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Acute Care Seminar 1 > Sexual Health > Flashcards

Sexual Health Flashcards

1
Q

Ectopic Pregnancy

A

Implantation of fertilized ovum in tissue other than endometrium

Most commonly occurs in the fallopian tube -96%

Life-threatening complication is tubal rupture

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2
Q

Causes: Ectopic Pregnancy

A

-PID, STIs, Endometriosis,
-Prior tubal or uterine surgery
-Use of IUD,
-Ovulation inducing drugs (infertility treatment)
-Prior ectopic pregnancy,
-Cigarette smoking

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3
Q

Subjective Findings of Ectopic Pregnancy

A

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

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4
Q

Ectopic Pregnancy on US

A

Positive Morrison’s pouch/splenorenal/pelvic view on bedside US exam

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5
Q

Ectopic Pregnancy: Treatment

A

-Surgical: Salpingostomy vs. Salpingectomy
-Medication: Methotrexate therapy

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6
Q

Pelvic Inflammatory Disease

A

-Acute infection/inflammation of upper genital tract structures in women
-Causes: Normal vaginal flora, trauma, surgery (N. gonorrhoeae and Chlamydia)

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7
Q

PID Early Subjective Findings

A

-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

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8
Q

PID exam

A

-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

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9
Q

PID Diagnoses

A

-Uterine/adnexal tenderness
-Cervical motion tenderness

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10
Q

PID Treatment Inpatient

A

-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

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11
Q

PID Treatment Outpatient

A

-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

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12
Q

Chlamydia Trachmoatis

A

-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

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13
Q

Chlyamydia Subjective/PE findings

A

-Women
Asymptomatic, spotting, bleeding, abdominal pain, dysuria, dyspareunia, cervical discharge
-Men
Asymptomatic, dysuria, cloudy discharge, unilateral testicular pain/swelling

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14
Q

Chlymadia Dx

A

-Nucleic acid amplification testing (NAAT) is test of choice
-Vaginal swabs for women and urine for men

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15
Q

Chlymadia Tx

A

-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.

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16
Q

Gonorrhea

A

-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

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17
Q

Gonorrhea Subjective/PE Findigns

A

-Women
Often asymptomatic, mucopurulent discharge, labial swelling, pain, abdominal discomfort, pharyngitis
-Men
Usually asymptomatic, dysuria, yellow-greenish, profuse discharge, pharyngitis, epididymitis, lower abdominal pain

18
Q

Gonorrhea Dx

A

Gram stain and culture on Thayer-Martin medium
Nucleic acid methods

19
Q

Gonorrhea Tx/Management

A

-Ceftriaxone 500mg IM once <150 kg
>150 kg Ceftriaxone 1 gm IM
-Doxycycline/Azithromycin for treatment of concurrent chlamydia

20
Q

Syphilis

A

-Caused by Treponema pallidum
-Can present in different phases: Primary, Secondary, Latent, Tertiary (Late)

21
Q

Diagnostics of Syphilis

A

-VDRL – non-specific
-RPR – non-specific
**FTA-ABS – specific (identifies antibodies against the spirochete)

22
Q

Treatment of Syphilis: Early Late

A

-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

23
Q

Tx of Syphilis: Tertiary

A

-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)

24
Q

Mycoplasma Genitalium

A

-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

25
Q

Mycoplasma Genitalium Tx

A

-Macrolide resistance extremely high
-2-stage treatment recommended
-If Macrolide sensitive: Doxy 100 mg PO BID x7 days, followed by Azithro 1 g PO x1, 500 mg PO qd x 3 days (2.5gtotal)
-Macrolide resistant: Doxy 100 mg po BID x7 days, followed by moxifloxacin 400 mg qd x7 days

26
Q

condylomata acuminata(Genital Warts)

A

-Caused by human papilloma virus (HPV)-HPV types 6 and 11
-Most common viral STI in the United States
-More common in women and MSM
-Complications: increase anogenital cancers, HPV types 16 & 18 cause 70% of cervical cancers

27
Q

condylomata acuminata(Genital Warts) Treatment

A

-Patient applied: Imiquimod, Podophyllotoxin, Sinecatechins
-Clinician applied: Cryotherapy, electrosurgery, trichloracetic acid, laser therapy, surgical excision
-Women-similar tx’s however depends on where the lesions are located-

28
Q

condylomata acuminata(Genital Warts) Prevention

A

*Quadrivalent vaccine (Gardasil) includes HPV types 6, 11, 16, and 18,

Bivalent vaccine (Cervarix) includes HPV types 16 and 18

*Recommended in boys and girls from 9-12 years and for men who have sex with men up to 26 years of age.

29
Q

Vaginitis

A

-Characterized by vaginal discharge, vulvular itching, vaginal odor
-Bacterial vaginosis
-Vulvovaginal candidiasis
-Trichomoniasis

30
Q

Bacterial Vaginosis

A

-Change in normal (lactobacillus) vaginal flora
-PH changes from normal of 4.0 to alkaline
-Causative agents: gardnerella, bacteroide species, mycoplasma hominis, among others (anerobes)

-Risk factors
Sexual activity
High fat diets
Smoking
Douching

31
Q

BV Consequences and Dx

A

-Pregnant women at risk for preterm delivery
-Increase risk of HIV, STI and precancerous cervical lesions

-Diagnosis
Amsels Criteria (3 out of 4) – gray white thin discharge, vaginal PH >4.5, positive whiff test, clue cells on wet prep.

32
Q

BV Tx

A

-Metronidazole 500mg BID 7 days (vaginal gel)
Caution in first trimester of pregnancy
-Tinidazole 2 gms QD for 2 days
-Clindamycin 300 BID for 7 days (vaginal troche or cream)

33
Q

Vulvovaginal Candidiasis

A

-Discharge – white, thick and clumpy “cottage cheese” appearance
-Erythema and inflammation of vaginal vault

34
Q

Dx of Candidiasis

A

-10% KOH wet prep shows psuedohypha or budding yeast
-Tx: Fluconazole 150mg tablet once
-Over the counter intravaginal agents (azoles) per packaging

35
Q

Trichomonas

A

-Protozoan infection caused by trichomonas vaginalis
-Most common non viral STI transmitted world wide

36
Q

Trichomonas Symptoms

A

-Symptoms
Frothy gray, green, yellow malodorous discharge
Cervical petechiae – Strawberry cervix
Men – usually asymptomatic or sx of urethritis

37
Q

Trichomonas Dx & Tx

A

-Wet prep-Motile trichomonade, Nucleic acid amplification test (more sensitive)
-Metronidazole 2gms po x 1 or 500mg po BID x 7 days (pregnant patients)
-Tinidazole 2 gms po x 1

38
Q

Herpes Simplex Virus (HSV) -symptoms

A

-Severe and painful genital vesicular lesions
-Dysuria
-Localized
-lymphadenopathy
-Fever
-Headache
HSV-1-Around mouth-Kanker sores
HSV-2-genital warts

39
Q

HSV Tx-primary infection

A

Acyclovir 400 mg TID
Famciclovir 250 mg TID
Valacyclovir 1000 mg BID
Treat for 7-10 days

40
Q

HSV Tx-Episodic

A

Acyclovir 800 mg TID for 2 days
Famciclovir 1000 mg BID for 1 day
Valacyclovir 500 mg BID for 3 days

Acute Care Seminar 1 (31 decks)

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