic Shock syndrome
Fluids, abx while awaiting cultures, but ultimately none, just want to decrease the chance of recurrence
