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

2: Gynecologic Infections Flashcards

1
Q

Why is penetration by sperm less likely to occur after ovulation?

A

Once ovulation occurs, progesterone secreted from the corpus luteum converts the cervical mucus into a thickened, tenacious substance, making penetration by sperm unlikely.

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2
Q

T/F There exist effective alternative treatments for BV.

A

False. Research is actively underway, but few studies currently demonstrate safety, effectiveness, and long-term outcomes of alternative treatments. Consider reliable sources only (no blogs and unsubstantiated websites).

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3
Q

When are amines produced?

A

Byproduct of anaerobic metabolism.

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4
Q

Among reproductive-age women in the United States, the prevalence of BV has been reported to be approximately _____%.

A

Among reproductive-age women in the United States, the prevalence of BV has been reported to be approximately 29%.

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5
Q

Many women develop VVC symptoms following treatment with what med? How is this sometimes handled?

A

Nitroimidazole. Providers often co-prescribe an antifungal, such as fluconazole.

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6
Q

An inflammation of the vagina that is NOT characterized by an increase in white blood cells.

A

Vaginosis

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7
Q

During what two phases of a woman’s life are vaginal secretions minimal and why?

A
  • Before menarche
  • After menopause

Low estrogen levels decrease secretions.

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8
Q

3 most common causes of abnormal vaginal discharge.

A
  1. Bacterial Vaginosis (BV)
  2. Vulvovaginal Candidiasis (VVC)
  3. Trichomoniasis
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9
Q

T/F There is clear evidence of how to screen and treat women with recurrent BV.

A

False. Although the majority of women with BV are asymptomatic, a significant number experience recurring and chronic symptoms. The scientific literature has not settled the controversy regarding whether and when to screen women with chronic recurrence and how to treat them.

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10
Q

How should recurrent BV be treated?

A

The CDC has considered the problem of recurrent BV and suggests retreating women with this condition with the original therapy, using metronidazole gel intravaginally weekly for 4 to 6 months, or monthly oral metronidazole with fluconazole. No studies have found a regimen effective enough to be recommended for treatment of recurrent BV.

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11
Q

In BV, what does miscroscopy show?

A

Clue cells (vaginal epithelial cells coated with bacteria that obscure cell borders) in the sample with normal saline is a characteristic sign because this phenomenon is specific to BV. A reduction in lactobacilli and typically very few white blood cells are noted.

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12
Q

When should you treat BV?

A

The CDC recommends treatment for symptomatic women.

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13
Q

Why do we want estradiol to increase the amount of cervical mucus and make it thin and watery?

A

To enable penetration of sperm immediately prior to ovulation.

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14
Q

When using clindamycin cream to treat BV what patient education should you include?

A

Clindamycin may weaken latex condoms or contraceptive diaphragms.

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15
Q

T/F The amount of vaginal discharge a woman experiences is not, in itself, an indication of infection.

A

True

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16
Q

What is BV associated with in pregnant women?

A

BV is associated with:

  1. chorioamnionitis
  2. premature rupture of fetal membranes
  3. preterm labor and birth
  4. postpartum endometritis
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17
Q

An increase in the amount of vaginal secretions is called _____.

A

An increase in the amount of vaginal secretions is called leukorrhea.

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18
Q

What is the most common symptom of BV?

A

Malodorous discharge.

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19
Q

An inflammation of the vagina characterized by an increased vaginal discharge containing numerous white blood cells.

A

Vaginitis

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20
Q

What promotes growth of opportunistic and pathogenic organisms in the vagina?

A
  • Antibiotics
  • Vaginal lubricants
  • Hormonal contraceptives
  • Douching
  • Other behavioral and intrinsic factors
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21
Q

Name preventive measures for vaginal infections.

A
  • General health promotion (rest, reduced stress, healthy diet low in sugar).
  • Good personal hygiene (regular, gentle cleansing and drying of perineal area removes perspiration and smegma accumulations).
  • Towels, sponges, douching equipment, sexual equipment, underwear, etc. should be cleaned after each use and never shared.
  • Proper wiping (front to back–most critical thing to teach).
  • Avoid sprays, powders, etc. that are perfumed or irritating.
  • Avoid chemicals that irritate skin or alter vaginal pH.
  • Avoid tight clothing in the crotch area (does not allow free flow of air or traps moisture).
  • Discourage daily use of panty liners (trap moisture). Counsel women to change pads, liners, tampons frequently, never wear tampons to bed, and don’t use tampons when flow is scant.
  • No douching except when recommended by clinician.
  • Cotton crotches.
  • Clip hair in vaginal area (no waxing, shaving, etc.).
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22
Q

What is the difference between vaginitis and vaginosis?

A

Vaginosis is not associated with an increase in white blood cells.

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23
Q

How should hair be managed in the vaginal area and why?

A

Recommend against vulvar shaving, waxing, and use of depilatories, as these practices strip the vulva—and, therefore, the vagina—of protective hair, expose the skin to bacteria, and may lead to severe inflammatory reactions. Excessive vulvar hair can be clipped with scissors rather than shaved or waxed.

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24
Q

What 2 things usually have pH of 4.5 or greater?

A
  1. BV
  2. Trichomoniasis
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25
Q

Can pap tests be used for diagnosis of BV?

A

No. Pap testing is both nonspecific and nonsensitive for diagnosing BV. Furthermore, vaginal cultures are not useful because BV is multibacterial in origin and cultures are nonspecific.

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26
Q

Who is most likely to need teaching about preventive measures for vaginal infections?

A

They are important for all infections, but particularly for women with recurrent vaginitis.

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27
Q

Inflammation of the vulva and vagina.

A

Vulvovaginitis

28
Q

T/F Having minimal lactobacilli populations always causes vaginal issues and symptoms.

A

False. At least some women with minimal lactobacilli populations are otherwise healthy and do not report vaginal symptoms.

29
Q

Thin or thick white discharge resulting from congestion of the vaginal mucosa and an increase in polymorphonuclear leukocytes (white blood cells) that is visible under microscopy.

A

Leukorrhea

30
Q

Describe cervical secretions.

A

The alkaline, shiny mucoid substance secreted by the cervix is more abundant than vaginal secretions and less viscous at ovulation.

31
Q

What is required for vaginal secretions?

A

Adequate endogenous or exogenous estrogen.

32
Q

How is BV assessed?

A
  • History.
  • Speculum exam.
  • Microscopic examination of vaginal secretions with both KOH and saline.
  • pH of vaginal secretions.
  • Gram stain.
33
Q

Why should women not use tampons when flow is scant?

A

The tampon may adhere to the vaginal wall or cervix and cause trauma when removed.

34
Q

When do vaginitis and vaginosis occur?

A

Vaginitis and vaginosis occur when the vaginal environment is altered, either by microorganisms or by a disturbance allowing pathogens normally found in the vagina to proliferate.

35
Q

In assessing BV, what are the most significant patient findings for diagnosis?

A
  1. Fishy odor.
  2. Vaginal irritation.
  3. Increased, thin vaginal discharge.
36
Q

Why do vaginal secretions occur?

A

Vaginal secretions provide physiologic lubrication and represent a response to the hormonal milieu.

37
Q

When is douching ok?

A

Except when recommended by a clinician to treat a vaginal problem, women should avoid douching, because it can remove normal, protective vaginal flora, introduce bacteria, and aggravate inflammation.

38
Q

What determines the numerous variations in the amount and characteristics of vaginal secretions?

A
  • Physiology
  • Timing in relation to menstrual cycle
  • Use of local/systemic meds
  • Sexual practices
  • Pathology
39
Q

What patient education should you include about BV treatment?

A
  • Complete course of meds.
  • Avoid alcohol (24 hours after treatment with metronidazole and 72 hours with tinidazole).
  • Nitroimidazole abx can cause a metallic taste, n/v, and cramps even if no alcohol is consumed.
  • Avoid intercourse until treatment is complete.
  • Consistently use condoms.
  • Avoid douching.
40
Q

Risk factors for BV.

A
  1. Presence of menstrual bleeding
  2. Douching
  3. New sexual partner
  4. Smoking
  5. Lack of condom use
  6. Race/ethnicity (Mexican American / Black)
  7. Possibly low vitamin D levels (may help explain the disparate rates of BV in women who are pregnant, black, or of Mexican American ethnicity).
  8. Possibly women who have sex with women, suggesting BV may be acquired via sexual exchange of vaginal secretions.
41
Q

Where should you collect secretions for pH testing?

A

A sample for pH testing is best collected from the lateral walls of the vagina to ensure an accurate pH assessment; pH is more variable in the cervix, reflecting the current point in the woman’s hormonal cycle. While vaginal pH can be a useful adjunct test, it is nonspecific and its results may be altered by the presence of blood in the vagina.

42
Q

While a clinical diagnosis of BV can be reliably made using the Amsel criteria, the gold standard for BV diagnosis remains _____.

A

While a clinical diagnosis of BV can be reliably made using the Amsel criteria, the gold standard for BV diagnosis remains THE GRAM STAIN.

43
Q

What happens if the vagina gets a more alkaline pH?

A

If the vaginal pH becomes more alkaline, an overgrowth of anaerobic and facultative organisms may occur, producing the characteristic symptoms of BV.

44
Q

What type of underwear should be worn?

A

Cotton crotches are advisable in underwear and pantyhose.

45
Q

When would mucoid discharge be seen?

A
  • The female newborn may have a mucous discharge for 1 to 10 days following birth as a result of in utero stimulation of the uterus and vagina by maternal estrogen.
  • A similar mucoid discharge may be seen a few years before and after menarche as a result of increased estrogen production by the maturing ovaries.
  • Pregnant women often report substantially increased mucus production, with a resulting profuse discharge, particularly during the last few weeks before childbirth.
46
Q

When is leukorrhea seen?

A

Leukorrhea may be seen under normal circumstances, such as pregnancy or menstruation, or in the presence of vaginal infection.

47
Q

Typically around day 9 of the menstrual cycle, rising levels of _____will increase the amount of cervical mucus.

A

Typically around day 9 of the menstrual cycle, rising levels of ESTRADIOL will increase the amount of cervical mucus.

48
Q

What are the gynecologic and obstetric sequelae associated with BV?

A
  1. Spontaneous abortion
  2. Upper genital tract infection
  3. Preterm birth
  4. Postpartum endometritis
49
Q

Why does a fishy odor occur with BV?

A

The woman or her partner may notice a fishy odor after heterosexual intercourse because semen releases the vaginal amines.

50
Q

Symptoms of BV.

A
  1. Malodorous discharge.
  2. Vaginal discharge that is increased, thin or gray, and milky in appearance.
  3. Mild irritation.
  4. Vulvar pruritis.
  5. Postcoital spotting.
  6. Irregular bleeding episodes.
  7. Vaginal burning after intercourse.
  8. Urinary discomfort.
51
Q

During what phases in life is the vagina most susceptible to infection?

A

When the mucosa is inactive: before menarche and after menopause. Estrogen-stimulated vaginal mucosa during reproductive years is less vulnerable.

52
Q

What are the sources of vaginal secretions?

A
  • Major source: cervical mucosa
  • Bartholin glands
  • Sebaceous, sweat, and apocrine glands of vulva
53
Q

What is a normal pH for a vagina and how is it maintained?

A

3.5-4.5. Lactobacillus species produce hydrogen peroxide, lactic acid, and bacteriocins to maintain the pH of the vagina.

54
Q

Clinical diagnosis for BV can be based upon the Amsel criteria. What are they?

A

Presence of 3 out of 4 of the following:

  1. White, thin adherent vaginal discharge.
  2. pH >4.5.
  3. Positive whiff test.
  4. Clue cells (20% of more).
55
Q

When do vaginal secretions increase?

A

These secretions vary throughout the menstrual cycle and increase in amount:

  • around ovulation
  • during the premenstrual period
  • during pregnancy
  • sexual arousal
56
Q

T/F Treatment of sexual partners in BV is recommended.

A

False. Treatment of sexual partners of women who have BV is not recommended because it does not affect the woman’s response to treatment or the likelihood of relapse or recurrence.

57
Q

What does an increased number of WBCs in addition to the presence of clue cells indicate?

A

It suggests BV with a concurrent vaginitis or coinfection with trichomoniasis, chlamydia, or candidiasis.

58
Q

5 causes of vulvovaginitis?

A
  1. Vaginal infection
  2. Copious amounts of leukorrhea
  3. Chemical irritants
  4. Allergens
  5. Foreign bodies
59
Q

Before menarche and after menopause, what happens to the vaginal area?

A

The vaginal epithelium is inactive and thin, the cells contain very little glycogen, lactobacilli are absent, and the vaginal pH is between 6 and 7.

60
Q

T/F During reproductive years, vaginal secretions are a normal, regularly occurring experience.

A

True

61
Q

This accounts for 22%-50% of women who present with vaginal symptoms. Highly prevalent cause of vaginal discharge.

A

Bacterial Vaginosis (BV)

62
Q

Describe normal vaginal secretions?

A

Normal vaginal secretions are usually clear or cloudy and nonirritating in nature, although they may leave a yellow cast on clothing after drying. Normal vaginal discharge is slightly slimy, is non-irritating, and has a mild inoffensive odor.

63
Q

Why is clindamycin vaginal cream not recommended for BV treatment in pregnant women?

A

It is associated with low birth weight and neonatal infections.

64
Q

T/F Gardnerella, Corynebacterium, and E. coli are not present until the vaginal pH becomes more alkaline.

A

False. Although these organisms, such as Gardnerella, Corynebacterium, and Escherichia coli, may be part of the normal vaginal flora, their growth is typically suppressed in the acidic vaginal environment.

65
Q

How does the vagina’s initial line of defense work?

A

Unique combinations of organisms in the vagina are believed to protect a woman by providing an initial line of defense against infection through production of lactic acid by Lactobacillus species.

NURP 501 - Ex 1 (63 decks)

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