MED II Vosk exam- Common Vaginal/Vulvar conditions

what is responsible for the pH of the vagina

glycogen being metabolized into lactic acid, creating a pH of 3.8-4.2

how does candida sp overgrowth occur from abx

abx kills bacteria in vagina so yeast can overgrow.

a healthy vaginal microbiome is dominated by what bacteria

lactobacillus species. then following is atopobium vaginae, megasphaera, leptotrichia

imbalance of normal vaginal flora. loss of vaginal acidity so loss of lactobacilli dominance so alkalization of vagina so overgrowth of pathogens, specifically G. vaginalis. happens with new or multiple sex partners, douching, IUD devices. this dz is

bacterial vaginosis

non irritating, malodorous vaginal discharge. thing grey-white discharge. vaginal mucosa and and cervical epithelium are nl. no CMT or pelvic pain

bacterial vaginosis

amsel’s diagnostic criteria for bacterial vaginosis

¾ criteria: thin, white, homogenous discharge. ph >4.5, pos amine whiff test, clue cells under microscope

how to tx bacterial vaginosis

metronidazole PO or intravaginally. clindamycin cream intravaginally. metro = don’t drink alc.

this dz is secondary to Candida albicans. sx of genital burning, pruritis, dyspareunia, dysuria, curd-like or cottage cheese like discharge. vaginal mucosa and cervix can be erythematous and friable. no CMT

yeast vulvogaginitis

tis dz has sporadic or infrequent episodes, mild to moderate, C. albicans, non immunocompromised pt with yeast infections.

uncomplicated yeast vulvovaginitis

this pt has recurrent (4 or more eps a yr), is severe, non-albicans sp., pt also has DM, HIV, debilitation, immunosuppressive therapy, or other immunocompromised state

complicated yeast vulvovaginitis

how to diagnose yeast infection

budding yeasts, pseudohyphae, large WBC ct, ph <4.5, amine whiff test is negative, order a yeast culture if nonalbicans sp is suspected.

how to tx uncomplicated yeast infection

short OTC topical antifungal OR single dose fluconazole

how to tx complicated yeast infection

7-14 day topical therapy OR fluconazole every 3rd day for 1 week (days 1,4,7).

how to tx severe yeast infection

7-14 days topical azole or 2 doses fluconazole

how to tx non albicans sp yeast infection

7-14 days of non fluconazole azole tx as first line therapy

this dz is a parasitic flagellated protozoan transmitted thru sexual intercourse. transmitted thru fomites like towels or toilet seats. vaginitis in women and maybe urethritis in men but usually asx. is STI

trichomonas

pt has malodorous, green to yellow frothy vaginal discharge. can have vaginal pruritis and irritation. dysuria, strawberry cervix from inflammation and hemorrhages.

trichomonas

how to tx trichomonas

metronidazole

inflammatory process in pts with vaginal atrophy due to dec estrogen from menopause. leads to changes in vaginal microbiome, dec amounts of lactobacillus sp and overgrowth of pathogens. pt has vulvovaginal dryness, itchy, dyspareunia, abnormal vaginal discharge, post coital pain, urethral pain, hematuria.

atrophic vaginitis

how to tx atrophic vaginitis

localized estrogen therapy cream

what type or organism is neisseria gonorrhoeae

gram negative diplococci

male pt has dysuria, white/yelow/green urethral dischage that disappears in at most 2 weeks. testicular pain from urethral infx and epididymitis. women have dysuria, inc discharge, vaginal bleeding between periods. both get rectal infection in men and women, including discharge, anal itching, bleeding, or painful BM.

gonorrhea

how to tx gonorrhea

one dose of IM ceftriaxone 500mg in the glute. if in eye erythromycin ointment in neonates

bacteremic spread of Neisseria gonorrhoeae. clinical manifestation of disseminated gonococcal infection. 

gonococcal arthritis, can be localized septic or arthritis-dermatitis syndrome.

how to tx gonococcal arthritis

ceftriaxone or doxy 

this gonococcal infection occurs thru the vertical transmission of gonorrhea. pt is a newborn and is sowing sx in 2-5 days of life. they have chemosis, mucopurulent discharge, eyelid edema, globe tenderness, preauricular LAD

gonococcal conjunctivitis

how to tx gonococcal conjunctivitis

erythromycin or tetracycline as prophylaxis in neonates. ceftriaxone or cefotaxime in high risk neonates.

if a newborn is showing signs of conjunctivitis within the first 24 hours of life what is the likely causde

chemical conjunctivitis

what STI is responsible for the greatest number of STIs and majority of infection related blindness worldwide. it can manifest as cervicitis, urethritis, PID, perihepatitis, proctitis. cervix is most commonly infected site for women. pt has vaginal discharge, bleeding, abdominal pain, dysuria, postcoital bleeding or spotting bw menses

chlamydia

infants born to mothers with chlamydia develop conjunctivitis within how many days of life

5-14 days

how to tx chlamydia

doxy and azithromycin in pregnancy

leading infectious cause of blindness worldwide

trachoma

this infection is spread by direct/indirect transfer of eye or nasal secretions, usually in preschool kids. particular species of flies that pick up discharge. inside of eyelid becomes severely scarred, turning eyelashes inward causing them to rub on globe = corneal scarring. this dz is

trachoma

inflammation of the upper genital tract from infection. affects uterus, fallopian tubes, and ovaries. ascending infection spreading from lower genital tract. mostly related to STIs, most commonly gonorrhea and chlamydia.

PID

pt has lower abdominal/pelvic pain, vaginal discharge, dyspareunia, and abnl vaginal bleeding. pt has intercourse with multiple partners, has has a previous STI, and not use protection. this dz is lower abdominal pain and fever, + CMT (cervical motion tenderness), yes friable cervix. do more testing to confirm dz.

PID

how to tx PID

ceftriaxone AND doxy. if inpt then doxy and ceftriaxone and metronidazole. if pregnant then azithromycin 

inflammation of liver capsule with adhesions resulting in right upper quadrant pain. uncommon chronic manifestation of PID. pt is less than 25 yrs old, has has a hx of PID, is on oral contraceptives, has RUQ abdominal pain worse when moving and breathing. pt can also have lower abdominal, pelvic, or back pain. also pt has fever, chills, n/v, discharge, dyspareunia, dysuria, cramps, postcoital bleeding. PE shows CMT, adnexal tenderness, uterine compression tenderness on bimanual exam. this dz is

fitz-hugh curtis syndrome

what is the most common pathogen involved in PID

chlamydia trachomatis

how to diagnose PID

CT shows inc perihepatic enhancement, pelvic fat infiltration. also pyosalpinx, tubo ovarian abscess, fluid in pelvic cavity. transvaginal ultrasolographic scan used when PID picture is unclear, shows hydrosalpinx, pyosalpinx endometritis, oophoritis. MRI shows tubo ovarian abscess, edematous tubes, or free pelvic fluid collection. laparoscopy!!

gold standard for diagnosing FHCS and PID

laparoscopy shows edema with exudates on tubal surfaces, ectopic pregnancy, tubo ovarian abscess. FHCS dx with visualization of adhesions b/w diaphragm and liver OR liver and anterior abdominal wall

how to tx PID

ceftriaxone, doxy, metro

ulcerative STI of genitals caused by Chlamydia trachomatis and transferred by vaginal, oral, or anal sex. gram negative. common in tropical and subtropical areas of the world.

lympogranuloma venereum (LGV)

3-12 days after exposure. painless genital ulcer or papule or in mouth. usually unnoticed bc no other sx. lesion heals after days

primary stage of LGV

2-6 weeks after primary stage. uni/bilateral tender inguinal and femoral lymphadenopathy aka buboes. body aches HA fever. anorectal syndrome presents which is proctitis or proctocolitis like syndrome, so pain during urination, rectal bleeding, pain during stool passing, ab pain, anal pain. if thru anal route then body ache, HA, fever. if thru oral route then cervical lymphadenopathy.

secondary stage of LGV

if LGV is left untreated what can happen

necrosis and rupture of lymph nodes. anogenital fibrosis, strictures. anal fistulae.

how to tx LGV

doxy, erthyro, aspirate the buboes

extremely rare STI caused by haemophilis ducreyi. not easily available in labs. can cause the transmission of HIV 50- 300- fold per each unprotected encounter of vaginal intercourse. incubates for 4-10 days. usually in younger males and sex workers. lesion is usually on prepuce, glans, labia, introitus, perianal. pthas multiple ulcers that come together “kissing”. tender often unilateral regional LAD

chancroid

how to dx chancroid

one or more painful genital ulcers. appearance of genital ulcers, regional lymphadenopathy. no evidence of treponema infection. herpes simplex virus PCR test or culture performed on exudate is -.

how to tx chancroids

spontaneously resolve in 1-3 months. azithromycin 1 dose or ceftriaxone 1 dose