ch 12 GU GYN Flashcards
physiologic leukorrhea
physiologic; white clear flocculent discharge
-normal/healthy women of reproductive age
-1-2 tsp/day (antimicrobial/viral properties)
vaginal pH
3.8-4.2
lactobiacilli makes lactic acid and Hydrogen peroxide and kills pathogens; resist infections
white curdy cottage cheese discharge
candida vulvovaginitis (candida albicans)
candida vulvovaginitis: patient complaints:
pH?
KOH whiff test?
Microscopic exam on saline wet mount?
itching/burning discharge
pH: < 4.5 (usually)
KOH: absent
Micrscope: mycelia, budding yeast pseudohyphae with kOH prep
candida vulvovaginitis intervention
-azole antifungal (oral fluconazole [Diflucan] or vaginal miconazole [Monistat], terconazole [Terazol])
bacterial vaginosis (BV) discharge
thin, homogenous. white gray, adherent, often increased
-overgrowth of bacterial that exists in the vagina
etiology: unclear, likely polymicrobial a/s wit hG. vaginalis
bacterial vaginosis patient complaints:
pH?
KOH whiff test?
Microscopic exam on saline wet mount?
foul odor, itching sometimes, discharge
pH? 5-7 (less lactobacilli to make the acid environment)
KOH: Present (fishy)
Microscopic exam on saline wet mount? >20 clue cell (vaginal epithelial cells) and few WBC
bacterial vaginosis intervention
metronidazole (Metrogel) or oral Flagyl
clindamycin vaginal cream
ovules (Cleocin, oral tinidazole (Tindamax)
oral secnidazole (Solosec $$$)
genitourinary syndrome of menopause (GSM) aka atrophic vaginitis
etiology? discharge?
-estrogen deficiency; women after menopause
-discharge is less and is scant, white clear
-more prone to infections and STI’s
-reversible with supplemental estrogen
GSM aka atrophic vaginitis complaints:
pH?
KOH whiff test?
Microscopic exam on saline wet mount?
itching/burning (can be entire urethra region but not UTI), discharge, but can have no sx’s
- > 5 (once estrogen leaves, lactobacilli leaves)
-KOH absent
-few lactobacilli
GSM aka atrophic vaginitis intervention
give topical and/or vaginal estrogen IF symptomatic and/or recurrent UTI
if estrogen lvls go down= lacto goes down and includes urethra region. using topical estrogen, lacto recolonizes = fewer UTI
oral estrogen ALONE is NOT effective , can be effective WITH topical
human herpes virus/herpes simplex 2
clinical findings
genital herpes
-with initial outbreak, painful ulceratedlesions, marked lymphadenopathy (ie: L mark inguinal lymphadenopathy if L labial ulcer)
-women: thin vaginal discharge if lesion IN vagina or introitus
-can be few lesions, sx’s vary
-can transmit even if asymptomatic
herpes simplex 2 intervention
1st line: oral valacylovir (Valtrex)
-acyclovir (Zovirax)
-famciclovir (Famvir)
nongonococcal urethritis and cervicitis clinical findings
-irritative voiding sx’s; occassional mucopurulent discharge
-women: cervicitis common
-often w/o sx’s regardless of gender
-culture to see large # of WBC
nongonococcal urethritis and cervicitis treatment
1st line: doxycycline 100 mg PO BID x 7 days
alt: azithromycin 1 g PO x1 or levofloxacin 500 mg PO QD x 7 days
nongonococcal urethritis and cervicitis organisms
chlamydia trachomatis
ureaplasma urealyticum
mycoplasma genitalium
gonococcal urethritis and vaginitis causative organism
neisseria gonorrhaoeae (Gram - bacteria)
gonococcal urethritis and vaginitis clinical findings
irritavei voiding sx’s, occasional purulent discharge
often w/o sx’s
-large # of WBC
gonococcal urethritis and vaginitis treatment
1st line: ceftriazone 500 mg IM x 1 PLUS doxycycline 100 mg PO BID x 7 days IF chlamydia trachomatis infection has NOT been ruled out
alternative if cef not available: gentamicin 240 mg IM x1, azithromycin 2 g PO as single dose, or cefixime 800 mg PO x1
trichomoniasis organism
trichomonas vaginalis (protozoan)
(protozoan pathogen)
trichomoniasis clinical finding
dysuria
itching
vulvovaginal irritation
frothy yellow-green vaginal discharge (only 30% have tho)
strawberry spots: cervical petechial hemorrhage (only 30% have tho)
often NO symptoms
motile organisms and lots of WBC
alkaline pH
trichomoniasis intervention
1st line:
female: metronidazole 500 mg PO BID x 7 days
males: metronidazole 2 g PO x 1
[not gel; need oral]
alt: tinidazole 2 g PO x 1
EDUCATE NO ALCOHOL FOR 24 HRS after metronidazole completion (abdominal pain!) or 72 hrs after completion of tinidazole
most chamydial infections occur in what age groups
teen and < 25 yrs old
acute UNcomplicated UTI (cystitis, urethrtis) in non pregnant women organisms
E. coli (gram - ) 75% of all UTI’s
Klebseilla
S saprophyticus
acute UNcomplicated UTI (cystitis, urethrtis) in non pregnant women treatment
-if local E. coli resistance to TMP/SMX < 20% and no allergy, then give TMP/SMX-DS PO BID x 3 days
or ***choose-if local E coli resistance to TMP/SMX > 20% or sulfa allergy, give nitrofurantoin (Macrobid) 100 mg PO BID x 5 days
-ADD urinary analgesic phenazopyridine (Pyridium) PO for sx control (urethra inflammation lingers even after day 2 of therapy)
2nd line: levofloxacin, Augmentin, ciprofloxacin, cephalexin,
which medication can’t be given if pt is allergic to sulfa?
bactrim (TMP-SMX)
epididymo-orchitis in those 35 and under years old, most likely what organisms?
N gonorrhoeae
Chlamydia trachnomatis
epididymo-orchitis clinical presentation
irritive voiding sx’s (frequency, hematuria, dysuria)
fever,
painful swelling of epididymis and scrotum
-infertility potential post infection
epididymo-orchitis treatment under 35 yrs old
ceftriaxone 500 mg IM x 1 PLUS doxycycline 100 mg PO BID x 10 d
-educate scrotal elevation to help with symptom relief (Preh’s sign)
Preh’s sign
relief of discomfort with scrotal elevation
tinea cruris
aka jock itch
red rash upper bilateral thighs, groin, or vulva involvement ONLY
benign prostatic hyperplasia (BPH) sx’s & management
lower urinary tract sx’s (nocturia, weak stream, urgency, incontinence, voiding difficulties)
- get UA, PSA
-alpha 1 receptor blockage (tamsulosin)
transient continence
-there was an underlying condition
urge incontinence
-sudden onset; overactive detruser muscle
