WH - Illnesses Flashcards
Define Vaginitis
Syndrome characterized by vaginal discharge and/or irritation
What are the 3 most common types of vaginitis?
Bacterial vaginosis, candida vulvovaginitis, trichomonas vaginitis
Define Bacterial Vaginosis
A change in the balance of bacteria; undergrowth or overgrowth of normally present bacteria in the vagina, usually an overgrowth of Gardnerella vaginalis
What are the clinical criteria for diagnosis of BV?
- Thin white or yellow discharge
- pH greater than 4.5
- Positive whiff test
- Presence of clue cells on wet-mount exam
- Vaginal itching/burning
What is the treatment for BV?
Metronidazole 500mg tabs, 1 tab po BID x 7 days or Clindamycin intravaginal 2% cream, 1 applicator (5 grams) intravaginally at night x 7 days
Should sexual partners be treated for BV?
Treatment of partner is controversial and currently not recommended
What is vaginal candidiasis typically caused by and what is it often associated with?
usually caused by candida albicans; associated with diabetes or recent antibiotic use
Describe the common presentation of vaginal candidiasis
- Intense vulvar or vaginal pruritus
- White curd-like vaginal discharge
- Burning after urination
How is vaginal candidiasis diagnosis?
- KOH prep for presence of budding yeast (hyphee)
- May require culture as only 50% of cases will have positive KOH
- Experienced clinicians may treat based on typical “cottage cheese” type discharge, then culture if no resolution of sx
- Findings may be reported on cytology smear
- Women may self diagnose based on symptoms and the availability of OTC
How is vaginal candidiasis treated?
- OTC treatment include topical antifungals (Monistat/miconazole)
- Prescription antifungals (both topical and oral) i.e. Diflucan (fluconazole) 150mg tab, one tablet daily x1
- Culture positive yogurt intake has not been consistently found to decrease recurrences or to prevent post antibiotic CVV
- Strict DM control may decrease recurrences
- Use of cotton underwear
- Screen pt for diabetes if infections are recurrent or persistent
Describe Trichomoniasis
Caused by a flagellated protozoan (Trichomonas vaginalis) and considered an STI, so partners need to be treated
What is the clinical presentation of Trichomoniasis?
- Frothy yellowish-greenish-whitish discharge
- +- foul smelling
- May have vulvar erythema
- May have burning/itching
- Cervix will have strawberry spots
How is Trichomoniasis diagnosed?
- Microscopic identification of actively swimming Trichomonads on wet-mount
- NAAT if patient has persistent sx and Trichomonads not identified on prior exam
How is Trichomoniasis treated?
- Metronidazole - either 2g orally as single dose or 500mg 1 tab po BID x 7 days
- Prolonged treatment may be needed for persistent sx
- Treatment of all sexual partners of women is indicated
What is atrophic vaginitis?
It is when the vaginal epithelium gets very thin and is very susceptible to infection/trauma; it is caused by a decrease in estrogen. It may be totally asymptomatic
What is atrophic vaginitis?
It is when the vaginal epithelium gets very thin and is very susceptible to infection/trauma; it is caused by a decrease in estrogen. It may be totally asymptomatic
What is the clinical presentation of atrophic vaginitis?
- Vaginal dryness
- Vaginal spotting
- Dyspareunia
- Friable vaginal tissue
How is atrophic vaginitis treated?
Topical estrogen - Premarin 0.625mg vaginal cream with applicator, 30g tube, 0.5g intravaginally twice weekly before bed
Describe Chlamydia
Common sexually transmitted infection in women caused by bacteria chlamydia trachomatis
What is Chlamydia associated with?
infertility and ectopic pregnancies secondary to chronic inflammation after infection - may develop PID
Describe the clinical presentation of Chlamydia
- May be asymptomatic
- May have purulent discharge
- Urinary frequency/pain and burning with urination
- Inflammation of genital organs
How is Chlamydia diagnosed?
- Lab testing using NAAT is the current standard (vaginal swab)
What should also be tested for along with Chlamydia?
Gonorrhea should also be tested for because of high number of co-infections (50%)
How is Chlamydia treated?
Doxycycline 100mg tab, 1 tab po BID x 7 days
Describe Gonorrhea
An STI caused by bacteria Neisseria Gonorrhoeae that may progress to PID, infertility, or ectopic pregnancy; most affected women are asymptomatic
What is the clinical presentation of gonorrhea?
- Vaginal discharge
- Urinary frequency
- Dyspareunia
- Burning
- Inflammation of vulva, vagina, and/or urethra
How is gonorrhea diagnosed?
NAAT
How is uncomplicated gonorrhea treated?
Ceftriaxone 500mg IM x 1 (add chlamydia treatment if positive for chlamydia as well)
Define Pelvic Inflammatory Disease
General term used for acute, chronic, or recurrent infection of the ovaries, fallopian tubes, uterus, or cervix
What typically causes PID?
A bacteria (chlamydia or gonorrhea), use of IUDs, post abortion, or other pelvic surgery
What type of women are more likely to have PID?
Women with multiple partners
What are the clinical findings of PID?
- Can be insidious or acute
- Lower abdominal or pelvic pain
- Usually bilateral
- Pelvic pressure and back pain
- May have fever +-
What are the PE findings for PID?
- Purulent vaginal discharge
- Tenderness of the abdomen
- Tenderness on movement of the cervix (bimanual exam)
How is PID diagnosed?
Diagnosis is based on clinical findings through exam and history with no lab tests needed; Examples) pain, discharge, tenderness, WBC on wet mount, temp > 101 if have one
What is the outpatient treatment for PID?
- Ceftriaxone 500mg IM x 1
- Doxycycline 100mg 1 tab po BID x 14 days
- Metronidazole 500mg 1 tab po BID x 14 days
What are the reasons to admit a PID patient to the hospital?
- Presence of a TOA - tube ovarian abscess - feel lump when bimanual/ultrasound to confirm
- Patient is pregnant
- Unable to tolerate 3 medications
- If illness includes severe symptoms
- Do not respond to meds
Describe Human Papilloma Virus
A very common STI in USA that has over 100 strains
What are the low risk strains of HPV and what do they cause?
genital warts - 90% are strains 6 and 11
what are the high risk strains of HPV and what do they cause?
Cervical cancer - 70% are strains 16 and 18
What is the incubation period of condyloma?
2 months to 18 months
What are the symptoms of condyloma?
itching and pain, especially when wiping
How can HPV be prevented and how is it recommended?
Gardasil 9
Ages 9-14 - two doses
Ages 15-45 - three doses
How is condyloma treated?
- Liquid nitrogen/Cryotherapy (most frequent for cervical warts)
- Snipping/removing with scalpel, usually only if 1 or 2 and depends on location
- Laser therapy
- Topical creams
- Spontaneous resolution
What are the 4 strains of Herpes Simplex Virus?
Type 1 - Oral Herpes
Type 2 - Genital Herpes
Type 3 - Varacella Zoster
Type 4 - Epstein-Barr Virus
Describe Type 1 HSV
Oral herpes; cold sores with 2-7 day incubation
Describe Type 2 HSV
Genital; sexual contact, up to 70% of cases are caused by asymptomatic shedding
What are the signs/symptoms of genital herpes?
- Usually the first outbreak is the worst
- Associated with inguinal lymphadenopathy
- Prodrome: time before vesicles erupt; tingling and burning sensation
- Then vesicles appear on a red base usually in a cluster
- The vesicles erode and leave painful ulcers
How are genital herpes diagnosed?
PCR testing - get specimen and lab runs the test; sensitivity of the test declines as the vesicles heal
How is the first episode of HSV treated?
Acyclovir 400mg tabs, 1 tab po TID x 10 days
How are recurrent episodes of HSV treated?
Acyclovir 400mg tabs, 1 tab po TID x 5 days
What is the symptomatic treated for HSV?
- Loose fitting underwear/clothes
- Cottom underwear
- Cool compress
- Tylenol, Ibruprofen, Naproxen
What is important to note about HSV?
Asymptomatic viral shedding can occur in some individuals and no type of intervention absolutely prevents transmission
What can precipitate HSV recurrences?
- fever
- emotional stress
- period
Describe Syphilis
“The great masquerader” is a systemic infection caused by a spirochete: treponema pallidum, and it presents in 4 distinct phases
Describe the primary phase of syphilis
- Presents as a solitary painless genital ulcer known as a chancre
- Occurs 10-90 days after exposure
- Ulcer heals within 3-6 weeks
- Non-tender lymph nodes (inguinal)
Describe the secondary phase of syphilis
- Occurs 4-10 weeks after primary infection heals
- Presents as non-pruritic maculopapular rash all over the truck and the limbs including the palms and soles of the feet
- Muscle aches, fatigue, and low-grade fever
- symptoms will resolve spontaneously in 3-12 weeks
Describe the latency period of syphilis
The period of time with no signs or symptoms that may last months or years
Describe the tertiary phase of syphilis
- One third of latent infections will progress to this stage
- Patients can develop cardiac, neurological, auditory abnormalities and gummatous lesions (small, rubbery granulomas with a necrotic center enclosed by a fibrous capsule)
How is early syphilis diagnosed?
Dark field exam: Remove sample of discharge from chancre and inspect it on a slide; no contrast, so you have to use a black background to see the bacteria
How is syphilis diagnosed if there is no lesion present for screening?
- Non-treponemal testing (VDRL - Venereal Disease Research Laboratory or RPR - Rapid Plasma Reagin)
- If non-treponemal testing is positive, Treponemal testing (TP-PA - Treponemal Pallidum particle Agglutination) to confirm diagnosis
What are some important things to remember about syphilis diagnostic testing?
Non-treponemal testing will become negative over time, and a positive TP-PA will remain positive for the patient’s life
What is the treatment for syphilis?
Benzathine Penicillin G IM single dose of 2.4 mil units can be used to treat primary, secondary, and early latency phase but does not treat damage caused by tertiary infection
