Women's Health Exam 2

asymptomatic

MC symptoms of STIs

chlamydia

MC bacterial cause of STI, often asymptomatic, dysuria, abnormal mucopurulent vaginal discharge

chlamydia trachomatis

gram negative coccoid or rod-shaped bacteria that causes chlamydia

chlamydia

causes PID when ascends to upper reproductive tract

NAAT

diagnostic test of choice for chlamydia and gonorrhea

doxycycline 100 mg PO BID x7 days

treatment of chlamydia

azithromycin 1g PO x1 dose

treatment of chlamydia in pregnant patient

Reiter's syndrome

occurs 2-6 weeks after GI/GU infection, triad of conjunctivitis, non-gonococcal urethritis, arthritis

lymphogranuloma venereum

chlamydia trachomatis serotypes L1, L2, L3; primary infection causes painless ulcers, secondary causes inguinal syndrome

doxycycline 100 mg PO BID x21 days

treatment for lymphogranuloma venereum

neisseria gonorrhoeae

gram negative obligate intracellular diplococci bacteria that causes gonorrhea

gonorrhea

2nd most common STI, infection may facilitate HIV transmission, major cause of urethritis & cervicitis, manifests as vaginal pruritus and/or mucopurulent discharge (greenish/yellow)

septic arthritis

inflammation of the joint caused by infection; complication of gonorrhea

gram stain

may be used to diagnose gonorrhea in symptomatic men

ceftriaxone 500 mg IM x1 dose

treatment for gonorrhea

gentamicin, azithromycin

alternatives for gonorrhea if ceftriaxone allergy

pelvic inflammatory disease

infection in the upper genital tract, ascending infection, associated with risk of ectopic pregnancy, chronic pelvic pain, infertility, affected by timing of menstrual cycle; patient presents with lower abdominal/pelvic pain, vaginal discharge, abnormal bleeding, purulent discharge, cervical motion tenderness, rebound tenderness, adnexal tenderness, mass/fullness

prior PID

greatest risk factor for PID

PID

pelvic/lower abdominal pain with at least 1 of the following symptoms: cervical motion tenderness, uterine tenderness, adnexal tenderness

ceftriaxone 500 mg IM + doxy 100 mg BID x14 days + metronidazole 500 mg BID x14 days

outpatient treatment for PID

Fitz-Hugh-Curtis syndrome

perihepatitis, PID, RUQ pain, fibrosis, and scarring from ascending infection

genital herpes

herpes simplex virus infection that appears on vulva, vagina, cervix, perineum, perianal skin; painful cluster of vesicles that lyse and progress to shallow, painful ulcers with a red border

HSV1

oral herpes, associated with cold sores, less likely to re-occur

HSV2

genital herpes

aseptic meningitis

complication of genital herpes; presents with fever, HA, meningismus, occurs in some patients 5-7 days after appearance of genital lesions

viral culture

gold standard diagnostic for genital herpes infection

PCR

gold standard diagnostic for HSV infection of the CNS

Tzanck smear

used to diagnose HSV; multinucleated giant cells

acyclovir, famciclovir, valacyclovir x7-10 days

treatment for genital herpes

human papilloma virus

most common STD in the US, transmitted via intimate skin to skin contact, 90% cleared by body's immune system within 2 years and without treatment, typically asymptomatic

HPV 6, 11

low risk HPV strains

HPV 16, 18

high risk HPV strains for cervical cancer

Gardasil9

HPV vaccine distributed in the US; covers strains 6, 11, 16, 18, 31, 33, 45, 52, 58

condyloma acuminata

genital warts caused by HPV 6 and 11, often asymptomatic, pruritus, bleeding, burning, tenderness/pain, vaginal discharge, soft and fleshy growths 1-5mm but can evolve into cauliflower-like growths

podofilox, imiquimod, sinecatechins

patient administered treatment options for condyloma acuminata

cryotherapy, TCA, surgery

provider administered treatment options for condyloma acuminata

treponema pallidum

spirochete that causes syphilis

primary syphilis

first stage of disease, small painless chancre, appears 3 weeks after infection, heals spontaneously without therapy

secondary syphilis

occurs weeks to months after chancre development, acute systemic manifestations (fever, HA, fatigue, myalgia, LAD), macular-papular skin rash on palms and soles, flat moist papules called condyloma lata (warts)

tertiary syphilis

patients with late syphilis who are symptomatic; may have CV symptoms (aortic aneurysm/insufficiency), gummas, CNS involvement (tabes dorsalis, argyll robertson pupil)

tabes dorsalis

loss of proprioception, associated with tertiary syphilis

argyll robertson pupil

pupil accommodates but does not react to light

latent syphilis

patient is infected by asymptomatic, can be early or late (before/after 1 year of infection)

neurosyphilis

infection of the CNS by t. pallidum

lumbar puncture, VRDL

diagnostic for neurosyphilis

VDRL or RPR then FTA-ABS

serology testing for syphilis diagnosis

non-treponemal

screening test for syphilis

treponemal

confirmatory test for syphilis

benzathine penicillin G 2.4 million units IM x1 dose

treatment for primary, secondary, early latent syphilis

benzathine penicillin G 2.4 million units IM weekly x3 doses

treatment for late latent, tertiary, or unknown syphilis

IV penicillin q4 hours x10-14 days

treatment for neurosyphilis

Jarisch Herxheimer reaction

acute, self-limited, febrile reaction that occurs within the first 24 hours after patient receives therapy; most common after treatment for primary syphilis

15-65

recommended age for HIV screening

HIV-1

type of HIV most common in the US

HIV

RNA retrovirus that targets helper T cells (CD4) and monocytes; initial infection presents as a mono-like illness

antigen immunoassay, western blot

diagnostic of HIV

AIDS

CD4 <200 or defining illness

hepatitis C

most common chronic bloodborne infection in the US

donovanosis

klebsiella granulomatis, rare in the US, affects men twice as much as women, often between 20-40 years; papule or nodule that evolves into large painless ulcer (clean, friable bases with distinct, raised, rolled margins, beefy red)

donovan bodies

seen on dark-staining with donovanosis

azithromycin 1 g weekly until ulcer heals

treatment of donovanosis

chancroid

Haemophilus ducreyi; multiple, painful genital ulcers and tender suppurative inguinal adenopathy

PCR

used to confirm chancroid diagnosis

oral azithromycin or IM ceftriaxone

treatment of chancroid

molluscum contagiosum

DNA poxvirus; small, painless, pearly papules dome with umbilicated center, appear on genital region/inner thigh/buttocks, resolve spontaneously within 6-12 months

pediculosis pubis

crab louse, phthirus pubis, itching in pubic areas

permethrin cream

treatment for pediculosis pubis and scabies

scabies

human itch mite, Sarcoptes scabiei, itching in pubic area, generally worse at night

internal os

upper part of cervix that opens into the endometrium

external os

lower part of the cervix that opens into the vagina

ectocervix

vaginal surface of cervix, seen during speculum exam

columnar epithelium

surrounds external os; plushy, red, resembles lining of uterus

squamous epithelium

continuous with vaginal lining, shiny pink outer layer

squamocolumnar junction

area where two types of cervical epithelia meet

transition zone

area between original SCJ (on ectocervix) and active SCJ; represents newest and least mature cells in cervix; 90% of neoplasms arise from this site; targeted in pap smear

cervical intraepithelial neoplasia

premalignant changes in cervical epithelium, usually at the transformation zone; postcoital bleeding/spotting; can take 3-7 years to develop into cancer

cervical carcinoma

90% caused by HPV, 3rd MC gynecologic cancer, preventable, average age 40-50; asymptomatic early, watery vaginal discharge, odorous, intermittent spotting, postcoital bleeding, abnormal vaginal bleeding, pelvic pain/pressure

SCC

MC type of cervical cancer

adenocarcinoma

AGUS pap smear suggests this type of cervical cancer

colposcopy

diagnostic procedure of choice for cervical cancer

pap smear

screening test for cervical dysplasia/CIN

pap alone every 3 years

cervical cancer screening recommendation age 21-29

pap alone every 3 years, hrHPV testing every 5 years, or hrHPV and cytology cotesting every 5 years

cervical cancer screening recommendation age 30-65

bethesda classification system

classifies the various possible results of cervical cytology, used to determine management guidelines

ASCUS

changes in cervical cells, least concerning of abnormal pap results

LSIL

cervical cells show mildly abnormal changes

HSIL

cervical cells show more serious changes, more likely to be linked to precancer/cancer

ASCH

atypical squamous cells on pap, cannot exclude HSIL

AGC

atypical glandular cells on pap

reflex HPV or repeat pap in 1 year

<25 with no PMH and ASCUS pap next steps

repeat pap in 1 year

<25 with no PMH and ASCUS + HPV next steps

repeat pap in 1 year

<25 with no PMH and LSIL next steps

colposcopy

<25 with no PMH ASC-H or HSIL next steps

colposcopy

>25 with ASCUS, LSIL, HSIL, ASC-H plus HPV next step

colposcopy with directed biopsy

technique of choice for evaluation of abnormal pap; magnified view of abnormal transformation zone and extension into endocervical canal; entire SCJ must be visualized, use acetic acid to highlight dysplastic cells

endocervical curettage

small curette used to collect cells from endocervical canal; used to detect disease farther inside cervical canal where colposcope cannot reach

Monsel's solution

coagulant that helps control bleeding; thick and looks like mustard; applied to cervix and turns into a coffee ground substance

CIN 1

colposcopy result that shows mild changes in the cells that usually go away on their own without treatment

CIN 2

colposcopy result that shows moderate changes

CIN 3

colposcopy results used for severe (high-grade) changes