Women's Health - Gyn Infections - EXAM 2
Terms in this set (50)
What is Pelvic Inflammatory Disease (PID)?
Infection of upper genital tract by pathologic organisms
Pelvic Inflammatory Disease (PID) MOST COMMONLY cased by ______ and______
Pelvic Inflammatory Disease (PID) MOST COMMONLY cased by chlamydia, gonorrhea; They damage the:
normal cervical barriers to ascending infection
What are the risk factors for PID? (4)
<25 yrs, multiple partners, prior PID, lack of barrier contraception
What are the s/sx of patients with PID?
-Chlamydia is most commonly asymptomatic
-Pelvic pain is most common presentation for care*
-Fever, cervical motion tenderness less common
PID that is caused by _______ is most commonly Asymptomatic.
What is the MOST COMMON presentation of PID?
What are the physical findings of PID?
Variable: Mucopurulent discharge, cervical motion tenderness (CMT) - NOT very specific, fever all possible but often absent
What are the labs findings of PID?
-Positive GC/C-zyme is definitive but take about 1 day to return
-Elevated WBC and ESR possible but not common
Laparoscopy useful for laboratory findings for PID but too INVASIVE - trial of ______ first*.
For laboratory finding of PID culdocentesis virtually useless and barbaric; Needle aspiration of:
posterior aspect of vagina into culdesac of douglas.
How do you diagnose patient with PID?
-High incidence of suspicion based on risk factors***
-Pelvic pain of any type is most reliable symptom
When you diagnosing patient with PID remember to r/o:
pregnancy (ectopic), appendicitis, ovarian (cyst) etiology
When you diagnosing patient with PID remember to r/o: pregnancy (ectopic), appendicitis, ovarian (cyst) etiology; What test may be useful for that?
How do you manage patients with PID?
Better an error of commission than an error of omission
-Low threshold to treat
Treatment of PID can be ______ or ________.
outpatient & inpatient
How do you treat patient PID outpatient?
- Mild disease and ideally good compliance
- Remove IUD if present! makes PID worse
PID treated as an outpatient when there is mild disease and ideally good compliance; What antibiotics usually prescribe?
Rocephin 250mg IM +
Zithromax 1gm +
BID for 7d
If you treating PID as outpatient make sure to follow up in _____.
3 days or sooner if symptoms worsen; should be
improving by 3d
When do you treat PID as inpatient?
Abscess, T >101, poor compliance, failed outpt therapy, severe pain,
Findings unclear diagnosis
What antibiotics usually prescribe when PID treated as INPATIENT?
IV cefotan or Rocephin + vibramycin
(treat a multi-organ infection)
You can do _______ for PID if failed treatment of abscess occur.
List complications related to PID?
___% tubal infertility rate after one* episode of PID.
What is Chronic PID?
Persistent pain without* evidence of ACUTE infection - fever, Inc. WBC
How do you diagnose Chronic PID?
How do you treat Chronic PID?
Surgery for pain results are often disappointing; What type of surgery usually done for treatment of Chronic PID?
lysis of adhesions and removal of hydrosalpinges - damaged tubes
What is Tubo-ovarian abscess (TOA)?
Abscess in pelvic cavity. Severe infection, fever >101, ↑ WBC, n/v
Tubo-ovarian abscess (TOA) mass* palpable or present on _______.
How do you treat Tubo-ovarian abscess (TOA)?
Inpatient antibiotics and possibly surgery warranted:
-often weeks of IV antibiotics are required
-Laparoscopic/ laparotomy to drain or resect if antibiotics fail
Explain NORMAL vaginal discharge?
-Thin, clear to white, non-odorous
-pH 3.5- 4.5. Lacrobacillis dominates - produces lactic acid
What is Vaginosis? ("nosis")?
Alteration in normal flora
↓ lactobacillis, ↑ anaerobes
What is Vaginitis? ("itis")?
-Inflammatory response to Candida or Trichomonas
-Edema, erythema, pain
How vaginitis usually diagnose?
*Abnormalities usually diagnosed clinically
What is the most common abnormal discharge in US*?
Bacterial Vaginosis (BV)
What is the etiology of Bacterial Vaginosis (BV)?
-↑ anaerobic species -not just Gardnerella
-pH > 4.5
-Most common abnormal discharge in US*
What are the findings of Bacterial Vaginosis (BV)?
-Whitish gray discharge, fishy amine odor
-Minimal or no inflammation (erythema, WBCs)
How do you treat Bacterial Vaginosis (BV)?
Oral metronidazole - Flagyl 500mg BID x7 days
Remember Don't drink _____ when you taking Metronidazole*.
What are the etiology of Candida vaginitis?
- Yeast overgrowth - usually C. albicans
- Common in immunosuppressed - DM, HIV, chemo, prior abx, especially penicillin*
What test can be order to diagnose patient with Candida vaginitis?
How do you treat Candida vaginitis?
Oral: Fluconazole (Diflucan) 150 mg PO (not in OB)
Vaginal: "Azoles" 1,3,7 day, messy but works
What is the findings of Candida vaginitis?
- Thick white discharge, usually no odor, external dysuria
- Vaginal erythema, edema and tenderness (inflammation)
- KOH prep shows hyphae
What is the etiology of Trichomonas vaginitis?
A flagellated parasite which may be sexually transmitted
What are the findings for Trichomonas vaginitis?
-Frothy, greenish discharge, malodorous
-Vaginal inflammation - erythema, edema, tenderness
-"Wet prep" show WBCs and flagellated organisms
What test you can order to diagnose patient with Trichomonas vaginitis?
How do you treat Trichomonas vaginitis?
Metronidazole 2 gm. PO
or 500mg bid x 7 days
(same med as BV, just a larger dose)
Remember if patient diagnose with Trichomonas vaginitis make sure treat _________ especially if it's recurrent.
What STD you will need to treat partner* especially if it's recurrent?
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