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30 Cards in this Set
- Front
- Back
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What is PID?
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Pelvic Inflammatory Disease
= inflammatory disorder of upper genital tract, which may involve: - fallopian tubes **most common (most long-term sequelae related to this) - uterus - ovaries - myometrium - peritoneum |
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What is the prevalence of PID?
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1% sexually active women
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What are the risk factors for PID?
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- previous PID
- previous STD - multiple sex partners - IUD - adolescence (less confident to make smart sexual decisions; tendency to think invincible; transformation zone farther out of cervix, so more endocervix exposed, which is more susceptible to bact infection) - recent instrumentation - e.g., endometrial biopsy on post-menopausal women |
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What are the diagnostic criteria for PID?
What is the "gold standard" for DX? |
ALL OF 3 MAJOR CRITERIA:
- lower abdominal tenderness - cervical motion tenderness - adnexal tenderness AT LEAST 1 MINOR CRITERION: - temp > 100.4 F - leukocytosis - sonographically visual mass - purulent material from culdocentesis/*laparoscopy - gram stain for gm neg diplococci - elevated ESR **Laparoscopy = gold standard of dx - go through umbilicus and see pus! |
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What is CVAT?
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Costovertebral Angle Tenderness
- from tapping on lower back - indicates kidney damage (when assessing for PID, rule this out) |
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What is CMT?
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Cervical Motion Tenderness
- detected on bimanual exam from lifting and moving around cervix with fingers |
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What is the pathogenesis of PID?
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Usually ascending organisms from vagina or cervix:
1. Chlamydia Trachomatis 2. Neisseria Gonorrhea 3. Aerobic organisms endogenous to vagina (e.coli, non-hemolytic strep, group B strep, staph) 4. Anaerobic organisms tend to predominate (bactericides, peptostreptococcus, peptococcus) |
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Chlamydia Trachomatis
- mechanism of action - link to PID? - pregnancy problem assoc'd? - tx |
MOA: obligate intracellular parasite that attaches to cervical cells and causes mucopurulent discharge; ascending inflammation causes fibrotic changes in tubes --> insidious onset of salpingitis
- present in 40% hospitalized pts with PID - assoc'd with preterm delivery Tx: - doxycycline 100 mg BID x 7 days (BUT NOT IN PREGNANCY) - azythromycin 1 gm po single dose - erythromycin 500 mg QID x 7 days |
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What is the leading cause of PID?
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chlamydia trachomatis
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Neisseria Gonorrhea
- # cases per year - link to PID? - description of bacteria - MOA - tx |
- 1-2 million cases/year
- 15% women with gonorrhea devlop PID - gram negative diplococcus - MOA: intracellular parasite; produces endotoxin, which attaches to fallopian tubeleading to narrowed tubal lumen; produces Ig protease that deactivates immune system Tx: - Ceftriaxone 125 mg IM single dose - Cipro 500 mg po single dose - Oflaxin 400 mg po single dose !!!PLUS CHLAMYDIA TX!!! - azithromycin 2 gm po single dose |
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Treatment of PID
- outpatient? - inpatient? -- criteria? |
Outpatient
- ceftriaxone 250 mg IM x 7 and doxycycline 100 mg BID x 14 - ofloxacin 400 mg BID x 14 and metronidazole 500 mg po BID x 14 Inpatient Criteria: - uncertain dx - suspected abscess - pregnancy - concurrent illness/immune deficiency - unable to tolerate or non-compliance with outpatient tx - failure to respond to outpatient tx in 48-72 hours = IV tx for 48 hrs or clinical improvement: cefoxitin 2 mg IV Q 12 hrs and doxycycline 100 mg IV Q 12 hrs |
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What are the early sequelae of PID?
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- peritonities
- perihepatitis - tubo ovarian abscess |
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Tubo ovarian abscess
- incidence with PID? - tx success? |
= 7-34% incidence if have PID
- if unruptured: 50-70% successfully treated - if ruptured: 50-70% mortality without tx (usually due to ARDS) |
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What are the late sequelae of PID?
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- ectopic pregnancy - 6-10-fold increase due to tubal decrease in motility and function
- recurrent PID (25%) - chronic pelvic pain = pain > 6 months - tubal infertility risk increases with each episode of PID - 50% incidence of infertility after 3 episodes of PID |
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HSV II
- type of DNA? - incubation period - number of women who are asymptomatic but still shedding virus? |
- dsDNA
- incubation pd: 3-7 days - 1/200 asymptomatic but shedding |
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HSV II Recurrent outbreaks:
- How often (__% in __ months) - when is suppressive tx indicated? how effective is it? |
50% recurrence in 6 months
suppressive tx indicated for >6 recurrences/year --> decreases recurrences by 75% and transmission rates |
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HSV II tx??
- when must it be initiated for effectiveness? |
**Must be initiated during prodrome or within 1 day of onset of lesions to be effective
Acyclovir 400 mg po TID x 7 days Famciclovir 250 mg po TID x 7 days Valacyclovir 1 gm po BID x 7 days |
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What is the % coexistance of G and C?
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45-60%
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What are the criteria for inpatient admission for HSV II?
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- severe headache
- CNS involvement - extreme pain - urinary retention |
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Syphilis
- causative agents? - transmission? |
= treponema pallidum
- transmitted thru sexual contact with mucocutaneous lesions |
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Primary Syphilis
- incubation pd? - sx? |
incubation pd: 21 days
CHANCRE - painless ulcer at site of innoculation; usually vulvar and regional lympadenopathy |
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Secondary Syphilis
- when occurs? - sx? |
- usually 6 wks - 6 months after chancre
- sx: rash on palms and soles of feet (infectious); condyloma lata - smooth, wart-like vulvar lesion (due to hematogenous dissemination) |
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Latent Syphilis
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positive serology without clinical signs and symptoms... can last for months or years
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Tertiary Syphilis
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- Gummas - indolent granulomatous lesions --> cause distruction of liver, bone, skin
Neurosyphilis - paresis, tabes dorsalis CV syphilis - aortic aneurysm |
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Syphilis - diagnosis?
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- suspected by clinical findings and history
- microscopy: corkscrew bacteria moving in spiral fashion - serology screen: VDRL/rpr and definitive test with FTA-ABS/MHA-ATP (later will always be positive) |
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Syphilis tx:
- meds? - pregnancy? Follow-up?? |
Primary, secondary, early latent (<1 year):
- benzathine penicillin (IM) for 1 week - if allergic, tetracycline or doxycyline Late latent or tertiary (>1 year) OR unknown duration: - penicillin for 3 weeks Pregnancy: must use PCN (if allergic, must desensitize) Follow-up: expect titer (VDRL/RPR) to go to zero(if not, must be resistent, so re-treat) **FTA-ABS/MHA-ATP always positive!!!!!! |
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What is the most common viral STD?
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HPV!
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HPV
- incubation pd? - transmission? - strains? |
incubation pd: 1-8 months
transmission: skin-to-skin (so condom isn't 100% protective) strains 16-18: pre-malignant/malignant lesions of vulva, vagina, cervix strains 6, 11: benign lesions (condyloma acuminatum) |
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HPV
- dx? |
dx:
- direct inspection for warts (generally on moist skin) - pap smear for cervical/vaginal lesions; HPV typing with PCR |
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HPV
- tx for warts? - tx for cervical lesions? |
Warts:
patient-applied - podofilox, imiquod practitioner-applied - TCA, podophylin, surgical removal Cervical lesions: - close-monitoring for progression - oblation with cryosurgery - excision with electrocautery or cold knife |
