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Clin Med3: Womens Health > Pelvic Infections and STIs > Flashcards

Pelvic Infections and STIs Flashcards

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1
Q

what is the #1 cause of vaginal discharge

A

bacterial vaginosis (BV)

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2
Q

what is the #1 cause of symptomatic bacterial infection in reproductive age women

A

bacterial vaginosis (BV)

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3
Q

what are risk factors of BV

A

Multiple male partners
female partners
>1 partner
new parner
not using condoms
douching
HSV+
Menses
copper IUD

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4
Q

if symptomatic, what is the presentation of BV

A

vaginal discharge
milky with ‘fishy’ odor (after addition of KOH prep)
worse after unprotected intercourse
non-irritating

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5
Q

how is BV diagnosed

A

Amsel’s criteria or Nugent score (more sensitive and specific)

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6
Q

what is seen on miscroscopy with BV

A

Clue cells - secondary to Gardnerella vaginalis infection

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7
Q

what is the first line treatment for BV

A

Metronidazole PO x 7 days
Metrinidazole intravaginal gel
clindamycin intravaginal gel

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8
Q

what are alternative treatment for BV

A

oral clindamycin
clindamycin ovules

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9
Q

what are risks of untreated BV infection

A

increased risk for STI’s, including HIV
increased risk of preterm delivery
risk of candidiasis infection after treatment

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10
Q

what is Gonorrhea

A

gram negative intracellular diplococci
infects mucous membranes
highest incidence in ages 15-24
common co-infection with chlamydia

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11
Q

what are the presenting symptoms of gonorrhea

A

dysuria (urethritis)
purulent discharge (white, green, yellow)
increased vaginal discharge
friable cervix
vaginal bleeding
scrotal pain (epididymitis)

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12
Q

what are the possible extra-genital infections associated with gonorrhea

A

conjunctivitis
arthritis
disseminated

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13
Q

how is gonorrhea diagnosed

A

Nucleic acid amplification test (NAAT) - urine or swab
screening recommended regardless of symptoms

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14
Q

what is the treatment of gonorrhea

A

ceftriaxone IM single dose PLUS azithromycin or dyoxycycline
no intercourse for 7 days
treat partners
re-test at 3 months after treatment

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15
Q

what are the complications of gonorrhea

A

PID - infertility, abscess, chronic pain, ectopic pregnancy
epididymitis - infertility (rare)
mom-to-baby transmission - blindness, joint infection, sepsis

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16
Q

what is chlamydia

A

intracellular gram negative bacterium
common co-infection with gonorrhea
highest in ages 15-24

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17
Q

what are the symptoms of chlamydia

A

dysuria (urethritis)
pyruia
increased urinary frequency
purulent discharge (mucopurulent, mucoid, watery)
increased vaginal discharge
friable cervix
vaginal bleeding
scrotal pain, tenderness, edema

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18
Q

how is chlamydia diagnosed

A

Nucleic acid amplification test - swab or urine
screen recommended in sexually active pts regardless of symptoms

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19
Q

what is the treatment of chlamydia

A

Doxycycline BID for 7 days (Drug of choice)
alternative: azythromycin or levofloxacin
consider addition of ceftriaxone IM single dose

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20
Q

what are the complications of chlamydia

A

PID
Mom-to-baby transmission: conjunctivitis and PNA
preterm labor
reactive arthritis

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21
Q

What is Trichomonas Vaginitis

A

most preventable non-bacterial STI (flagellate protozoan)
prevented with condom use

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22
Q

what are the risk factors for trich

A

incarceration
2+ partners in one year
less than a HS education
poverty
BV
douching

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23
Q

what is the clinical manifestations of Trich

A

males: urethritis, epidydmitis, prostatitis
females: produce, malodorous, frothy, yellow or greenish discharge
“Strawberry cervix”

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24
Q

how is Trich diagnosed

A

Microscopy / wet mount (POC) - must do immediately after sampling
Nucleic acid type testing
culture

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25
what is the treatment of Trich
first line: metronidazole PO x 7 days (women) MetroPO x 1 for males Tindazole PO alternative NO GELS
26
what are complications of Trich
1.5x increased risk for preterm labor PROM small for gestational age infants 2x increased risk for cervical CA some evidence for increased prostate CA risk HIV infection
27
What is candidiasis
aka vulvovaginal candidiasis primarily caused by C. albicans not a true STI
28
what are risk factors for candidiasis
DM obesity HIV+ pregnancy antibiotic use steroid use OCP use debilitation moist vaginal environment
29
what is uncomplicated candidiasis
sporadic or infrequent mild to moderate ssx likely c. albicans immunocompetent
30
what is complicated candidiasis
recurrent severe likely non c.albicans spp. DM immunocompromised immunosuppressant tx
31
How is candidiasis diagnosed
presence of budding yeast and hyphae on KOH wet mount if negative or complicated: culture (gold standard)
32
what is the treatment of candidiasis
OTC: clitrimazole, miconazole Rx: butoconazole cream, terconazole cream/suppository, PO fluconazole
33
what is syphilis
caused by treponema pallidum (spirochete) can cause infection of virtually any tissue/organ infection via oral/vaginal/anal intercourse, placenta, non-sexual blood contact
34
what are risk factors of syphilis
MSM, SUD, lack of condom use -condoms dont eliminate risk- exposed areas can be infectious
35
what are the categories of syphilis
primary, secondary and tertiary syphilis
36
what is primary syphilis
single painless ulcer (chancre) nontender, non purulent, indurated 3-4 weeks after infection may have multiple lesions, atypical lesions, painful appear on genitals, breast, oropharynx or others
37
what is secondary syphilis
skin rash, mucocutaneous lesions, lymphadenopathy
38
what is tertiary syphilis
many pts remain latent and dont develop dertiary manifestation cardiac manifestations, gummas (soft granulomas), bone lesions, liver lesions, paresis can occur 10-30 years non-infectious lesions
39
what is neurosyphilis
can occur at any stage; meningitis, AMS, stroke, cranial nerve dysfunction
40
what is ocular syphilis
can occur at any stage; conjunctivitis, uveitis, keratitis, optic neuropathy, vision loss
41
what is auditory syphilis
can occur at any stage; tinnitus, vertigo, SN HL
42
how is syphilis diagnosed
darkfield microscopy or molecular testing (early) later stages requires two testing methods: non-treponemal test and treponemal test
43
what is the treatment of syphilis
parenteral penicillin G - first line for all stages Doxy-2nd line no intercourse for 7-10 days reportable disease
44
what is a Jarisch-Herxheimer reaction
fever and worsening clinical ssx starts within hours of treatment lysis of spirochetes - release of endotoxin
45
What is a Chancroid
rare STI m/c age 21-30 sex workers and younger men caused by Haemophilus ducreyi (gram negative bacilli) incubation period 3-5 days
46
what is the presentation of chancroid
ulcerations: painful, pustule, papule, soft, irregular boarders, necrotic base with yellow-grey exudates, erythematous halo
47
what is the gold standard for diagnoisng chancroid
lesion culture (requires special medium)
48
what is the treatment of chancroid
azithry 1gPO x1 ceftriaxone 250mg IM x1
49
what is herpes simplex
very common STI m/c cause of genital ulcers HSV type 1 or 2
50
what is the presentation of herpes simplex
+/- tingling prodrome macular or papular lesions - vesicles on an erythematous base - ulcerations ulcerations are shallow and severely painful associated with edema, burning, itching, dysuria, vaginal/urethral discharge tender lymphadenopathy
51
how is HSV diagnosed
clinical if vesicles present swab of lesion for HSV PCR HSV serology (antibodies) HSV serum PCR Tzank smear
52
what is the treatment of HSV
lifelong infection acute treatment to decrease length of sx prophylactic tx decreases # of recurrences
53
what are the risks with HSV
HIV, meningitis, acute retinal necrosis
54
what is another name for genital warts
condyloma acuminata related to HPV types 6 or 11
55
what is the presentation of condyloma acuminata
many infections are asymptomatic characterized by flat, papular or pedunculated lesions lesions occur near introitus, under foreskin or penile shaft +/- pain +/- puritis
56
how are genital warts diagnosed
primarily clinica definitive dx with biopsy of lesion
57
what is the treatment of genital warts
no gold standard - shared dx making cryotherapy, surgical removal, TCA or BCA
58
what are patient applied options for the treatment of genital warts
imiquimod cream podofilox gel sinecatechins ointment
59
what is imiquimod cream
tx for genital warts stimulates interferon and cytokines tx 8-16weeks once daily or once 3x/week
60
what are the sx of imiquimod cream
primarily skin irritation, hypopigmentation
61
what is podofilox gel
tx for genital warts antimitotic - wart ecrosis BID for 3 days then 4 days off, repeat max 4x limited by size
62
when is podofilox gel contraindicated
pregnancy
63
what is sinecatechins ointment
tx of genital warts green tea extract + catechins 3x/day for no more than 16 weeks
64
what are the SE of sinecatechins
skin irritation unknown pregnancy risk
65
what is the inflammation of the upper genital tract
PID
66
what are risk factors for PID
multiple partners age previous PID IUD tubal ligation
67
what is the presentation of PID
abd and lower pelvic pain vaginal discharge dyspareunia abnormal vaginal bleeding
68
what is seen on exam with PID
cervical discharge cervical motion tenderness (chandelier sign) uterine tenderness adnexal tenderness +/- pelvic mass
69
how is PID diagnosed
dx is primarily clinical reliable dx if 3 clinical criteria present: *cervical motion tenderness *uterine tenderness *adnexal tenderness
70
what is the definitive dx test for PID
laparoscopic endometrial biopsy -wont ID any organisms, shows scarring
71
what is the treatment of PID
IV or PO abx first line: ceftriaxone IM/IV PLUS Doxy PO/IV PLUS Metronidazole PO/IV
72
what are the three clinical criteria for PID dx
*cervical motion tenderness *uterine tenderness *adnexal tenderness
73
what are the indication for admission with PID
need to r/o other surgical emergency presence of tubo-ovarian abscess pt is pregnant severe infection (+n/v, temp >101) pt cant tolerate PO tx no response to PO tx
74
what are complications of PID
tubo-ovarian abscess pelvic abscess ectopic pregnancy (d/t scaring in fallopian tubes) infertility (5x increased risk) adhesions
75
what is the duration of acute pelvic pain
< 3 months duration
76
what is chronic pelvic pain
presistent, noncyclic pain perceived to be in structure related to the pelvis and lasting more than six months often no etiology identified - CRPS or somatic syndrome

Clin Med3: Womens Health (13 decks)

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