VII- Other GU Infections

Question 1

predominant organisms normal vaginal flora

Answer 1

lactobacillus - gram pos microaerophilic rod that metabolize glycogen into lactic acid to make vaginal pH 3.8-4.5

Question 2

factors that alter normal flora

Answer 2

1. age- young girls and postmeno women have lower lactobacillus
2. menstruation causes transient changes
3. hysterectomy/removal of cervix

Question 3

cause of bacterial vaginosis

Answer 3

abnormal vaginal microbiota aka dysbiota so overgrowth of anaerobic species + dec lacto
-not an infection just change in normal flora

Question 4

pres of bacterial vaginosis

Answer 4

-asymp of course
-discharge, odor, pain, itching, burning

Question 5

risk factors of BV

Answer 5

1. oral sex
2. douching
3. smoking
4. sex during menses
5. early age of intercourse
6. new/multi partners
7. activity with other women

Question 6

diagnosing BV

Answer 6

amsel criteria need 3/4
1. white/gray discharge
2. clue cells on wet mount
3. whiff test of volatile amines
4. pH +4.5

or nugent score of 7-10 (BV, no lactobacilli, predom other morphotypes) 0-3 is normal

Question 7

complications of BV

Answer 7

1. inc suscept to HIV infect
2. inc chances that HIV woman can pass to partner
3. inc dev of infection after surgery
4. inc risk for preterm delivery, miscarriage, infection after delivery
5. inc suscept to other STDs (HSV, chlamydia, gonorrhea)

Question 8

pres of vulvovaginal candidiasis

Answer 8

1. thick, odorless, white vaginal discharge, cottage cheese
2. can be uncomplicated with mild/moderate symps in healthy pt
3. or complicated with recurrent or severe VVC OR nonalbicans candidiasis OR pt has uncontrolled diabetes, debilitation, immunosup

treat with topical azole

Question 9

C. albicans features

Answer 9

oval year form can produce buds, pseudohyphae and hyphae
-germ tubes
-in the normal flora of vagina so endogenous infection usually

Question 10

risk factors of VVC

Answer 10

1. after antibiotic use
2. immunocomp > esophagitis, disseminated
3. oral contraceptive use
4. preg
5. diabetes
6. systemic corticosteroids
7. HIV infection

Question 11

pres of trichomoniasis

Answer 11

70% asymp or have scant/watery vaginal discharge within 6 mo
-range from mild to severe vaginitis (itching, burning, painful urination) + strawberry cervix

men are asymp carriers as reservoir

Question 12

T. vaginalis features

Answer 12

1. small pear shaped protozoa motile/darting on wet mount
2. exist only in trophozoite form so strict parasite
3. anaerobic

Question 13

diagnosing/treating trichomoniasis

Answer 13

NAAT most sensitive method + pap smear + wet mount
-can culture but diff to grow

treat with metronidazole

Question 14

menstrual toxic shock pres

Answer 14

1. diarrhea
2. general ill feeling
3. high fever + chills sometimes
4. nausea, vomit
5. widespread red rash like sunburn

Question 15

mechanism of TSST-1

Answer 15

from S. aureus that multiply rapidly in hyperabsorbant tampons and release toxin
-catalase pos, coagulase pos, gram pos cocci in clusters
-TSST penetrates mucosal barrier and is superantigen so stims T cells and cytokines
-IL 1B = fever and TNFa = hypotension, shock

Question 16

diagnosing toxic shock

Answer 16

1. major criteria - hypotension <90 systolic, orthostatic syncope, diffuse macular erythroderma, temp +38.8, skin desquamation @ hands, palms, soles feet
2. minor criteria - GI, mucous membrane erythema, muscular myalgia or x2 creatinine phosphokinase levels

all major + 3 minor

Question 17

treating toxic shock

Answer 17

1. remove tampon duh
2. supportive measures like fluids
3. beta lactamase resistant penicillin or vancomycin if allergic to pen
4. avoid tampon use bc recurrence high