GYN PPT3

1. OBSTETRIC & GYNECOLOGY III GYNECOLOGICAL INFECTIONS Pascale Gehy-Andre PA-C

2. GYNECOLOGICAL INFECTIONS GENERAL DX CONSIDERATIONS Symptoms : Discharge, fever & abd./pelvic pain Age group : Adult, Pre-adolescent or geriatric Past Medical History : Diabetes, cancer or HIV Sexual history: Known & unknown Medications : Recent antibiotics Etiologies : Viral, bacterial, fungal or parasitic Location : External, lower &/or upper tract Previous infections : Primary or re-occurrence Bleeding : Location of bleeding/relationship to cycle

3. DIAGNOSTIC APPROACH Vaginal Discharge (Leukorrhea) Volume, frequency & duration Nature clear, bloody, color & viscosity Location of irritation, pruritus, odor Pain-external discomfort PQRST Constitutional symptoms Presence of fever, nausea, or vomiting Previous episodes/current exposures Pregnancy. infertility Social Issues

4. DIAGNOSTIC TESTS Cultures: GC, Chlamydia, Viral Smears: PAP, wet mount, KOH prep & Gram stain Vaginal pH- acetic acid prep KOH Whiff test Urinalysis Blood test: CBC, SMA, RPR, Hepatitis & HIV Rare: Cervical biopsy or Pelvic U/S

5. GYNECOLOICAL INFECTIONS Lower tract Vulvovaginitis: aka Vaginitis/Vulvitis Vaginosis Upper tract Cervicitis, endometritis, salpingitis, pelvic inflammatory disease

13. Gram stain

37. VIRAL INFECTIONS Herpes simplex - Typically caused by HSV Type 2 (STD) can be by Type 1 - Never total resolution Chronic & Recurrent - External infection easier to diagnosis & more symptomatic - Pain may be prodromal in nature - Rarely systemic - Viral shedding for 7-10 days - Requires tissue culture confirmation

38. Herpes simplex - Initial infection with severe pain, pruritus & burning, frequency & dysuria. Asymptomatic shedding common - Initial with more symptoms & have a longer duration 2 – 6 weeks - Recurrent infections usually with less lesions milder presentation, heal faster. - Progressively shorter varying duration

40. Herpes simplex Treatment: Primary infection- Acyclovir, Valacyclovir & Famciclovir for 7 -10 days Recurrent infection- Same meds but for 5 days Local measures- Topical antifungals, Monsel solution or trichloroacetic acid. Hospitalize if severe for IV antiviral, sedation & analgesia If systemic or if immunosuppressed will need IV for 5-7 days or until resolved

53. HUMAN PAPILLOMA VIRUS Treatment -Topical salicylic acid products Imiquimod 5% cream 3*wk bedtime max 16 wks Podofilox 0.5% solutionor podophyllin resin 10 to 25% solution twice daily * 3days hiatus 4 days Local sharp excision for large pedunculated lesion Laser vaporization, cryotherapy for small lesions Electrocauterization Hysterectomy for high grade changes Prognosis unpredictable

73. GONOCOCCAL INFECTIONS TREATMENT - Drug resistant common - Uncomplicated gonorrhea non pregnant patients: Ceftriaxone 125mgIM x 1 Ciprofloxacin 500mg PO X 1 Ofloxacin 400 mg PO X 1 Also Doxycycline 100 mg po bid X 7 days Azithromycin 1g PO X 1 In pregnant patients: Ceftriaxone 250mgIM x 1 Spectinomycin 2g IM X 1 Also: Erythromycin 500mg PO qid X 7days Amoxacillin 500mg po tid X 7 days

81. Inclusion cells

84. CHLAMYDIAL INFECTIONS Treatment - Doxycycline bid X 7 days - Macroides alternative if PCN allergic In pregnancy : Erythromycin 500 mg PO qidX7 Amoxicillin 500mgPO tidX10d - Must assume & treat PID coinfection - Lymphogranuloma venereum Tx for 21 days

100. SYPHILIS Diagnostic Test - Serologic Test VDRL/RPR - Treponemal antibody test FTA rate from 16.2-100/100,000 - Darkfield exam - May need CSF test

103. SYPHILIS Treatment - Penicillin is treatment of choice - If pregnant will need desensitization if allergic - Jarisch-Herxheimer reaction is a flu like reaction secondary to pyrogen release from treponemes - Doxycycline/Macroides as alternative (not as effective)