Lower Genital Tract Infections

Question 1

What must be ruled out in patients over 40 with multiple recurrences of bartholin’s gland ABSCESSES?

Answer 1

Adenocarcinoma

Question 2

MOST contagious STI

Answer 2

Lice (pediculosis pubis, crab louse, pthirus pubis)

Question 3

Primary sx of lice (pediculosis pubis, crab louse, pthirus pubis)

Answer 3

Constant itching (2/2 allergic sensitization)

Question 4

Tx for Lice (pediculosis pubis, crab louse, pthirus pubis)

Answer 4

Permethrin (Nix)

Lindane (Kwell)

Question 5

Primary sx of scabies (itch mite), sarcoptes scabei

Answer 5

Severe intermittent itching

Question 6

What populations cannot take Lindane (Kwell)?

Answer 6

Pregnant or lactating women

Children under 2 years

Question 7

Tx for Primary sx of scabies (itch mite), sarcoptes scabei

Answer 7

Permethrin (Nix)

Lindane (Kwell)

Question 8

Aka “water wart”

Answer 8

Molluscum contagiosum, pox virus

Question 9

How contagious is Molluscum contagiosum, pox virus?

Answer 9

Mildly

Question 10

Describe the nodules of Molluscum contagiosum, pox virus

Answer 10

“Water wart”

The more mature nodules have an umbilicated center

Question 11

How is Molluscum contagiosum (pox virus) diagnosed?

Answer 11

Intracytoplasmic molluscum bodies with WRIGHT’s or GIEMSA STAIN confirm the diagnosis

Question 12

What is a major complication of Molluscum contagiosum (pox virus)?

Answer 12

Bacterial superinfection

Question 13

Tx of Molluscum contagiosum (pox virus)

Answer 13

Local anesthesia injection followed by evacuation of the caseous material and excise the nodule with a sharp dermal curet

Treat the base with Monsel’s or 885% TCA

Also use electrocautery or cyrosurgery

Question 14

How contagious is condyloma acuminatum (HPV)?

Answer 14

Highly, 25-65%

Question 15

High risk HPV strains

Answer 15

16 and 18

Question 16

HPV types that are found in benign lesions

Answer 16

HPV 6 and 11

Question 17

How is HPV spread?

Answer 17

Sexually or auto-inoculation

Question 18

Incubation period for HPV

Answer 18

Long, 1-8 months

Question 19

Where is genital HPV found?

Answer 19

Cervix - 70%

Vulva - 25%

Anus - 20%

Vagina - 10%

Question 20

Where does the herpes virus reside during the latent phase?

Answer 20

The dorsal root ganglia of S2-4

Question 21

How contagious is genital herpes?

Answer 21

Highly, 75%

Question 22

What is the recurrence rate of HSV 1?

Answer 22

55% recurrence within 12 months

Question 23

What is the recurrence rate of HSV II?

Answer 23

80% within 12 months

Question 24

Dx of HSV

Answer 24

Viral cultures (rapid monoclonal antibody tests or cytology can studies are less reliable than viral cultures)

PCR (MOST accurate and newest test)

Western blot (most specific method to dx recurrent herpes or recent unrecognized or sub clinical infection)

Question 25

Bacterial infections, common in tropics, AKA Donovanosis

Answer 25

Granuloma inguinale (gram neg calymmatobacterium granulomatosis)

Question 26

What is the rate of Granuloma inguinale (gram neg calymmatobacterium granulomatosis) in the US?

Answer 26

<199 cases/year

Question 27

Tx of Granuloma inguinale (gram neg calymmatobacterium granulomatosis)

Answer 27

Azithromycin

Question 28

Dx of Granuloma inguinale (gram neg calymmatobacterium granulomatosis)

Answer 28

Finding Donovan bodies in specimens and smears

Question 29

Classic clinical sign is the “Groove sign” (double genitocrural fold)

Answer 29

Lymphogranuloma venereum (LGV), Chlamydia trachamotis

Question 30

How is Lymphogranuloma venereum (LGV)/Chlamydia trachamotis dx?

Answer 30

Culture (of purulent drainage with monoclonal antibodies for chlamydia) Complement fixation antibody titer (most frequent serum method; antibodies tigers > 1 in 64 indicate active infection). Don’t use Frei Skin Test (low sensitivity)

Question 31

Tx of Lymphogranuloma venereum (LGV)/Chlamydia trachamotis

Answer 31

***CDC - Doxycycline 100mg BID at least 21 days Tetracycline, Erythromycin, Sulfasoxazole

Question 32

Is chancroid (H. ducreyi) more common in males or females?

Answer 32

Males

Question 33

Describe the lesions of chancroid (H. ducreyi)

Answer 33

Soft chancre that is painful and tender

Question 34

How is chancroid (H. ducreyi) diagnosed?

Answer 34

Gram stain/culture revealing “school of fish” pattern on gram stain

Question 35

Tx of chancroid (H. ducreyi)

Answer 35

CDC - erythromycin base x 7 days

Question 36

How is syphilis dx?

Answer 36

Serologic tests - 2 types (becomes positive 4-6 weeks after exposure) SCREENING either nonspecific, nontreponemal antibody tests (VDRL, RPR) or specific, antitreponemal antibody tests (FTA-ABS, MHA-TP) If a patient has a positive treponemal test, they will usually remain positive for life

Question 37

If a patient is found to have syphilis, they should be tested for HIV infection. What is the treatment in an HIV positive pt?

Answer 37

Desensitize and then PCN G 2.4 million units IM

Question 38

Describe primary syphilis

Answer 38

Hard, painless chancre that develops in 3 weeks and heals within 2-6 weeks

Question 39

Describe secondary syphilis

Answer 39

SYSTEMIC disease that develops from 6 weeks to 6 months after primary chancre with a rash and vulvar condyloma latum

Question 40

Describe the rash associated with secondary syphilis

Answer 40

Red macules and papules over the palms and soles

Question 41

Is the lymphadenopathy associated with secondary syphilis painful or painless?

Answer 41

Painless

Question 42

How long does it take for latent stage secondary syphilis to develop?

Answer 42

20 years

Question 43

When is the majority of females diagnosed with syphilis?

Answer 43

During the latent stage

Question 44

What percentage of patients develop tertiary syphilis?

Answer 44

33% of untreated patients

Question 45

Manifestations of tertiary syphilis

Answer 45

Potentially destructive effects on the central nervous, cardiovascular, and musculoskeletal systems Optic atrophy, Tabes dorsalis, generalized paresis, aortic aneurysm, gummas of the skin and bones

Question 46

Treatment of primary, secondary, and 1st year of latent syphilis

Answer 46

Benzathine PCN G 2.4 million units IM (if allergic, then give tetracycline)

Question 47

Treatment of syphilis in pregnancy

Answer 47

Desensitize then PCN G 2.4 million units IM

Question 48

Treatment of late latent or tertiary syphilis (gummas and CV syphilis)

Answer 48

Benzathine PCN G 7.2 million units IM