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cervicitis Flashcards

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1
Q

complications of cervicitis?

A

If untreated, cervicitis can result in Pelvic Inflammatory Disease & lead to higher risk of infertility, ectopic pregnancy & chronic pelvic pain

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2
Q

what causes the s/sx of cervicitis?

A

edema and increased vascularity, making the cervix appear swollen and reddened → Presence of hypervascularity, erythema & ectopy may be found with either squamous metaplasia or inflammatory changes requiring therapy

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3
Q

how can cervicitis be diagnosed?

A

histologically when polymorphonuclear leukocytes, lymphocytes, or histiocytes are noted

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4
Q

can cervicitis occur w/o a vaginal dz?

A

YES

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5
Q

WHAT Is acute cervicitis?

A

Purulent vaginal discharge is the primary sign and symptom of acute cervicitis → Some women have vaginal bleeding, most frequently after sexual intercourse, although intermenstrual bleeding and bleeding during examination can also occur

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6
Q

what is chronic cervicitis?

A

-leukorrhea
-may have purulent d/c or thick tenacious, turbid
Intermenstrual or postcoital bleeding may occur → Also associated with lower abdominal pain, lumbosacral backache, dysmenorrhea, dyspareunia, urinary frequency, urgency and dysuria

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7
Q

chlamydia etiology?

A

Chlamydia Trachomatis
Most common cause of cervicitis
Causes LGV in developing countries → Rare in U

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8
Q

s/sx of chlamydia

A 
May be asymptomatic
Mucopurulent cervicitis
Increased frequency, dysuria
Abd pain, PID, post coital bleeding 
LVG → PAINLESS genital ulcer → PAINFUL inguinal lymphadenopathy
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9
Q

dx of chlamydia?

A

Nucleic Acid Amplification → PCR test most spp/sensitive

Cultures, DNA probe

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10
Q

tx of chlamydia

A

Azithromycin → 1g PO x 1 dose
OR
Doxycycline → 100mg PO BID x 10d

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11
Q

2cd line tx of chlamydia

A

Erythromycin, Ofloxacin, Levofloxacin

can co-treat with gonorrhea- cetriaxone

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12
Q

complications of chlamydia?

A

PID, infertility, ectopic pregnancy, premature labor

Reactive arthritis

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13
Q

gonorrhea etiology

A

Neisseria Gonorrhoeae

IP 3-5 day

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14
Q

s/sx of gonorrhea

A 
May be asymptomatic
Vaginal discharge
Cervicitis
Increased frequency
Dysuria
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15
Q

dx of gonorrhea

A

Nucleic Acid Amplification → PCR most specific/sensitive

Cultures, DNA

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16
Q

tx of gonorrhea

A

Ceftriaxone → 250mg IM x 1

CO-TREAT for Chlamydia
Azithromycin → 1g PO x 1
Doxycycline →PO BID x 10d

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17
Q

2cd line tx of gonorrhea

A

Cefixme

Azithromycin 2g can also be given as an alternative but associated w/GI sxs

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18
Q

complications of gonorrhea

A

PID, infertility, ectopic pregnancy

Reactive arthritis

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19
Q

HSV etiology

A

HSV-2 causes most genital herpes infxns

HSV-1 causes some through oral–genital or genital–genital contact

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20
Q

s/sx of HSV

A

Produces cervical lesions similar to those found on vulva

First the lesion is vesicular → becomes ulcer → Heal w/o scarring

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21
Q

what is important to know about HSV primary infxn?

A

extensive & severe → constitutional sxs of low-grade fever, myalgia & malaise x ~ 2 weeks

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22
Q

pt educations for HSV

A

Virus continues to reside in the nerve cells of the affected area for life → Can shed when asymptomatic

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23
Q

dx of HSV

A

Viral culture, PCR, and direct fluorescence Ab

Most laboratories moving toward non-culture assays such as PCR → high sensitivity and specificity

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24
Q

what will you see on a wet prep with HSV

A

Enlarged, multinucleated cells w/ ground-glass cytoplasm & nuclei containing inclusion bodie

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25
tx of HSV
Acyclovir | Valacyclovir
26
complications of HSV
Women w/ active infxn or asymptomatic HSV shedding from normal-appearing skin can infect their infants during vaginal delivery
27
HPV etiology
+↑Oncogenic → 16 & 18, 31, 33, 35 +Also causes genital warts Genital warts → 6, 11 have low oncogenic potential
28
s/sx of HPV
May be asymptomatic Flat, pedunculated or papular flesh-colored growths → ‘cauliflower-like’ lesions + postcoital bleeding
29
dx of HPV
Whitening with 4% acetic acid application Clinical diagnosis +/- Colposcopy, biopsy → Look for dysplasia or cancer
30
tx of HPV in office
Trichloroacetic acid Podophyllin → Wash off after 4h to minimize irritation - NOT used on bleeding lesions Cryotherapy Surgical removal
31
tx of HPV outpt
``` Podofilox Imiquimod (Aldara) ```
32
complications of HPV
Cervical Dysplasia | Cervical Cancer
33
chancroid etiology
Haemophilus Ducreyi → Gram - bacillus Uncommon in US IP 3-5 days
34
s/sx of a chancroid
Genital Ulcer → Soft, shallow, painful, may have foul discharge from the ulcer +/- Small vesicles or papules PAINFUL inguinal lymphadenopathy
35
dx of chancroid
clinicla | culture
36
tx of chancroid
Azithromycin (first line) Ceftriaxone 250mg IM x 1 dose Erythromycin Ciprofloxacin
37
complications of chancroid
Secondary infections | Scarring
38
what is syphilis aka?
Known as ‘the great imitator’ because the rash and disease can present in many different ways similar to other diseases
39
what causes syphilis
spirochete Treponema pallidum
40
how is syphilis transmitted
Direct Contact → Of an infected lesion during sexual activity & contact with lesions (including mucous membranes) May also be transmitted to the fetus via the placenta Organism enters tissue from direct contact, forming a chancre at the inoculation site and from there, goes to the regional lymph nodes before disseminating
41
what is the incubation period of syphilis?
3 days and 3 months → 3 phases
42
what is the primary incubation phase?
Chancre → Painless ulcer at/near the inoculation site with raised indurated edges Usually begins as a papule that ulcerates Chancres heal spontaneously → Average within 3-4 weeks even without medical management Non-tender regional lymphadenopathy near the chancre site lasting 3-4 weeks
43
what is the secondary incubation phase?
Secondary sxs may occur a few weeks to 6 months after the initial sxs
44
what are s/sx of secondary phase?
maculopapular rash, chondyloma lata systemic sx: Fever, lymphadenopathy (may be tender), arthritis, meningitis, headache, hepatitis (elevated alkaline phosphatase)
45
describe the secondary maculopapular rash of syphilis
Diffuse bilateral maculopapular lesions → Involvement of the palms/soles common Lesions may be pustular in some patients
46
what is a condyloma lata?
Wart-like, moist lesions involving the mucous membranes & other moist areas → Especially near the chancre site → Highly contagious
47
tertiary/late phase of syphilis? (when does it occur?)
May occur from 1 to >20 years after initial infection or after latent infection
48
s/sx of tertiary/late phase?
- GUMMA - neruosyphilis - Argyll-Robertson pupil - cardiovascular
49
what is GUMMA?
Non-cancerous granulomas on skin & body tissues (ex: bones)
50
describe neurosyphilis
Headache, meningitis, dementia, vision/hearing loss, incontinence
51
what is tabes dorsalis?
Demyelination of posterior columns → Ataxia, areflexia, burning pain, weakness
52
argyll-robertson pupil
Small, irregular pupil that constricts normally to near accommodation but does not constrict/react to light
53
cardiovascular sx of syphilis
Aortitis, aortic regurgitation, aortic aneurysms
54
describe early syphilis
Clinical syndrome that occurs within the first year of infection → Includes primary, secondary and early latent syphilis
55
describe latent syphilis
Asymptomatic infection + Normal physical exam but positive serologic testing
56
stages of latent syphilis
Early Latent → If <1 year → Patients are usually highly infectious Late Latent → > 1 year → Associated with lower transmission rate → Except in fetal transmission
57
describe symptoms of congenital syphilis
+Hutchinson Teeth → Notches on teeth +Sensorineural hearing loss, +CNS abnormalities +Saddle-nose deformity +ToRCH Syndrome
58
dx of syphilis in pts with chancre of condyloma lata
Darkfield Microscopy → Allows for direct visualization of the spirochete Indications → Used in patients with a chancre or condyloma lata
59
screening tests for syphilis
Non-treponemal testing → Nonspecific → False positives can be seen with antiphospholipid syndrome, pregnancy, TB, rickettsial infections (RMSF) Rapid Plasma Reagent (RPR) → These tests look at titers (Ex: Positive test indicated a titer of 1:32 or greater) Changes in titers help determine therapeutic response → However, these tests are also nonspecific in initial testing & must be confirmed by more specific treponemal testing (ex: FTA) → RPR is usually positive 4-6 wks after infection VDRL → Venereal Disease Research Laboratory
60
what are the confimatory tests for syphilis?
FTA-ABS → Fluorescent Treponemal Antibody Absorption Microhemagglutination test for T. pallidum antibodies
61
tx of syphilis in all stages
Pen G
62
what are adr of pen g
Jarisch-Herxheimer Reaction → Acute febrile response due to rapid lysis of many spirochetes with antibiotic administration → Associated with myalgias & headaches Antipyretics during the 1st 24 hours reduces the incidence of the reaction
63
what if pt is allergic to pen g
Doxycycline or Tetracycline, Macrolide, Ceftriaxone → None are as effective as PCN
64
pt f/u after syphilis tx
All patients should be reexamined clinically & serologically @ 6 & 12 mos after tx → 4 fold reduction in the titer of the nontreponemal antibody serologic tests within 6 mos denotes adequate management → If not, may indicate re-infection or treatment failure → ALL patients with syphilis should be tested for HIV
65
describe lymphogranuloma venereum
Genital/Rectal lesion with softening, suppuration & lymphadenopathy
66
what is LGV causes by?
aggressive L serotypes (L1, L2 or L3) of Chlamydia trachomatis
67
where is LGV most commonly found?
tropical and subtropical nations of Africa & Asia but also seen in southeastern US
68
how is LGV transmitted?
sexual contact → Men > Women (6:1) → Incubation Period = 7-21 days
69
what other infection is LGV associated with?
HIV
70
what is the MC s/sx of LGV in heterosexuals
Tender, usually unilateral inguinal and/or femoral lymphadenopathy
71
what may occur at the site of inoculation?
genital ulcers
72
what s/sx of rectal exposure in LGV?
Can result in proctocolitis, including mucoid and/or hemorrhagic rectal discharge, pain, constipation, fever or tenesmus
73
sx of late phase
fever, headache, arthralgia, chills and abdominal cramps may develop
74
how is LGV dx?
Based on clinical suspicion, epidemiologic info & exclusion of other etiologies → Proven only by isolating C. trachomatis from genital or lymph node specimens and confirming immunotype
75
what is a complement fixation test?
heat-stable antigen that is group-specific for all Chlamydia species available Titer of >1:64 is considered positive, whereas a titer of <1:32 is considered negative
76
what are some complications of LGV?
lead to chronic, colorectal fistulas and strictures, which can involve the entire sigmoid Vulvar elephantiasis can cause marked distortion of the external genitalia Vaginal narrowing and distortion may result in severe dyspareunia
77
how is LGV prevented
condome/avoid screwing infected pt
78
tx of LGV
first line: doxy 100 mg po bid 21 days (repeated of dz persists)
79
what is 2cd line tx for LGV?
erythromycin
80
what is local/surgical tx for LGV
Anal strictures should be dilated manually at weekly intervals → Severe stricture may require diversionary colostomy If disease is arrested → Complete vulvectomy may be done for cosmetic reasons Abscesses should be aspirate
81
what is PID?
scending infection of the upper reproductive tract
82
what are complications of PID?
sepsis, ectopic prego, infertility, chronic pelvic pain Fitz-hugh Curtis syndrome
83
what is fitz-hugh curtis syndrome?
Hepatic fibrosis/scarring & peritoneal involvement RUQ pain due to PERIHEPATITIS (liver capsule involvement) → May radiate to the right shoulder Often have normal LFTs ‘Violin String’ Adhesions on the anterior liver surface
84
what are the main etiologies of PID?
Most commonly N.gonorrhoeae & Chlamydia, G. vaginalis, anaerobes, H. flu, etc.
85
RF for PID?
Multiple sex partners, unprotected sex, prior PID, age 15-19, nulliparous, IUD placement
86
s/sx of PID?
- Lower abdominal tenderness - Fever - Purulent cervical discharge + bleeding - CHANDELIER SIGN → CERVICAL MOTION TENDERNESS to palpation & rotation so severe they seem to rise off the bed as if ‘reaching for the chandelier’
87
how is PID dx?
rimarily a clinical diagnosis → Obtain a 𝛃-hCG to rule out ectopic pregnancy pelvic US-may be used if adnexal or abscess suspected laparoscopy
88
PID dx criteria
Abdominal tenderness + rebound tenderness if severe + cervical motion tenderness + adnexal tenderness + > 1 of the following: ``` +gram stain, temperature >38℃, WBC > 10,000, pus on culdocentesis or laparoscopy, pelvic abnormality on bimanual exam or US, ↑ESR/CRP ```
89
out pt tx of PID
doxy + ceftriaxone +/-metronidazole
90
inpt tx of PID
IV doxy + 2cd gen cephalosponre (cefoxitin or cefotetan) OR clinda + genta

Womens Health (24 decks)

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