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Gyn Theory > Vaginitis & STIs > Flashcards

Vaginitis & STIs Flashcards

1
Q

Define vaginitis vs vaginosis

A
  1. Vaginitis: inflammation of vagina w/ increased discharge containing WBC & increased bacteria
  2. Vaginosis: inflammation of vagina e/ increased discharge and vaginal order w/o increase WBC & decrease in lactobacilli
    *both occur when ecology of vagina distrubed
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2
Q

How can vaginal discharge be evauluated

A
  1. 0.9% saline wet prep
  2. 10% KOH for hyphae (after wet prep)
  3. Whiff or amine test for fishy odor (after KOH)
  4. nitrazine strep for pH
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3
Q

Bacterial Vaginosis (BV)
- etiology
- symptoms
- appearance/odor
- pH
- wet mount
-whiff test

A

most common cause of vaginitis
- etiology: d/t decrease in lactobacilli allowing for overgrowth of anaerobes
- symptoms: vaginal irritation, itching
- appearance/odor: milky white discharge; adherent to vaginal walls; malodorous
- pH > 4.5
- wet mount: clue cells (clumping) present on wet prep
-whiff test (+)

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4
Q

BV treatment & edu

A

Treatment
- metronidazole or clindamycin (oral)
treat all pregnant people
- metronidazole (gel) for pregnancy
Education
- no yogurt or oral lactobacillus
- can use boric acid BUT NO oral ingestion (can cause death)

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5
Q

Vulvovaginal candidiasis (VVC) [yeast infection]
- etiology
- symptoms
- appearance/odor
- pH
- wet mount
-whiff test

A
  • etiology: candida albicans (90%)
  • symptoms: pruritus, erythema, edema, dysuria d/t contact w/ vulva
  • appearance/odor: thick, white, curdy/clumpy discharge clinging to vaginal wall (cottage cheese)
  • pH < or = 4.5
  • wet mount: hyphae (oval budding) & WBC present; lactobacilli in KOH
    -whiff test (-)
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6
Q

Which STI resembles cottage cheese

A

Vulvovaginal candidiasis [yeast infection]

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7
Q

BV linked to

A

high recurrence rate
- PROM
- premature delivery
- low birthweight delivery
- aquisition of HIV/STD
- PID or post op infections after gyn procedure
- chorio
- postpartum endometritis
- post c/s wound infection

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8
Q

Risk factors for VVC (yeast infection)

A
  • repeated courses of antibiotics
  • diabetes (uncontrolled)
  • pregnancy
  • obesity
  • genetics
  • corticosteroids and hormones
  • immunosuppression
  • local allergic reactions
  • hormone therapy (vaginal estrogen) [remember estrogen regulated pH]
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9
Q

UTI dysuria vs VVC dysuria

A

UTI: internal burning in urethra
VVC: external burning when urine contacts vulva

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10
Q

Treatment & education for VVC

A

Treatment
- Fluconazole (oral) 1 tablet
- topical azole only for pregnancy
- boric acid intravaginally for recurrent VVC
Education
- sitz bath or colloidal oatmeal for irriation/swelling
- dry perineal area w/ hair dryer
- avoid tight clothing

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11
Q

Trichononiasis “trich”
- etiology
- symptoms
- appearance/odor
- pH
- wet mount
-whiff test
- testing

A
  • etiology: trichomonas vaginalis
  • symptoms
  • appearance/odor: frothy gray/yellowish/green discharge; strawberry pink cervic w/ cervial petechiae; malodorous
  • pH >4.5
  • wet mount: motile flagellated (swimming w/ tail) WBC present
    -whiff test: (+)
  • testing: microscopy & NAAT
    sexually transmitted
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12
Q

Trich treatment & education

A

Treatment
- metronidazole (7 days) women & (1 day) for men
- same treatment for pregnancy
always treat partner - STD
retest 3 months after tx

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13
Q

Screening recommendations for STIs

A
  1. All individuals who are sexually active should be screened for STI
    - annual screening for all women <25 & >25 w/ risk factors for GC & CT
  2. Ask 5 P’s
    - Partners
    - Practices
    - Prevention of pregnancy
    - Protection from STIs
    - Past hx of STIs
  3. Edu on s/sx of STIs
  4. All pregnancy ppl should be screens for
    - Chlamydia
    - Gonorrhea
    - Syphilis
    - Hep B
    - HIV
    - Hep C
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14
Q

Assessment for STIs include:

A
  1. sexual hx
  2. menstrual hx
  3. PE (external genitalia, speculum exam, bimanual exam, inguinal nodes & abd)
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15
Q

What STIs are required to be reported to public health officials

A
  1. Gonorrhea
  2. Chlamydia
  3. Syphilis
  4. HIV
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16
Q

Chlamydia
- etiology
- symptoms
most common STI

A

-etiology: chlamydia trachomatis
-symptoms (female): usually asymptomatic; spotting, postcoital bleeding, dysuria & urine frequency, lower abd pain, dyspareunia; CMT or rebound –> PID
-symptoms (male): usually asymptomatic; acte epididymitis, testicular pain, swollen scrotum, painful intercourse, blood in semen, discharge from penis

17
Q

Consequences of delayed treatment of chlamydia

A
  • PID
  • infertility
18
Q

Treatment for chlamydia

A

Doxycycline
Azithromycin for pregnancy
follow up culture obtained no sooner than 3 months

19
Q

Gonorrhea
- etiolgoy
- symptoms
2nd most common STI
most common complication of GC = PID

A
  • etiology: neisseria gonorrhoeae
  • symptoms (women): usually asymptomatic; dyspareunia, change in vag discharge, uni/bilateral labial pain/swelling, lower abd discomfort
  • symptoms (men): green/yellow/white discharge, buring urination, epididymitis, swollen throat (oral)
20
Q

Treatment for gonorrhea

A

Ceftriaxone
-safe for pregnancy
*test for cure 3-4 wks after tx is completed. if (+) in 1st trimester retest in 3rd trimester

21
Q

Newborn complication of untreated gonorrhea & chlamydia and treatment

A

complication: ophthalmia neonatorum
treatment: 0.5% erythromycin

22
Q

PID
- symptoms
GC or CT most common cause

A
  • symptoms: pelvic/abd pain (peritonitis), CMT, adnexal tenderness (bilateral), abd tenderness, abnormal discharge, T >102 F, low backache, WBC on wet prep
23
Q

Tx of PID

A

Non-pregnant: parenteral (IV) abx regimen (ceftriaxone + doxycycline etc)
Pregnant: hospitalized for parenteral (IV) abx d/t risk of pretemr birth & matenral morbidity (NO doxycycline)

24
Q

IUD and PID risk

A
  • greatest risk for PID 1st 21 days after insertion
  • IUD usually does not need to be removed if tx successful
  • no improvement w/in 48-72 hrs –> remove IUD
25
Q

Syphilis

A
26
Q

HIV

A
27
Q

HPV

A
28
Q

Anogenital warts

A
29
Q

HSV

A
30
Q

Hep B

A
31
Q

Bartholin’s cyst

A
32
Q

Toxic Shock Syndrome

A

Gyn Theory (4 decks)

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