Infections of the Lower Female Reproductive Tract

Question 1

Symptoms of UTI (2)?

Answer 1

Urethritis (dysuria) and cystitis (frequency).

Question 2

Symptoms of pyelonephritis that are not found in UTI (2)?

Answer 2

Costovertebral angle tenderness and fever.

Question 3

Most common cause of vulvitis (vulvar pruritis)?

Answer 3

Candidiasis (yeast infection).

Question 4

Cause of knife cut vulvar ulcers?

Answer 4

Chrohn’s Disease.

Question 5

Cause of destructive vulvar lesions, fenestrations in the labia, and scarring?

Answer 5

Behcet disease?

Question 6

A woman presents with one painless, red, round, firm, 1cm ulcer.

1. Infectious agent?
2. Secondary presentation of the disease?
3. Most common cutaneous tertiary presentation?
4. Most cfamous neurological tertiary presentation?

Answer 6

1. Treponema Pallidum - Syphilis
2. 1-3 months later after primary syphylis resolves, maculopapular rash on the palms and soles.
3. Gumma (granulomas of the skin)
4. Tabes dorsalis.

Question 7

Screening tests for syphilis?
How long will they remain positive after treatment of primary syphilis?
Confirmatory tests?

Answer 7

RPR (Rapid Plasma Reagin) or VDRL (Venereal Disease Research Laboratory).
6-12 months.
FTA-ABS (fluorescent treponemal antibody absorption test) or TPPA (T. pallidum particule agglutination test).

Question 8

Treatment of Syphilis?

Treatment of Neurosyphilis?

Answer 8

Oral benzathine penicillin.

IV penicillin.

Question 9

A patient receiving treatment for syphilis develops fever, chills, headache, malaise, myalgia, and a rash about 8 hours later.

1. Diagnosis?
2. More common in primary or secondary syphilis?

Answer 9

Jarisch-Herzheimer reaction.

Secondary syphilis.

Question 10

Most common cause of genital herpes lesions?

Cause of 40% of new genital herpes lesions?

Answer 10

HSV2.

HSV1.

Question 11

A woman complains vulvar pruritis with multiple genital lesions that become painful after 36 hours.

1. Diagnosis?
2. Tests?
3. Treatment?

Answer 11

1. HSV
2. Viral culture
3. Herpes is forever…but acyclovir can suppress primary infection and recurrence. Treat partners as well.

Question 12

A woman complains of a painful, demarcated, non-indurated ulcer in the anogenital region.

1. Diagnosis and infectious agent?
2. Tests?
3. Treatment?

Answer 12

1. Chancroid - Haemophilus ducreyi.
2. Clinically rule out other sources of infection (no good test).
3. IM Ceftriaxone once or PO Azithromycin once. Treat partners as well.

Question 13

What are the three stages of presentation for lymphogranuloma venereum (LGV)?

Answer 13

Primary: local transient, painless papule/ulcer that often goes unnoticed.
Secondary: (Inguinal Syndrome) Painful enlargement of inguinal nodes +/- fever, headaches, malaise, anorexia.
Tertiary: (Anogential Syndrome) Anal pruritus that develops into fistulas, strictures, and elephantiasis.

Question 14

Infectious agent that causes LGV?
Diagnostic tests?
Treatment?

Answer 14

Chlamydia trachomatis (L1, L2, L3 serotypes).
Clinical assessment and culture of C. trachomatis.
PO Doxycycline 2/day or erythromycin 4/day.

Question 15

What should be included in the ddx regaurding non ulcerative lesions in the pubic region?
Infectious agent?

Answer 15

Folliculitis.

Staph Aureus.

Question 16

A sexually active patient presents with multiple warty regions in the anogential region that are itchy and occasionally bleed.

1. Diagnosis?
2. Which serotypes cause condyloma acuminata?
3. Which serotypes cause cervical cancer?
4. Treatments?
5. Recurrance rate regardless of treatment?

Answer 16

1. HPV
2. 6 and 11
3. 16, 18 and 31
4. Local excision, cryotherapy, laster, podophyllin, 5-FU cream
5. 20%

Question 17

Water warts are the colliqual name of what infection?
Where do these warts not occur?
Treatments?

Answer 17

Molluscum Contagiosum.
Palms or soles.
Local excision or trichloroacetic acid.

Question 18

What is a healthy vagina predominately colonized with?

Answer 18

Lactobacillus

Question 19

What species is often found in Bacterial vaginosis?

Concerning complication?

Answer 19

Gardnerella vaginalis.

Preterm births in infected mother.

Question 20

A patient presents with profuse, non-irritative, vaginal discharge with a fishy amine odor.

1. Diagnosis?
2. Diagnostic tests (3)?
3. Treatment?

Answer 20

1. Bacterial Vaginosis
2. A. Gram stain with examination of bacteria in discharge (gold standard)
   B. Thin white homogenous discharge coating the vaginal walls
   C. Clue cells present
3. PO Metronidazole or clindamycin for 7 day course.

Question 21

A patient presents with vulvar and vaginal pruritis, urethritis, and vaginal discharge.

1. Diagnosis and infectious agent?
2. Diagnostic test?
3. Treatment?

Answer 21

1. Candidiasis - most commonly Candida albicans
2. KOH prep of discharge
3. Azole agents (topical/vaginal micronazole or terconazole). Recurrent cases use oral fluconazole.

Question 22

A patient presents with profuse, colored, odorous vaginal discharge. pH is 6.5.

1. Diagnosis?
2. Common cervical finding?
3. Diagnostic test?
4. Treatment?

Answer 22

1. Trichomonas vaginalis
2. Strawberry cervix
3. Wet preps of vaginal swabs - see them swimming
4. Metronidazole 2g orally single dose. Partners should be treatd (75% infected)

Question 23

Most common infectious agents that cause cervicitis (2)?

Answer 23

Neisseria gonorrhoeae and Chlamydia trachomatis.

Question 24

A neonate presents with fevers, red macular skin lesions, tenosynovitis, and septic arthritis. His mother is 22 y/o and has a history of STI. Diagnosis?

Answer 24

Disseminated infection from Neisseria gonorrhoeae.

Question 25

Diagnostic tests for N. gonorrhoeae infection?

Answer 25

Thayer Martin chocolate agar (Culture) or nucleic acid amplification tests.

Question 26

Treatment for N. gonorrhoeae infection?

Additional treatment if concurrent chlamydial infection has not been ruled out?

Answer 26

Ceftriaxone 125mg IM once or cefixime 400mg PO once.

1g azithromycin PO once.

Question 27

Which agent has seen a recent increase in infections - Chlamydia or Gonorrhoeae? Which agent is typically more symptomatic - Chlamydia or Gonorrhoeae

Answer 27

Chlamydia - due to better diagnostic testing (NAAT).

Gonorrhoeae - chlamydia often completely asymptomatic.

Question 28

Treatment for Chlamydia infection?

Answer 28

1g azithromycin PO once OR

100 mg Doxycycline PO 2x/day for 7 days.