STIs, PID and Discharge

Question 1

what is the predominant organism of the normal flora

Answer 1

lactovacilius

Question 2

normal vaginal discharge is called ___ ____

Answer 2

physiologic leukorrhea.

Transparent, mucousy, white-yellow, variable odor (none to some), can vary over time (cycles, pregnancy, medications), lactobacillus maintains acidity in discharge (H2O2 and lactic acid), pH 3.8 to 4.2, increased in low estrogen states.

Question 3

most common cause of abnormal vaginal discharge

Answer 3

bacterial vaginosis

Question 4

presentation and management of bacterial vaginosis

Answer 4

Presentation: up to 50% have no symptoms, some may have a fishy odor. Discharge may be white/grey, thin, copious.

Management: metronidazole, clindamycin. Same treatments in pregnancy or in HIV positive persons.

Question 5

pathophysiology of bacterial vaginosis

Answer 5

overgrowth of certain organisms and depletion of lactobacillus

Question 6

T/f treatment for bacterial vaginosis changes with pregnancy

Answer 6

false. the management is metronidazole and clindamycin. same treatment in pregnancy and in HIV

Question 7

presentation and management of candidiasis

Answer 7

Presentation: 20% are asymptomatic. Others may have pruritus, dysuria, dyspareunia, discharge (white, clumpy, curd-like), erythema, edema of the vulva.

Management: fluconazole. Longer courses may be needed for immunocompromised hosts. Topical azoles for pregnancy.

Question 8

T/F BV is an STI

Answer 8

false

Question 9

T/F candidiasis is an STi

Answer 9

false

Question 10

trichomonas is an STI?

Answer 10

true.

Question 11

which age group is most affected by trichomonas

Answer 11

older?younger, women?men

Question 12

presentation and symptoms and management of trichomonas

Answer 12

Sexually transmitted. Most curable STI.

Presentation: frequently asymptomatic, women>men; older>younger, mild to severe, symptoms lasting 5-28 days after being infection.

Symptoms: genital itching or burning, redness or soreness, burning with urination or ejaculation, discharge, possible dyspareunia. Discharge is off-white, yellow, frothy. Erythema of vulva and cervix.

Management: treatment regardless of symptoms. Metronidazole 2g PO 1 dose.

Question 13

gram stain results in bacterial vaginosis

Answer 13

glue cells, more gram negative curved vacilli and coccobacilli

Question 14

gram stain results in VVC

Answer 14

budding years, hyphae

Question 15

gram stain results in tricomona (TV)

Answer 15

PMN, trichonmonas

Question 16

strawberry cervix and off-white yellow frothy appearance of discharge is an indication of ____

Answer 16

trichomonas (TV)

Question 17

how does the pH differ btween BV, VVC, and TV?

Answer 17

both BV and TV will be basic, and VVC would result in ACIDIC environment

Question 18

what type of condition would result in a positive whiff test with KOH?

Answer 18

bacterial vaginosis

Question 19

BV in pregnancy can lead to:

Answer 19

PROM, chorioamnionitis, preterm labour, pre-term birth, post C-section endometritis

Question 20

having BV while undergoing a procuedure like IUD, biopsy or curretage is associated with:

Answer 20

PID and vaginal cuff cellulitis

Question 21

T/F lichen sclerosis can cause dischage

Answer 21

false.

Question 22

Amsel Criteria for BV Diagnosis (B-C-D-W)

Answer 22

Thin, white, yellow, homogenous discharge

Clue cells on wet mount microscopy

Vaginal fluid pH over 4.5 BASIC

Release of fishy ofor when adding 10% KOD (Whiff test positive). Need at least 3 criteria for positive result.

DO a BV TEST SWAB.

Question 23

clinical presentation of chlamydia in males and females

Answer 23

Chlamydial Infections

• Incubation period 2-3 weeks (up to 6)
• Persists for months with no treatment.
• Co-infection with NG common (20-42%)

Diagnosis of Chlamydia: nucleic acid amplification testing (NAAT), consistent syndrome, partner with a positive test.

Management: azithromycin first line in non pregnant adults. Doxycycline second line.

If pregnant: azithromycin or amoxicillin.

Question 24

diagnosing chlamydia

Answer 24

NAAT, consistent syndromes, partner with a positive test

Question 25

management of chlamydia

Answer 25

azithromycin first line in nonpregnant adults. Doxycycline second line. - if pregnant: azithromycin or amoxicillin

Question 26

outline the ages of males nad females most likely to be affected with gonorrhea

Answer 26

Males 20-24 years and females 15-19 years most affected Presentation: incubation period 2-7 days. Often asymptomatic in females, symptomatic in males. Risk factors: sex, prior infection, other STIs, youth, number/multiple partners, vulnerable populations, HIV transmission is increased with GC.

Question 27

neonatal presentation of gonorrhea

Answer 27

opthalmia, conjunctivits, sepsis, disseminated gonoccal infection. in chilrdren: urethritis, vagininitis, conjunctivits, pharyngeal infection, proctitis, disseminate gonoccal infection

Question 28

diagnosis and treament of gonorrhea

Answer 28

Diagnosis: NAAT, culture in select cases, urethral gram stain may be done in some contexts. Management in both pregnant and heterosexual adult**s: cefixime or ceftriaxone PLUS azithromycin.** **Or azithromycin + gentamicin or gemifloxacin.** Must NOTIFY. Also treat CT if GC+. Test of cure in select situations (culture 3-7 after, NAAT 2-3 weeks after)

Question 29

pelvic inflammatory disease definition and microbiology

Answer 29

Definition: infection of the female upper genital tract-- any combination of anatomic structures (endometrium, fallopian tubes, pelvic peritoneum et al). Most common infectious cause of lower abdominal pain) Micro: **polymicrobial. can be categorized as STI vs endogenous pathogen causes** **- stis: ct, gc, hsv is rare, Tv is rare** **- genital tract organisms; mycoplasma genitalium, m. hominis** **anaerobes; bacteroids spp., peptostrptococcus spp,** **aerobes; ecoli, g. vaginallis, H.influenzae, strep.**

Question 30

minimum diagnostic criteria for pID

Answer 30

lower abdominal tenderness adnexal tenderness cervical motion tendeness

Question 31

gold standard definitive diagnostic criteria for PID

Answer 31

laparoscopy demonstrating abnormalities consistent with PID, such as fallopian tube erythema and/or mucopurulent exudates

Question 32

definitive diagnostic crtiera for PID

Answer 32

Question 33

management of PID

Answer 33

Management: early diagnosis and treatment is crucial for fertility PO or IV antibiotic treatment: poly microbial coverage Cefoxitin + doxycyclin Goals: prevent infertility, ectopic pregnancy, chronic pelvic pain.

Question 34

complications of chlamydia for males and females

Answer 34

Complications of Chlamydia Female: PID, ectopic pregnancy, infertility, chronic pelvic pain, reiter syndrome Males: epididymo-orchitis, reiter syndrome.

Question 35

complications of gonorrhea

Answer 35

Complications of Gonorrhea Female: PID, infertility, ectopic, chronic pelvic pain, reactive arthritis, disseminated gonococcal infection Males: epididymo-orchitis, infertility, disseminated gonococcal infection

Question 36

4. List etiologies for non-infectious vaginal discharge.

Answer 36

Non-infectious causes with discharge: * Physiologic * Desquamative inflammatory vaginitis * Atrophic vaginitis * Foreign bodies * Cervical ectropion