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OB+GYN > Genital Tract Infections > Flashcards

Genital Tract Infections Flashcards

1
Q

Common triad of infections associated with Vaginal Discharge

A

1) Bacterial Vaginosis
2) Trichomoniasis
3) Vulvovaginal Candidiasis

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2
Q

What is the Disease Entity?

  • Thick curdy discharge
  • Vaginal erythema and pruritus
  • Vaginal pH <4.5
A

Vulvovaginal candidiasis

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3
Q

What is the Disease Entity?

  • Yellow frothy discharge
  • Vaginal pH > 4.5
  • Odor and pruritus
A

Trichomoniasis

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4
Q

What is the Disease Entity?

  • White thin discharge with odor
  • Vaginal pH > 4.5
  • Clue cells on wet mount
A

Bacterial vaginosis

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5
Q

Amsel’s Criteria for the diagnosis of Bacterial Vaginosis (4 criterion)

A

1) Thin watery vaginal discharge
2) Vaginal discharge with pH > 4.5
3) Amine-like odor when mixed with KOH (whiff test)
4) Clue cells >20% on wet mount

≥3 = BV

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6
Q

Recommended treatment for Trichomoniasis caused by protozoan T. vaginalis

A

Nitroimidazoles:
1) Metronidazole
2) Tinidazole

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7
Q

Findings on wet mount for vulvovaginal candidiasis

A

Hyphae and pseudohyphae, Mycelia

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8
Q

Glands located in the entrance of the vagina (5’ and 7’ o-clock) that secrete mucus

A

Bartholin glands

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9
Q

Usually pathogen involved in Bartholin abscesses

A

E. coli

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10
Q

Management of Bartholin gland abscess

A

1) Marsupialization (I&D)
2) Antibiotics with anaerobic coverage

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11
Q

Management of Bartholin gland cyst in patients either < 40 or > 40 y/o

A

<40 y/o = Marsupialization (I&D)

> 40 y/o = Excision

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12
Q

Superficial vulvar lesions

A

1) Molluscum contagiosum
2) Pediculosis pubis
3) Scabies
4) Genital warts

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13
Q
  • Most contagious of all STDs
  • Confined to hairy areas of the vulva
  • Pruritus
  • Finding of eggs (nits), lice, and pepper feces in pubic hair
A

Pediculosis pubis

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14
Q

Management of pediculosis pubis

A
  • 1% Permethrin cream rinse
  • OR Pyrethrin with piperonyl butoxide
  • OR malathion 0.5% lotion
  • OR Ivermectin 250ug/kg PO for 7-14 days
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15
Q

Pathogen causing Scabies

A

Sarcoptes scabiei

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16
Q

Skin lesion found in Scabies

A

Burrows

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17
Q

Management of Scabies

A
  • Permethrin 5% cream or Ivermectin 1% lotion applied to all areas of body and washed off after 8 hours
  • OR Ivermectin 250ug/kg PO for 7-14 days
  • OR Lindane lotion/cream applied to all areas of body and washed off after 8 hours
  • Antihistamines for pruritus
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18
Q

Benign mild skin disease due to Pox virus

A

Molluscum contagiosum

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19
Q

Transmission of Molluscum contagiosum

A

Via skin-to-skin contact, autoinoculation, or fomites

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20
Q

Lesions in Molluscum contagiosum

A

2-5mm flesh colored dome-shaped papules with central umbilication

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21
Q

Areas of involvement of Molluscum Contagiosum

A

Vulva, thighs, buttocks

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22
Q

Management of Molluscum contagiosum (?)

A
  • Heals spontaneously within 6-12 months
  • Monsel solution
  • TCA (Trichloroacetic acid)
  • Cryotherapy
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23
Q

Pathogen causing Genital warts (Condyloma acuminatum)

A

Human papillomavirus (HPV) 6 & 11

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24
Q

Transmission in HPV 6 & 11 genital warts

A

Direct contact, autoinoculation

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25
Q

Description of lesions in HPV 6 & 11

A

Cauliflower-like genital warts that may be asymptomatic or may present with pain, pruritus

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26
Q

T/F HPV serotyping is still required for patients presenting with genital warts

A

False.

Visual inspection is enough to warrant treatment

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27
Q

Management of Genital warts

A
  • Imiquimod cream
  • Sinecatechins ointment
  • Podofilox solution/gel

Procedures:
- Chemical (TCA)
- Electrocautery
- Cryotherapy
- Surgical excision

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28
Q

2 infectious agents implicated in Mucopurulent Cervicitis

A

1) Chlamydia trachomatis
2) Neisseria gonorrhea

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29
Q

Cervicitis has a tendency to ascend and cause the following infections:

A

Endometritis
Pelvic inflammatory disease

(same pathogens involved)

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30
Q

Clinical manifestations of cervicitis

A
  • Usually asymptomatic
  • Vaginal discharge/ intermenstrual bleeding
  • Dyspareunia
  • Edematous/ hypertrophic cervix
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31
Q

2 simple definitive objective criteria to establish mucopurulent cervicitis

A

1) Gross visualization of yellow mucopurulent material on cotton swab (or sustained bleeding on gentle passage)

2) ≥10 PMN/hpf on Gram stain smear of endocervix

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32
Q

Findings of trichomoniasis on wet mount

A

Motile trichomonads

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33
Q

Type of culture used for Gonococcal cervicitis

A

Thayer martin

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34
Q

Gold standard diagnostic for Chlamydia & Gonorrhea

A

Nucleic acid amplification test (NAAT)

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35
Q

Alternative criteria for mucopurulent cervicitis

A

1) Erythema and edema of cervix/associated bleeding secondary to endocervical ulceration

2) Friability of cervix

3) Increased vaginal discharge or intermenstrual bleeding

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36
Q

Findings of gonococcal cervicities on Gram stain

A

Gram stain showing gram negative diplococci

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37
Q

Medical Management of Chlamydia Cervicitis

A

Azithromycin 1g PO single dose

OR

Doxycycline 100mg BID for 7 days

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38
Q

Medical Management of Gonococcal Cervicitis

A

Ceftriaxone 500mg/IM single dose
AND
Azithromycin 1g PO single dose (for concomitant chlamydia)

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39
Q

Complications of Mucopurulent cervicitis

A
  • Preterm labor and PROM
  • Endometritis (pre and post partum)
  • Pelvic inflammatory disease
  • Fitz-Hugh-Curtis syndrome
  • Salpingitis
  • Ophthalmia neonatorum
  • Neonatal pneumonia
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40
Q

Treatment given for ophthalmia neonatorum in the infant

A

0.5% Erythromycin ophthalmic ointment at birth

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41
Q

Alternative antibiotic regimen for gonococcal cervicitis

A

Cefixime 800mg PO single dose

OR

Gentamicin 240mg IM single dose; AND
Azithromycin 2g orally single dose

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42
Q

Alternative regimen for Chlamydia cervicitis in pregnant patients

A

Azithromycin 1g PO single dose

OR

Amoxicillin 500mg PO TID for 7 days

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43
Q

Gold standard diagnosis of endometritis is via:

A

Endometrial biopsy

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44
Q

EM biopsy findings in endometritis

A

≥ 1 plasma cells/120 field
≥ 5 PMNs/400 field

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45
Q

Descriptive classification of upper genital tract infections

A

Infections that ascend through the cervix into the endometrium or salpinx

46
Q

Usual pathogens involved in Endometritis

A

C. trachomatis and N. gonorrhea

47
Q

Treatment for Endometritis

A

Clindamycin 900mg IV q6

OR
Cefoxitin 2g IV + Gentamycin 2mg/kg IV q6

OR
Cefixime 400 mg PO + Azithromycin 1000mg PO +/- Metronidazole 500mg PO BID for 7 days

48
Q

Additional treatment for Chronic Endometritis (possible C. trachomatis)

A

100mg Doxycycline PO BID for 10-14 days

49
Q

Different components of PID (varied involvement)

A

(ESPM)
Endometritis
Salpingitis (most common)
Parametritis
Myometritis

50
Q

2 Classic sexually transmitted organisms associated with PID

A

C. trachomatis and N. gonorrhea

but most of the time polymicrobial with both aerobes and anaerobes

51
Q

PID caused by which organism has been studied to increase the risk of ectopic pregnancy 3-6x

A

C. trachomatis

52
Q

Anaerobic organisms usually found in tubal cultures in PID

A

Bacteroides spp., Peptostreptococcus, Peptococcus

53
Q

Usual age distribution of PID

A

75% occurring in women < 25 y/o

54
Q

Empirical therapy for PID should be initiated in sexually active young women and other women at risk for STIs with pelvic pain IF any of these 3 signs are present:

A

1) Cervical motion tenderness
2) Uterine tenderness
3) Adnexal tenderness

55
Q

PID evolvement depending on organism involved:
1) N. gonorrhea:
2) C. trachomatis

A

1) N. gonorrhea - rapid onset, pelvic pain a few days after menstrual period

2) C. trachomatis - slow onset, indolent course, less pain, less fever

56
Q

Syndrome of PID with perihepatic inflammation and violin string adhesions

A

Fitz-Hugh-Curtis syndrome

57
Q

Most accurate method of diagnosing PID (with advantage of concurrent operative procedure)

A

Laparoscopy

58
Q

Addition to the management of PID to evaluate for presence of concurrent lower genital tract infections

A

NAAT for N. gonorrhea and C. trachomatis

59
Q

2 most important goals of medical therapy of acute PID

A

1) Resolution of symptoms
2) Preservation of tubal function

60
Q

Women who are not treated for PID within the first ___ hours of symptom onset are 3x more likely to develop tubal infertility or ectopic pregnancies

A

72 hours

61
Q

Recommended outpatient treatment for PID

A

Ceftriaxone 500mg IM single dose +
Doxycycline 100mg PO BID for 14 days +
Metronidazole 500mg PO BID for 14 days

OR

Cefoxitin 2g IM single dose +
Probenecid 1g PO single dose +
Doxycyline 100mg PO BID for 14 days +
Metronidazole 500mg PO BID for 14 days

62
Q

Recommended in-patient treatment of PID

A

Cefotetan 2g IV BID +
Doxycycline 100mg PO BID

OR

Cefoxitin 2g IV every 6h +
Doxycycline 100mg PO BID

63
Q

Bartholin gland cysts are usually _____ cm, (uni/bi lateral), (painful/nonpainful)

A

1-8cm
unilateral
non-painful

64
Q

Cultures grown in Bartholin gland abscesses

A

Usually polymicrobial

65
Q

Management for asymptomatic cysts in women < 40 y/o

A

Supportive. No medical treatment necessary.

66
Q

Surgical treatment of choice for Bartholin gland abscesses

A

Marsupialization

67
Q

Alternative management of Bartholin duct abscesses makes use of a _____ catheter

A

Word catheter

68
Q

Biiopsy of bartholin gland cysts are warranted in patients < 40 y/o in order to exclude the following IM condition:

A

Adenocarcinoma of the Bartholin gland

69
Q

The 2 most common animal parasites found on the skin

A

Crab louse, itch mite

70
Q

Pediculosis pubis is an infestation by what organism

A

Phthirus pubis (crab louse)

71
Q

Most contagious of all STIs

A

Pediculosis pubis

72
Q

Treatment for Pediculosis pubis

A

Permethrin 1% cream rinse, applied to affected area and washed off after 10 mins;
OR
Pyrethins with piperonyl butoxide, applied to affected area and washed off after 10 mins

73
Q

Alternative medical management of pediculosis pubis

A

Malathion 0.5% lotion applied for 8-12 hours then rinsed off

Ivermectin 250ug/kg orally repeated in 2 weeks

74
Q

Scabies is a parasitic infection of which organism

A

Sarcoptes scabei (itch mite)

75
Q

Which of the following has predilection for hairy areas vs widespread over the body

1) Pediculosis pubis
2) Scabies

A

1) Pediculosis pubis - hairy areas
2) Scabies - widespread

76
Q

Itching during scabies infestation is more intense in the (morning/night)

A

Night
- skin is warmer and mites are more active

77
Q

Pathognomonic sign of scabies infection

A

Burrows in the skin
- twisted line in the skin surface with a vesicle at one end
- where female itch mites burrow their eggs

78
Q

Treatment for Scabies

A

Permethrin cream (5%) applied to all areas of the body from the neck down, washed off after 8-14 hours

79
Q

Alternative medical management of Scabies

A

Ivermectin 200 ug/kg orally, repeated after 2 weeks

80
Q

Flesh colored, dome-shaped papules with an umbilicated center containing caseous material

A

Molluscum contagiosum

81
Q

Molluscum contagiosum is a chronic localized skin infection by what pathogen

A

Poxvirus

82
Q

Diagnostic tool used to detect molluscum contagiosum if unable to diagnose by inspection

A

Wright and Giemsa stain showing:
Intracytoplasmic molluscum bodies

83
Q

Major complication of Molluscum contagiosum

A

Bacterial superinfection

84
Q

Despite Molluscum’s ability to spontaneously resolve, treatment can be offered such as

A

> Nodule Excision with dermal curette
Base treatment with Monsel solution or 85% TCA acid
Canthardin
Imiquimod
Cryotherapy

85
Q

Cauliflower-like vulvar lesions that can be asymptomatic or may present with pain/itching

A

Genital warts/Condyloma acuminatum

86
Q

Genital warts (Condyloma acuminatum) are caused by which pathogen/s

A

Human papillomavirus (HPV) 6 and 11

87
Q

Treatment for Genital warts (Condyloma acuminatum)

A

Patient applied
> Imiquimod cream
> Sinecatechins ointment
> Podofilox solution/gel

Provider applied
> TCA acid
> Electrocautery
> Cryotherapy
> Surgical excision

88
Q

Enumerate the 5 ulcerative vulvar infections

A

1) Syphilis (Condyloma Lata)
2) Chancroid
3) Genital Herpes
4) Lymphogranuloma venereum
5) Donovanosis (Granuloma inguinale)

89
Q

Pathogen involved in syphilis infection

A

Treponema pallidum

90
Q

Pathogen involved in Donovanosis

A

Klebsiella granulomatis

91
Q

Pathogen involved in Genital Herpes

A

HSV 1 and HSV 2

92
Q

Pathogen involved in chancroid lesions

A

Haemophilus ducreyi

93
Q

Pathogen involved in LGV

A

Chlamydia trachomatis (L1, L2, L3)

94
Q

Vulvar infection that presents initially as a papule that multiplies and coalesces, with ragged irregular edges, soft indurations, on a purulent base, with unilateral tender suppurative lymphadenopathy.

A

Chancroid

  • Haemophilus ducreyi
95
Q

Vulvar infection that presents initially as a vesicle that multiplies and coalesces, with sharp edges, on an erythematous base, with firm tender bilateral lymphadenopathy.

A

Genital Herpes

  • HSV1, HSV2
96
Q

Vulvar infection that can spread by sexual contact and transplacental, presents as nonpainful, single round or oval papular lesions, sharply demarcated, with firm nontender lymphadenopathy

A

Syphilis (Condyloma lata)

97
Q

Vulvar infection that begins as a papule, with elevated irregular edges on a rough red and beefy base, pseudobuboes unilaterally

A

Donovanosis (Granuloma inguinale)

  • Klebsiella Granulomatis
98
Q

Vulvar infection presenting as a papule/pustule/vesicle, with elevated/round/oval edges, and with tender multiloculated bilateral buboes in inguinal region

A

Lymphogranuloma venereum

  • C. trachomatis serovar L1, L2, L3
99
Q

Herpesvirus resides in the Latent phase in dorsal root ganglia of ___, ____, and ____.

A

S2, S3, and S4

100
Q

Most accurate and sensitive technique in identifying herpesvirus

A

PCR assay

101
Q

Recommended treatment for the 1st clinical episode of Genital Herpes

A

Acyclovir
> 200mg 5x/day for 7-10 days
> 400mg TID for 7-10 days
OR
Valacyclovir
1000mg BID for 7-10 days

102
Q

Recommended treatment for Recurrent Genital Herpes

A

Acyclovir
> 400mg TID for 5 days
OR
Valacyclovir
> 1000mg OD for 5 days
> 500mg BID for 3 days

103
Q

What is the gold standard for definitive diagnosis of Syphilis

A

Dark field microscopy showing tight spirochetes

103
Q

Daily suppressive therapy for Genital herpes

A

Acyclovir 400mg BID daily
OR
Valacyclovir
> 1000mg OD (≥ 10 recurrences/year)
> 500mg OD (≤ 9 recurrences/year)

104
Q

Nontreponemal serum tests that can detect immune response to syphilis

A

VDRL
RPR

105
Q

Antitreponemal tests that detect antibodies to syphilis

A

FTA-ABS (Flourescent treponema antibody absorption)
MHA (Micro hemagglutination assay)

106
Q

Hallmark lesion of primary syphilis. Describe

A

Chancre
Single painless ulcer, 1-2cm, with a raised indurated margin and nonexudative base. Found in affected areas from cervix, vagina, vulva, mouth, anus. With nontender lymphadenopathy

107
Q

Secondary syphilis in patients whose primary syphilis underwent hematogenous dissemination will start after how long a time period

A

6 weeks to 6 months (ave 9 weeks)

108
Q

Characteristic skin lesion of secondary syphilis

A

maculopapular rashes on the palms of hands and soles of feet

109
Q

Characteristic vulvar lesion of secondary syphilis

A

Condyloma lata

Large raised flattened grayish white mucoid patches

110
Q

Duration of the latent stage of syphilis

A

2 - 20 years

OB+GYN (11 decks)

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