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Flashcards in Infections of the Lower female reproductive tract Deck (39):
1

how to ID a contaminated urine sample?

high amts of bacteria but no pyuria

2

what are the 5 most common organisms causing UTIs

E. coli
S. saprophyticus
Proteus
Klebsiella
Enterococcus

3

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

interstitial cystitis

4

what are the initial abx chosen for UTI?

ampicillin
TMP-SMX
macrodantin
cephalexin

5

what is most common cause of vulvitis?

candidiasis

6

how can Crohn's disease present on vulva?

kinfe-cut ulcers

7

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

syphilis & LGV are not painful
HSV and chancroid are.

8

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

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

9

causative organism for syphilis?

Treponema pallidum

10

initial test for syphilis?

dark field microscopy of material expressed from lesion.
RPR/VDRL

11

primary vs. secondary vs. tertiary syphilis:

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)

12

when does the latent period of syphils happen?

after the second stage. Can remain latent for years.

13

tx for syphilis?

benzathine PCN
IV if its neurosyphillis

14

what can occur a few hours after tx of syphilis?

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

15

CP of genital herpes:

first flu-like sx's, nausea, diarrhea, fever
vulvar burning & pruritis, then painful vesicles which ulcerate

16

mgt of pg women w/HSV?

if active outbreak, deliver via c/s

17

dx of HSV?

Tzanck smear, look for multinucleated giant cells
viral cultures

18

tx of HSV

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

19

causative organism of chancroid

Haemophilus ducreyi

20

CP of chancroid:

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

21

how to dx chancroid:

hard to cx. R/o other causes

22

tx of chancroid:

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

23

causative organism of lymphogranuloma vereneum?

Chlamydia trachomatis (L-serotypes)

24

stages of LGV?

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

25

tx of LGV

doxycycline

26

ddx of non-ulcerative genital lesions:

folliculitis (S. aureus)
condyloma
MC

27

tx of condylomas

local excision
cryotherapy
trichloroacetic acid
podophyllin
5-FU cream

repeated weekly until gone

imiquimod
podofilox

CO2 laser to vaporize

28

diff b/w scabies & crabs

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

29

why is the vagina acidic?

b/c lactobacillus produces acid, maintains pH < 4

30

how does BV happen?

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

31

how does BV affect pg'y?

ass'd w/preterm birth

32

dx of BV

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

33

tx of BV

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

34

CP of candidiasis

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

35

tx for trichomoniasis

metronidazole once PO

36

general transmission rates of gonococcal infection?

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

37

tx of gonococcal infection?

ceftriaxone + doxycycline or azithromycin (cover chlamydia)

38

why is prevalence of chlamydia so high?

earlier age of first sexual encounter, greater # sexual partners

both sexes can be asx'c carriers (bad for women...can => undx'd PID)

39

tx of chlamydia

doxycycline or azithromycin
if pregnant, erythromycin