Gynaecology Marrow Pg 171-180 (Gynaecological Infections)
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Questions and Answers

Which of the following are long-term consequences of Pelvic Inflammatory Disease (PID)?

  • Chronic headaches
  • Skin rashes
  • Ectopic pregnancy (correct)
  • Infertility (correct)

    • Metronidazole should be avoided while consuming alcohol.

    True

    What is the recommended duration for taking oral antibiotics in the management of PID?

    14 days

    In cases of PID, if a patient is not responding to oral treatment, the _____ should consider admission.

    <p>doctor</p> Signup and view all the answers

    Match the types of treatment kits with their corresponding details:

    <p>Yellow Kit = Tab Cefixime 400mg stat. + Tab metronidazole 400mg BD × 14 days Grey Kit = Tab Doxycycline 100mg BD × 14 days + Tab Azithromycin 1g</p> Signup and view all the answers

    What is the gold standard test for Chlamydia?

    <p>Culture on McCoy cell lines</p> Signup and view all the answers

    In non-pregnant patients, the treatment for Gonorrhoea includes injecting Ceftriaxone.

    <p>True</p> Signup and view all the answers

    What procedure shows >10 neutrophils/field when testing for Chlamydia?

    <p>Gram stain</p> Signup and view all the answers

    The treatment for a pregnant patient with Chlamydia is a single dose of ___________ given orally.

    <p>Azithromycin</p> Signup and view all the answers

    Match the following conditions with their associated symptoms or characteristics:

    <p>Chlamydia = Cervix bleeds on touch Gonorrhoea = Gram -ve diplococci PID = Uterine tenderness Fitz Hugh Curtis syndrome = Perihepatitis</p> Signup and view all the answers

    What is the drug of choice (DOC) for bacterial vaginosis during the first trimester of pregnancy?

    <p>Vaginal metronidazole</p> Signup and view all the answers

    Candidiasis treatment with oral fluconazole is indicated during pregnancy.

    <p>False</p> Signup and view all the answers

    What is the primary symptom of cervicitis?

    <p>Discharge</p> Signup and view all the answers

    The ectocervix is lined by __________ epithelium while the endocervix is lined by __________ epithelium.

    <p>stratified squamous, columnar</p> Signup and view all the answers

    Match the type of cervicitis with its most common causative agent:

    <p>Chlamydial cervicitis = Chlamydia Gonococcal cervicitis = Gonorrhoea Trichomonas vaginitis = Trichomonas Herpes Simplex cervicitis = HSV</p> Signup and view all the answers

    What is included in the Green Kit 2 for treating vaginitis with discharge and pruritis?

    <p>Secnidazole 1 gm + Fluconazole 150 mg</p> Signup and view all the answers

    Antibiotic treatment for partner cervicitis is indicated in cases of vaginitis.

    <p>False</p> Signup and view all the answers

    What are the recommended contraceptive methods mentioned for supportive treatment?

    <p>Condom contraceptive</p> Signup and view all the answers

    The presentation for lower abdominal pain may include _____ tenderness, cervical movement tenderness, or adnexal tenderness.

    <p>uterine</p> Signup and view all the answers

    Match the treatment kits to their indications:

    <p>Green Kit 2 = Vaginitis with discharge and pruritis Grey Kit 1 = Unhealthy cervix with discharge Yellow Kit 6 = Lower abdominal pain with tenderness Kit 1 = Partner treatment for cervicitis and PID</p> Signup and view all the answers

    What is the primary causative organism of genital tuberculosis?

    <p>Mycobacterium tuberculosis</p> Signup and view all the answers

    Genital tuberculosis can only spread through sexual transmission.

    <p>False</p> Signup and view all the answers

    What condition can result from inflammation of the fallopian tubes due to genital tuberculosis?

    <p>Endosalpingitis</p> Signup and view all the answers

    The infection can spread to the uterine lining (endometrium) via the _______.

    <p>fimbriae</p> Signup and view all the answers

    Match the symptoms of genital tuberculosis with their descriptions:

    <p>Caseous necrosis = A form of tissue death Fibrosis/Adhesion = Scarring and tissue adhesion Hydrosalpinx = Fluid build-up in the fallopian tubes B/L cornual block = Potential blockage of both fallopian tubes</p> Signup and view all the answers

    Which of the following infections is the most common cause of PID in reproductive-aged women?

    <p>Chlamydia</p> Signup and view all the answers

    PID can only occur in sexually active females aged 15 to 35 years.

    <p>False</p> Signup and view all the answers

    Name one protective measure that can help prevent PID.

    <p>Condoms</p> Signup and view all the answers

    What is the gold standard test for diagnosing Bacterial Vaginosis?

    <p>Gram staining</p> Signup and view all the answers

    The spread of infection in PID primarily occurs through _______ infection along with sperms.

    <p>ascending</p> Signup and view all the answers

    The Whiff test is positive for Trichomonas Vaginitis.

    <p>False</p> Signup and view all the answers

    Which of the following is NOT a symptom commonly associated with the acute phase of Pelvic Inflammatory Disease (PID)?

    <p>Nausea</p> Signup and view all the answers

    Match the following types of PID infections to their associated characteristics:

    <p>Chlamydia = Most common in reproductive age Genital TB = Common in virgins E. coli = Common in menopausal females Actinomyces = Associated with Cu-IUD</p> Signup and view all the answers

    Right upper quadrant pain is a symptom associated with Fitz-Hugh-Curtis Syndrome, a complication of PID.

    <p>True</p> Signup and view all the answers

    What is the microscopic appearance of Candidiasis?

    <p>Pseudohyphae and spores of candida</p> Signup and view all the answers

    What is the gold standard diagnostic method for Pelvic Inflammatory Disease?

    <p>Laparoscopy</p> Signup and view all the answers

    In Bacterial Vaginosis, the pH of vaginal discharge is typically __________.

    <p>≥ 4.5</p> Signup and view all the answers

    An elevated _____ and an elevated C-reactive protein (CRP) can help in diagnosing Chlamydia or Gonorrhea associated with PID.

    <p>erythrocyte sedimentation rate (ESR)</p> Signup and view all the answers

    Match the following conditions with their associated symptoms:

    <p>Bacterial Vaginosis = Clue cells and fishy odor Candidiasis = Pseudohyphae Trichomonas Vaginitis = Strawberry cervix Vulvovaginal Candidiasis = Culture on Sabouraud media</p> Signup and view all the answers

    Match the symptom with its corresponding characteristic related to PID:

    <p>Lower abdominal pain = Bilateral pain Dysmenorrhea = Painful menstruation Vaginal discharge = Abnormal discharge Infertility = Difficulty conceiving</p> Signup and view all the answers

    What is the surest sign of Pelvic Inflammatory Disease (PID) during laparoscopy?

    <p>Pus trickling from fimbrial end</p> Signup and view all the answers

    The Boer-misel score is a scoring system used to assess the severity of a pelvic abscess.

    <p>False</p> Signup and view all the answers

    What imaging technique is used as a diagnostic method for genital tuberculosis (TB)?

    <p>Hysterosalpingography (HSG)</p> Signup and view all the answers

    The type of organism causing infections was not ________ in the study.

    <p>identified</p> Signup and view all the answers

    Match the ultrasound sign with its corresponding description:

    <p>Violin string adhesions = Thin, string-like structures in reproductive organs Cogwheel sign = Thickened endosalpingeal walls Beads on string sign = Beaded appearance along the fallopian tube Waist sign = Fluid-filled structure in the fallopian tube</p> Signup and view all the answers

    Which of the following organisms are associated with bacterial vaginosis?

    <p>Gardnerella vaginalis</p> Signup and view all the answers

    Candidiasis is characterized by a discharge that is curdy white and a main complaint of intense pruritis.

    <p>True</p> Signup and view all the answers

    What is the pH level associated with Bacterial Vaginosis?

    <p>4.5 or higher</p> Signup and view all the answers

    The organism responsible for Trichomonas Vaginitis is __________.

    <p>Trichomonas vaginalis</p> Signup and view all the answers

    Match the type of vaginitis with its corresponding characteristic:

    <p>Bacterial Vaginosis = Greyish white discharge with foul smell Candidiasis = Curdy white discharge and intense pruritis Trichomonas Vaginitis = Frothy yellowish-green discharge and foul smell</p> Signup and view all the answers

    Study Notes

    Chlamydia

    • Greater than 10 neutrophils per field on Gram stain
    • Collected from endocervical swab or urine if urethritis is positive
    • Gold standard is culture on McCoy cell lines
    • Non-pregnant treatment is doxycycline 100 mg once daily for 7 days
    • Pregnant women cannot take doxycycline, use azithromycin 1 g orally as a single dose

    Gonorrhea

    • Gram-negative diplococci on Gram stain
    • Gold standard is culture on Thayer-Martin media

    Per Speculum Examination

    • Unhealthy cervix: friable (easily crumbles), bleeds on touch, erosion/ulcer present

    Per Vaginal Examination

    • Normal uterus, normal adnexa

    Differential Diagnosis

    • PID can be differentiated by uterine and adnexal tenderness

    Complications

    • PID: Due to ascending infection
    • Perihepatitis: Fitz-Hugh-Curtis syndrome

    Management

    • Syndromic management is advised by NACO
    • Color-coded kits are used, based on history, physical examination, and minimal investigations

    Bacterial Vaginosis

    • Metronidazole is the drug of choice
      • Vaginal metronidazole in the 1st trimester
      • Oral metronidazole in the 2nd and 3rd trimester

    Candidiasis

    • Oral fluconazole is contraindicated
    • Topical clotrimazole is used

    Trichomonas Vaginitis

    • Metronidazole is the drug of choice
      • Vaginal in the 1st trimester
      • Oral in the 2nd and 3rd trimester
      • Same dose is used

    Partner Treatment

    • Partner treatment is indicated

    Cervicitis

    • Ectocervix is lined by stratified squamous epithelium similar to the vagina
    • Endocervix is lined by columnar epithelium

    Ectocervix

    • Infections include:
      • Candida
      • Trichomonas
      • HSV
      • HPV

    Endocervix

    • Infections include Chlamydia and Gonorrhea

    Chlamydial & Gonococcal Cervicitis

    • Most common route of spread is ascending infection along with sperm (STD)
    • Most common site is the endocervix, followed by the urethra

    Clinical Presentation

    • 50-80% are asymptomatic
    • Discharge is the most common presentation, mucoid or purulent
    • Other clinical presentations include:
      • Dysuria
      • Dyspareunia
      • Post-coital bleeding

    Pelvic Inflammatory Disease (PID)

    • Long-term consequences include:
      • Infertility
      • Ectopic pregnancy
      • Chronic pelvic pain
      • Hydrosalpinx: fluid accumulation within the fallopian tube
      • Recurrent PID
      • Fitz-Hugh-Curtis syndrome

    Management

    • Broad-spectrum antibiotics are used:
      • Ceftriaxone 250 mg IM single dose
      • Doxycycline 100 mg twice daily for 14 days
      • Metronidazole 400 mg twice daily for 14 days

    Advice for PID Management

    • Abstinence for 7-14 days
    • Partner treatment is essential
    • Barrier contraception, such as condoms
    • Avoid alcohol while taking metronidazole

    Indications for Admission

    • No response to oral treatment
    • Pelvic abscess
    • Pregnant females with severe disease
    • Pregnant females unable to take oral medications

    IV Antibiotics

    • Continue for 24 hours after patient becomes afebrile
    • Oral antibiotics are continued for 14 days

    Syndromic Approach

    • Indicates lower abdominal pain with any of the following findings:
      • Uterine tenderness
      • Cervical motion tenderness
      • Adnexal tenderness
    • Ensure a negative urine pregnancy test

    Syndromic Treatment

    • Patient receives:

      • Cefixime 400 mg stat
      • Metronidazole 400 mg twice daily for 14 days

    • Partner receives:

      • Doxycycline 100 mg twice daily for 14 days
      • Azithromycin 1 g

    Syndromic Approach Advice

    • Abstinence for 7-14 days
    • Use condoms

    Bacterial Vaginosis

    • Microscopic appearance shows epithelial cells with adhered bacteria, called clue cells
    • Saline microscopy reveals normal vaginal flora and clue cells
    • Gram staining is the gold standard with a Nugent score of 7-10
    • Whiff test: Adding 10% KOH to discharge results in a fishy or amine-like odor
    • Amsel's criteria: At least 3/4 of the following are positive:
      • Greyish-white discharge
      • pH ≥ 4.5

      • 20% of epithelial cells are clue cells

      • Positive whiff test

    Candidiasis

    • Microscopic appearance shows pseudohyphae and spores of Candida
    • Culture is performed on Sabouraud media

    Trichomonas Vaginitis

    • Microscopic appearance shows motility or a tennis racket appearance
    • Culture is performed on Sabouraud media
    • Whiff test is negative
    • Strawberry cervix or angry-looking vagina may be seen on physical examination

    Diagnostic Treatment

    • Drug of choice:
      • Non-pregnant: Oral metronidazole 500 mg twice daily for 7 days or 2 g as a single dose
      • Non-pregnant: Oral fluconazole 150 mg as a single dose

    Pelvic Inflammatory Disease (PID)

    • Most common symptoms:

      • Lower abdominal pain, typically bilateral
      • Painful intercourse

    • Acute phase symptoms:

      • Fever
      • Abnormal uterine bleeding (AUB)
      • Intermenstrual bleeding
      • Post-coital bleeding
      • Dysmenorrhea
      • Infertility
      • Vaginal discharge

    Fitz-Hugh-Curtis Syndrome

    • A complication of PID, causing perihepatitis
    • Characterized by violin string adhesions between the liver capsule and the anterior abdominal wall
    • Presents with right upper quadrant pain
    • Commonly associated with Chlamydia or Gonorrhea infections

    PID Clinical Diagnosis

    • Centers for Disease Control and Prevention (CDC) criteria:
      • Minimal criteria: Lower abdominal pain with any of the following on pelvic exam:
        • Cervical tenderness
        • Adnexal tenderness
        • Uterine tenderness
      • Additional criteria:
        • Temperature > 101°F
        • Abnormal cervical/vaginal discharge
        • Saline microscopy of vaginal discharge showing abundant white blood cells (WBCs)
      • Lab diagnosis of Chlamydia/Gonorrhea
        • Elevated erythrocyte sedimentation rate (ESR)
        • Elevated C-reactive protein (CRP)

    Pelvic Inflammatory Disease (PID) Investigations for Definitive Diagnosis

    • Ultrasound (USG)
      • Tubo-ovarian mass
      • Swollen fallopian tubes
    • Signs during Pelvic Exam
      • Waist sign
      • Beads on a string sign
      • Cogwheel sign
    • Endometrial biopsy
      • Can indicate endometritis
    • Laparoscopy
      • Gold standard
      • Allows direct visualization of fallopian tubes, ovaries, and uterus
      • Can be used for specimen collection
      • Can be used for scoring conception potential
      • Rules out ectopic pregnancy and appendicitis

    Vaginitis

    • Organisms responsible:
      • Bacterial vaginosis: Gardnerella vaginalis, mycoplasma, mobiluncus
      • Candidiasis: Candida albicans (fungus)
      • Trichomonas vaginitis: Trichomonas vaginalis (flagellated protozoan)

    Predisposing Factors

    • Bacterial vaginosis:
      • Alteration of vaginal pH (alkaline)
      • Pregnancy - most common vaginitis in pregnant women
      • Immunocompromised state
      • Antibiotic use
      • Steroids
      • Oral contraceptive pill consumption

    Vaginal Discharge

    • Bacterial vaginosis: Greyish-white or dirty-white, foul smell
    • Candidiasis: Scanty, curdy white/cottage cheese-like discharge, not the primary complaint
    • Trichomonas vaginitis: Frothy, yellowish-green color, foul smell

    Vaginal pH

    • Bacterial vaginosis: ≥ 4.5
    • Candidiasis: < 4.5
    • Trichomonas vaginitis: ≥ 4.5

    Pruritis

    • Bacterial vaginosis: No inflammation, so absent
    • Candidiasis: Intense pruritis, excoriation - primary complaint
    • Trichomonas vaginitis: Intense pruritis

    Dysuria

    • Bacterial vaginosis: No inflammation, so absent
    • Candidiasis: Splash dysuria
    • Trichomonas vaginitis: Present

    Polymorphonucleocytes (PMNs)/ Epithelial Cells

    • Bacterial vaginosis: PMNs are not found, but epithelial cells are present with bacteria adhered (clue cell)
    • Candidiasis: PMNs are present with the spores and hyphae
    • Trichomonas vaginitis: PMNs are present with the organism

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    Test your knowledge on the diagnosis and management of sexually transmitted diseases focusing on Chlamydia and Gonorrhea. This quiz covers clinical findings, treatment options, and complications associated with these infections. Gain insights into the differential diagnosis and effective management strategies as recommended by health authorities.

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