Infectious diseases of the female reproductive and urinary tract Flashcards
(47 cards)
What triad of symptoms is classically associated with PID?
1) Pelvic pain
2) Cervical and Adnexal tenderness
3) Fever
What are clue cells? What are they associated with?
- Superficial vaginal epithelial cells with adherent bacteria
- Associated with bacterial vaginosis
- Most commonly Gardnerella vaginalis *
What is bacterial vaginosis?
- Alteration in the normal vaginal flora that results in a loss of hydrogen peroxide producing lactobacilli and an overgrowth of anaerobic bacteria
Which two anaerobic bacteria are found in much higher concentrations of women during bacterial vaginosis infection?
1) Gardnerella vaginalis
2) Mycoplasma hominis
* Note lactobacilli are usually absent
Women with BV are at increased risk of which gynecological problems?
- Pelvic inflammatory disease
- Postabortal PID
- Postoperative cuff infections after hysterectomy
- Abnormal cervical cytology
- Due to change in flora making more suceptable to infection *
- Also, although not an STI, increased sexual activity is a risk factor for BV (which also increases change of other STI and HPV)
Pregnanct women with BV have increased risk of what?
- PROM
- Pre-term labour
- Chorioamnionitis
- Postcesarean endometritis
What is the Whiff test?
- Addition of potassium hydroxide to vaginal secretions releases a fishy odor
- Associated with BV
How is BV diagnosed?
- Clue cells of microscopy
- Fishy smelling whiff test
- pH testing
How would you treat a patient with BV? explain your choice
Metronidazole (vaginal gel or PO)
- Antibiotic with excellent anaerobic coverage, but poor coverage of lactobacilli (kills anaerobes and allows lactobacilli to repopulate)
- Clindamycin (gel) may also be used
What type of infection is trichomonas vaginitis?
- Parasitic infection
Why is Trichomonas vaginitis commonly associated with BV?
- Trichomonas creates an anaerobic environment which favors the development of BV
What are the clinical symptoms of Trichomonas?
- Profuse, purulent, and malodorous vaginal discharge
- Vulvar pruritis
- Patchy vaginal erythema
- Colpitis macularis (STRAWBERRY CERVIX)
Strawberry cervic is associated with which condition?
- Trichomonas vaginitis
How may trichomonas vaginitis be diagnosed on microscopy?
- Viewing motile trichomonads
- Cells with visible flagella (kind of look like kites)
How is trichomonas vaginitis treated?
- Metronidazole
- 2g PO once
- or 500mg BID x 7d
- Treat sexual partners to avoid reinfection
Which pathogen is most commonly responsible for vulvovaginal candidiasis?
- Candida albicans (85-90%)
What are risk factors for the development of vulvovaginal candidiasis?
- Antibiotic use
- Pregnancy
- Diabetes
- Both are associated will decrease in cell mediated immunity (making immunocompromised)
What are the clinical features associated with vulvovaginal candidiasis?
- Vulvar pruritis
- Discharge (can be watery to homogenous and thick)
- Vaginal pain, burning
- dyspareunia
- erythema or edema of labia and vulvar skin
What would candidiasis look like under microscope?
- Budding yeast
How is vulvovaginal candidiasis treated?
1) Topical “azole” drugs (typically 1-7 days)
- clotrimazole
- miconazole
- tioconazole
2) Oral “azole”
- fluconozole 150mg PO once
- Note: Treatment will kill yeast quickly, but symptoms, from irritation, will last for 2-3 days *
What is atrophic vaginitis?
- Atrophy of the vaginal and vulvar epithelium
- Due to lack of estrogen
- Can result in post-coital bleeding, dyspareunia
What is the treatment of atrophic vaginitis?
- Topical vaginal estrogen cream
What is your differential diagnosis for endocervicitis with discharge?
- N. gonorrhoeae
- C. trachomatis
- Above 2 cause 50% of time
- M. genitalium
- Bacterial vaginosis
- Birth control pill use
Why is dual therapy recommended in the treatment of gonoccocal infection of the cervix, urethra or rectum? What therapy is recommended?
- Dual therapy due to increasing rates of resistant gonoccocal infection
- Dual therapy is
1) IM ceftriaxone 250mg OR Cefixime 400-800mg single dose
2) 1g single dose of PO azithromycin OR Doxycycline 100mg BID for 7 days
* Note that the azithro is not presumtive treatment for chlamydia it is incase there is resistance to cephalosporins
