Women's Health Flashcards
lots of thin, yellow green “frothy” discharge at introitus and os
foul-smelling
“strawberry” cervix and/or vaginal/perineum redness
vaginal soreness or dyspareunia
symptoms may be start or worsen during menses
trichomonas vaginalis: protozoan STD
wet mount:
motile, flagellated
WBCs
trichomonas vaginalis
treatment for trichomonas vaginalis
treat woman AND partner:
metronidazole PO single dose
SCREEN for other STDs
recent Abx use/infxn and vaginal discharge
candida vaginitis:
alter vaginal flora
allows overgrowth of fungal organisms
woman with DM and vaginal discharge
candida vaginitis
thick, white vaginal discharge no odor pruritus of vagina and vulva edema + erythema of vagina/vulva 75% women have at least 1 episode in lifetime
candida vaginitis and/or vulvar
need 3/4 criteria: thin vaginal discharge vaginal pH >4.5 \+ KOH "whiff" test: "fishy" odor (alkaline) wet mount: clue cells
bacterial vaginosis: excessive anaerobic bacteria + gardnerlla vaginalis replace normal vaginal bacteria
NOT an STD, but multiple sex partners is a risk factor
all vaginal discharge is examined via: microscope
wet mount (mix with normal saline): epithelial cells, WBC, RBC, clue cells, motile trichomonads KOH prep (mix with 10% KOH): hyphae or psuedohyphae of candida
cause of vulvovaginal candidiasis
C. albicans
vaginal pH: 4-5
candida vaginitis
wet mount or KOH prep: budding yeast, pseudohyphae
candida vaginitis: confirms diagnosis
treatment of candida vaginitis
vaginal suppository or
fluconazole PO single dose
if recurrent: 10-14 days fluconazole, 6 mo maintenance
treat male if has balanitis
risk factors for trichomonas vaginalis
multiple sex partners
pregnancy
menopause
treatment of bacterial vaginosis
topical or PO metronidazole or clindamycin
DON’T treat partner
why treat asymptomatic pregnant women with BV
reduce incidence of preterm delivery
purulent/mucopurulent discharge from endocervix
+/- vaginal discharge, cervical bleeding
chlamydia trachomatis or N. gonorrhoeae
50% gonococcal + 70% chlamydial are asymptomatic
diagnosis of chlamydia or gonorrhea
culture of cervical discharge
treatment of chlamydia or gonorrhea
gonorrhea: ceftriaxone IM single dose
chlamydia: doxycycline 100 mg PO BID for 7 days or azithromycin 1 g PO single dose
EMPIRIC tx if high prevalence of infection or follow-up unlikely
treat sexual partner
cause of: pelvic peritonitis endometritis salpingitis tuboovarian abscess
PID due to chlamydia, gonorrhea, vaginal or bowel flora
lower abdominal tenderness with adnexal and cervical motion tenderness
supportive criteria:
T: >101
abnormal cervical/vaginal dicharge
↑ ESR, CRP
cervical infection with gonorrhea or chlaymdia
- pregnancy test: MUST r/o ectopic pregnancy
diagnosis = PID
definitive diagnosis: surgery, biopsy of endometrium, U/S of tubes
treatment of PID (p. 212 case files)
mild: outpatient, IM ceftriaxone + doxycycline PO
if pregnant, HIV +, severe: hospitalize, IV
safe sex practices if diagnosed with STD or at risk
LATEX condoms
when patient has STD: do following
treat sexual partner
screen for HIV, hepatitis B and C, syphilis (initially asymptomatic infxns)
anovulatory (irregular) menstrual cycles - pregnancy test infertility obese, metabolic syndrome, acanthosis nigricans (insulin resistance) hirsuitism, acne (androgen excess)
PCOS
treatment of PCOS
OCP: induce menses with progesterone
weight loss: increase fertility
clomiphene citrate, aromatase inhibitors, gonadotropins: increase fertility
metformin and TZD
ABSENCE of menstrual bleeding for 6 or more months when not pregnant
amenorrhea
HEAVY menstrual flow or PROLONGED duration of flow (> 7 days) occurring at IRREGULAR intervals
menometrorrhagia
HEAVY menstrual flow or PROLONGED duration of flow (>7 days) occurring at REGULAR intervals
menorrhagia
bleeding occurring at IRREGULAR intervals
metrorrhagia
regular interval for menstrual cycle
21-35 days
diff dx for menstrual irregularities
pregnancy
PCOS
physiology of menstrual cycle
hypothalmus secretes GnRH → ant. pit secretes FSH + LH
FSH: maturation of ovarian follicle → secrete estrogen: endometrial proliferation, mid-cycle LH surge causes ovulation, follicle is now corpus luteum
CL secretes progesterone: endometrial maturation
if no pregnancy: ↓ progesterone → menses
diagnosis of PCOS
2/3 of following:
↑ androgen: hirsuitism, acne, serum total T and SHBP, free serum T
chronic anovulation: no CL to produce progesterone → no sloughing of endometrium
polycystic ovaries on U/S
diff dx of excessive bleeding + regular menstrual cycles (menorrhagia)
normal ovulation: no endocrine issues
leiomyomata (fibroids): ↑ endometrial surface →↑ bleeding
endometrial polyps
inherited coagulopathy: von willebrand disease
coagulopathy d/t med: warfarin
liver disease: ↓ PLT
diff dx of reduced bleeding + regular menstrual cycles
asherman syndrome: scarred uterine cavity d/t curettage, small uterus
scarred or obstructed cervical os
diff dx of abnormal bleeding (timing, flow) + irregular menstrual cycles: dysfunctional uterine bleeding
*normally occurs after menarche (watchful waiting, takes 1-2 years to resolve) and near menopause
*abnormal HPA during child-bearing years: prolactinoma (galactorrhea), serum LH levels
causes anovulation: continuous estrogen exposure with no progesterone→ endometrial hyperplasia →irregular sloughing, ↑ risk endometrial carcinoma
*thyroid: skin, hair, hot or cold intolerance, weight gain/loss
*anorexia nervosa
*cervicitis → cervical bleeding: culture, pap smear
*endometritis: vaginal spotting between periods
risk factors for endometrial carcinoma
anovulatory menstrual cycle history obesity nulliparity >35 yo tomoxifen use or unopposed exogenous estrogen
treatment for abnormal uterine bleeding (anovulation)
if
teratogenic meds
anticoagulants phenytoin antipsychotics TCAs steroids
vaginal spotting
mildly enlarged + tender uterus
ascending infection of normal vaginal flora (gonorrhea, chlaymydia, ureaplasma urealyticum, gardnerella vaginalis, GBS)
endometritis
endometrial biopsy shows plasma cells
endometritis
initial workup of anovulation (irregular periods)
TSH prolactin level pregnancy test total serum testosterone NOT free estrogen
