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EOR - Women's Health > Infections > Flashcards

Infections Flashcards

1
Q

what women’s health infections do we need to know about

A

cervicitis
HPV
chancroid
LGV (lymphogranuloma venereum)
PID
syphilis
candida vaginitis
BV
trichomonas
atrophic vaginitis

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2
Q

what are the different types of cervicitis

A

gonorrhea
chlamydia
HSV
HPV

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3
Q

mucopurulent vaginal d.c
gram negative diplococci

A

gonorrhea cervicitis

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4
Q

dx for gonorrhea cervicitis

A

NAAT of d.c or urine

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5
Q

tx for gonorrhea cervicitis

A

</=150 kg: ceftriaxone 500 mg IM single dose
>/= 150 kg: 1 g

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6
Q

tx for coinfection of gonorrhea cervicitis PLUS chlamydia trachomatis

A

cetriaxone
PLUS
doxy

give doxy if you haven’t excluded chlamydia

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7
Q

what should you think of if a pt has persistent pharyngitis

A

gonococcal pharyngitis

get samples for culture

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8
Q

urethritis, vulvovaginitis
pain, pruritis
cervicitis
clcear vaginal d.c

A

chlamydia cervicitis

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9
Q

mc STI of the urethra, cervix, and rectum

A

chlamydia

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10
Q

what bacteria causes chlamydia infxn

A

chlamydia trachomatis
sterotypes D-K

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11
Q

symptoms of chlamydia (5)

A

urethritis
bartholinitis
cervicitis
d.c
post-coital bleeding

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12
Q

8 complications of chlamydia

A

PID
endometritis
salpingo-oophritis
neonatal conjunctivitis
neonatal PNA
infertility
miscarriage
ectopic pregnancy

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13
Q

dx for chlamydia

A

NAAT

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14
Q

tx for chlamydia

A
  1. doxy
    alt: azithromycin OR levofloxacin
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15
Q

all pt’s w. chlamydia should also be tested for _

A

gonorrhea

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16
Q

t/f: all pt’s w. positive NAAT for gonorrhea should also be treated for chlamydia, even if asymptomatic

A

t!

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17
Q

tx for chlamydia in pregnant pt

A

azithromycin
OR
amoxicillin

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18
Q

painful blisters on vulva/vaginal introitus - prodrome of burning, tingling, pruritis - vesicles on an erythematous base

A

HSV cervicitis

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19
Q

which HSV strain causes HSV cervicitis

A

HSV 2

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20
Q

enveloped linear double-stranded DNA virus

A

HSV 2

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21
Q

with genital herpes, were do ulcers/pustules mc form

A

labia majora/minora
mons pubis
vaingal mucosa
cervix

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22
Q

classic description of HSV

A

vesicles on an erythematous base

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23
Q

t/f: reactivation of HSV is often asymptomatic

A

t!

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24
Q

gs dx for HSV (3)

A

PCR
direct fluorescence antibody
type-specific serologic tests

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25
Q

what prep is associated w. HSV and waht does it show

A

Tzanck prep ->multinucleated giant cells

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26
Q

tx for HSV (3)

A

acyclovir
valacyclovir
famiciclovir

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27
Q

severe presentation of HSV (3)

A

sacral nerve involvement
urinary retention
meningitis

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28
Q

who should get suppressive tx for HSV

A

severe/frequent recurrent episodes 6 or more/year

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29
Q

suppressive tx for HSV

A

valacyclovir

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30
Q

more than 90% of genital warts are caused by

A

HPV 6
HPV 11

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31
Q

which HPV vaccination is indicated for females and males ages 9-45 yo

A

gardasil-9 (HPV 9-valent)

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32
Q

more than 90% of cervical ca is associated with which types of HPV (5)

A

16
18
31
33
35

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33
Q

_ is commonly seen in combo w. condyloma acuminata

A

trichomonas

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34
Q

condylomata acuminata is a clinical dx, but _ can confirm dx

A

shave or punch bx

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35
Q

pap smear findings of condylomata acuminata

A

koilocytic squamous epithelial cells in clumps

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36
Q

tx for condylomata acuminata (4)

A

most resolve w.in months-years
pdophyllin OR trichloroacetic acid (TCA)
topical imiquimod (aldara)
cryotherapy w. liquid nitrogen vs excision vs laser

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37
Q

3 HPV vaccines

A

quadrivalent (gardasil)
9-valaent (gardasil-9)
bivalent (cervarix)

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38
Q

t/f: both garadasil vaccines cover HPV 6, 11, 16, 18

A

t!

gardasil 9 also covers 31, 33, 45, 52, 58

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39
Q

the cervarix vaccine targets HPV (2)

A

16
18

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40
Q

only HPV vaccine available in the US

A

gardasil-9

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41
Q

all persons _ to _ yo should receive _ doses of gardasil 9

A

11-12
2 doses

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42
Q

gardasil 9 may be given starting at age _

A

9

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43
Q

catch up gardasil 9 should be given to all persons _ to _ yo regardless of risk factors

A

13-26

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44
Q

what are the 4 ulcerative STIs of the genital area

A

HSV
chancroid
lymphogranuloma venereum (LGV)
syphilis

45
Q

30 yo f c/o painful sore on vulva that first resembled a pimple - PE shows an ulcer w. clearly demarcated borders on a gray base w. foul smelling d.c

A

chancroid

46
Q

STI that results in painful genital ulcers

A

chancroid

47
Q

what pathogen causes chancroid

A

haemophilus ducreyi

48
Q

t/f: chancroid ulcers bleed easily when scraped

A

t!

49
Q

where are chancroid ulcers mc found

A

areas most susceptible to friction: glans penis, vaginal introitus

50
Q

half of pt’s w. chancroid will have what associated PE finding

A

marked LAD in the inguinal chain

51
Q

dx for chancroid

A

RPR/VRDL

gram stain, culture, bx used in combo due to high rates of false negatives

52
Q

tx for chancroid

A

ceftriaxone
+/- needle aspiration/drainage of LAD

53
Q

what pathogen causes LGV

A

chlamydia trachomatis
serotypes L1, L2, L3

54
Q

primary infxn of LGV occurs in the

A

lymph nodes

55
Q

3 rf for LGV

A

HIV
Hep C
MSM

56
Q

3 stages of LGV infxn

A

primary
secondary
late

57
Q

primary stage of LGV is chracterized by

A

painless genital ulcers/papules

58
Q

secondary stage of LGV infxn is chracterized by

A

unilateral or bilateral tender inguinal and/or femoral LAD

aka buboes

59
Q

late stage of LGV infxn is characterized by

A

strictures/fibrosis/fistulae of the anogenital area

60
Q

definitive dx for LGV

A

serology

61
Q

preferred dx test for LGV for MSM

A

NAAT of rectal specimens

62
Q

tx for LGV

A
  1. doxy
    alt: azithromycin

pregnant: erythromycin

63
Q

t/f: you should wait for official dx before treating for LGV

A

f!
treat if you suspect

64
Q

STI that ascends from the cervix or vagina to involve the endometrium and/or fallopian tubes

A

PID

65
Q

causative agents for PID

A

gonorhea
chlamydia

66
Q

what is chandelier sign

what does it make you think of

A

cervical motion tenderness
PID

67
Q

4 sx of PID

A

pelvic pain
fever
vaginal d.c
cervicitis

68
Q

3 complications of PID

A

infertility
ectopic pregnancy
tubo-ovarian abscess (adnexal mass)

69
Q

PE findings suggestive of PID

A

abdominal tenderness
cervical motion tenderness
adnexal tenderness
PLUS one or more:
-temp > 38
-WBC > 10,000
-pelvic abscesses via exam or US

70
Q

inpt tx of PID:
op tx of PID:

A

inpt:
cefotetan/cefoxitin PLUS doxy
OR
clinda PLUS gentamicin

outpt:
ceftriaxone PLUS doxy +/- metronidazole
OR
cefoxitin PLUS probenecid PLUS doxy +/- metronidazole

71
Q

6 indications for hospitalization w. PID

A

-uncertain dx w. inability to exclude d.o requiring surgical intervention (ex appendicitis)
-pregnancy
-no response to op tx w.in 72 hr
-severe illness: high fever, n/v
-inability to tolerate or follow op instructions
-tubo-ovarian abscess

72
Q

what pathogen causes syphilis

A

spirochete Treponema pallidum

73
Q

3 phases of syphilis

A

primary
secondary
tertiary

74
Q

presentation of primary syphilis

A

chancre

75
Q

describe a chancre

A

painless ulcer
groin or genital region
presists 3-6 weeks

76
Q

presentation of secondary syphilis

A

erythematous rash on palms/soles
OR
condyloma lata

77
Q

presentation of tertiary syphilis

A

neurosyphilis
mucosal growths (gummas)

78
Q

dx for syphilis

A

RPR/VDRL
confirmed by: FTA-ABS

79
Q

tx for primary and secondary syphilis

A

benathine pcn g 2.4 million units IM x 1 dose

*more doses if infected > 1 year or if pregnant *

80
Q

tx for syphilis if pt is pcn allergic

A

doxy

81
Q

tx for tertiary or congenital syphilis

A

iv pen g

82
Q

what are the 4 types of vaginitis

A

trichmoniasis
BV
atrophic
candidiasis

83
Q

mc cause of vaginitis

A

candida

84
Q

describe the d.c w. candida vaginitis

A

clumpy/cheesy

mmmm

85
Q

sx of candidal vaginitis (6)

A

pruritis
dysuria
burning
dyspareunia
vaginal/vulvar edema
erythema

86
Q

3 predisposing factors for candidal vaginosis

A

DM
OCP
abx

87
Q

dx for candidal vaginosis

A

KOH

88
Q

KOH findings of candidal vaginosis

A

budding hyphae

89
Q

pH associated w. bacterial candidiasis

A

acidic: < 4.5

90
Q

tx for candidal vaginosis

A
  1. oral fluconazole
    alt: topical: clotrimazole, tioconazole
    severe: amphotericin B, capsofungin, voriconazole
91
Q

pathogen associated w. BV

A

gardnerella

92
Q

d.c associated w. BV

A

grayish white
fishy smelling

93
Q

dx for BV

A

gram stain -> clue cells

94
Q

KOH prep findings of BV

A

fishy smell -> whiff test

95
Q

pH associated w. BV

A

basic: > 4.5

96
Q

first line tx for BV

A

metronidazole
alt: clinda

97
Q

important pt ed for pt on metronidazole

A

avoid etoh

98
Q

d.c associated w. trichomonas vaginitis

A

greenish gray
frothy

99
Q

rf for trichomonas vaginitis

A

sexually active

considered STI

100
Q

hallmark PE finding of trichomonas

A

strawberry cervix -> petecchiae on cervix

101
Q

dx for trichomonas

A

wet mount

102
Q

wet mount findings of trichmonas

A

mobile and pear shaped protozoa w. flagella

103
Q

tx for trichomonas

A

metronidazole

104
Q

important tx consisderation w. trichmonas

A

considered an STI to treat partner too

105
Q

post menopausal woman w. irritation, dryness, painful intercourse, increased UTI’s, urinary incontinence

A

atrophic vaginitis

106
Q

what do you think when you see a pt w. recurrent UTI’s despite treatment in a post menopausal woman

A

atrophic vaginitis

107
Q

dx for atrophic vaginitis

A

pelvic exam: thin, pale appearing mucosa

108
Q

tx for atrophic vaginitis

A
  1. conjugated estrogen vaginal cream
  2. HRT if no contraindication
  3. non hormonal vaginal moisturizers

EOR - Women's Health (15 decks)

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