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GU / GYN & Renal > GYN Infections > Flashcards

GYN Infections Flashcards

1
Q

Classification of Infections

A
  • Lower genital tract infections
    • Common infections not typically linked to STDs
      • Vulvovaginal candidiasis
      • Bacterial vaginosis
    • Common STIs
      • Trichomonas vaginalis
      • Molluscum contagiosum
      • Herpes simplex infections
      • Neisseria gonorrheae
  • Lower & upper genital tract infections
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2
Q

Most common fungal species associated with human disease

A

Candida albicans

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3
Q

Candida

Clinical Diseases

A

C. albicans grows best on warm, moist surfaces
* Oral thrush: most common candidiasis; superficial infection of oral mucosa
* Candida esophagitis: common in AIDS patients; Sx: dysphagia & retrosternal pain; leukoplakia & pseudomembranes on endoscopy
* Candida vaginitis: common vaginal infection; frequent in diabetics, pregnant or on oral contraceptives
* Cutaneous candidiasis: diabetics & burn patients at-risk

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4
Q
  • Common GYN infection in US
    • 3/4 of women experience at least 1 episode
    • 1/2 of women experience >1 episode
  • In smaller % of women, condition becomes chronic with multiple relapses over several years
  • Uncommon before menarche; rapidly increasing incidence in late 20s, peaking in 30s-40s

Epidemiology

A

Vulvovaginal Candidiasis (VVC)

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5
Q
  • Uncontrolled DM
  • Immunosuppression
  • Steroid / antibiotic use
  • Oral contraceptive use

Predisposing Factors

A

Vulvovaginal Candidiasis (VVC)

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6
Q
  • Intense vulvar pruritis
  • Dysuria
  • Erythema
  • Edema
  • White vaginal discharge with curd-like appearance

Signs & Symptoms

A

VVC

White curd-like discharge = hallmark; “candidus” = dazzling white

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7
Q

VVC

Approach to Diagnosis

A
  • KOH wet prep / Pap smear
  • Culture
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8
Q
  • Branching pseudohyphae & yeast forms
  • “Shish kabob” appearance

Pap smear

A

Candida

“Shish kabob”: tangles of squamous cells around pseudohyphae

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9
Q

Bacterial vaginosis (BV)

A

Complex change in normal vaginal flora
* Decreased: lactobacilli
* Increased:
* G. vaginalis
* Mobiluncus spp.
* Mycoplasma hominis
* Anaerobic Gram-negative belonging to genera Prevotella, Porphyromas, Bacteroides
* Peptostreptococcus spp.

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10
Q
  • Frothy gray vaginal discharge with pH > 4.5
  • Foul, “fishy” odor that is more noticeable following intercourse & during menses

Signs & Symptoms

A

BV

Most common cause of vaginal discharge

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11
Q

BV

Approach to Diagnosis

A
  • Vaginal pH: >4.5
  • Wet prep / Pap smear: clue cells; absence of lactobacilli & WBCs
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12
Q

Dense, evenly distributed collections of bacterial rodlike forms in squamous cells

Pap smear

A

BV

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13
Q
  • Clue cells
  • Fishy odor when KOH is added

Wet prep

A

BV
* Clue cells = epithelial cells entirely covered with bacteria, giving cell a “furlike” appearance
* Fishy odor: due to release of amines by anaerobic bacteria (whiff test)

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14
Q
  • Purulent yellow-green discharge
  • “Strawberry cervix”
A

Trichomonas vaginalis

“Strawberry cervix” = fiery red vaginal & cervical mucosa

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15
Q

Trichomonas vaginalis

Approach to Diagnosis

A
  • Microscopy of vaginal secretions: low sensitivity
    • Wet prep
    • Pap smear
  • Culture: most sensitive commercially available method
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16
Q

Rapid movement & flagella

Wet prep

A

Trichomonas vaginalis

17
Q
  • Indistinct, ghostly appearance
  • Pale oval nucleus
  • Faint red granules
A

Trichomonas vaginalis

18
Q

Discrete, dome-shaped, pink-colored papules

Signs & Symptoms

A

Molluscum contagiosum

19
Q

Molluscum contagiosum

Approach to Diagnosis

A
  • Clinical appearance is diagnostic in most cases
  • Diagnosis can be confirmed via biopsy or cytologic inspection of debris expressed from center of lesion
20
Q
  • Epithelial hyperplasia with formation of a cup-shaped lesion
  • Large, roiunded, homogenous cytoplasmic inclusions
  • Peripheral pyknotic nuclei

Histology

A

Molluscum contagiosum

21
Q

Most common STD worldwide

HS

A

HSV-2 (genital herpes)

22
Q
  • Red papules that progress to vesicles and then painful coalescent ulcers
  • Vulvar lesions: clinically apparent
  • Cervica / vaginal lesions: present with severe purulent discharge & pelvic pain
  • Urethral lesions: painful uirination & urinary retention
A

HSV

23
Q

HSV

Approach to Diagnosis

A
  • Usually clinically apparent
  • Confirmatory tests:
    • Serology
    • Tissue culture
    • Direct immunofluorescene
    • Molecular rechniques
  • Reliable & rapid identification can be made using smears of vesicles (Tzanck preparation) & immunofluorescence mAbs
24
Q
  • Multinucleation
  • Miolding of nuclei
  • Margination of chromatin
  • Ground glass nuclei
  • Eosinophilic intranuclear inclusions

Histology

A

HSV

Triple M

25
Q
  • Urethritis
  • Purulent urethral discharge

Signs & Symptoms

A

Neisseria gonorrheae

Men

26
Q
  • Blindness
  • Pharyngitis
  • Sepsis

Signs & Symptoms

A

Neisseria gonorrheae

Neonates

27
Q
  • Endocervical infection with urethritis
  • Bartholin’s & Skene’s glands inections
  • Pharyngeal & rectal infections
  • Spontaneous abortion; placental abruption

Signs & Symptoms

A

Neisseria gonorrheae

Women

28
Q
  • Septic arhritis (asymmetric)
  • Low grade fever
  • Rash of hemorrhagic papules & pustiules
  • Tenosynovitis
  • Migratory arthralgies

Signs & Symptoms

A

Neisseria gonorrheae

Disseminated

29
Q

Neisseria gonorrheae

Approach to Diagnosis

A
  • Direct detection: microscopt
  • Antigen detection
  • Nucleic acid-based methods
  • Culture

GU / GYN & Renal (23 decks)

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