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DU PA GYN infections
Duke PA Gyn Infections
| Question | Answer |
|---|---|
| What is the lifetime risk of contracting an STD | 1 in 4 |
| What age group is the highest at risk population | 15-24 |
| What geographic regions are at highest risk for STD’s | southeast and urban |
| History of sexual intercourse with trauma increases the risk for what STD | Hep B , and Hep C |
| Why would you check the palms of a patient when concerned about STD’s | you are looking for secondary syphilis |
| 3 causes of genital ulcers in US | Herpes simplex virus, primary syphilis, chancroid |
| Herpes ulcers are __ | Painful, small, shallow, may have a clear exudate |
| Secondary herpes ulcers are __ | Smaller, and less dramatic looking than the primary lesions |
| Primary syphilis is a __ | Solitary, painless, indurated, large/deep ulcer |
| Agent responsible for chancroid | H. ducreyi |
| Clinical presentation of lymphogranuloma venereum (LGV) | Rectal ulceration or stricture, inguinal LAD. |
| Etiology of LGV | Chlamydia trachomatis |
| Clinical presentation of granuloma inguinale | Chronic or recurrent ulcerative vulvitis. Donovan bodies on stained direct smear or biopsy of ulcer. |
| What is the etiologic agent of granuloma inguinale | Calymmatobacterium granulomatous |
| What is the etiologic agent of condyloma acuminata | HPV |
| What is the clinical appearance of condyloma acuminata | Papillomatous, white, cauliflower like |
| Vaccine available for HPV | Gardasil |
| Who should Gardasil be offered to | Females 9-26 years old (full benefit if given prior to onset of sexual activity) even if history of hpv |
| Secondary syphilis usually only lasts for __ | A few weeks |
| Clinical appearance of secondary syphilis | Bilaterally symmetrical papulosquamous rash, condyloma, alopecia, denuded tongue, lymphadenopathy (firm, rubbery, non-tender) |
| Secondary syphilis is contagious by __ | Skin on skin contact (any portion of the body) |
| Latent syphilis | period after secondary stage, no clinical manifestation |
| Tertiary syphilis is __ infectious | Rarely |
| Primary diagnosis of syphilis | Darkfield microscopy of chancre |
| Diagnosis of neurosyphilis | CSF examination recommended in symptomatic, late-latent, HIV co-infection (lumbar puncture) |
| What is herpetic whitlow | Herpes on the fingers (especially around the nail bed) |
| Characteristic of primary HSV outbreak | 2-7 day course, systemic symptoms possible, local symptoms (painful), first outbreak is the worst |
| Precipitants of HSV recurrent outbreaks | Sun, wind, trauma, fever, menses, stress |
| __ may reduce transmission of HSV | Antivirals |
| What type of bacterium is chlamydia trachomatis | Intracellular obligate bacteria |
| What is the most commonly reported STI in the US, >1 million infections in 2006 | Chlamydia |
| Who should be tested for chlamydia | Women<26 yo annually, new sex partner in past 60 days, >2 sex partners in past year, exam findings of cervical mucopus/friability/ectopy |
| If you are treating a patient for gonorrhea what else should you treat for | Chlamydia |
| If you are treating a patient for chlamydia do you need to also treat for gonorrhea | Not necessarily |
| Clinical course of chlamydia | Asymptomatic or minor symptoms in majority, vaginal discharge, dysuria, mucopurulent cervicitis, acute urethral syndrome, pelvic pain, lower abdominal pain |
| Perinatal transmission of chlamydia can cause __ | Ophthalmia neonatorum, pneumonia |
| Female chlamydia complications | PID, infertility, ectopic pregnancy, perihepatitis, perinatal transmission |
| What type of bacterium is Neisseria gonorrhea | Gram negative intracellular diplococcus |
| What is the 2nd most commonly reported infectious disease in the US | Gonorrhea |
| Symptoms of gonorrhea | Vaginal discharge, abdominal pain, 50% asymptomatic |
| Female complications of gonorrhea | PID, infertility, ectopic pregnancy, tubo-ovarian abscess, perihepatitis (Fitz-Hugh-Curtis syndrome), septic arthritis, vertical transmission, ophthalmia neonatorum |
| Offer __ testing for all patients evaluated for STIs | HIV |
| Acute HIV symptoms | Fever, mono-like illness, diarrhea |
| Which hepatitides are commonly sexually transmitted | A, B, and C (especially B) |
| Vaccinations are available for which hepatitides | A and B (no hep C vaccine available yet) |
| Males voiding within __ before urethral culture washes secretions away | 1-2 hours |
| Best source of HSV for testing | Unroofing the vesicle |
| Gold standard for HSV testing | Culture |
| __% of US population have positive herpes antibodies on serological testing | 50 |
| Etiology of syphilis | Treponema pallidum spirochete |
| How many stages of syphilis are there | 4 |
| Characteristic of acute syphilis. Chancre develops on skin near infection site about __ after inoculation | 3-6 weeks |
| Characteristic of secondary syphilis | Maculopapular rash often on palms and soles, generalized lymphadenopathy, typically lasts about 3 months |
| How long does the acute syphilitic chancre last | 5-6 weeks |
| How long may syphilis remain inactive | Up to 5 years |
| About how many patients with latent syphilis progress to tertiary phase | 2/3 |
| What is tertiary syphilis | End organ manifestation, including CNS, cardiovascular and ocular |
| VDRL becomes positive __ after inoculation with Syhpilis | About 2 weeks |
| What will gram stain show for positive Gonorrhea infection | Gram negative intracellular diplococci |
| If a patient is infected with Gonorrhea they are probably also infected with __ | Chlamydia |
| What is the etiology of Chancroid | Haemophilus ducreyi |
| Chancroid is most often a co-infection with what | Herpes and or syphilis |
| Gram stain with a “school of fish” appearance is probably what | Chancroid (Haemophilus ducreyi) |
| What is the most frequently occurring STD in developed countries | Chlamydia |
| Chlamydia is most prevalent in what population | <20 yr olds, nulliparous, users of non-barrier contraceptive methods |
| What are the 4 methods for diagnosis of HIV | Detect antibodies to the virus, detect viral p24 antigen, detect viral nucleic acid, culture HIV virus |
| What is the most widely used method to diagnose HIV | Detection of antibody to HIV |
| What is the most common cause of false positive tests for HIV in low risk patients | Recent immunization |
| What is the initial screening for HIV | EIA enzyme immunoassay (EILISA) |
| What is the confirmatory test for HIV (done after the screening test) | Western blot or IFA (Immunofluorescence Assay) |
| Multiple, vesicular, pruritic, painful, recurrent rash | Herpes simplex |
| Single, heaped up or rolled edge, textbook case never painful | Syphilitic chancre |
| Most appropriate way to test for herpes | Culture (not serological) |
| Trichomonas is tested for by use of what | Wet prep |
| Treatment for contact dermatitis | 1% hydrocortisone cream and removal of offending agent |
| What causes the fishy odor in bacterial vaginosis | Anaerobes |
| What do you look for on microscopic examination to show the presence of bacterial vaginosis | Clue cells (epithelial cells with irregular borders in clusters, very shiny) |
| Bacterial vaginosis requires 3 of 4 criteria. What are the 4 criteria | Typical discharge, alkaline pH(5.0-5.5), positive “whiff” test, clue cells on wet prep |
| Bacterial vaginosis is not considered an __ | STD |
| Treatment for bacterial vaginosis | Metronidazole or clindamycin, topical or orally |
| Should you treat male partners of women with bacterial vaginosis | No |
| Signs and Symptoms of trichomonas vaginitis | Severe pruritus, malodorous (musky) discharge, dysuria, dyspareunia, may be asymptomatic, greenish-yellow/frothy discharge, petechiae or “strawberry markings on cervix |
| Treatment for trichomonas vaginitis | 2gm metronidazole stat, treat partners, look for other STDs |
| Treatment for yeast vaginitis | Over the counter imidazoles, oral fluconazole 150mg stat |
| Atrophic vaginitis often masquerades as what | Infection |
| Signs and symptoms of atrophic vaginitis | Pruritis/burning, vaginal dryness, dyspareunia, possibly spotting, pale/thin vaginal mucosa, loss of vaginal rugation |
| Bilateral Bartholin’s abscess said to be associated with what | Gonorrhea |
| Treatments for Bartholin’s gland abscess if not pointing | Antibiotic treatment may be successful |
| Treatment for Bartholin’s gland abscess | I&D and placement of Word catheter (left in for 1-2 weeks), marsupialization, needs to remain open to avoid recurrence |
| What organism is associated with toxic shock syndrome | S. aureus/endotoxins |
| Woman with flu like symptoms, on her period think | Toxic shock syndrome |
| CDC case definition of __ ; fever >38.9 C, hypotension, diffuse erythroderma, desquamation, involvement of at least 3 organ systems | Toxic shock syndrome |
| Treatment for toxic shock syndrome | Supportive, look for foreign body in vagina and remove, clindamycin and oxacillin/nafcillin, MRSA: clindamycin and vancomycin/linezolid |
| Common condition in which microorganisms spreads from the lower genital tract infect and inflame upper genital tract structures including the endometrium, tubes, ovaries and peritoneum | Pelvic inflammatory disease |
| Symptoms of PID | Abdominal pain, dyspareunia, possibly fever/chills, possibly RUQ pain |
| Start empiric treatment for these 3 CDC minimum criteria for PID | Lower abdominal tenderness, adnexal tenderness, cervical motion tenderness |
| In addition to the 3 CDC minimum criteria what are the additional criteria for PID | Elevate oral temp (>101), abnormal cervical or vaginal discharge, elevated ESR, Elevated C-reactive protein, positive GC or chlamydia, increased WBC |
| Which PID patients need hospitalization | Nulliparous/adolescents/non compliant, pregnant, treatment failure, HIV/immunosuppression, unable to tolerate oral regimen, Tubal ovaria cyst, severe peritonitis/uncertain diagnosis |
| Violin string adhesions between liver and parietal peritoneum, RUQ pain may be prominent symptom especially in young women, PID complication | Fitz-Hugh-Curtis syndrome |
| What cancer is a sexually transmitted infection caused by HPV | Cervical cancer |
| Risk factors for cervical cancer | Smoker, hormones, multiple sexual partners, sex before 18, HIV, poor SES, age, multiple pregnancies, chlamydia infection, diet low in fruit and vegetables |
| Effective methods to prevent cervical cancer | Routine pap tests, avoid smoking, condom use, limit partners, HPV vaccine |
| Low risk HPV strains | HPV-6, and HPV-11 (cause genital warts) |
| High risk strain | HPV-16 and HPV-18 |
| What is the HPV vaccine | Gardasil (HPV 6,11,16,18) |
| Bilateral papulosquamous rash on palms and soles | Secondary syphilis |
Created by:
bwyche
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