Gynecologic and Pregnancy Related Infections Part 3

Question 1

What is the herpes virus?

Answer 1

• DNA virus

- Lifelong persistent infection

Question 2

What is the usual site of involvement of the herpes virus?

Answer 2

• HSV I: orofacial

- HSV II: genital

Question 3

What is the treatment of herpes?

Answer 3

• Acyclovir
• Famciclovir
• Valacyclovir

Question 4

When is treatment of herpes most effective?

Answer 4

• If started within 72 hours

Question 5

What is the MOA of acyclovir?

Answer 5

• Inhibits herpes virus DNA polymerase competitively

- Gets incorporated in viral DNA and stops lengthening of DNA strands

Question 6

How does acyclovir resistance develop?

Answer 6

• Decreased or absent production of viral thymidine kinase

- Prevents acyclovir from reaching the activated triphosphate state

Question 7

What is seen in primary syphillis?

Answer 7

• Painless chancre that develops 3-6 weeks after contact

Question 8

What is seen in secondary syphillis?

Answer 8

• Condyloma lata; macular red rash on palms and soles
• Patchy hair loss
• Lymphadenopathy

Question 9

What is seen in tertiary syphillis?

Answer 9

• Gummatous lesions of skin and bone
• Thoracic aortic aneurysm
• Tabes dorsalis –> involvement of posterior columns and dorsal roots

Question 10

When does syphilis become tertiary?

Answer 10

• 6 years after secondary infection

Question 11

What is tabes dorsalis in tertiary syphillis?

Answer 11

• Decreased coordination
• Loss of pain and temp sensation
• Diminished proprioception and vibratory sensation

Question 12

What is the cause of syphillis?

Answer 12

• Spirochete –> treponema pallidum

- Looks like corkscrew organism on silver stain

Question 13

What is seen histologically in syphillis?

Answer 13

• Lymphoplasmacytic infiltrate

Question 14

What can be used to diagnose syphillis?

Answer 14

• Non-treponemal tests –> VDRL, RPR
• Treponemal tests –> FTA-ABS
• Direct specimen –> PCR

Question 15

What is the general treatment for primary, secondary or early latent syphilis?

Answer 15

• Benzathine penicillin or Doxycycline

Question 16

What is the general treatment for neurosyphilis?

Answer 16

• Aqueous crystalline penicillin G

Question 17

What is the spectrum for benzathine penicillin?

Answer 17

• Gram pos bacteria

- Gram neg bacteria

Question 18

What is the MOA of beta lactam antibiotics?

Answer 18

• Inhibition of bacterial wall synthesis

Question 19

What is a chancroid? Association?

Answer 19

• Multiple painful ulcers usually 1-2 cm

- Associated with inguinal lymphadenopathy

Question 20

What is the main cause of chancroids?

Answer 20

• Haemophilus ducreyi

Question 21

What are some treatment options of chancroids?

Answer 21

• Azithromycin
• Ceftriaxone
• Ciprofloxacin
• Erythromycin

Question 22

What is lymphogranuloma venereum?

Answer 22

• A single, painless genital ulcer

- Heals within few days

Question 23

What happens weeks after a lymphogranuloma venereum?

Answer 23

• Buboes develops

- A painful unilateral inguinal lymphadenopathy

Question 24

What is the main cause of lymphogranuloma venereum?

Answer 24

• Chlamydia trachomatis L1, L2, L3

Question 25

What is the treatment for lymphogranuloma venereum?

Answer 25

- Doxycycline | - Azithromycin or Erythromycin if pregnant

Question 26

What is a granuloma inguinale?

Answer 26

- Painless, slowly enlarging, highly vascular, beefy red nodules/ulcers

Question 27

Does granuloma inguinale usually produce lymphadenopathy?

Answer 27

- No

Question 28

What is the main cause of granuloma inguinale?

Answer 28

- Klebsiella granulomatosis

Question 29

What is seen with Klebsiella granulomatosis?

Answer 29

- Donovan bodies

Question 30

What is the treatment for granuloma inguinale?

Answer 30

- Azithromycin

Question 31

What is seen in TSS?

Answer 31

- Rapid onset fever - Diffuse macular rash involving palms and feet - Desquamation of rash after a week or two - Hypotension - Multiorgan involvement

Question 32

What organism causes TSS?

Answer 32

- S. aureus --> Coag pos, catalase pos

Question 33

What toxin causes TSS?

Answer 33

- TSST-1 which crosslinks T cells and macrophages producing a bunch of cytokines

Question 34

What is the treatment of TSS?

Answer 34

- Removal of foreign body - Supportive care for shock - Empiric antibodies until culture results

Question 35

What drug is used for MRSA?

Answer 35

- Vancomycin

Question 36

What is the MOA of vancomycin?

Answer 36

- Inhibits bacterial wall synthesis

Question 37

What is tazobactam?

Answer 37

- Beta lactamase inhibitor | - Used in conjunction with beta lactam antibiotics

Question 38

What is the combo piperacillin/tazobactam used for?

Answer 38

- P. aeruginosa | - PID

Question 39

What is the MOA of cefepime?

Answer 39

- 4th gen cephalosporin

Question 40

What is the spectrum for cefepime?

Answer 40

- P. aeruginosa - S. aureus - Multiple drug resistant S. pneumoniae ** Front line agent when infection Enterobacteriaceae

Question 41

What is the MOA of meropenem?

Answer 41

- IV beta lactam

Question 42

What are some serious side effects of meropenem?

Answer 42

- C diff infection - Seizures - Allergic reactions

Question 43

What is imipenem/cilastatin?

Answer 43

- Carbapenem | - Not active against MRSA

Question 44

What degrades imipenem?

Answer 44

- Renal enzyme dehydropeptidase 1 (DHP1)

Question 45

Why is imipenem combined with cilastatin?

Answer 45

- To prevent inactivation by DHP1