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Clin Med3: Womens Health > Pelvic Infections and STIs > Flashcards

Pelvic Infections and STIs Flashcards

1
Q

what is the #1 cause of vaginal discharge

A

bacterial vaginosis (BV)

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2
Q

what is the #1 cause of symptomatic bacterial infection in reproductive age women

A

bacterial vaginosis (BV)

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3
Q

what are risk factors of BV

A

Multiple male partners
female partners
>1 partner
new parner
not using condoms
douching
HSV+
Menses
copper IUD

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4
Q

if symptomatic, what is the presentation of BV

A

vaginal discharge
milky with ‘fishy’ odor (after addition of KOH prep)
worse after unprotected intercourse
non-irritating

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5
Q

how is BV diagnosed

A

Amsel’s criteria or Nugent score (more sensitive and specific)

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6
Q

what is seen on miscroscopy with BV

A

Clue cells - secondary to Gardnerella vaginalis infection

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7
Q

what is the first line treatment for BV

A

Metronidazole PO x 7 days
Metrinidazole intravaginal gel
clindamycin intravaginal gel

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8
Q

what are alternative treatment for BV

A

oral clindamycin
clindamycin ovules

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9
Q

what are risks of untreated BV infection

A

increased risk for STI’s, including HIV
increased risk of preterm delivery
risk of candidiasis infection after treatment

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10
Q

what is Gonorrhea

A

gram negative intracellular diplococci
infects mucous membranes
highest incidence in ages 15-24
common co-infection with chlamydia

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11
Q

what are the presenting symptoms of gonorrhea

A

dysuria (urethritis)
purulent discharge (white, green, yellow)
increased vaginal discharge
friable cervix
vaginal bleeding
scrotal pain (epididymitis)

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12
Q

what are the possible extra-genital infections associated with gonorrhea

A

conjunctivitis
arthritis
disseminated

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13
Q

how is gonorrhea diagnosed

A

Nucleic acid amplification test (NAAT) - urine or swab
screening recommended regardless of symptoms

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14
Q

what is the treatment of gonorrhea

A

ceftriaxone IM single dose PLUS azithromycin or dyoxycycline
no intercourse for 7 days
treat partners
re-test at 3 months after treatment

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15
Q

what are the complications of gonorrhea

A

PID - infertility, abscess, chronic pain, ectopic pregnancy
epididymitis - infertility (rare)
mom-to-baby transmission - blindness, joint infection, sepsis

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16
Q

what is chlamydia

A

intracellular gram negative bacterium
common co-infection with gonorrhea
highest in ages 15-24

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17
Q

what are the symptoms of chlamydia

A

dysuria (urethritis)
pyruia
increased urinary frequency
purulent discharge (mucopurulent, mucoid, watery)
increased vaginal discharge
friable cervix
vaginal bleeding
scrotal pain, tenderness, edema

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18
Q

how is chlamydia diagnosed

A

Nucleic acid amplification test - swab or urine
screen recommended in sexually active pts regardless of symptoms

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19
Q

what is the treatment of chlamydia

A

Doxycycline BID for 7 days (Drug of choice)
alternative: azythromycin or levofloxacin
consider addition of ceftriaxone IM single dose

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20
Q

what are the complications of chlamydia

A

PID
Mom-to-baby transmission: conjunctivitis and PNA
preterm labor
reactive arthritis

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21
Q

What is Trichomonas Vaginitis

A

most preventable non-bacterial STI (flagellate protozoan)
prevented with condom use

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22
Q

what are the risk factors for trich

A

incarceration
2+ partners in one year
less than a HS education
poverty
BV
douching

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23
Q

what is the clinical manifestations of Trich

A

males: urethritis, epidydmitis, prostatitis
females: produce, malodorous, frothy, yellow or greenish discharge
“Strawberry cervix”

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24
Q

how is Trich diagnosed

A

Microscopy / wet mount (POC) - must do immediately after sampling
Nucleic acid type testing
culture

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25
Q

what is the treatment of Trich

A

first line: metronidazole PO x 7 days (women)
MetroPO x 1 for males
Tindazole PO alternative
NO GELS

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26
Q

what are complications of Trich

A

1.5x increased risk for preterm labor
PROM
small for gestational age infants
2x increased risk for cervical CA
some evidence for increased prostate CA risk
HIV infection

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27
Q

What is candidiasis

A

aka vulvovaginal candidiasis
primarily caused by C. albicans
not a true STI

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28
Q

what are risk factors for candidiasis

A

DM
obesity
HIV+
pregnancy
antibiotic use
steroid use
OCP use
debilitation
moist vaginal environment

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29
Q

what is uncomplicated candidiasis

A

sporadic or infrequent
mild to moderate ssx
likely c. albicans
immunocompetent

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30
Q

what is complicated candidiasis

A

recurrent
severe
likely non c.albicans spp.
DM
immunocompromised
immunosuppressant tx

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31
Q

How is candidiasis diagnosed

A

presence of budding yeast and hyphae on KOH wet mount
if negative or complicated: culture (gold standard)

32
Q

what is the treatment of candidiasis

A

OTC: clitrimazole, miconazole
Rx: butoconazole cream, terconazole cream/suppository, PO fluconazole

33
Q

what is syphilis

A

caused by treponema pallidum (spirochete)
can cause infection of virtually any tissue/organ
infection via oral/vaginal/anal intercourse, placenta, non-sexual blood contact

34
Q

what are risk factors of syphilis

A

MSM, SUD, lack of condom use
-condoms dont eliminate risk- exposed areas can be infectious

35
Q

what are the categories of syphilis

A

primary, secondary and tertiary syphilis

36
Q

what is primary syphilis

A

single painless ulcer (chancre)
nontender, non purulent, indurated
3-4 weeks after infection
may have multiple lesions, atypical lesions, painful
appear on genitals, breast, oropharynx or others

37
Q

what is secondary syphilis

A

skin rash, mucocutaneous lesions, lymphadenopathy

38
Q

what is tertiary syphilis

A

many pts remain latent and dont develop dertiary manifestation
cardiac manifestations, gummas (soft granulomas), bone lesions, liver lesions, paresis
can occur 10-30 years
non-infectious lesions

39
Q

what is neurosyphilis

A

can occur at any stage; meningitis, AMS, stroke, cranial nerve dysfunction

40
Q

what is ocular syphilis

A

can occur at any stage; conjunctivitis, uveitis, keratitis, optic neuropathy, vision loss

41
Q

what is auditory syphilis

A

can occur at any stage; tinnitus, vertigo, SN HL

42
Q

how is syphilis diagnosed

A

darkfield microscopy or molecular testing (early)
later stages requires two testing methods: non-treponemal test and treponemal test

43
Q

what is the treatment of syphilis

A

parenteral penicillin G - first line for all stages
Doxy-2nd line
no intercourse for 7-10 days
reportable disease

44
Q

what is a Jarisch-Herxheimer reaction

A

fever and worsening clinical ssx
starts within hours of treatment
lysis of spirochetes - release of endotoxin

45
Q

What is a Chancroid

A

rare STI
m/c age 21-30
sex workers and younger men
caused by Haemophilus ducreyi (gram negative bacilli)
incubation period 3-5 days

46
Q

what is the presentation of chancroid

A

ulcerations: painful, pustule, papule, soft, irregular boarders, necrotic base with yellow-grey exudates, erythematous halo

47
Q

what is the gold standard for diagnoisng chancroid

A

lesion culture (requires special medium)

48
Q

what is the treatment of chancroid

A

azithry 1gPO x1
ceftriaxone 250mg IM x1

49
Q

what is herpes simplex

A

very common STI
m/c cause of genital ulcers
HSV type 1 or 2

50
Q

what is the presentation of herpes simplex

A

+/- tingling prodrome
macular or papular lesions - vesicles on an erythematous base - ulcerations
ulcerations are shallow and severely painful
associated with edema, burning, itching, dysuria, vaginal/urethral discharge
tender lymphadenopathy

51
Q

how is HSV diagnosed

A

clinical if vesicles present
swab of lesion for HSV PCR
HSV serology (antibodies)
HSV serum PCR
Tzank smear

52
Q

what is the treatment of HSV

A

lifelong infection
acute treatment to decrease length of sx
prophylactic tx decreases # of recurrences

53
Q

what are the risks with HSV

A

HIV, meningitis, acute retinal necrosis

54
Q

what is another name for genital warts

A

condyloma acuminata
related to HPV types 6 or 11

55
Q

what is the presentation of condyloma acuminata

A

many infections are asymptomatic
characterized by flat, papular or pedunculated lesions
lesions occur near introitus, under foreskin or penile shaft
+/- pain
+/- puritis

56
Q

how are genital warts diagnosed

A

primarily clinica
definitive dx with biopsy of lesion

57
Q

what is the treatment of genital warts

A

no gold standard - shared dx making
cryotherapy, surgical removal, TCA or BCA

58
Q

what are patient applied options for the treatment of genital warts

A

imiquimod cream
podofilox gel
sinecatechins ointment

59
Q

what is imiquimod cream

A

tx for genital warts
stimulates interferon and cytokines
tx 8-16weeks once daily or once 3x/week

60
Q

what are the sx of imiquimod cream

A

primarily skin irritation, hypopigmentation

61
Q

what is podofilox gel

A

tx for genital warts
antimitotic - wart ecrosis
BID for 3 days then 4 days off, repeat max 4x
limited by size

62
Q

when is podofilox gel contraindicated

A

pregnancy

63
Q

what is sinecatechins ointment

A

tx of genital warts
green tea extract + catechins
3x/day for no more than 16 weeks

64
Q

what are the SE of sinecatechins

A

skin irritation
unknown pregnancy risk

65
Q

what is the inflammation of the upper genital tract

A

PID

66
Q

what are risk factors for PID

A

multiple partners
age
previous PID
IUD
tubal ligation

67
Q

what is the presentation of PID

A

abd and lower pelvic pain
vaginal discharge
dyspareunia
abnormal vaginal bleeding

68
Q

what is seen on exam with PID

A

cervical discharge
cervical motion tenderness (chandelier sign)
uterine tenderness
adnexal tenderness
+/- pelvic mass

69
Q

how is PID diagnosed

A

dx is primarily clinical
reliable dx if 3 clinical criteria present:
*cervical motion tenderness
*uterine tenderness
*adnexal tenderness

70
Q

what is the definitive dx test for PID

A

laparoscopic endometrial biopsy
-wont ID any organisms, shows scarring

71
Q

what is the treatment of PID

A

IV or PO abx
first line: ceftriaxone IM/IV PLUS Doxy PO/IV PLUS Metronidazole PO/IV

72
Q

what are the three clinical criteria for PID dx

A

*cervical motion tenderness
*uterine tenderness
*adnexal tenderness

73
Q

what are the indication for admission with PID

A

need to r/o other surgical emergency
presence of tubo-ovarian abscess
pt is pregnant
severe infection (+n/v, temp >101)
pt cant tolerate PO tx
no response to PO tx

74
Q

what are complications of PID

A

tubo-ovarian abscess
pelvic abscess
ectopic pregnancy (d/t scaring in fallopian tubes)
infertility (5x increased risk)
adhesions

75
Q

what is the duration of acute pelvic pain

A

< 3 months duration

76
Q

what is chronic pelvic pain

A

presistent, noncyclic pain perceived to be in structure related to the pelvis and lasting more than six months

often no etiology identified - CRPS or somatic syndrome

Clin Med3: Womens Health (13 decks)

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