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std and packrat > Vaginitis, PID, HPV, HSV, Syphillis > Flashcards

Vaginitis, PID, HPV, HSV, Syphillis Flashcards

1
Q

3 types of vaginitis?

A
  1. Bacterial Vaginosis
  2. Vulvovaginal Candidiasis
  3. Trichomoniasis
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2
Q

Normal vaginal discharge color, smell, and viscosity?

A

Clear to white
Odorless
High viscosity

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3
Q

Dominant flora in healthy vagina?

A

Lactobacilli

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4
Q

What do some Lactobacilli make to lower vaginal pH?

A

H2O2

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5
Q

Normal pH range in vagina?

A

3.8-4.2

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6
Q

What does the acidic environment of vagina inhibit?

A

Inhibits bacterial overgrowth

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7
Q

What to Lactobacilli metabolize? What does it do to pH of vagina?

A

Metabolize glycogen which maintains acidic pH

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8
Q

What happens to Lactobacilli and another anaerobic bacteria during overgrowth in the vagina?

A

Decrease of Lactobacilli, increase of anaerobic bacteria normally present

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9
Q

Are the anaerobic bacteria which increase during overgrowth normally present in the vagina?

A

Yes. They are normally present but numbers kept low. When lactobacilli numbers decrease the acaerobic bacteria increase.

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10
Q

Bacterial Vaginosis and Trichomoniasis associated with a pH of what?

A

pH >4.5

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11
Q

Candida associated with a pH of what?

A

pH <4.5

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12
Q

KOH Whiff Test positive in which two vaginitises?

A
  1. Bacteria Vaginitis

2. Trichomoniasis

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13
Q

KOH Wet Mount will show what two things with Candidia?

A

Pseudohyphae and budding yeast

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14
Q

Bacterial Vaginitis will show what on NaCl Wet Test?

A

≥ 20% Clue Cells

No or few WBCs

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15
Q

Candidiasis will show what on NaCl Wet Test?

A

Few to many WBCs

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16
Q

Trichomoniasis will show what on NaCl Wet Test?

A

Motile flagellated protozoa

Many WBCs

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17
Q

1 most common vaginitis?

A

Bacterial Vaginosis

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18
Q

Etiology of Bacterial Vaginitis?

A

Gardnerella Vaginitis

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19
Q

Loss of what can lead to Bacterial Vaginitis?

A

Loss of Lactobacilli

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20
Q

What “cleansing” method can lead to Bacterial Vaginitis?

A

Douching

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21
Q

Discharge in Bacterial Vaginitis?

A

Homogenous, adherent, thin, milky, white or grey. Malodorous “fishy”.

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22
Q

Which Vaginitis has a “fishy” smell?

A

Bacterial Vaginitis

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23
Q

Bacterial Vaginitis linked to what other issues?

A

Premature membrane rupture, premature labor, other infections

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24
Q

pH in Bacterial Vaginitis?

A

pH >4.5

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25
Q

NaCol Wet Mount in Bacterial Vaginitis?

A

20% clue cells. No to few WBCs.

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26
Q

What is Amsel Criteria in Bacterial Vaginitis?

A

3 or more of following:

  1. pH > 4.5
  2. 20% clue cells on NaCl wet mount
  3. Positive Whiff Test
  4. Homogenous non-viscous white discharge adhering to vag walls
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27
Q

Tx for Bacterial Vaginitis? (Hint: 3)

A
  1. Metronidazole 500mg PO BID q7d
  2. Metro gel full applicator 5g intravaginally daily or BID q5d
  3. Clinda 2% cream in vag at bedtime q7d
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28
Q

2 most common vaginitis?

A

Candidiasis

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29
Q

Etiology of Candidiasis?

A

C Albicans overgrowth. Excessive yeast growth.

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30
Q

Risk factors in Candidiasis?

A

DM, Abx use, immunosuppression

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31
Q

1 complaint in Candidiasis?

A

Pruitis (itching)

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32
Q

Pain during urination in Candidiasis?

A

Burns when peeing. (UTI is burn after peeing.)

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33
Q

Describe discharge in Candidiasis?

A

Cottage cheese. Thick, clumpy, white.

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34
Q

pH in Candidiasis?

A

pH ≤ 4.5

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35
Q

KOH Whiff Test results in Candidiasis?

A

NEGATIVE

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36
Q

WBCs on NaCl Wet Mount in Candidiasis?

A

Few to many WBCs

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37
Q

KOH Wet Mount results in Candidiasis shows what?

A

Pseudohyphae or non-albicans species

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38
Q

Tx in Candidiasis? Severe?

A

Fluconazole (Diflucan) 150mg PO once

Severe=Repeat in 72h

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39
Q

Fluconazole and preggers?

A

NOT IN FIRST TRIMESTER! Use topical.

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40
Q

Metronidazole in preggers?

A

Category B. Pretty safe.

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41
Q

3 most common vaginitis?

A

Trichomoniasis

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42
Q

What is the most prevalent non-viral STI?

A

Trichomoniasis

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43
Q

Etiology of Trichomoniasis?

A

Trichomonas vaginalis parasite

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44
Q

What percent Trichomoniasis have symptoms?

A

Only 30%.

70% of Trichomoniasis are ASx.

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45
Q

Discharge in Trichomoniasis?

A

Frothy, gray, yellow-green, malodorous

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46
Q

Cervix in Trichomoniasis?

A

Cervical petechiae. “Strawberry Cervix”.

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47
Q

Strawberry Cervix in which vaginitis?

A

Trichomoniasis

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48
Q

Trichomoniasis linked to?

A

Premature membrane rupture, preterm labor, etc

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49
Q

pH in Trichomoniasis?

A

pH > 4.5

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50
Q

KOH Whiff Test results in Trichomoniasis?

A

Often positive

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51
Q

NaCl Wet Mount results in Trichomoniasis? WBCs?

A

Motile, flagellated protzoa. Many WBCs.

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52
Q

Tx for Trichomoniasis? (Hint: 3)

A
  1. Metronidazole 2g PO single dose
  2. Metro 500mg PO BID q7D
  3. Tinidazole 2g PO single dose
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53
Q

Who else to treat in Trichomoniasis?

A

Sex partners from past 60 days

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54
Q

Who to report Trichomoniasis to?

A

DPH

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55
Q

What’s the most common infection worldwide?

A

Chlamydia

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56
Q

1 bacterial STI?

A

Chlamydia

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57
Q

Main age of GC/Chlamydia?

A

15-24 y/o

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58
Q

50% of Chlamydia co-infected with what?

A

Gonorrhea

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59
Q

Majority of Chlamydia sx or asx?

A

ASx

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60
Q

Chlamydia might have what sx in pelvis?

A

PID

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61
Q

Describe discharge from Chlamydia?

A

Mucopurulent. White or clear from penis, may only see with milking.

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62
Q

Dx preferred for GC/Chlamydia?

A

NAAT

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63
Q

NAAT test uses what type of urine?

A

First-catch dirty urine

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64
Q

Tx of Chlamydia? (Hint: 2)

A

Azithromycin 1g PO single dose
or
Doxy 100mg PO BID x7D

65
Q

Gram negative intracellular diplococci which dz?

A

Gonorrhea. Not seen in F.

66
Q

Etiology of Gonorrhea?

A

N. Gonorrheae

67
Q

How Gonorrhea transmitted? (Hint: 2 ways)

A

Sex contact or vertical transfer to baby

68
Q

Gonorrhea sx or asx?

A

ASx most of the time

69
Q

Describe discharge in Gonorrhea?

A

White-yellow-green, mucopurulent

70
Q

Dx for Gonorrhea?

A

NAAT

71
Q

Tx for Gonorrhea?

A

Ceftriaxone 250mg IM
PLUS
Azithromycin 1g PO single dose

72
Q

Tx for GC/Chlamydia epididymitis?

A

Ceftriaxone 250mg IM
PLUS
Doxy 100mg BID PO x10-21d

73
Q

Tx for GC/Chlamydia Proctitis?

A

Ceftriaxone 250mg IM
PLUS
Doxy 100mg PO x7-21D depending on severity

74
Q

Dx for GC and Chlamydia?

A

NAAT

75
Q

When to retest preggers GC/Chlamydia PT after tx?

A

3 weeks after tx for test of cure

76
Q

When to test non-preggers GC/Chlamydia after tx?

A

3-4 months only if sx continue, reinfection, or compliance problems

77
Q

When can GC/Chlamydia have sex again?

A

7 ASx days after tx

78
Q

Who to report GC/Chlamydia to?

A

Local DPH

79
Q

What disease is a spectrum of inflammatory disorders which is a combination or endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis?

A

Pelvic Inflammatory Disease

80
Q

PID is usually due to one or more microbes?

A

Polymicrobial. N Gonorrheae and C Trachomatis 25-75%

81
Q

Which are the two most common microbes in PID?

A

N Gonorrheae and C Trachomatis

82
Q

Describe the movement of microbed in PID

A

Ascending spread of microorganisms from vagina or cervix to endometrium, fallopian tubes, ovaries, and contiguous structures

83
Q

Which three symptoms are the minimum required for a dx of PID?

A
  1. Uterind Tenderness OR
  2. Adenxal Tenderness OR
  3. Cervical Motion Tenderness
84
Q

List some additional results and sx for PID dx

A

Oral temp > 38.3, abnormal discharge, increased WBCs in vaginal fluid, increased ESR, increased CRP, cervical infection with GC/Chlamydia

85
Q

When to hospitalize a PID patient?

A

Can’t exclude surgical emergency, preggers, no response to oral treatment, can’t follow or tolerate oral outpatient therapy, severe illness, N/V, high fever, tubo-ovarian abscess

86
Q

Tx for PID?

A 
Ceftriaxone 250mg IM single dose 
PLUS
Doxy 100mg PO BID q14D
WITH OR WITHOUT
Metro 500mg PO BID q14D
87
Q

When should a PID PT begin to show major signs of improvement?

A

72h after tx

88
Q

When to retest PID PT for GC/Chlamydia after initial treatment?

A

3-6 months after PID treatment

89
Q

Are the sex partners of PID patients symptomatic?

A

Often ASx

90
Q

When to treat sex partners of PID patients?

A

From 60 days before female symptoms began

91
Q

Who to treat if more than 60 days since last sex partner of PID patient?

A

Last sex partner

92
Q

What to treat for in sex partner of PID patient?

A

Empirically for C. Trach and N. Gono

93
Q

Two HPV risk categories and the viral sterotypes in them?

A

Low-risk=HPV 6 and 11

High-risk=HPV 16 and 18

94
Q

70% cervical CAs caused by which two HPV serogroups?

A

HPV 16 and 18

95
Q

Most women with HPV 16 and 18 do or don’t develop cell changes or cervical CA?

A

Don’t! 90% HPV is cleared by the immune system and doesn’t cause a problem.

96
Q

What percent of HPV is cleared by the immune system? How long does it take?

A

90% cleared within 2 years

97
Q

75% drop of Cervical CA due to what?

A

Pap screening

98
Q

What percent of sexually active men and women acquire HPV?

A

100%

99
Q

Most HPV Sx or ASx?

A

ASx

100
Q

2 most common clinically significant signs in HPV? (Hint: one is a test result)

A
  1. Genital warts

2. Cervical cell abnormalities on pap smear

101
Q

What are Condylomata Acuminata in HPV?

A

Cauliflower-like genital warts. Skin colored, pink, hyperpigmented

102
Q

ASC-H cells on pap smear are most often precancerous or not?

A

Most often precancerous

103
Q

DX of HPV?

A

Clinical dx

104
Q

2 types of TX in HPV?

A
  1. PT Applied

2. Provider applied

105
Q

PT Applied HPV TX?

A

Podofilex (Condilox) 0.5% gel or solution

106
Q

Provider applied HPV tx?

A

Cryotherapy w/liquid NTG or cryoprobe

107
Q

Two types of HSV?

A

HSV-1, HSV-2

108
Q

Which HSV is the most common cause of recurrent genital herpes?

A

HSV-2

109
Q

How is HSV-2 transmitted? (Hint: 2 ways)

A
  1. Sex

2. Perinatal transmission

110
Q

HSV Sx or ASx 90% of the time?

A

ASx 90% of the time

111
Q

Can HSV shed when ASx?

A

Yes!

112
Q

Which HSV sheds less often when ASx? Which more?

A

Less=HSV-1

More=HSV-2

113
Q

Does treatment prevent HSV from shedding?

A

Reduces but doesn’t stop shedding

114
Q

What is Primary Infection in HSV?

A

First ever infection with HSV-1 or 2.

115
Q

Are you antibodies present in HSV Primary Infection when Sx occur?

A

No antibodies when Sx occur

116
Q

Does Primary Infection of HSV have moderate or severe Sx?

A

Severe

117
Q

What is Non-Primary Infection in HSV?

A

Get HSV-2 when already had HSV-1 and vice-versa.

118
Q

Mild or severe Sx in Non-Primary Infection in HSV

A

Milder

119
Q

Are antibodies present during Recurrent Symptomatic Infection in HSV?

A

Yes

120
Q

Describe Sx and duration of Recurrent Symptomatic Infection in HSV

A

Mild Sx, short duration average 4-6 days

121
Q

What is ASymptomatic Infection in HSV? Has antibodies present?

A

Antibodies present.

No known history of cervical outbreaks.

122
Q

Describe lesions in HSV

A

Numerous, bilateral genital lesions. Pain, itching, dysuria, vaginal and uretheral discharge. Tender inguinal adenopathy.

123
Q

Etiology of Syphillis?

A

Treponema Pallidum

124
Q

2 transmission routes of Syphillis?

A

Sex or vertical transmission

125
Q

Which Syphillis stages most contagious?

A

Primary and Secondary

126
Q

Early Syphillis stages?

A

Primary, Secondary, and Early Latent

127
Q

What develops during Primary Syphillis? Where?

A

Chancre lesion at site of inoculation

128
Q

Chancre in Syphillis painful or painless?

A

Painless.

Indurated, clean base.

129
Q

Is Chancre in Primary Syphillis infectious?

A

Yes! Highly infectious!

130
Q

What might happen to serologic tests during very early Syphillis?

A

Test might not be positive

131
Q

Can the Primary and Secondary Stages of Syphillis overlap?

A

Yes they can

132
Q

When does the Secondary Stage of Syphillis develop? Lasts how long?

A

Develops weeks to months after primary chancre.

Lasts weeks to months.

133
Q

What state are the Syphillis titers highest?

A

Secondary Syphillis

134
Q

What is most common complaint of Secondary Syphillis?

A

Rash on palms and feet

135
Q

Describe Latent Syphillis

A

Only a positive serologic test. No actual signs or symptoms!

136
Q

Define Early Latent Syphillis

A

<1 year of initial infection

137
Q

Define Late Latent Syphillis

A

≥1 year from initial infection of if time since infection unknown

138
Q

Is Late Syphillis common and infectious?

A

Rare d/t abx. Non-infectious.

139
Q

Gummatous Lesions and Cardiovascular Syphillis during which state?

A

Late Syphillis

140
Q

How many serologic tests are needed to dx Syphillis?

A

At least 2

141
Q

Darkfield Microscopy used to ID what in Syphillis?

A

ID lesions or ulcers

142
Q

What’s the major benefit of Darkfield Microscopy?

A

It’s quick

143
Q

Which antibody does Non-Treponemal test for in Syphillis?

A

Reagin antibody

144
Q

VDLR and RPR are titers in which Syphillis test? Good for?

A

Non-Treponemal test.

Good for measuring therapeutic effect and evaliation of reinfection.

145
Q

What antibody does the Treponmal test for in Syphillis?

A

T. Pallidum antigens

146
Q

FTA-ABS, TP-EIA titers are part of which test in Syphillis?

A

Treponemal test

147
Q

Which is more specific test in Syphillis: Non-Treponemal or Treponemal test

A

Treponemal test

148
Q

When to screen preggers women for Syphillis?

A

At first prenatal visit

149
Q

When to screen for Syphillis if still born?

A

After 20 weeks

150
Q

Tx for Primary, Secondary, and Early Latent Syphillis?

A

Benzathine PCN G 2.4 M units IM once

151
Q

Tx for Primary, Secondary, and Early Latent Syphillis if allergic to PCN?

A

Doxy 100mg PO BID x14d or

Tertacycline 500mg PO QID x14D

152
Q

Tx for Tertiary and Late Latent Syphillis?

A

Benzathine PCN G 2.4 M units once for 3 weeks. Total 7.5 M units.

153
Q

Tx for Tertiary and Late Latent Syphillis if allergic to PCN?

A

Doxy 100mg PO BID x28D or

Tetra 500mg PO QID x 28D

154
Q

When to follow up with Primary and Secondary Syphillis? What to compare?

A

Reexamine at 6 and 12 months and compare titers to max or baseline nontrep titers on day of treatment

155
Q

When to follow up with Latent Syphillis? What to compare?

A

6, 12, and 24 months

156
Q

When to follow up with Primary Syphillis if PT has HIV?

A

3, 6, 9, 12, 24

157
Q

When to follow up with Latent Syphillis if PT has HIV?

A

6, 12, 18, 24 months

158
Q

When to follow up with Neuro Syphillis?

A

Repeat CSF test every 6 months until clear

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