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54 Cards in this Set
- Front
- Back
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What is leukorrhea?
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vaginal discharge
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What can observation of vaginal discharge characteristics help determine?
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• organism causing infection
• duration of infection |
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What are examples of gynecological infections of the upper tract?
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• cervicitis
• endometritis • pelvic inflammatory disease • salpingitis • tubo-ovarian abscess |
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What is the most common symptom associated with infections of the vagina?
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discharge
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What is the definition of vulvovaginitis?
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inflammation involving the vulva and vagina
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What are some presenting symptoms of vulvovaginitis?
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• burning
• dyspareunia • foul odor • itching • vaginal discharge |
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What are the 4 conditions of vulvovaginitis?
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• Atrophic vaginalis
• Bacterial Vaginosis • Candida (yeast) vulvovaginitis • Trichomonas vulvovaginitis |
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What is the pH of a normal vagina?
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3.5-4.2
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What is the most common bacterial in the normal flora of the vagina?
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lactobacillus acidophillus
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List examples of bacteria present in the vaginal normal flora
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• Lactobacilli
• Candida spp. • Clostridium spp. • Enterococcus • Escherichia coli • Gardnerella vaginalis • Group B streptococci • Peptococci • Stahpylococcus Aureus |
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What organisms cause Bacterial Vaginosis?
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• Garderlla vaginalis
• Other anaerobes (Bacteroides, Peptococcus, Mobiluncus) |
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Generally, what are signs and symptoms of Bacterial Vaginosis?
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• "musty" or "fishy" odor
• increased thin gray-white to yellow discharge • mild vulvar irritation |
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What is a positive "whiff test"?
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• mixing of vaginal secretion with 10% KOH
• causes liberation of amines that may be detected by their fishy odor |
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What are clue cells?
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• epithelial cells with numerous coccoid bacteria attached to their surface
• seen under saline wet mount for Bacterial Vaginosis |
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A diagnosis of BV is defined as 3 out of 4 criteria. What are the 4 criteria?
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• homogenous discharge
• pH greater than 4.5 • positive "whiff test" • presence of clue cell |
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What are the different intravaginal creams that can be used to treat BV?
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• Metronidazole 0.75% vaginal gel BID x 5 days
• Clindamycin 2% vaginal cream QD x 7 days |
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What are different oral medications that can be used to treat BV?
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• Metronidazole 500 mg PO BID x 7 days
• Metronidazole 2 g PO (one time dose) • Clindamycin 300 mg PO x 7 days |
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What are the only areas of the body that Trichomonas lives?
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• male and female urethra
• Skene's ducts • vagina |
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What are signs and symptoms of Trichomonas vaginalis?
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• burning
• diffuse vaginal erythema • dysuria • dyspareunia • malodorus frothy yellow-green discharge • pruritus • strawberry cervix |
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What is a strawberry cervix?
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red petechiael or macular lesions on the cervix
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What is gold standard for diagnosing Trichomonas Vaginalis?
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culture
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What is the treatment for Trichomonas Vaginalis?
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• Metronidazole (either 2g single dose OR 500 mg PO BID x 7 days)
* sexual partner should be treated even if asymptomatic |
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What substance should people taking Metronidazole avoid?
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• avoid alcohol
• can lead to disulfiram-like reaction |
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What are predisposing factors for Vulvovaginal Candidiasis?
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• broad spectrum antibiotics
• corticosteroids • chronic debilitation • diabetes • heat • HIV • immunosuppresion • moisture • occlusive clothing • pregnancy • vaginal douching |
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What are treatment options for Vulvovaginal Candidiasis?
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• Clotrimazole 500 mg single dose
• Fluconazole 150 mg single dose (most widely used) • Miconazole 200 mg vaginal supp x 3 days • Terconazole 0.8% cream 5 g supp x 3 days |
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What are signs and symptoms of Vulvovaginal Candidiasis?
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• burning sensation w/ urination
• pruritus • vulvovaginal erythema (w/ fissures) • white curd-like, cheesy vaginal discharge |
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What are characteristics of the vagina in atrophic vaginitis?
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• thinning of the vaginal mucosa
• epithelium alteration • pH 5-7 (predisposed to trauma & infections) |
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What are signs and symptoms of atrophic vaginits?
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• burning
• dyspareunia • itching • spotting • vaginal dryness • vaginal irritation |
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How is atrophic vaginitis diagnosed?
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• on saline wet mount
• increase polymorphonuclear cells and parabasal epithelial cell |
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What is the treatment for atrophic vaginitis?
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• Estradiol vaginal ring q 90 days
• Vagifem 1 tab intravaginal QD x 2 weeks |
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What is the most commonly sexually transmitted organism in the US?
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Chlamydia trachomatis
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True/False: Herpes simplex virus is a DNA virus
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The correct answer is: True
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Describe the clinical course of genital herpes
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• prodromal phase: mild paresthesia and burning beginning 2-5 days after infection in symptomatic pts
• progresses to painful vesicular and ulcerated lesion (3-7 days after exposure) • usually resolves in 1 week |
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What are other signs & symptoms of genital herpes?
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• aseptic menigitis
• dysuria (caused by vulvar lesions) • inguinal adenopathy • low-grade fever • malaise • non-purulent cervicitis |
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What are treatment options for Genital Herpes?
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• Acyclovir
OR • Valacyclovir OR • Famciclovir * same medications for recurrent infection |
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What are condylomata acuminata?
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• soft, fleshy frowths on the vulva, vagina, cervix, urethral meatus, perineum, and anus
• may form large cauliflower-like masses • seen in HPV |
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What are treatment options for HPV?
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• Imiquimod
• Podofilox • cryotherapy, cautery, or laser treatment • Hysterectomy (for high grade changes) |
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What are newborns predisposed to if born by vaginal delivery to a mother with HPV?
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laryngeal papilomatosis
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What is treatment for gonorrhea in non-pregnant patients?
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• Ceftriaxone
OR • Ciprofloxacin OR • Ofloxacin PLUS • Doxycycline OR • Azithromycin |
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What is the treatment for gonorrhea in pregnant patients?
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• Ceftriaxone
OR • Spectinomycin PLUS • Erythromycin OR • Amoxacillin |
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What are treatment options of Chlamydia infections in non-pregnant women?
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• Doxycycline
OR • Macrolides (alternative if PCN allergic) |
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What are treatment options for Chlamydial infections for pregnant women?
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• Erythromycin
• Amoxicillin |
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What is the definition of PID?
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• inflammation of the upper genital tract
• includes the fallopian tubes, uterus, ovaries, and broad ligament |
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When can PID become life threatening?
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if complicated by ruptured tubo-ovarian abscess
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What are physical signs of PID?
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• abdominal tenderness, guarding, rebound
• cervical motion tenderness • purulent vaginal discharge • uterine & adnexal tendeness |
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How many major and minor criteria must be present for a diagnosis of PID?
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3 major and one minor criteria
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What are the major criteria for diagnosing PID?
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• abdominal tenderness
• adnexal tenderness • cervical motion tenderness |
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What are the minor criteria for diagnosing PID?
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• fever (> 38 °C or 100.4 °F)
• leukocytosis • purulent fluid from peritoneal cavity • pelvic abscess on exam or sonogram |
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When should a laparoscopy or laparotomy be performed in patients with PID?
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• laparoscopy:
- with uncertain diagnosis - to lyse adhesions - to drain abscess • laparotomy: in cases of ruptured TOA |
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What are complications of PID?
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• ectopic pregnancy
• Fitz-Hugh-Curtis syndrome • infertility |
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What are symptoms of primary infection of syphilis?
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hard, painless chancre with spontaneous resolution in 3-6 weeks
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What are symptoms of secondary syphilis?
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• systemic disease lasting 2-6 weeks
• fever • headache • lymphadenopathy • skin rash • vulva condylomata lata |
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What are symptoms of tertiary syphilis?
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• aortic aneurysm
• generalized paresis • gummata (destructive necrotic granulomatous lesions) of soft tissues and bones • progressive damage to the CNS and musculoskeletal system • tabes doraslis |
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What is a Jarisch-Herxheimer reaction?
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a flu-like reaction secondary to pyrogen release from treponemes
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