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NURP 501 - Ex 1 > 2: Gynecologic Infections 2 > Flashcards

2: Gynecologic Infections 2 Flashcards

1
Q

What is patient education during treatment of VVC?

A
  • Complete full course of meds.
  • Apply even during menstruation.
  • Avoid intercourse during treatment (or use non-latex condom).
  • Don’t use tampons during treatment (absorbs medication).
  • Avoid sprays, scented stuff in vaginal area.
  • Avoid colored / scented toilet paper and fabric softener.
  • Ingesting vitamin C, yogurt, oral acidophilus may be helpful to prevent recurrences.
  • Decrease unnecessary ABX and refined sugars.
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2
Q

What pathogens cause bartholin gland abscesses?

A

Previous studies identified Neisseria gonorrhea and other STIs, but more recent studies indicate most cases are caused by opportunistic bacteria.

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3
Q

Other than candida albicans, what other organisms cause VVC?

A

Non-albicans species such as:

  1. Candida glabrata
  2. Candida tropicalis
  3. Candida parapsilosis
  4. Candida krusei
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4
Q

What are treatment options for VVC during pregnancy?

A

Pregnant women should never self-treat. Use topical azoles only. Oral meds (fluconazole) is not recommended in pregnancy (Category C). Do not use boric acid during pregnancy.

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5
Q

Common symptoms for women with desquamative inflammatory vaginitis?

A
  1. Burning
  2. Dyspareunia
  3. Yellow discharge with a green tinge
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6
Q

Who is most at risk for TSS?

A

Young women using high-absorbency tampons.

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7
Q

Which organisms usually cause complicated VVC?

A
  1. C. albicans
  2. C. glabrata
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8
Q

What helps maintain vaginal health and delay atrophic conditions?

A

Regular, safe, sexual activity.

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9
Q

How is atrophic vaginitis diagnosed?

A

Often made based on a woman’s history and clinical findings. No specific diagnostic tests for this condition.

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10
Q

What should you teach patients about VVC treatments and sex?

A

Vaginal creams and suppositories recommended for treatment of this condition are oil based, so they may weaken latex condoms and diaphragms.

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11
Q

What causes desquamative inflammatory vaginitis?

A

In this condition, the predominant lactobacilli flora of the vagina is replaced with gram-positive coccobacilli, usually group B Streptococcus. Often the diagnosis of DIV occurs only after more common conditions have been ruled out.

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12
Q

What is patient education to prevent VVC?

A
  1. Bathe daily with lots of water and minimal unscented soap.
  2. Don’t wear underwear to bed.
  3. Loose fitting clothes.
  4. Cotton crotches.
  5. Don’t sit in wet bathing suits or clothes for long periods of time.
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13
Q

What are lab criteria for diagnosis of TSS?

A

Negative results on the following tests, if obtained:

  1. Blood or cerebrospinal fluid cultures (blood culture may be positive for Staphylococcus aureus).
  2. Negative serologies for Rocky Mountain spotted fever, leptospirosis, or measles.
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14
Q

What should assessment for atrophic vaginitis (AV) include?

A
  1. Thorough history.
  2. Physical exam.
  3. Vaginal pH and vaginal maturation index can be helpful.
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15
Q

What is the difference between atrophic vaginitis and an atrophic vagina?

A

Both result from urogenital atrophy, but atrophic vaginitis is additionally accompanied by inflammation.

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16
Q

T/F Candid albicans may be more resistant to commonly used azole antifungals, both OTC and Rx.

A

False. NON-albicans species may be more resistant to commonly used azole antifungals, both OTC and Rx.

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17
Q

How do abscesses occur in the bartholin glands?

A

Abcess formation occurs when the cystic fluid becomes infected.

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18
Q

What findings on pelvic exam would indicate bartholin gland abscess?

A
  1. Very tender, edematous fluctuant mass with erythema of the overlying skin.
  2. Labial edema and distortion are observed on the affected area.
  3. Rarely larger than 5 cm in size.
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19
Q

What should you use for assessment of VVC?

A
  1. History
  2. Predisposing risk factors
  3. Physical inspection of vulva and vagina
  4. Speculum and microscopic exam of vaginal secretions with saline and KOH
  5. Vaginal pH (normal)
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20
Q

What are the characteristics of atrophic vaginitis?

A
  1. Scant vaginal secretions, immature epithelial cells, elevated vaginal pH, and an increase in white blood cells.
  2. Vaginal epithelium is pale, with diminished rugae.
  3. Petechiae may or may not be seen on the cervix.
  4. Vaginal pH is typically greater than 5.0.
  5. Parabasal cells with large nuclei are seen.
  6. Nuclear to cytoplasmic ratio is increased.
  7. White blood cells are often increased, while lactobacilli are diminished or absent.
  8. Consequently, the atrophic vagina is frequently repopulated with enteric organisms previously kept in check by the healthy, acidic vagina
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21
Q

_____ is associated with these common complications: allergic reactions, compromise of barrier contraception, infection, keloid formation.

A

Genital piercing is associated with these common complications: allergic reactions, compromise of barrier contraception, infection, keloid formation.

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22
Q

The proportion of _____ in women with vulvovaginal atrophy is less than 5%.

A

The proportion of SUPERFICIAL CELLS in women with VVA is less than 5%. This is measured by vaginal maturation index (VMI) which measures relative proportions of parabasal, intermediate, and superficial vaginal epithelial cells.

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23
Q

Boric acid has been show to be an effective treatment for what?

A

Non-albicans VVC (600 mg once daily for 14 days intravaginally).

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24
Q

T/F Untreated vulvovaginal trophy is a progressive condition.

A

True

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25
Q

When does TSS usually occur?

A

Within 5 days of onset of menses symptoms.

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26
Q

Treatments for desquamous inflammatory vaginitis?

A

Clindamycin cream with or without local estrogen therapy. Reevaluate after 2-4 weeks of treatment. Relapse is common.

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27
Q

What do parabasal cells look like compared to mature epithelial cells?

A

When compared with mature epithelial cells, parabasal cells are typically smaller in size, have a rounded appearance, and have denser nuclei.

28
Q

What findings on pelvic exam would likely indicate bartholin gland cyst?

A
  1. The cyst appears as a visible round or oval mass causing a crescent-shaped vestibular entrance.
  2. It is nontender but tense, and palpable swelling is apparent.
  3. Swelling is usually unilateral and without erythema or inflammation.
29
Q

If the pH is above 4.5 in VVC, what might be the cause?

A

If the pH is greater than 4.5, the clinician should suspect coinfection with trichomoniasis or BV.

30
Q

Oral fluconazole can’t be used during pregnancy. Can it be used postpartum while breastfeeding?

A

Not recommended as it is found in breastmilk.

31
Q

What is treatment for bartholin cysts or abscesses?

A
  • No treatment for small, asymptomatic cysts.
  • The aim of abscess treatment is to permit drainage of cyst contents and prevent reaccumulation of fluid. One option is incision and drainage (I/D), irrigation, and packing. However, I/D with packing is associated with a higher rate of recurrence.
  • Word catheter.
  • Marsupialization (surgical procedure that is wide excision of mass) is reserved for recurrent episodes.
32
Q

What is the difference in desquamous inflammatory vaginitis and atrophic vaginitis?

A

The most notable difference is that DIV does not respond to estrogen therapy alone.

33
Q

In DIV, when women are using intravaginal antimicrobial or corticosteroid therapies, how could VVC be prevented?

A

Addition of weekly oral fluconazole in conjunction with intravaginal azole to minimize the occurrence of secondary VVC.

34
Q

In VVC, often the discharge is found in patches on _____, _____, and _____.

A

Often the discharge is found in patches on the VAGINAL WALLS, CERVIX, and LABIA.

35
Q

What are the primary and secondary pathogenic agents in toxic shock syndrome (TSS)?

A

Staphylococcus aureus is primary with Streptococcal pyogenes secondary.

36
Q

Nonprescriptive treatments for atrophic vaginitis.

A
  1. Regular use of lubricants and moisturizing agents.
  2. Combo of vitamin E and phytoestrogen.
37
Q

When do you refer bartholin cysts and abscesses?

A

Referral is indicated for:

  1. marsupialization
  2. recurrent cyst or abscess formation
  3. any solid mass
  4. cyst or abscess in women older than 40 years of age to rule out neoplasm
38
Q

A symptomatic condition seen frequently among women experiencing decreased estrogen production. Develops as a result of vulvovaginal atrophy.

A

Atrophic Vaginitis (AV)

39
Q

What are findings of TSS after the acute phase?

A

After the acute phase, findings may include:

  1. generalized maculopapular rash and desquamation of the fingers, palms, toes, and soles
  2. Pelvic examination may reveal hyperemic vaginal mucosa and vulvar and vaginal tenderness
40
Q

How does TSS occur?

A

Some strains of S. aureus and S. pyogenes produce powerful toxins that result in massive immune cell activation and cytokine release, leading to shock and organ failure.

41
Q

T/F Bartholin cyst fluid should be cultured.

A

False. Routine culture of draining fluid is not recommended, as the results are rarely useful in treatment.

42
Q

How big are bartholin gland cysts?

A

1-8 cm.

43
Q

What patient education is required with genital piercings and pregnancy?

A
  1. Pregnant women with existing piercings on any body part are recommended to remove them.
  2. Women considering pregnancy within a year are recommended to defer genital piercing, as piercing tracts may lead to infection and blood-borne diseases, such as hepatitis, or cause fetal effects as a consequence of medications used to treat infection.
44
Q

What is the preferred mode of administration for estrogen therapy?

A

Vaginal applications is generally more effective. Systemic therapy is helpful when all symptoms are not vaginal.

45
Q

What does estrogen therapy due in atrophic vaginitis?

A

Estrogen therapy promotes revascularization of the vaginal epithelium and restores the normal pH of the vagina.

46
Q

What qualifies as recurrent VVC?

A

4 or more episodes in 1 year.

47
Q

Most common symptom of VVC?

A

Vulvar and possibly vaginal pruritis.

48
Q

Causes of atrophic vaginitis (AV).

A
  1. Decreased estrogen production (perimenopause, menopause, lactation).
  2. Cancer treatments (surgical therapy and radiation). Pharmacologic therapies of breast cancer (aromatase inhibitors such as anastrazole, letrozole, and exemestane).
  3. Surgical menopause.
  4. Meds use for endometriosis or uterine fibroids (such as gonadotropin-releasing hormone (GnRH) agonists).
  5. Hypothalamic amenorrhea caused by excessive physical activity (athletes, anorexia).
49
Q

What would indicate impending rupture of a bartholin abscess?

A

An area of softening or pointing suggests an impending rupture.

50
Q

An obese woman comes to see you with recurrent VVC. What should you consider testing for?

A

Diabetes should be tested for recurrent infx and comorbidities such as obesity, family history of DM.

51
Q

What are early/acute signs of TSS?

A

Early signs may include:

  • generalized erythematous and macular rash
  • generalized, nonpitting edema
  • erythema of the palms and soles
52
Q

An uncommon syndrome characterized by a profuse, noninfectious, vaginal discharge, accompanied by vaginal irritation, burning, and dyspareunia.

A

Desquamative Inflammatory Vaginitis (DIV)

53
Q

Treatments for atrophic vaginitis.

A

Varies, but includes OTC products, estrogen therapy, vaginal testosterone, tamoxifen, and ospemifene.

54
Q

T/F In VVC, the vulva is commonly red and swollen, as are the labial folds, vagina, and cervix. Although no characteristic odor is associated with VVC, sometimes a yeasty or musty smell occurs.

A

True

55
Q

What is the most common cause of VVC?

A

Candida albicans (90% or more).

56
Q

Fever, rash, hypotension, myalgia, and vomiting.

A

Toxic Shock Syndrome (TSS)

57
Q

Risk factors for VVC?

A
  1. Repeated courses of ABX therapy (esp broad-spectrum).
  2. Diabetes (esp uncontrolled).
  3. Pregnancy.
  4. Obesity.
  5. Refined sugars or artificial sweeteners.
  6. Corticosteroids or exogenous hormones.
  7. Immunosuppressed states.
  8. Local allergic or hypersensitivity reactions.
  9. Postmenopausal hormone therapy (esp vaginal application).
  10. Tight-fitting clothing.
  11. Non-cotton crotches.
58
Q

How do cysts occur in the bartholin glands?

A

Continued fluid secretion after obstruction of the ducts.

59
Q

How quickly do bartholin gland abscesses occur?

A

Form quickly over 2-4 days and rupture within 3-4 days.

60
Q

Two mucus-secreting, nonpalpable glandular structures with duct openings within the posterolateral vulvar vestibule that provide minimal lubrication.

A

Bartholin glands

61
Q

What does assessment show in desquamative inflammatory vaginitis?

A
  1. Vaginal examination often reveals a profuse, purulent-appearing discharge with or without vaginal and vestibular erythema.
  2. An amine test will be negative, and a pH test will be elevated toward the basic end of the scale (> 5).
  3. Microscopic examination of vaginal secretions shows large numbers of polymorphonuclear cells and parabasal cells.
  4. DIV can appear very similar to trichomoniasis; however, no motile trichomonads will be seen and cultures for Candida, trichomoniasis, chlamydia, and gonorrhea will be negative.
62
Q

Desquamous inflammatory vaginitis can appear similar to what?

A

Trichomoniasis (though no motile trichomonads will be seen).

63
Q

What qualifies VVC as complicated vs. uncomplicated.

A

Complicated is:

  1. recurrent
  2. severe
  3. non-albicans
  4. occurs in:
    1. DM
    2. immunocompromising conditions
    3. debilitation
    4. immunosuppressive therapy
64
Q

How is TSS diagnosed?

A

Clinical findings based on:

  1. Fever (102 or greater)
  2. Rash (diffuse macular erythroderma)
  3. Desquamation (1-2 weeks after onset)
  4. Hypotension (less than 90 for less than 5th percentile for younger than 16)
  5. Multiystem involvement (3+ of these symptoms):
    1. Vomiting or diarrhea
    2. Severe myalgia or creatine phosphokinase level twice the norm)
    3. Mucous membranes hyperemic
    4. BUN or creatinine twice the norm
    5. Urinary sediment with pyuria Hepatic levels twice the norm
    6. Platelets less than 100,000
    7. Disorientation or alterations in consciousness
65
Q

Most common populations for desquamative inflammatory vaginitis?

A

Premenopausal and postmenopausal women.

66
Q

What might be an issue with OTC lubricants and moisturizers?

A

Hyperosmolar properties which could damage vaginal tissue.

NURP 501 - Ex 1 (63 decks)

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