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STD Review/ PID / Infections in Pregnancy
Terms in this set (40)
What is the most common overall bacterial cause of STIs?
Clinical manifestations of chlamydia
Urethritis: purulent discharge, pruritus, dysuria, dyspareunia, hematuria, men asymptomatic
PID: abdominal pain + cervical motion tenderness
Lymphogranuloma venereum: genital/ rectal lesion with softening
How to diagnose chlamydia?
Nucleic acid amplification for C. trachomatis
Treatment is Azithromycin (Zithromax) 1 gm po x 1 dose or doxycycline 100 mg po bid x 7 days
Azithromycin safe in PG
What is the incubation for Neisseria gonorrhea?
2-8 days --> gram negative diplococci
Clinical manifestations of gonorrhea
Urethritis and cervicitis: anal, vaginal, penile, pharyngeal discharge, PID, epididymitis, prostatitis
Disseminated gonococcal infection
Triad of polyarthralgias, tenosynovitis, and vesiculopustular skin lesions (dermatitis)
chills, fever, malaise +/- purulent septic arthritis esp in women during menses
Diagnosis of gonococcal infection
Nucleic acid amplification for N. Gonorrhoeae (first void/catch if urethritis), if disseminated take samples from multiple sites (rectal, urethral, cervical, pharyngeal)
•Ceftriaxone (Rocephin) 250 mg IM
•Azithromycin (Zithromax) 1 gm po x 1 dose
both safe in PG
chronic infection caused by the spirochete Treponema pallidum
known as the 'great imitator' because the rash and disease can present in many different ways similar to other dx
transmission of syphilis
direct contact of mucocutaneous lesion (sexual activity) and also to fetus via placenta
Painless ulcer at/near infection site with raised indurated edges + nontender regional lymphadenopathy near the chancre site lasting 3-4 weeks
Sx may occur for weeks - 6 months after initial sx.
Maculopapular rash (esp palms and soles), condyloma lata (wart like moist lesion), with systemic sx (fever, lymphadenopathy, arthritis, HA, hepatitis, alopecia)
May occur from 1 to >20 yrs after initial or latent infection
Gumma (noncancerous granulomas on skin/body tissue), Neurosyphilis (HA, meningitis, dementia, hearing/vision loss, incontinence), CV effects (aortic regurig, aortitis, AAA)
Degeneration of dorsal columns and dorsal roots due to tertiary syphilis, resulting in impaired proprioception, burnging, weakness
Associated with charcot's joints, shooting (lightning pain)
Argyll Robertson pupil
Constricts w/ accommodation but is not reactive to light. Associated w/ tertiary syphilis.
•Treatment with Bicillin L-A - benzathine penicillin (2.4) for any stage of syphilis
•NOT Bicillin CR which is a combination of benzathine, procaine PCN or oral PCN
NO alternative, so if PCN allergic, must first desensitize
what is the leading cause of infertility and ectopic PG?
pelvic inflammatory disease
ascending infection of the upper reproductive tract
MC due to chlamydia
Risks for PID
multiple sex partners, unproducted sex, ages 15-19, nulliparous, IUD placement
Symptoms of PID
pelvic or lower abdominal pain, dysuria, dysparenia, vaginal discharge, bleeding, n/v, cervical motion tenderness, purulent cervical discharge, fever
cervical motion tenderness (moving cervix back and forth)
RUQ pain: Perihepatic inflammation & fibrosis in the setting of PID
Complication of Chlamydia infection
Minimum diagnostic criteria to treat PID
•Women with CMT, uterine or adnexal tenderness should be treated as PID with antibiotics (unless another diagnosis: appendicitis, ectopic)
Other things that support: fever 100.9, abnormal discharge, elevated ESR/CRP, positive culture for GC/Chlamydia
Diagnostic criteria to diagnose PID
•Pelvic and vaginal US: ectopic, ovarian cysts; ovarian torsion, TOA, PID
•Laparoscopy: if not responding to antibiotics in 48 hours of if no clear diagnosis: can visualize appendix, ovaries and surrounding areas for infection
When to admit your PID patient
•When they have a TOA
•If patient is pregnant
•Patient is unable to follow or tolerate an outpatient regimen
•Patient has failed 72 hours of outpatient treatment
•Severe illness with fever, vomiting
•If unable to rule out other surgical emergencies like appendicitis, admit for serial exams and monitoring
Inpatient treatment for PID
IV cefoxitin/cefotetan (2g, q12 hrs) + IV Doxycycline (2g, q12 hrs)
IV Clindamycin + Gentamicin (if PCN allergy or Tubo-ovarian abscess)
Outpatient treatment for PID
Ceftriaxone (250mg IM x1) + doxycycline (100mg x14 days).
Metronidazole (500mg, BID, x14 days) often added if BV is associated
Levo + Metronidazole if PCN allergy
surgical implications for PID
•TOA my require surgical excision or transcutaneous or transvaginal aspiration
•Total hysterectomy may be required for overwhelming or chronic infections
Does PID affect fertility?
•Future ectopic pregnancy
•Infertility: risk increases with repeated episodes: 10% after 1st, 25% after a second, and 50% after a third
Why are pregnant women more prone to UTIs?
Due to altered secretions of steroid sex hormones and the pressure exerted by the gravid uterus on the ureters and bladder cause hypotonia and congestion and predispose to urinary stasis
Treatment of UTIs in pregnancy
Nitrofurantoin (100 mg orally twice daily), ampicillin (250 mg orally four times daily), and cephalexin (250 mg orally four times daily) are acceptable medications for 4-7 days.
E. coli is the MC
Risks of UTI and PG
up to 15% of PG women have asymptomatic bacteriuria --> pyelonephritis will develop in 20-40% of these women if untreated
associated with an increased risk of preterm birth
Adverse perinatal outcomes associated with group B streptococcal colonization
urinary tract infection, intrauterine infection, premature rupture of membranes, preterm delivery, and postpartum metritis.
postpartum metritis puerperal sepsis
Occurs within 21 days and is most common within 10 days of delivery.
Metritis is characterized by an enlarged uterus and a watery red-brown fluid to viscous off-white purulent uterine discharge, which often has a bad smell.
Neonatal outcomes if mom has GroupB strep
common cause of neonatal sepsis, these infections can contribute markedly to chronic morbidity, including mental retardation and neurologic disabilities, meningitis.
prevention and prophylaxis for GroupB strep
Screening and prophylaxis for group B streptococcal
Syphilis and PG
Untreated syphilis in pregnancy can cause late abortion, stillbirth, transplacental infection, and congenital syphilis.
Gonorrhea and PG
Gonorrhea can produce large-joint arthritis by hematogenous spread as well as ophthalmia neonatorum.
Chlamydia and PG
Maternal chlamydial infections are largely asymptomatic but are manifested in the newborn by inclusion conjunctivitis and, at age 2-4 months, by pneumonia.
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