Vaginitis, PID, HPV, HSV, Syphillis Flashcards
(158 cards)
1
Q
3 types of vaginitis?
A
- Bacterial Vaginosis
- Vulvovaginal Candidiasis
- Trichomoniasis
2
Q
Normal vaginal discharge color, smell, and viscosity?
A
Clear to white
Odorless
High viscosity
3
Q
Dominant flora in healthy vagina?
A
Lactobacilli
4
Q
What do some Lactobacilli make to lower vaginal pH?
A
H2O2
5
Q
Normal pH range in vagina?
A
3.8-4.2
6
Q
What does the acidic environment of vagina inhibit?
A
Inhibits bacterial overgrowth
7
Q
What to Lactobacilli metabolize? What does it do to pH of vagina?
A
Metabolize glycogen which maintains acidic pH
8
Q
What happens to Lactobacilli and another anaerobic bacteria during overgrowth in the vagina?
A
Decrease of Lactobacilli, increase of anaerobic bacteria normally present
9
Q
Are the anaerobic bacteria which increase during overgrowth normally present in the vagina?
A
Yes. They are normally present but numbers kept low. When lactobacilli numbers decrease the acaerobic bacteria increase.
10
Q
Bacterial Vaginosis and Trichomoniasis associated with a pH of what?
A
pH >4.5
11
Q
Candida associated with a pH of what?
A
pH <4.5
12
Q
KOH Whiff Test positive in which two vaginitises?
A
- Bacteria Vaginitis
2. Trichomoniasis
13
Q
KOH Wet Mount will show what two things with Candidia?
A
Pseudohyphae and budding yeast
14
Q
Bacterial Vaginitis will show what on NaCl Wet Test?
A
≥ 20% Clue Cells
No or few WBCs
15
Q
Candidiasis will show what on NaCl Wet Test?
A
Few to many WBCs
16
Q
Trichomoniasis will show what on NaCl Wet Test?
A
Motile flagellated protozoa
Many WBCs
17
Q
1 most common vaginitis?
A
Bacterial Vaginosis
18
Q
Etiology of Bacterial Vaginitis?
A
Gardnerella Vaginitis
19
Q
Loss of what can lead to Bacterial Vaginitis?
A
Loss of Lactobacilli
20
Q
What “cleansing” method can lead to Bacterial Vaginitis?
A
Douching
21
Q
Discharge in Bacterial Vaginitis?
A
Homogenous, adherent, thin, milky, white or grey. Malodorous “fishy”.
22
Q
Which Vaginitis has a “fishy” smell?
A
Bacterial Vaginitis
23
Q
Bacterial Vaginitis linked to what other issues?
A
Premature membrane rupture, premature labor, other infections
24
Q
pH in Bacterial Vaginitis?
A
pH >4.5
25
NaCol Wet Mount in Bacterial Vaginitis?
20% clue cells. No to few WBCs.
26
What is Amsel Criteria in Bacterial Vaginitis?
3 or more of following:
1. pH > 4.5
2. 20% clue cells on NaCl wet mount
3. Positive Whiff Test
4. Homogenous non-viscous white discharge adhering to vag walls
27
Tx for Bacterial Vaginitis? (Hint: 3)
1. Metronidazole 500mg PO BID q7d
2. Metro gel full applicator 5g intravaginally daily or BID q5d
3. Clinda 2% cream in vag at bedtime q7d
28
#2 most common vaginitis?
Candidiasis
29
Etiology of Candidiasis?
C Albicans overgrowth. Excessive yeast growth.
30
Risk factors in Candidiasis?
DM, Abx use, immunosuppression
31
#1 complaint in Candidiasis?
Pruitis (itching)
32
Pain during urination in Candidiasis?
Burns when peeing. (UTI is burn after peeing.)
33
Describe discharge in Candidiasis?
Cottage cheese. Thick, clumpy, white.
34
pH in Candidiasis?
pH ≤ 4.5
35
KOH Whiff Test results in Candidiasis?
NEGATIVE
36
WBCs on NaCl Wet Mount in Candidiasis?
Few to many WBCs
37
KOH Wet Mount results in Candidiasis shows what?
Pseudohyphae or non-albicans species
38
Tx in Candidiasis? Severe?
Fluconazole (Diflucan) 150mg PO once
| Severe=Repeat in 72h
39
Fluconazole and preggers?
NOT IN FIRST TRIMESTER! Use topical.
40
Metronidazole in preggers?
Category B. Pretty safe.
41
#3 most common vaginitis?
Trichomoniasis
42
What is the most prevalent non-viral STI?
Trichomoniasis
43
Etiology of Trichomoniasis?
Trichomonas vaginalis parasite
44
What percent Trichomoniasis have symptoms?
Only 30%.
| 70% of Trichomoniasis are ASx.
45
Discharge in Trichomoniasis?
Frothy, gray, yellow-green, malodorous
46
Cervix in Trichomoniasis?
Cervical petechiae. "Strawberry Cervix".
47
Strawberry Cervix in which vaginitis?
Trichomoniasis
48
Trichomoniasis linked to?
Premature membrane rupture, preterm labor, etc
49
pH in Trichomoniasis?
pH > 4.5
50
KOH Whiff Test results in Trichomoniasis?
Often positive
51
NaCl Wet Mount results in Trichomoniasis? WBCs?
Motile, flagellated protzoa. Many WBCs.
52
Tx for Trichomoniasis? (Hint: 3)
1. Metronidazole 2g PO single dose
2. Metro 500mg PO BID q7D
3. Tinidazole 2g PO single dose
53
Who else to treat in Trichomoniasis?
Sex partners from past 60 days
54
Who to report Trichomoniasis to?
DPH
55
What's the most common infection worldwide?
Chlamydia
56
#1 bacterial STI?
Chlamydia
57
Main age of GC/Chlamydia?
15-24 y/o
58
50% of Chlamydia co-infected with what?
Gonorrhea
59
Majority of Chlamydia sx or asx?
ASx
60
Chlamydia might have what sx in pelvis?
PID
61
Describe discharge from Chlamydia?
Mucopurulent. White or clear from penis, may only see with milking.
62
Dx preferred for GC/Chlamydia?
NAAT
63
NAAT test uses what type of urine?
First-catch dirty urine
64
Tx of Chlamydia? (Hint: 2)
Azithromycin 1g PO single dose
or
Doxy 100mg PO BID x7D
65
Gram negative intracellular diplococci which dz?
Gonorrhea. Not seen in F.
66
Etiology of Gonorrhea?
N. Gonorrheae
67
How Gonorrhea transmitted? (Hint: 2 ways)
Sex contact or vertical transfer to baby
68
Gonorrhea sx or asx?
ASx most of the time
69
Describe discharge in Gonorrhea?
White-yellow-green, mucopurulent
70
Dx for Gonorrhea?
NAAT
71
Tx for Gonorrhea?
Ceftriaxone 250mg IM
PLUS
Azithromycin 1g PO single dose
72
Tx for GC/Chlamydia epididymitis?
Ceftriaxone 250mg IM
PLUS
Doxy 100mg BID PO x10-21d
73
Tx for GC/Chlamydia Proctitis?
Ceftriaxone 250mg IM
PLUS
Doxy 100mg PO x7-21D depending on severity
74
Dx for GC and Chlamydia?
NAAT
75
When to retest preggers GC/Chlamydia PT after tx?
3 weeks after tx for test of cure
76
When to test non-preggers GC/Chlamydia after tx?
3-4 months only if sx continue, reinfection, or compliance problems
77
When can GC/Chlamydia have sex again?
7 ASx days after tx
78
Who to report GC/Chlamydia to?
Local DPH
79
What disease is a spectrum of inflammatory disorders which is a combination or endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis?
Pelvic Inflammatory Disease
80
PID is usually due to one or more microbes?
Polymicrobial. N Gonorrheae and C Trachomatis 25-75%
81
Which are the two most common microbes in PID?
N Gonorrheae and C Trachomatis
82
Describe the movement of microbed in PID
Ascending spread of microorganisms from vagina or cervix to endometrium, fallopian tubes, ovaries, and contiguous structures
83
Which three symptoms are the minimum required for a dx of PID?
1. Uterind Tenderness OR
2. Adenxal Tenderness OR
3. Cervical Motion Tenderness
84
List some additional results and sx for PID dx
Oral temp > 38.3, abnormal discharge, increased WBCs in vaginal fluid, increased ESR, increased CRP, cervical infection with GC/Chlamydia
85
When to hospitalize a PID patient?
Can't exclude surgical emergency, preggers, no response to oral treatment, can't follow or tolerate oral outpatient therapy, severe illness, N/V, high fever, tubo-ovarian abscess
86
Tx for PID?
```
Ceftriaxone 250mg IM single dose
PLUS
Doxy 100mg PO BID q14D
WITH OR WITHOUT
Metro 500mg PO BID q14D
```
87
When should a PID PT begin to show major signs of improvement?
72h after tx
88
When to retest PID PT for GC/Chlamydia after initial treatment?
3-6 months after PID treatment
89
Are the sex partners of PID patients symptomatic?
Often ASx
90
When to treat sex partners of PID patients?
From 60 days before female symptoms began
91
Who to treat if more than 60 days since last sex partner of PID patient?
Last sex partner
92
What to treat for in sex partner of PID patient?
Empirically for C. Trach and N. Gono
93
Two HPV risk categories and the viral sterotypes in them?
Low-risk=HPV 6 and 11
High-risk=HPV 16 and 18
94
70% cervical CAs caused by which two HPV serogroups?
HPV 16 and 18
95
Most women with HPV 16 and 18 do or don't develop cell changes or cervical CA?
Don't! 90% HPV is cleared by the immune system and doesn't cause a problem.
96
What percent of HPV is cleared by the immune system? How long does it take?
90% cleared within 2 years
97
75% drop of Cervical CA due to what?
Pap screening
98
What percent of sexually active men and women acquire HPV?
100%
99
Most HPV Sx or ASx?
ASx
100
2 most common clinically significant signs in HPV? (Hint: one is a test result)
1. Genital warts
| 2. Cervical cell abnormalities on pap smear
101
What are Condylomata Acuminata in HPV?
Cauliflower-like genital warts. Skin colored, pink, hyperpigmented
102
ASC-H cells on pap smear are most often precancerous or not?
Most often precancerous
103
DX of HPV?
Clinical dx
104
2 types of TX in HPV?
1. PT Applied
| 2. Provider applied
105
PT Applied HPV TX?
Podofilex (Condilox) 0.5% gel or solution
106
Provider applied HPV tx?
Cryotherapy w/liquid NTG or cryoprobe
107
Two types of HSV?
HSV-1, HSV-2
108
Which HSV is the most common cause of recurrent genital herpes?
HSV-2
109
How is HSV-2 transmitted? (Hint: 2 ways)
1. Sex
| 2. Perinatal transmission
110
HSV Sx or ASx 90% of the time?
ASx 90% of the time
111
Can HSV shed when ASx?
Yes!
112
Which HSV sheds less often when ASx? Which more?
Less=HSV-1
| More=HSV-2
113
Does treatment prevent HSV from shedding?
Reduces but doesn't stop shedding
114
What is Primary Infection in HSV?
First ever infection with HSV-1 or 2.
115
Are you antibodies present in HSV Primary Infection when Sx occur?
No antibodies when Sx occur
116
Does Primary Infection of HSV have moderate or severe Sx?
Severe
117
What is Non-Primary Infection in HSV?
Get HSV-2 when already had HSV-1 and vice-versa.
118
Mild or severe Sx in Non-Primary Infection in HSV
Milder
119
Are antibodies present during Recurrent Symptomatic Infection in HSV?
Yes
120
Describe Sx and duration of Recurrent Symptomatic Infection in HSV
Mild Sx, short duration average 4-6 days
121
What is ASymptomatic Infection in HSV? Has antibodies present?
Antibodies present.
| No known history of cervical outbreaks.
122
Describe lesions in HSV
Numerous, bilateral genital lesions. Pain, itching, dysuria, vaginal and uretheral discharge. Tender inguinal adenopathy.
123
Etiology of Syphillis?
Treponema Pallidum
124
2 transmission routes of Syphillis?
Sex or vertical transmission
125
Which Syphillis stages most contagious?
Primary and Secondary
126
Early Syphillis stages?
Primary, Secondary, and Early Latent
127
What develops during Primary Syphillis? Where?
Chancre lesion at site of inoculation
128
Chancre in Syphillis painful or painless?
Painless.
| Indurated, clean base.
129
Is Chancre in Primary Syphillis infectious?
Yes! Highly infectious!
130
What might happen to serologic tests during very early Syphillis?
Test might not be positive
131
Can the Primary and Secondary Stages of Syphillis overlap?
Yes they can
132
When does the Secondary Stage of Syphillis develop? Lasts how long?
Develops weeks to months after primary chancre.
| Lasts weeks to months.
133
What state are the Syphillis titers highest?
Secondary Syphillis
134
What is most common complaint of Secondary Syphillis?
Rash on palms and feet
135
Describe Latent Syphillis
Only a positive serologic test. No actual signs or symptoms!
136
Define Early Latent Syphillis
<1 year of initial infection
137
Define Late Latent Syphillis
≥1 year from initial infection of if time since infection unknown
138
Is Late Syphillis common and infectious?
Rare d/t abx. Non-infectious.
139
Gummatous Lesions and Cardiovascular Syphillis during which state?
Late Syphillis
140
How many serologic tests are needed to dx Syphillis?
At least 2
141
Darkfield Microscopy used to ID what in Syphillis?
ID lesions or ulcers
142
What's the major benefit of Darkfield Microscopy?
It's quick
143
Which antibody does Non-Treponemal test for in Syphillis?
Reagin antibody
144
VDLR and RPR are titers in which Syphillis test? Good for?
Non-Treponemal test.
| Good for measuring therapeutic effect and evaliation of reinfection.
145
What antibody does the Treponmal test for in Syphillis?
T. Pallidum antigens
146
FTA-ABS, TP-EIA titers are part of which test in Syphillis?
Treponemal test
147
Which is more specific test in Syphillis: Non-Treponemal or Treponemal test
Treponemal test
148
When to screen preggers women for Syphillis?
At first prenatal visit
149
When to screen for Syphillis if still born?
After 20 weeks
150
Tx for Primary, Secondary, and Early Latent Syphillis?
Benzathine PCN G 2.4 M units IM once
151
Tx for Primary, Secondary, and Early Latent Syphillis if allergic to PCN?
Doxy 100mg PO BID x14d or
| Tertacycline 500mg PO QID x14D
152
Tx for Tertiary and Late Latent Syphillis?
Benzathine PCN G 2.4 M units once for 3 weeks. Total 7.5 M units.
153
Tx for Tertiary and Late Latent Syphillis if allergic to PCN?
Doxy 100mg PO BID x28D or
| Tetra 500mg PO QID x 28D
154
When to follow up with Primary and Secondary Syphillis? What to compare?
Reexamine at 6 and 12 months and compare titers to max or baseline nontrep titers on day of treatment
155
When to follow up with Latent Syphillis? What to compare?
6, 12, and 24 months
156
When to follow up with Primary Syphillis if PT has HIV?
3, 6, 9, 12, 24
157
When to follow up with Latent Syphillis if PT has HIV?
6, 12, 18, 24 months
158
When to follow up with Neuro Syphillis?
Repeat CSF test every 6 months until clear
