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50 Cards in this Set
- Front
- Back
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What causes atrophic vaginitis?
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Irritation + inflammation 2/2 atrophy of vaginal mucosa
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General symptoms of vaginitis?
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Increased vaginal discharge
Malodorous discharge Vaginal or vulvar pruritis or burning, edema, erythema Dyspareunia |
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How to distinguish causes of vaginitis from one another?
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Pex of vagina & vulva
Determine fluid pH Micro eval of fluid w/ saline & KOH Whiff test |
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Positive Whiff test means?
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Bacterial vaginosis
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Thick, white “cottage cheese” appearance of vaginal fluid?
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Candidiasis
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See the organism under the microscope when examining vaginal fluid sample in which 2?
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Candidiasis and Trichomoniasis
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Can see clumping of bacteria onto epithelial cells in micro eval of vaginal fluid in which disease?
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Bacterial vaginosis
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Which 3 species causes candidiasis?
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C. albicans (budding hyphae)
C. tropicalis (budding hyphae) C. glabrata (spores) |
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Symptoms of candidiasis?
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Vulvar itching/burning
+/- Bladder sx (may be misdiagnosed as cystitis) Thick, white discharge |
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Tx candidiasis?
1 PO 5 topical |
po: fluconazole (diflucan)
top: miconazole (monistat) clotrimazole (mycelex, lotrimin) tioconazole (vagistat) terconazole (terazol) butoconazole (femstat) |
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What is thought to be the mechanism behind recurrent yeast infections?
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Colonization of the GI tract which serves as a repository
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Tx recurrent yeast infections?
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Prolonged course of PO antifungals (fluconazole or ketoconazole)
Vaginal applicants of boric acid, gentian violet |
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Tx bacterial vaginosis?
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PO or vaginal metro or clinda (flagyl, metrogel, cleocin)
Treat sexual partners if recurrent infections |
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T or F Metro or Clinda are safe throughout pregnancy
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TRUE
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Trichomonads are unicellular or multicellular?
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Unicellular
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Cause of atrophic vaginitis?
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Inadequate estrogen
Associated with menopause, breastfeeding |
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Tx of atrophic vaginitis?
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Supplemental estrogen (locally in vagina or systemic)
NO ABX needed |
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Most common STDs? (5)
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Chlamydia
Genital herpes Gonorrhea Syphilis Trichomoniasis |
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Gonorrhea primarily infects upper or lower genital tract
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Upper
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Diagnose syphilis via?
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RPR or VDRL
Confirm with fluorescent-labeled treponema Ab test (FTA) Or Microhemagglutination assay of Ab to T.pallidum (MHA-TP) |
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Diagnose chlamydia via?
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PEx (characteristic discharge)
Culture of d/c mRNA |
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Tx chlamydia?
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Doxycycline
azithromycin A quinolone |
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Which organism causes genital herpes?
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HSV-2 > HSV-1
Infection is chronic! |
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What disease has this presentation:
small vesicles → shallow, painful ulcers on labia, cervix, vaginal mucosa, perineum; may be clusters +/- inguinal adenopathy + vaginal discharge Pain so severe it may require narcotics, topical anesthetics, hospitalization, bladder cath +/- fever & malaise |
Genital herpes
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Difference between primary and recurrent herpes outbreak?
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Primary usu more severe, lasts 12-21d
Recurrent usu 2-5d, more mild |
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When is genital herpes contagious?
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In days prior to and during recurrent outbreak
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What are prodrome symptoms of genital herpes?
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Tingling or burning in affected region
+/- mild systemic symptoms |
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Tx genital herpes? (3)
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Acyclovir
Famciclovir Valacyclovir Tx recurrent for 3d |
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Who should get suppressive tx for recurrent genital herpes?
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Pt's decision.
Usually recommended for pts with >2-3 outbreaks a year Single daily dose is effective to reduce frequency of secondary outbreaks |
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When should you c-section with HSV?
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If woman has prodrome or active lesion at time of delivery
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Prevent need for c-section with HSV?
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Place on antivirals at 36w
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What is Bartholin's gland cyst caused by?
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Dilation of Bartholin's gland DUCT
Gland secrets mucin → gets obstructed, dilates, fills w/ fluid Becomes a soft tissue mass in vulva Is sterile, NOT an infection |
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Difference between Bartholin's gland cyst vs abscess vs malignancy
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Cyst: sterile, clear fluid
Abscess: polymycrobial (maybe nessie gonorrhea), purulent Malignancy: Can present as a cyst, most are benign (biopsy in women >40y) |
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Tx Bartholin's cyst?
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Usu tx only if symptomatic
Incision and drainage (leave Ward catheter in place) Marsupialization (open widely & suture back edges to keep open) Excision (take whole gland and duct out) |
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What is Fitz-Hugh-Curtis syndrome?
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PID that has spread along upper peritoneum to the liver capsule, causing perihepatic adhesions
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What is pelvic inflammatory disease (PID?)
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Spectrum of infection and inflammation involving varying degrees of (depending on severity):
Upper genital tract (endometrium, tubes, ovaries) Surrounding peritoneum |
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Cause of PID?
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Polymicrobial - Infection with STD organism such as GC or CT
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Mechanism of microbial invasion in PID? (2 ways)
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1. Infection of cervix breaks down cervix barrier → infxn ascends → endogenous superinfection of upper tract by aerobic + anaerobic organisms than normally inhabit lower tract
2. Mechanical instrumentation during procedure (e.g., D&C, hysteroscopy, endometrial/cervical biopsy, IUD insertion) (#2 is less common) |
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PID w/GC vs w/CT?
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GC: More acute and severe
CT: Often silent & diagnosed only retrospectively |
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Is there a relationship btw bacterial vaginosis and PID?
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A cause and effect relationship is not proven
They are caused by similar organisms Bac vag is more common in women with PID |
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PID presentation (history)?
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Can be acute pelvic pain & fever (GC), often during or after a period in a sexually active female. Or gradual and less severe (CT)
Often nausea & vomiting |
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What is the classic physical exam finding for PID?
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Chandelier sign (cervical motion tenderness)
Also can get varying degrees of LQ, uterine, and adnexal tenderness |
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Pt with PID, on exam you palpate a unilateral adnexal or cul-de-sac mass is suspicious for?
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Tubo-ovarian abscess (TOA)
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PID findings on speculum exam?
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Mucopurulent discharge coming from cervix
If is more advanced in course, this may have resolved since Nessie or Chlam often will have been eliminated by this point. |
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Lab findings in PID?
In Fitz-Hugh-Curtis? In TOA? |
1) Often positive cervical cultures
Elevated wbcs, ESR, CRP 2) Fitz-Hugh-Curtis: elevated LFTs 3) TOA: may see complex adnexal mass |
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Why does PID often present during or after a period?
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Blood is a good culture medium for PID-causing organisms
Cervical barrier to ascending infection has broken down |
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Other things in DDx for PID?
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GI: appy, diverticulitis, IBD
U: kidney stone, UTI GYN: ectopic pregnancy, septic SAB, endometriosis, degenerating fibroids, ovarian torsion, ruptured ovarian cyst |
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Tests to r/o or r/i PID?
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UPT, cervical gram stain/wet mount, US, laproscopy (“gold standard” for diagnosis but used infrequently)
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Clinical criteria for diagnosis of PID? (4 minimum and 6 supporting)
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Minimum:
Sexually active or recent h/o instrumentation Lower abdominal pain Adnexal and cervical motion tenderness Supporting: >101F (38.3C) Abnormal cervical/vaginal discharge Elevated ESR/CRP & wbcs Positive GC or CT US shows TOA or hydro/pyosalpinx Laproscopy shows tubal inflammation &/o pyosalpinx |
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Which groups are at higher risk for PID?
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Women in late teens and early 20s
Lower socioeconomic status African/Afro-Carribean Women w/ h/o prior PID History of douching Recent sex w/ new partner or multiple partners |
