Infections of the Lower female reproductive tract

Question 1

how to ID a contaminated urine sample?

Answer 1

high amts of bacteria but no pyuria

Question 2

what are the 5 most common organisms causing UTIs

Answer 2

E. coli
S. saprophyticus
Proteus
Klebsiella
Enterococcus

Question 3

what dx should you consider if pt has dysuria & urinary frequency but a negative urine cx?

Answer 3

interstitial cystitis

Question 4

what are the initial abx chosen for UTI?

Answer 4

ampicillin
TMP-SMX
macrodantin
cephalexin

Question 5

what is most common cause of vulvitis?

Answer 5

candidiasis

Question 6

how can Crohn’s disease present on vulva?

Answer 6

kinfe-cut ulcers

Question 7

syphillis vs. herpes vs. chancroid vs. LGV - painful or not?

Answer 7

syphilis & LGV are not painful

HSV and chancroid are.

Question 8

syphillis vs. herpes vs. chancroid vs. LGV - # of lesions?

Answer 8

syphilis & LGV are a single papule
HSV is multiple vesicles
chancroid is 1-3 papules/pustules

Question 9

causative organism for syphilis?

Answer 9

Treponema pallidum

Question 10

initial test for syphilis?

Answer 10

dark field microscopy of material expressed from lesion.

RPR/VDRL

Question 11

primary vs. secondary vs. tertiary syphilis:

Answer 11

primary = painless, red, round, firm ulcer on genitals
secondary = maculopapular rash on skin, mucous mems, palms & soles
tertiary syphilis = gummas (granulomas of skin & bones), aortitis, neurosyphilis, tabes dorsalis (degradation of dorsal columns)

Question 12

when does the latent period of syphils happen?

Answer 12

after the second stage. Can remain latent for years.

Question 13

tx for syphilis?

Answer 13

benzathine PCN

IV if its neurosyphillis

Question 14

what can occur a few hours after tx of syphilis?

Answer 14

Jarisch-Herxheimer rxn - malaise, fever, HA, pharyngitis, rash
(also occurs w/tx of other spirochete infections - Lyme)

Question 15

CP of genital herpes:

Answer 15

first flu-like sx’s, nausea, diarrhea, fever

vulvar burning & pruritis, then painful vesicles which ulcerate

Question 16

mgt of pg women w/HSV?

Answer 16

if active outbreak, deliver via c/s

Question 17

dx of HSV?

Answer 17

Tzanck smear, look for multinucleated giant cells

viral cultures

Question 18

tx of HSV

Answer 18

acyclovir to decrease length of infection & viral shedding. But no definitive “cure.”

Question 19

causative organism of chancroid

Answer 19

Haemophilus ducreyi

Question 20

CP of chancroid:

Answer 20

a single or multiple painful, demarcated, non-indurated ulcer
painful inguinal LAD

Question 21

how to dx chancroid:

Answer 21

hard to cx. R/o other causes

Question 22

tx of chancroid:

Answer 22

ceftriaxone, or azithromycin/erythromycin, or ciprofloxacin, or TMP-SMX. Treat partners.

Question 23

causative organism of lymphogranuloma vereneum?

Answer 23

Chlamydia trachomatis (L-serotypes)

Question 24

stages of LGV?

Answer 24

primary - painless, transient papule or shallow ulcer
secondary = painful inguinal LAD, fever, HA, malaise, anorexia
Tertiary = anal pruritis, rectal discharge, proctocolitis, rectal stricture, rectovag fistula, elaphantiasis

Question 25

tx of LGV

Answer 25

doxycycline

Question 26

ddx of non-ulcerative genital lesions:

Answer 26

folliculitis (S. aureus) condyloma MC

Question 27

tx of condylomas

Answer 27

``` local excision cryotherapy trichloroacetic acid podophyllin 5-FU cream ``` repeated weekly until gone imiquimod podofilox CO2 laser to vaporize

Question 28

diff b/w scabies & crabs

Answer 28

scabies can spread anywhere. crabs (pediculosis) is confined to pubic hair

Question 29

why is the vagina acidic?

Answer 29

b/c lactobacillus produces acid, maintains pH < 4

Question 30

how does BV happen?

Answer 30

a shift in bacterial flora in vagina => pH change. Gardnerella vaginalis is most common org found in cx.

Question 31

how does BV affect pg'y?

Answer 31

ass'd w/preterm birth

Question 32

dx of BV

Answer 32

``` fishy odor wet prep shows elevated pH (5-6) clue cells whiff test (addition of KOH) cx for Gardnerella, Bacteroides, other anaerobes ```

Question 33

tx of BV

Answer 33

metronidazole or clindamycin | don't take alcohol when using metronidazole (disulfiram reaction - makes acetaldehyde accumulate)

Question 34

CP of candidiasis

Answer 34

vulvar edema & erythema scant discharge some pts have char'ic white plaques or cottage cheese discharge

Question 35

tx for trichomoniasis

Answer 35

metronidazole once PO

Question 36

general transmission rates of gonococcal infection?

Answer 36

much easier for men to give it to women than for women to give it to men

Question 37

tx of gonococcal infection?

Answer 37

ceftriaxone + doxycycline or azithromycin (cover chlamydia)

Question 38

why is prevalence of chlamydia so high?

Answer 38

earlier age of first sexual encounter, greater # sexual partners both sexes can be asx'c carriers (bad for women...can => undx'd PID)

Question 39

tx of chlamydia

Answer 39

doxycycline or azithromycin | if pregnant, erythromycin