Genitourinary Infections

Question 1

What kinds of organisms are common in bacterial vaginosis?

Answer 1

Anaerobes:

Gardnerella vaginalis, Mycoplasma hominis, Mobiluncus species, Bacteroides species (other than Bacteroides fragilis)

Question 2

What kinds of organisms are common in VVC?

Answer 2

Candida species

Question 3

The most common pathogen in VVC is…

Answer 3

Candida albicans

Question 4

Risk factors of VVC include:

Answer 4

Impaired immune status
Broad-spectrum abx
Inhibition of normal bacterial flora
30% test + after 2-3 week course of TETRACYCLINE
Post treatment for trichomoniasis or BV
CORTICOSTEROID medications
Pregnancy
Diabetes
Changes in glycogen

Question 5

Which GU infection has thick and curdy (“cottage cheese-like” discharge?

Answer 5

VVC

Question 6

Which GU infection has normal vaginal pH, a negative “Whiff” test, and the presence of pseudohyphae on wet mounts?

Answer 6

VVC

Question 7

A recurrent VVC is considered ____ or more episodes of symptomatic VVC in

Answer 7

3 or more episodes in <1 year

Question 8

Women with these conditions are considered to have complicated VVCs:

Answer 8

Diabetes, Immunocompromising conditions (HIV), underlying immunodeficiency, or immunosuppressive therapy (corticosteroids)

Question 9

Uncomplicated VVC treatment

Answer 9

OTC intravaginal agents:
Clotrimazole 1% or 2% cream, Miconazole 2% or 4$ cream [5g intravaginally daily ranging from 3-14 days], miconazole 100 mg or 200 mg vaginal suppository for 3-7 days

Oral agent:
Fluconazole 150 mg orally in a single dose

Question 10

What is the treatment for severe vaginitis (complicated)?
Fluconazole 100, 150, or 200 mg PO q___h for ___ doses
OR
Topical antifungal therapy daily for _____ days

Answer 10

q72h for 3 doses [3 doses total, 9 days to complete]
OR
topical therapy daily for 7-14 days

Question 11

What is the treatment for recurrent VVC (complicated) - maybe no longer albicans but a different species of candida?
Induction:
___ days of oral or topical therapy

Maintenance:
Fluconazole 100, 150, 200 mg ______ for _____ months

Answer 11

Induction: 7-14 days of oral or topical therapy

Maintenance: weekly for 6 months

Question 12

Treatment for treatment failure/non-albicans candida vaginitis:
C. glabrata - intravaginal ____ acid _____ mg daily for ____ days
C. krusei - intravaginal ____ acid ____ mg daily for ____ days OR non-fluconazole (oral or topical) azole for _____ days

Answer 12

C. glabrata: boric acid 600 mg daily for 21 days

C. krusei: boric acid 600 mg daily for 21 days or non-fluconazole (oral or topical) azole for 7-14 days

Question 13

New treatment approved for adult and post-menarchal pediatric females with VVC

Answer 13

Brexafemme (ibrexafungerp)

Question 14

Oral VVC drug that is contraindicated during pregnany and a strong CYP3A4 inducer

Answer 14

Brexafemme (ibrexafungerp)

Question 15

Which GU infection has an elevated vaginal pH (~5), a positive “Whiff” test, and thin, white discharge?

Answer 15

Bacterial vaginosis

Question 16

Treatment of sexual partners is usually not needed for bacterial vaginosis: True or False

Answer 16

True

Question 17

Recommended regimens for BV:
_______ 500 mg PO BID for 7days OR
_______ gel 0.75% one full applicator (5g) intravaginally once daily for 5 days OR
______ cream 2% one full applicator (5g) intravaginally at bedtime for 7 days

Answer 17

Metronidazole, metronidazole, clindamycin

Question 18

Alternative regimen for BV:

_____ 300 mg orally BID for 7 days

Answer 18

Clindamycin *but anaerobic coverage has declined from before

Question 19

Clindamycin ovules for BV treatment weaken ___ and ___ products.

Answer 19

Latex and rubber products. Patients should abstain from sex until treatment is complete

Question 20

BV treatment in pregnant women:
_____ 500 mg PO ___ for 7 days OR
_____ 250 mg PO ___ for 7 days OR
____ 300 mg PO BID for 7 days

Trichomonas treatment in pregnant women:
Metronidazole ___ g PO _____

Answer 20

BV:
Metronidazole 500 mg PO BID for 7 days OR
Metronidazole 250 mg PO TID for 7 days OR
Clindamycin 300 mg PO BID for 7 days

Trichomonas:
Metronidazole 2 g PO ONCE

Question 21

Which GU infection has a pH ~5, a positive “Whiff” test, and white to greenish , frothy discharge?

Answer 21

Trichomonas vaginitis

Question 22

The incubation period for Trichomonas vaginitis is short/long?

Answer 22

Long, 3-28 days, so can take a while for symptoms to show, if any

Question 23

___% of patients are asymptomatic for trichomonas vaginitis

Answer 23

50%

Question 24

Treatment of sexual partners is usually not needed for trichomonas vaginitis: True or False

Answer 24

False, you must treat all sexual partners because trichomonas is an STI

Question 25

Distinct findings for trichomonas include ____ spots and ___-shaped flagellate

Answer 25

Strawberry spots, pear-shaped flagellate

Question 26

Trichomonas Treatment: Women - Metronidazole ____ mg BID for __ day(s) Men - Metronidazole ___ g for ____ day(s) Alternative - Tinidazole 2 g in a ___ dose

Answer 26

Women - Metronidazole 500 mg BID for 7 days Men - Metronidazole 2 g for 1 days (single dose) Alternative - Tinidazole 2 g in a single dose

Question 27

A lot of women will not know they have PID until they try to get pregnant (True/False)

Answer 27

TRUE

Question 28

BV, VVC, STIs, and parasite infections are all common causes of PID (True/False)

Answer 28

True

Question 29

PID treatment: 3 drugs - _____ + doxycycline + metronidazole OR 2 drugs - _____ + doxycycline OR 2 drugs - ____ + doxycycline

Answer 29

3 drugs - CEFTRIAXONE (1g IV q24h) + doxycycline (100 mg PO/IV q12h) + metronidazole (500 mg PO/IV q12h) (added for anaerobic coverage) 2 drugs - CEFOTETAN (2g IV q12h) + doxycycline (100 mg PO/IV q12h) 2 drugs - CEFOXITIN (2g IV q6h) + doxycycline (100 mg PO/IV q12h) cephalosporin + doxycycline partially covers for N. gonorrhea and chlamydia

Question 30

Pregnant women with PID can be treated as an outpatient procedure (True/False)

Answer 30

False, pregnancy needs automatic admission

Question 31

For PID, you should generally start with IV and deescalate to PO. (True/False)

Answer 31

True

Question 32

Oral therapy for PID after clinical improvement: | Doxycyline 100 BID + Metronidazole 500 mg BID for ___ days

Answer 32

14 days!

Question 33

Alternative regimen for PID: ______ + doxycycline OR ______ + gentamicin

Answer 33

Ampicillin-sulbactam (3g IV q6h) + Doxycycline (100 mg PO/IV q12h) OR Clindamycin (900 mg IV q8h) + Gentamicin (loading dose + maintenance dose)

Question 34

If not in an hospital/ER settings for PID, there are IM or oral options for treatment (True/False)

Answer 34

True

Question 35

PO Probenacid is given with ____ to increase the half-life but can _____

Answer 35

Given with cefoxitin IM to increase its half-life but can also change the half-life of other drugs

Question 36

Ways to prevent PID

Answer 36

``` Control of STDs Promotion of condoms Use of oral contraceptives Avoidance of vaginal douching Chlamydia screening Early diagnosis and completed treatment ```