Sexual Health Flashcards
(40 cards)
Ectopic Pregnancy
Implantation of fertilized ovum in tissue other than endometrium
Most commonly occurs in the fallopian tube -96%
Life-threatening complication is tubal rupture
Causes: Ectopic Pregnancy
-PID, STIs, Endometriosis,
-Prior tubal or uterine surgery
-Use of IUD,
-Ovulation inducing drugs (infertility treatment)
-Prior ectopic pregnancy,
-Cigarette smoking
Subjective Findings of Ectopic Pregnancy
6-8 weeks following LNMP
Normal pregnancy s/s plus
*Classic symptoms:
Abdominal pain
Amenorrhea
Vaginal bleeding
*50% of women are asymptomatic prior to tubal rupture
Fait, vertigo, dizziness
Shoulder strap pain
Ectopic Pregnancy on US
Positive Morrison’s pouch/splenorenal/pelvic view on bedside US exam
Ectopic Pregnancy: Treatment
-Surgical: Salpingostomy vs. Salpingectomy
-Medication: Methotrexate therapy
Pelvic Inflammatory Disease
-Acute infection/inflammation of upper genital tract structures in women
-Causes: Normal vaginal flora, trauma, surgery (N. gonorrhoeae and Chlamydia)
PID Early Subjective Findings
-Lower abdominal pain is cardinal presenting symptoms (pain is usually bilateral)
-Pain that worsens with intercourse or with jarring movement
-Onset of pain during or shortly after menses
-Menstrual cramping
-Malaise
Late Findings
-Severe pain
-Temperature
-Profuse foul and purulent vaginal discharge
PID exam
-Chandelier’s Disease: uterine and cervical motion tenderness; marked tenderness of cervix, uterus, and adnexa
-Diffuse tenderness
-Friable cervix
-Rebound tenderness
-Purulent cervical discharge/bleeding
PID Diagnoses
-Uterine/adnexal tenderness
-Cervical motion tenderness
PID Treatment Inpatient
-Ceftriaxone 1 g Q24 h IV OR
-2nd generation cephalosporin (cefotetan, cefoxitin)
Cefotetan 2 gms IV every 12 or Cefoxitin 2 gms IV every 6 hrs.
-Plus doxycycline IV
100mg every 12 hours
-Plus Metronidazole 500mg IV q 8 hrs.
-Convert to oral after at least 24-48 hours of significant clinical improvement – treat for 14 days
PID Treatment Outpatient
-Outpatient tx
-One IM dose of 500 mg ceftriaxone
-Plus doxycycline 100mg BID po for 14 days
-Plus metronidazole 500mg BID for 14 days
-Close follow up at 72 hours
-All women who receive a diagnosis of PID should be tested for gonorrhea, chlamydia, HIV, and syphilis
Chlamydia Trachmoatis
-Most common bacterial cause of STIs
-Majority of those affected are asymptomatic
-Complications include:
Women: PID, infertility, pelvic absecesses, ectopic pregnancy, endometritis
Men: epidiymitis, Retier’s synd,
Newborn: conjunctivitis, pneumonia
Chlyamydia Subjective/PE findings
-Women
Asymptomatic, spotting, bleeding, abdominal pain, dysuria, dyspareunia, cervical discharge
-Men
Asymptomatic, dysuria, cloudy discharge, unilateral testicular pain/swelling
Chlymadia Dx
-Nucleic acid amplification testing (NAAT) is test of choice
-Vaginal swabs for women and urine for men
Chlymadia Tx
-First line
Doxycycline 1000mg po BID x 7 days
Pregnancy-erythromycin or amoxicillin
Alternative-azithromycin 1 gm or Levofloxacin 500 mg daily for 7 days.
Gonorrhea
-Gram negative Neisseria gonorrhea
-Incubation period 3-7 days average
-M2F transmission is 80-90%
-Complications: PID, infertility, ectopic pregnancy, epididymitis, Most common cause of infected septic joint
Gonorrhea Subjective/PE Findigns
-Women
Often asymptomatic, mucopurulent discharge, labial swelling, pain, abdominal discomfort, pharyngitis
-Men
Usually asymptomatic, dysuria, yellow-greenish, profuse discharge, pharyngitis, epididymitis, lower abdominal pain
Gonorrhea Dx
Gram stain and culture on Thayer-Martin medium
Nucleic acid methods
Gonorrhea Tx/Management
-Ceftriaxone 500mg IM once <150 kg
>150 kg Ceftriaxone 1 gm IM
-Doxycycline/Azithromycin for treatment of concurrent chlamydia
Syphilis
-Caused by Treponema pallidum
-Can present in different phases: Primary, Secondary, Latent, Tertiary (Late)
Diagnostics of Syphilis
-VDRL – non-specific
-RPR – non-specific
**FTA-ABS – specific (identifies antibodies against the spirochete)
Treatment of Syphilis: Early Late
-Early Late: PCN G 2.4 million units IM x 1; or Doxycycline 100mg po BID x 14d
-Late, Cardiovascular, Gumma: PCN G 2.4mil units IM weekly for 3 weeks; Doxycycline 100 mg oral twice daily for four weeks
Tx of Syphilis: Tertiary
-Tertiary Syphilis with normal CSF Examination:Benzathine penicillin G7.2 million units total, administered as 3 dosesof 2.4 million units IM each at 1-week intervals
-PCN G 3 to 4 million units IV every four hours or 24 million units continuous IV infusion for 10 to 14 days OR
-PCN G procaine 2.4 million units IM daily PLUS probenecid 500 mg four times daily oral, both for 10 to 14 days OR
-Ceftriaxone 2 g IV once daily for 10 to 14 days (23% failure rate)
Mycoplasma Genitalium
-Men
Causes 15-25% of non gonococcal urethritis and up to 40% of recurrent NGU.
-Women
Causes cervicitis, PID, preterm labor, spontaneous abortion and infertility (2 fold increase).
Often asymptomatic
