Genital Tract Infections Flashcards
(111 cards)
1
Q
Common triad of infections associated with Vaginal Discharge
A
1) Bacterial Vaginosis
2) Trichomoniasis
3) Vulvovaginal Candidiasis
2
Q
What is the Disease Entity?
- Thick curdy discharge
- Vaginal erythema and pruritus
- Vaginal pH <4.5
A
Vulvovaginal candidiasis
3
Q
What is the Disease Entity?
- Yellow frothy discharge
- Vaginal pH > 4.5
- Odor and pruritus
A
Trichomoniasis
4
Q
What is the Disease Entity?
- White thin discharge with odor
- Vaginal pH > 4.5
- Clue cells on wet mount
A
Bacterial vaginosis
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
6
Q
Recommended treatment for Trichomoniasis caused by protozoan T. vaginalis
A
Nitroimidazoles:
1) Metronidazole
2) Tinidazole
7
Q
Findings on wet mount for vulvovaginal candidiasis
A
Hyphae and pseudohyphae, Mycelia
8
Q
Glands located in the entrance of the vagina (5’ and 7’ o-clock) that secrete mucus
A
Bartholin glands
9
Q
Usually pathogen involved in Bartholin abscesses
A
E. coli
10
Q
Management of Bartholin gland abscess
A
1) Marsupialization (I&D)
2) Antibiotics with anaerobic coverage
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
12
Q
Superficial vulvar lesions
A
1) Molluscum contagiosum
2) Pediculosis pubis
3) Scabies
4) Genital warts
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
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
15
Q
Pathogen causing Scabies
A
Sarcoptes scabiei
16
Q
Skin lesion found in Scabies
A
Burrows
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
18
Q
Benign mild skin disease due to Pox virus
A
Molluscum contagiosum
19
Q
Transmission of Molluscum contagiosum
A
Via skin-to-skin contact, autoinoculation, or fomites
20
Q
Lesions in Molluscum contagiosum
A
2-5mm flesh colored dome-shaped papules with central umbilication
21
Q
Areas of involvement of Molluscum Contagiosum
A
Vulva, thighs, buttocks
22
Q
Management of Molluscum contagiosum (?)
A
- Heals spontaneously within 6-12 months
- Monsel solution
- TCA (Trichloroacetic acid)
- Cryotherapy
23
Q
Pathogen causing Genital warts (Condyloma acuminatum)
A
Human papillomavirus (HPV) 6 & 11
24
Q
Transmission in HPV 6 & 11 genital warts
A
Direct contact, autoinoculation
25
Description of lesions in HPV 6 & 11
Cauliflower-like genital warts that may be asymptomatic or may present with pain, pruritus
26
T/F HPV serotyping is still required for patients presenting with genital warts
False.
Visual inspection is enough to warrant treatment
27
Management of Genital warts
- Imiquimod cream
- Sinecatechins ointment
- Podofilox solution/gel
Procedures:
- Chemical (TCA)
- Electrocautery
- Cryotherapy
- Surgical excision
28
2 infectious agents implicated in Mucopurulent Cervicitis
1) Chlamydia trachomatis
2) Neisseria gonorrhea
29
Cervicitis has a tendency to ascend and cause the following infections:
Endometritis
Pelvic inflammatory disease
(same pathogens involved)
30
Clinical manifestations of cervicitis
- Usually asymptomatic
- Vaginal discharge/ intermenstrual bleeding
- Dyspareunia
- Edematous/ hypertrophic cervix
31
2 simple definitive objective criteria to establish mucopurulent cervicitis
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
32
Findings of trichomoniasis on wet mount
Motile trichomonads
33
Type of culture used for Gonococcal cervicitis
Thayer martin
34
Gold standard diagnostic for Chlamydia & Gonorrhea
Nucleic acid amplification test (NAAT)
35
Alternative criteria for mucopurulent cervicitis
1) Erythema and edema of cervix/associated bleeding secondary to endocervical ulceration
2) Friability of cervix
3) Increased vaginal discharge or intermenstrual bleeding
36
Findings of gonococcal cervicities on Gram stain
Gram stain showing gram negative diplococci
37
Medical Management of Chlamydia Cervicitis
Azithromycin 1g PO single dose
OR
Doxycycline 100mg BID for 7 days
38
Medical Management of Gonococcal Cervicitis
Ceftriaxone 500mg/IM single dose
AND
Azithromycin 1g PO single dose (for concomitant chlamydia)
39
Complications of Mucopurulent cervicitis
- Preterm labor and PROM
- Endometritis (pre and post partum)
- Pelvic inflammatory disease
- Fitz-Hugh-Curtis syndrome
- Salpingitis
- Ophthalmia neonatorum
- Neonatal pneumonia
40
Treatment given for ophthalmia neonatorum in the infant
0.5% Erythromycin ophthalmic ointment at birth
41
Alternative antibiotic regimen for gonococcal cervicitis
Cefixime 800mg PO single dose
OR
Gentamicin 240mg IM single dose; AND
Azithromycin 2g orally single dose
42
Alternative regimen for Chlamydia cervicitis in pregnant patients
Azithromycin 1g PO single dose
OR
Amoxicillin 500mg PO TID for 7 days
43
Gold standard diagnosis of endometritis is via:
Endometrial biopsy
44
EM biopsy findings in endometritis
≥ 1 plasma cells/120 field
≥ 5 PMNs/400 field
45
Descriptive classification of upper genital tract infections
Infections that ascend through the cervix into the endometrium or salpinx
46
Usual pathogens involved in Endometritis
C. trachomatis and N. gonorrhea
47
Treatment for Endometritis
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
Additional treatment for Chronic Endometritis (possible C. trachomatis)
100mg Doxycycline PO BID for 10-14 days
49
Different components of PID (varied involvement)
(ESPM)
Endometritis
Salpingitis (most common)
Parametritis
Myometritis
50
2 Classic sexually transmitted organisms associated with PID
C. trachomatis and N. gonorrhea
but most of the time polymicrobial with both aerobes and anaerobes
51
PID caused by which organism has been studied to increase the risk of ectopic pregnancy 3-6x
C. trachomatis
52
Anaerobic organisms usually found in tubal cultures in PID
Bacteroides spp., Peptostreptococcus, Peptococcus
53
Usual age distribution of PID
75% occurring in women < 25 y/o
54
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:
1) Cervical motion tenderness
2) Uterine tenderness
3) Adnexal tenderness
55
PID evolvement depending on organism involved:
1) N. gonorrhea:
2) C. trachomatis
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
Syndrome of PID with perihepatic inflammation and violin string adhesions
Fitz-Hugh-Curtis syndrome
57
Most accurate method of diagnosing PID (with advantage of concurrent operative procedure)
Laparoscopy
58
Addition to the management of PID to evaluate for presence of concurrent lower genital tract infections
NAAT for N. gonorrhea and C. trachomatis
59
2 most important goals of medical therapy of acute PID
1) Resolution of symptoms
2) Preservation of tubal function
60
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
72 hours
61
Recommended outpatient treatment for PID
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
Recommended in-patient treatment of PID
Cefotetan 2g IV BID +
Doxycycline 100mg PO BID
OR
Cefoxitin 2g IV every 6h +
Doxycycline 100mg PO BID
63
Bartholin gland cysts are usually _____ cm, (uni/bi lateral), (painful/nonpainful)
1-8cm
unilateral
non-painful
64
Cultures grown in Bartholin gland abscesses
Usually polymicrobial
65
Management for asymptomatic cysts in women < 40 y/o
Supportive. No medical treatment necessary.
66
Surgical treatment of choice for Bartholin gland abscesses
Marsupialization
67
Alternative management of Bartholin duct abscesses makes use of a _____ catheter
Word catheter
68
Biiopsy of bartholin gland cysts are warranted in patients < 40 y/o in order to exclude the following IM condition:
Adenocarcinoma of the Bartholin gland
69
The 2 most common animal parasites found on the skin
Crab louse, itch mite
70
Pediculosis pubis is an infestation by what organism
Phthirus pubis (crab louse)
71
Most contagious of all STIs
Pediculosis pubis
72
Treatment for Pediculosis pubis
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
Alternative medical management of pediculosis pubis
Malathion 0.5% lotion applied for 8-12 hours then rinsed off
Ivermectin 250ug/kg orally repeated in 2 weeks
74
Scabies is a parasitic infection of which organism
Sarcoptes scabei (itch mite)
75
Which of the following has predilection for hairy areas vs widespread over the body
1) Pediculosis pubis
2) Scabies
1) Pediculosis pubis - hairy areas
2) Scabies - widespread
76
Itching during scabies infestation is more intense in the (morning/night)
Night
- skin is warmer and mites are more active
77
Pathognomonic sign of scabies infection
Burrows in the skin
- twisted line in the skin surface with a vesicle at one end
- where female itch mites burrow their eggs
78
Treatment for Scabies
Permethrin cream (5%) applied to all areas of the body from the neck down, washed off after 8-14 hours
79
Alternative medical management of Scabies
Ivermectin 200 ug/kg orally, repeated after 2 weeks
80
Flesh colored, dome-shaped papules with an umbilicated center containing caseous material
Molluscum contagiosum
81
Molluscum contagiosum is a chronic localized skin infection by what pathogen
Poxvirus
82
Diagnostic tool used to detect molluscum contagiosum if unable to diagnose by inspection
Wright and Giemsa stain showing:
Intracytoplasmic molluscum bodies
83
Major complication of Molluscum contagiosum
Bacterial superinfection
84
Despite Molluscum's ability to spontaneously resolve, treatment can be offered such as
> Nodule Excision with dermal curette
> Base treatment with Monsel solution or 85% TCA acid
> Canthardin
> Imiquimod
> Cryotherapy
85
Cauliflower-like vulvar lesions that can be asymptomatic or may present with pain/itching
Genital warts/Condyloma acuminatum
86
Genital warts (Condyloma acuminatum) are caused by which pathogen/s
Human papillomavirus (HPV) 6 and 11
87
Treatment for Genital warts (Condyloma acuminatum)
Patient applied
> Imiquimod cream
> Sinecatechins ointment
> Podofilox solution/gel
Provider applied
> TCA acid
> Electrocautery
> Cryotherapy
> Surgical excision
88
Enumerate the 5 ulcerative vulvar infections
1) Syphilis (Condyloma Lata)
2) Chancroid
3) Genital Herpes
4) Lymphogranuloma venereum
5) Donovanosis (Granuloma inguinale)
89
Pathogen involved in syphilis infection
Treponema pallidum
90
Pathogen involved in Donovanosis
Klebsiella granulomatis
91
Pathogen involved in Genital Herpes
HSV 1 and HSV 2
92
Pathogen involved in chancroid lesions
Haemophilus ducreyi
93
Pathogen involved in LGV
Chlamydia trachomatis (L1, L2, L3)
94
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.
Chancroid
- Haemophilus ducreyi
95
Vulvar infection that presents initially as a vesicle that multiplies and coalesces, with sharp edges, on an erythematous base, with firm tender bilateral lymphadenopathy.
Genital Herpes
- HSV1, HSV2
96
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
Syphilis (Condyloma lata)
97
Vulvar infection that begins as a papule, with elevated irregular edges on a rough red and beefy base, pseudobuboes unilaterally
Donovanosis (Granuloma inguinale)
- Klebsiella Granulomatis
98
Vulvar infection presenting as a papule/pustule/vesicle, with elevated/round/oval edges, and with tender multiloculated bilateral buboes in inguinal region
Lymphogranuloma venereum
- C. trachomatis serovar L1, L2, L3
99
Herpesvirus resides in the Latent phase in dorsal root ganglia of ___, ____, and ____.
S2, S3, and S4
100
Most accurate and sensitive technique in identifying herpesvirus
PCR assay
101
Recommended treatment for the 1st clinical episode of Genital Herpes
Acyclovir
> 200mg 5x/day for 7-10 days
> 400mg TID for 7-10 days
OR
Valacyclovir
1000mg BID for 7-10 days
102
Recommended treatment for Recurrent Genital Herpes
Acyclovir
> 400mg TID for 5 days
OR
Valacyclovir
> 1000mg OD for 5 days
> 500mg BID for 3 days
103
What is the gold standard for definitive diagnosis of Syphilis
Dark field microscopy showing tight spirochetes
103
Daily suppressive therapy for Genital herpes
Acyclovir 400mg BID daily
OR
Valacyclovir
> 1000mg OD (≥ 10 recurrences/year)
> 500mg OD (≤ 9 recurrences/year)
104
Nontreponemal serum tests that can detect immune response to syphilis
VDRL
RPR
105
Antitreponemal tests that detect antibodies to syphilis
FTA-ABS (Flourescent treponema antibody absorption)
MHA (Micro hemagglutination assay)
106
Hallmark lesion of primary syphilis. Describe
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
Secondary syphilis in patients whose primary syphilis underwent hematogenous dissemination will start after how long a time period
6 weeks to 6 months (ave 9 weeks)
108
Characteristic skin lesion of secondary syphilis
maculopapular rashes on the palms of hands and soles of feet
109
Characteristic vulvar lesion of secondary syphilis
Condyloma lata
Large raised flattened grayish white mucoid patches
110
Duration of the latent stage of syphilis
2 - 20 years
