INFECTIONS

Question 1

vaginal pH

Answer 1

4-4.5

glycogen - present in healthy mucosal vagina

Question 2

pH suggestive of menopause

Answer 2

6.0 to 7.5

Question 3

MCC of vaginal discharge among reproductive aged women

Answer 3

BACTERIAL VAGINOSIS

nonirritating, malodorous vaginal discharge

unpleasant vaginal odor - musty or fishy

thin and gray white frothy

Question 4

Diagnostic criteria for bacterial vaginosis

Answer 4

AMSEL CRITERIA (3 out of 4)

pH > 4.7
(+) clue cells
homogenous milky white discharge
release of fishy odor when KOH is added

microscopic evaluation of vaginal secretion saline preparation

release of volatile amines (w/ fishy odor) produced by anaerobic metabolism

determination of vaginal pH

Question 5

vaginal pH of bacterial vaginosis

Answer 5

> 4.7 - d.t. DECREASED acid production of bacteria

Question 6

Diagnostics of Bacterial Vaginosis

Answer 6

(+) clue cells
homogenous milky white discharge
release of fishy odor when KOH is added

Question 7

Bacterial Vaginosis causes

Answer 7

Gardnerella vaginalis
Ureaplasma urealyticum
Mobiluncus specieis
Mycopladma hominis
Prevotella species

Question 8

Treatment for Bacterial Vaginosis

Answer 8

Metronidazole 500 mg/tab BID for 7 days
Metronidazole 250 mg/tab BID for 7 days
Clindamycin 300 mg/cap BID for 7 days

Question 9

Maternal and Fetal Effects of Bacterial Vaginosis

Answer 9

abortion
preterm delivery, PROM
chorioamnionitis, intraamniotic infection
postpartum endometritis
post cesarean wound infection

Question 10

Highly contagious STI that is caused by a unicellular organism that is normally fusiform in shape

Answer 10

TRICHOMONIASIS

Question 11

Symptoms of Trichomoniasis

Answer 11

dysuria, dyspareunia, vulvar pruritus, vaginal spotting, pain

foul, thin and yellow or green vaginal discharge

“strawberry cervix”

Question 12

Diagnosis of Trichomoniasis

Answer 12

saline wet mount - motile trichomonads
vaginal pH > 4.5 
culture - GOLD standard
pap smear (liquid based(
DNA probe
rapid test (antigen detection)
NAAT (urine or vaginal swab)

Question 13

Maternal and Fetal Effects of Trichomonas

Answer 13

preterm labor and birth
PROM
postpartum endometritis
low birth weight infant

Question 14

Management of Trichomoniasis

Answer 14

POGS Clinical Practice Guidelines

METRONIDAZOLE 2 grams single dose

partners should be treated
withhold Metronidazole until the 1st trimester
treat symptomatic pregnant women regardless of pregnancy

breastfeeding must be WITHHELD up to 12-24 hrs AFTER last dose

Question 15

Manifestations of Vulvovaginal Candidiasis

Answer 15

vulvar pruritus - MC

thick white curdy discharge
erythema, irritation
external dysuria and dyspareunia

Question 16

Diagnosis of Vulvovaginal Candidiasis

Answer 16

KOH (10%) or saline wet prep

normal pH (4.0 - 4.5)

Question 17

Treatment of Vulvovaginal Candidiasis

Answer 17

AZOLE CREAMS
Butoconazole
Clotrimazole
Miconazole
Terconazole

RECOMMENDED FOR PREGNANCY
topical azole therapies (cream, suppository, tablet) applied for 7 days

FLUCONAZOLE - CONTRAINDICATED

Question 18

Causes of Suppurative (Mucopurulent Cervicitis)

Answer 18

Chlamydia trachomatis

Neisseria gonorrhea

Question 19

Maternal Effects of Chlamydia

Answer 19

preterm labor with PROM
postpartum endometritis
PID
salpingitis
Fitz Hugh Curtis syndrome
Reiter's syndrome

Question 20

Fetal Effects of Chlamydia

Answer 20

Neonatal pneumonia

Opthalmia neonatorum

Question 21

Management of Chlamydia

Answer 21

prenatal screening

AZITHROMYCIN 1 g PO as a single dose - DOC

AMOXICILLIN 500 mg PO TID for 7 da

Alternatives - Erythromycin base or Erythromycin ethylsuccinate

sexual partners during the 60 days preceding the onset should be evaluated and treated

Question 22

Maternal Complications of Gonorrhea

Answer 22

septic abortion
preterm delivery, PROM
chorioamnionitis
postpartum infection (endometritis, PID)
accessory gland infection (Bartholin and Skene’s gland)
perihepatitis (Fits-Hugh-Curtis syndrome)
meningitis and endocarditis

Question 23

Perinatal Complications of Gonorrhea

Answer 23

opthalmia neonatorum
pharyngeal and respiratory tract infection
anal canal infection

Question 24

Management of Gonorrhea

Answer 24

Ceftriaxone 250 mg IM, single dose OR
Cefixime 400 mg/tab, single dose OR
Single dose injectible cephalosporin regimen

PLUS

Azithromycin 1 gram PO as single dose

PLUS

treatment for Chlamydial infection unless it is excluded

ALL NEWBORNS ARE GIVEN OCULAR PROPHYLAXIS
0.5 % erythromycin ointment w/n 1 hr after birth OR
1 % silver nitrate solution OR
1 % tetracycline ointment or solution

Question 25

Infections whose complications increase during pregnancy

Answer 25

UTI Bacterial Vaginosis Surgical wound Group B Streptococcal

Question 26

Infections more common in pregnancy and the puerperium

Answer 26

Pyelonephritis Endomyometritis Mastitis Toxic Shock Syndrome (TSS)

Question 27

Infections specific to pregnancy

Answer 27

Chorioamnionitis Septic pelvic thrombophlebitis Episiotomy or Perineal lacerations

Question 28

Infections that affect the fetus

Answer 28

``` Neonatal sepsis (GBS, E. coli) HSV VZV Parvovirus B19 CMV Rubella HIV Hepatitis B and C Gonorrhea Chlamydia Syphilis Toxoplasmosis Zika virus ```

Question 29

Treatment for UTI/Asymptomatic Bacteriuria

Answer 29

Amoxicillin Nitrofurantoin TMP-SMX Cephalexin

Question 30

Treatment for Pyelonephritis

Answer 30

IV hydration IV antibiotics *Cephalosporins (Cefazolin, Cefotetan, or Ceftriaxone) OR Ampicillin and Gentamicin -- until afebrile and asymptomatic for 24-48 hrs

Question 31

Major risk factors for developing pyelonephritis

Answer 31

Previous pyelonephritis History of vesicoureteral reflux ASB

Question 32

Maternal and Fetal Effects of Bacterial Vaginosis

Answer 32

``` Abortion PPROM preterm delivery Puerperal infections --- chorioamnionitis and endometritis Postpartum endometritis Post cesarean wound infection ```

Question 33

Intrauterine inflammation, infection or both (TRIPLE I) MC precursor of neonatal sepsis

Answer 33

Chorioamnionitis

Question 34

Diagnosis for Triple I

Answer 34

2 > 38 C, 30 mins apart with additional clinical factor * elevated maternal WBC count (> 15 000/mL) * purulent fluid from cervical os * fetal tachycardia (> 160 bpm) * evidence from amniocentesis consistent with microbial invasion

Question 35

Gold standard for diagnosis of chorioamnionitis

Answer 35

Culture of amniotic fluid obtained via amniocentesis

Question 36

MCC of congenital viral infection

Answer 36

``` Cytomegalovirus (CMV) growth restriction microcephaly, intracranial calcifications chorioretinitis mental and motor retardation sensorineural deficits hepatosplenomegaly, jaundice hemolytic anemia thrombocytopenic purpura (blueberry muffin baby) ```