GYN: Infections 12%

Question 1

(RoshReview)

what are the Amsel criteria? With what infection do we use them?

Answer 1

BACTERIAL VAGINOSIS

3 out of 4 of the following:
> pH above 4.5
> presence of thin, homogenous discharge
> positive whiff test
> presence of >= 20% clue cells on microscopy.

Question 2

(RoshReview)

tx for bacterial vaginosis

Answer 2

CDC recommends treating symptomatic pregnant and nonpregnant women with:

> ORAL METRONIDAZOLE 500 mg po bid x7 days ~or~ 250 mg po tid x7days
METRONIDAZOLE GEL intravaginally qd x 5 days

~or~
>INTRAVAGINAL CLINDAMYCIN CREAM

*tinidazole has not been studied in pregnant women, should be avoided

Question 3

(RR)

what is the best diagnostic test for the MC bacterial STD?

Answer 3

nucleic acid amplification testing (NAAT)
(Chlamydia trachomatis)

NAAT works by apmlifying the C. trachomatis DNA or RNA sequences using PCR or transcription-mediated amplification. Specimen can be collected by pt or clinician-collected vaginal or endocervical swabs. First-catch urine samples can be used, but reduces sensitivity.

Question 4

(RR)

tx for uncomplicated chlamydial infection is?

Answer 4

doxycycline 100 mg bid x 1 week
~or~
azithromycin single dose (esp if pt is pregnant)

(add ceftriaxone for gonorrhea b/c these two infections always travel together)

Question 5

(SmartyPance) BUZZWORDS

Tzank preparation

Answer 5

Herpes

HSV

Question 6

(SmartyPance)

what tests are the most specific for the diagnosis of syphilis?

Answer 6

Fluorescent Treponemal Antibody Absorption (FTA-ABS)

RPR/VDRL common, but not as specific

Question 7

(SmartyPance)
“What should be the initial evaluation of the etiology of infertility in a 25 year-old female who has been trying to conceive for 1 year?”

Answer 7

serum progesterone levels

"LH and mid luteal phase progesterone (to determine ovulatory function)
 and 
transvaginal ultrasound (to rule out the possibility of fibroids or polycystic ovaries), are first-line investigations."

Question 8

(SmartyPance)
“A 16 year-old nulliparous acutely ill female presents with bilateral lower abdominal pain. She has a temperature of 100.4 degrees F and on examination has a tender, enlarged left adnexa. Cervical culture is positive for Chlamydia. Ultrasound reveals a complex tubular structure in the left adnexal area. What is the recommended treatment?”

Answer 8

hospitalization with parenteral doxycycline and cefoxitin

PID

“pt most likely has a tubo-ovarian abscess; it’s recommended that the pt be hospitalized and treated with high-dose IV antibiotic therapy. For pts with tubo-ovarian abscesses, surgical drainage is often necessary.”

Question 9

(RoshRevew) BUZZWORDS

NAAT
nucelic acid amplification test

Answer 9

PID offenders:

Chlamydia trachomatis
Neisseria gonorrhoeae
Mycoplasma genitalium

Question 10

(RR)

tx for PID (outpt)

Answer 10

ceftriaxone 500 mg IM
PLUS
doxy 100 mg po bid x 14 days WITH metronidazole 500 mg po bid x 14 days

Question 11

(RR)

tx for PID (inpt)

Answer 11

cefotetan 2gm IV q 12 hrs
~OR~
cefoxitin 2gm IV q 6 hrs PLUS doxy 100 mg PO/IV q 12 hrs

Question 12

(SmartyPance)

what is the treatment for syphillis?

Answer 12

benzathine PCN G (2.4 million units IM x one dose)

if PCN-allergic, use doxy

if disease is congenital and late, use IV PCN G (for Gummas)

Question 13

(RR)

what do labs for HSV show?

Answer 13

multinucleated giant cells on Tzank smear

Question 14

(RR)

what is the gold standard for diagnosing HSV?

Answer 14

tissue culture with PCR