Women's Health Competency Exam Study Guide PDF

+-----------------------------------+-----------------------------------+ | **Women's Health Competency Exam | | | Study Guide** | | +===================================+===================================+ | 1....

+-----------------------------------+-----------------------------------+ | **Women's Health Competency Exam | | | Study Guide** | | +===================================+===================================+ | 1. What are complications of | **Complications:** | | **PID (Pelvic Inflammatory | | | Disease)** | - Ectopic pregnancy | | | | | Pelvic Inflammatory Disease And | - Infertility | | You \| Eastside Gynecology | | | | - Chronic Pelvic Pain | | | | | | - Tubo-Ovarian Abscess | | | | | | - Infections | | | | | | - Scarring/Adhesions | | | | | | **Impact on fertility in women:** | | | **c**an lead to the formation of | | | scar tissue that can inhibit | | | transport of sperm to the ovum | | | and/or the ovum to the uterus. | | | Obstruction can then lead to | | | development of hydro salpinges, | | | which are collections of fluid | | | within the fallopian tubes. These | | | significantly interfere with the | | | success of in vitro fertilization | | | (IVF), possibly because | | | components in the hydrosalpinx | | | fluid are toxic to developing | | | embryos. In addition, obstruction | | | may result from tubal | | | endometriosis, pelvic | | | tuberculosis, and adhesions from | | | previous pelvic surgery. | +-----------------------------------+-----------------------------------+ | 2. Symptoms and complications of | Is a rare, chronic autoimmune | | **Vulvar Lichen sclerosis** | skin condition that causes thin, | | | white, wrinkled skin that can be | | **Symptoms** | itchy and painful. **Lichen | | | sclerosis** is a chronic, | | - Dyspareunia | inflammatory, skin condition of | | | unknown etiology. The most common | | - Itching | manifestations are vulvar atrophy | | | and whitening in postmenopausal | | - Thinning and progressive | females. Less commonly, it may | | atrophy of the epidermis | present in adults males and | | | prepubertal children. | | - Hyperkeratosis | | | | **Complications:** | | - White streak or shiny plaque | | | on vulva | In Women | | | | | - Wrinkled, parchment-like | - sensory abnormalities such as | | appearance of vaginal skin | vestibulodynia | | and tissue | and vulvodynia may persist | | | after resolution of lesions | | - Disappearance of the vulvar | | | sulci | - scarring at lesions sites may | | | occur and lead to | | - Biopsy to confirm diagnosis | | | | | | - Smooth discolored skin | | | patches. | - introital narrowing | | | | | - Blotchy, wrinkled skin | - clitoral hood phimosis, | | patches. | pseudocyst of the clitoris, | | | and other vulvar | | - Itching. | architectural changes | | | | | - Soreness or a burning | - painful sex and scarring, | | feeling. | including covering of the | | | clitoris. | | - Easy bruising. | | | | - Women with vulvar lichen | | - Fragile skin. | sclerosis are also at an | | | increased risk of vulvar | | - Changes in the tube for urine | squamous cell carcinoma & | | flow (urethra) | vulvar intraepithelial | | | neoplasia (VIN) | | - Bleeding, blistering or open | | | sores. | In Men: | | | | | | - Scarring of the penis can | | | cause painful erection, poor | | | urine flow and an inability | | | to retract the foreskin. | | | | | | - Scarring of the penis can | | | cause preputial adhesions and | | | phimosis | | | | | | - Scarring of the penis can | | | cause meatal stenosis | | | | | | - Squamous cell carcinoma of | | | penis | | | | | | - Urethral squamous cell | | | carcinoma (USCC) reported in | | | a man aged 56 years with long | | | history of genital lichen | | | sclerosus in case | | | presentation  | | | | | |  | +-----------------------------------+-----------------------------------+ | 3. Symptoms/characteristics and | **Symptoms** | | treatment of **PCOS** | | | | - Menstrual irregularity, | | PCOS (Polycystic Ovary Syndrome): | excess hair growth, acne, and | | Symptoms & Treatment | obesity | | | | | | **Characteristics** | | | | | | - **O**-Obesity | | | | | | - **V**-Virilizations (male | | | characteristics) | | | | | | - **A**-Anovulation | | | | | | - **R**-Resistance to insulin | | | | | | - **I**-Increased hair growth | | | | | | - **A**-Androgen excess | | | | | | - **N**-No period/Amenorrhea | | | | | | **Treatment** | | | | | | - birth control pills to | | | regularize periods | | | | | | - metformin to prevent diabetes | | | | | | - statins to control high | | | cholesterol | | | | | | - hormones to increase | | | fertility | | | | | | - procedures to remove excess | | | hair. | | | | | | - Self-care s/a: weight loss, | | | exercise, and electrolysis | | | | | | - Medications used are | | | anti-diabetic medications, | | | statins, hormones, and hair | | | growth inhibitor. | | | | | | **Pathology:** too much androgen | | | causing hirsutism (PCOS). | | | Hypersecretion of androgens | | | | | | - **Androgen excess** | | | | | | - **Insulin resistance** | | | | | | - **Ovarian dysfunction** | | | | | | - **Ovarian morphology** | | | | | | - **Genetic factors:** PCOS is | | | linked to many genes and | | | mutations that affect the | | | ovaries. These genes are | | | involved in steroidogenesis, | | | insulin action, and other | | | processes | | | | | | - **Environmental factors:** | | | Lifestyle factors, nutrition, | | | and the intrauterine | | | environment during pregnancy | | | can all contribute to the | | | development of PCOS | | | | | | - **Other factors:** | | | Hyperinsulinemia, or insulin | | | resistance, and disturbances | | | in the | | | hypothalamic-pituitary-ovaria | | | n | | | axis can also contribute to | | | PCOS | | | | | | | | | | | | - Normal puberty then longer | | | episodes of amenorrhea. | | | | | | - Hirsutism is the most | | | reliable clinical indicator | | | of hyperandrogenism | +-----------------------------------+-----------------------------------+ | 4. **Contraceptives**: Birth | **Combined hormonal | | control for treating | contraceptives** are first line | | menstrual cramps, painful | | | sex, abdominal cramps and | | | back pain during menstruation | | +-----------------------------------+-----------------------------------+ | 5. **PMS -Premenstrual syndrome | **Most common symptom:** | | characteristics**, treatment. | headache, bloating, breast | | and when does it occur | tenderness, and irritability. | | | Both somatic symptoms (e.g., | |  | pain, bloating) are present in | | | patients with PMS. | | | | | | **Hormone involved/ Menstrual | | | cycle:** occur during the | | | **luteal phase** of the menstrual | | | cycle. | | | | | | - Cyclical changes in levels of | | | **estrogen and progesterone** | | | appear to impact levels of | | | the **neurotransmitter | | | serotonin** | | | | | | - **Estrogen and | | | progesterone**: [During the | | | second half of the menstrual | | | cycle, after | | | ovulation,] the | | | body produces more + | | | progesterone and less | | | -estrogen. [Fluctuating | | | estrogen levels are linked to | | | mood changes. ] | | | | | | - **Serotonin**: Serotonin | | | precursors increase between | | | days 7 to 11 and 17 to 19 of | | | the menstrual | | | cycle. Serotonin helps | | | regulate mood and behavior.  | | | | | | - **Neurotransmitters**: | | | Hormones regulate | | | neurotransmitters like | | | serotonin and | | | gamma-aminobutyric acid | | | (GABA), which may protect | | | against PMS symptoms. GABA | | | affects calmness and anxiety | | | | | | **When do they occur:** PMS is | | | defined as a cyclical recurrence | | | of a constellation of physical | | | and psychological symptoms that | | | **arise during the second, or | | | luteal, phase of the menstrual | | | cycle and resolve 1 to 3 days | | | after the onset of menses.** | +-----------------------------------+-----------------------------------+ | 6. Symptoms of **Oligomenorrhea, | **Oligomenorrhea**: Prolonged | | Primary amenorrhea, Secondary | menstrual cycles \>35 days | | amenorrhea** | | | | **Primary amenorrhea:** | | | | | | - No menses by age 13 in | | | absence of secondary sex | | | characteristics OR | | | | | | - Absence of menses by age 15 | | | regardless of the development | | | of secondary sex | | | characteristics | | | | | | 1\. Chromosome mutations | | | | | | 2\. Outflow tract disorders | | | | | | 3\. Ovarian disorders | | | | | | 4\. Hypopituitarism | | | | | | 5\. CNS disorders | | | | | | 6\. Extreme weight loss/anore | | | xia | | | | | | **Secondary Amenorrhea:** | | | | | | | | | | | | - Cessation of menstruation for | | | 3 normal cycles or for 6 | | | months in a woman who | | | previously experiences | | | menstrual bleeding | +-----------------------------------+-----------------------------------+ | 7. Characteristics, diagnostic | - Most women with BV are | | test and treatment for | asymptomatic | | **Bacterial Vaginosis.** | | | | - **Fishy or musty vaginal | | Obstetrics and Gynecology \| | odor, more prominent after | | SpringerLink | sexual intercourse and | | | menses** | | | | | | - Thin, homogenous discharge, | | | No redness or edema | | | | | | - Normal bimanual exam | | | | | | **Treatment Recommended regimens | | | for recurrent BV:** | | | | | | - **Nitroimidazoles: | | | Metronidazole/Flagyl** | | | | | | - **Lincosamides: Clindamycin | | | (topical)** | | | | | | - Vaginal metronidazole | | | 0.75% twice a week for | | | 4-6 months following | | | initial appropriate | | | treatment | | | | | | - Oral nitroimidazole for 7 | | | days, followed by | | | intravaginal boric acid | | | 600 mg daily for 21 days, | | | and then vaginal | | | metronidazole 0.75% twice | | | weekly for 4-6 months | | | | | | - Monthly oral | | | metronidazole 2 g | | | administered with | | | fluconazole 150 mg | | | | | | - Boric acid is available | | | without a prescription: | | | 600 mg intravaginal once | | | a day for 21 days | +-----------------------------------+-----------------------------------+ | 8. How do you test for | **DIAGNOSTIC STUDIES** | | **Bacterial vaginosis** | | | | - Amsel's criteria specify that | |  | **three or more of** the | | | following clinical signs and | | | symptoms: | | | | | | - Homogenous, thin, gray-white | | | discharge coating the vaginal | | | wall | | | | | | - Vaginal pH \>4.5 | | | | | | - Positive whiff test: amine | | | (fishy) odor after | | | application of 10% KOH on | | | vaginal discharge sample | | | \*WHIFF test\* | | | | | | | | | | | | - A positive whiff test result | | | can indicate trichomoniasis | | | or bacterial vaginosis. The | | | whiff test is not highly | | | sensitive or specific for | | | diagnosing bacterial | | | vaginosis | | | | | | | | | | | | - Presence of more than 20% | | | epithelial cells (clue cells) | | | on saline microscopy: | | | microscopic evaluation of | | | vaginal discharge on glass | | | slide with normal saline | | | shows few WBCs, and | | | epithelial cells are obscured | | | with coccobacilli. | | | | | | - Gram stain: microscopic | | | evaluation of vaginal smears | | | for bacterial morphology | | | (*Lactobacilli* sp.) using | | | Nugent scoring criteria | | | | | | - Vaginal culture is not | | | diagnostic because G. | | | vaginalis can be present in | | | healthy asymptomatic women | | | | | | - Commercial tests for | | | diagnosis of BV if microscopy | | | is not available include: | | | | | | - **Affirm VP III:** an | | | automated DNA probe assay | | | for detecting *G. | | | vaginalis*. | | | | | | - **OSOM BVBLUE system:** a | | | chromogenic diagnostic | | | test based on the | | | presence of sialidase | | | enzyme produced by | | | anaerobes associated with | | | BV. | | | | | | - **Fem Exam test**: a | | | two-card system that | | | detects vaginal pH and | | | trimethylamine on one | | | card and a chemical | | | produced by G. vaginalis | | | (prolineaminopeptide) on | | | the other. | +-----------------------------------+-----------------------------------+ | 9. Symptoms of **Genital warts** | **[Genital Warts | | | -Symptoms:]** | | Genital warts: Causes, Risk | | | Factors, Symptoms, Treatment | - Soft, painless, flesh-colored | | | warts | | | | | | - Wart surface: smooth and | | | rough | | | | | | - Multiple finger-like | | | projections | | | | | | - May be confluent | | | | | | - Perianal warts usually rough | | | and cauliflower-like | | | | | | - Penile lesions often smooth | | | and papular | | | | | | - Pruritus | | | | | | - Irritation | | | | | | - Bleeding secondary to trauma | | | or irritation | | | | | | - Vaginal discharge possible | | | | | | - [Common sites of warts in | | | men]: penile | | | glans and shaft, anus, | | | buttocks; scrotal involvement | | | uncommon | | | | | | - [Common sites of warts in | | | women:] labia, | | | clitoral hood, periurethral | | | area, perineum, vagina, | | | cervix, anus, buttocks | | | | | |  | +-----------------------------------+-----------------------------------+ | 10. Treatment for **genital | Commonly used treatments: | | warts** | | | | - Provider treatment is | | | **cryotherapy** with liquid | | | nitro or cryoprobe | | | | | | - Patient applied treatment: | | | **imiquimod cream, podofilox | | | solution** or gel, or **sine | | | catechins** ointment. | | | | | | - Partner Tx. yes/no: No | | | | | | **Treatment:** | | | | | | - **Provider treatment of | | | external warts:** | | | | | | - Podophyllin resin 10-25% | | | (Podocon) | | | | | | - Trichloroacetic acid | | | (TCA) or bichloroacetic | | | acid (BCA) 80-90% | | | | | | - Cryotherapy | | | | | | - Surgical excisions may be | | | used as a precursor to | | | other treatment | | | modalities or as a | | | standalone treatment | | | | | | - Electrodessication | | | | | | - Laser treatment under | | | anesthesia for multiple warts | | | or debulking of large warts | | | | | | - **Self-treatment options | | | for:** | | | | | | - **External warts:** | | | | | | - Imiquimod 3.75% or 5% | | | cream (Aldara) | | | | | | - Podofilox 0.5% gel or | | | solution (Condylox) | | | | | | - Sinecatechins 15% | | | ointment (Veregen) | | | | | | - **Cervical warts:** | | | | | | - Refer to specialist | | | for biopsy prior to | | | treatment | | | | | | - **Vaginal warts**: | | | | | | - TCA or BCA 80-90% | | | | | | - Cryotherapy of vagina | | | not recommended due | | | to risk of fistula | | | | | | - **Anal warts:** | | | | | | - Cryotherapy | | | | | | - TCA or BCA 80-90% | | | | | | - Podofilox 0.5% gel or | | | solution (Condylox) | | | | | | Genital warts: Nursing: Video & | | | Causes \| Osmosis | +-----------------------------------+-----------------------------------+ | 11. **Mammogram** | The US Preventive Services Task | | | Force recommends that women who | | | are 40 to 74 years old and are at | | | average risk for breast cancer | | | get a mammogram **every 2 | | | years.** \*April 30, 2024, the | | | United States Preventative | | | Services Task Force (USPSTF) | | | updated their recommendations for | | | breast cancer screening. They now | | | recommend that **all women** get | | | screened **every other year** | | | starting at **age 40 and | | | continuing through age 74** | | | | | | **[Follow-up | | | guidelines:]** | | | | | | **After breast-conserving | | | surgery**: A mammogram should be | | | taken one year after the initial | | | mammogram, and at least six | | | months after radiation | | | therapy. After that, yearly | | | mammograms are recommended.  | | | | | | **After a mastectomy**: | | | Mammograms should be taken on the | | | remaining breast.  | | | | | | **For women at average risk**: | | | The U.S. Preventive Services Task | | | Force (USPSTF) recommends that | | | women start getting mammograms | | | every two years at age 40 and | | | continue until age 74.  | | | | | | **For women with high risk | | | factors**: Women who have had | | | breast cancer, have genetic | | | mutations, or have had high-risk | | | breast lesions should follow | | | their doctor\'s advice on | | | screening | +-----------------------------------+-----------------------------------+ | 12. Pap Smear guidelines | Screening ages: Screening is | | | initiated at age 21 | |  | - Age \65: no further testing | | | if: | | | | | | - You have had at least | | | three Pap tests or two | | | HPV tests in the past 10 | | | years, and the test | | | results were normal or | | | negative, and | | | | | | - You have not had a | | | cervical precancer in the | | | past, or | | | | | | - You have had your cervix | | | removed as part of a | | | total hysterectomy for | | | non-cancerous conditions, | | | like fibroids. | | | | | | Post-hysterectomy: Recommends | | | against screening in women who | | | have had a hysterectomy with | | | removal of cervix and do not have | | | a history of CIN2, CIN 3, or | | | cervical cancer | +-----------------------------------+-----------------------------------+ | 13. **Pap smear** report results: | **Pap report:** | | | | | | a\. **ASC-US**: \*most common\* | | | means that some cells don\'t | | | look completely normal, but | | | it\'s not clear if the changes | | | are caused by HPV infection | | | | | | b\. **LSIL**: a way of | | | categorizing mildly abnormal | | | cervical cells. First sign of | | | HPV and needs further testing. | | | | | | c\. **HSIL**: suggests more | | | serious changes in the cervix | | | than LSIL | | | | | | d\. **ASC-H**: means that | | | changes in the cervical cells | | | have been found that raise | | | concern for the presence of | | | HSIL | | | | | | e\. **AGC**: means that changes | | | have been found in glandular | | | cells that raise concern for | | | the presence of precancer or | | | cancer. | | | | | | A close-up of a blue and white | | | background Description | | | automatically generated | +-----------------------------------+-----------------------------------+ | 14. **Osteoporosis** guidelines | **Osteoporosis**: | | | | | ![Postmenopausal Osteoporosis: | - [When to order a dexa | | Everything You Need to | scan:] All woman | | Know](media/image12.png) | older than age 65; Younger | | | woman and men with risk | | | factors. | | | | | | - [What is recommended for | | | calcium and vitamin D | | | supplementation: | | | ] | | | | | | | | | | | | - Calcium Supplementation: | | | 1200-1500 mg/day | | | | | | Vitamin D Supplementation: | | | 800-100 IU/Day | +-----------------------------------+-----------------------------------+ | 15. Symptoms and treatment for | *Gardnerella vaginalis *is the | | **Gardnerella vaginalis** | primary organism associated with | | | the development of BV & in some | | | cases PID. BV puts you at risk | | | for PID. Lower abdominal or | | | pelvic pain, Vaginal discharge, | | | Abnormal vaginal bleeding, Fever, | | | N/V, Painful sex, Menstrual | | | problems, Urinary symptoms, | | | Smelly urine | | | | | | **BV S/S**: | | | | | | - Fishy or musty vaginal odor, | | | more prominent after sexual | | | intercourse and menses | | | | | | - Thin, homogenous discharge | | | | | | - Itching or burning around the | | | vulva and vaginal opening, or | | | when urinating | | | | | | **Treatment Recommended regimens | | | for recurrent BV:** | | | | | | - Nitroimidazoles: | | | Metronidazole/Flagyl & | | | Tinidazole/Tindamax | | | | | | - Lincosamides: | | | Clindamycin/Cleocin (topical) | | | | | | Gardnerella vaginalis (Bacterial | | | \... | | | | | |  | +-----------------------------------+-----------------------------------+ | 16. Know phases of the | Egg release occurs during | | **menstrual cycle** | [ovulatory | | | phase] begins with a | | theblood -- Revolutionizing the | surge in luteinizing hormone and | | Gender Data Gap | follicle-stimulating hormone | | | levels. Luteinizing hormone | | | stimulates egg release | | | **(ovulation),** which usually | | | occurs 16 to 32 hours after the | | | surge begins. | | | | | | The menstrual cycle has four | | | phases:  | | | | | | - **Menstruation**: The first | | | day of your period, when the | | | lining of the uterus sheds | | | and is shed as blood. This | | | phase typically lasts about | | | five days.  | | | | | | - **Follicular phase**: The | | | ovary\'s first phase.  | | | | | | - **Ovulation**: Usually occurs | | | around day 14 of a 28-day | | | cycle, and lasts about 24 | | | hours.  | | | | | | - **Luteal phase**: Occurs | | | after ovulation and before | | | your period. The corpus | | | luteum releases hormones that | | | thicken the uterine lining in | | | preparation for a fertilized | | | egg. If the egg isn\'t | | | fertilized, the lining sheds | | | and your period begins. | | | | | | When does | | | [Luteinizing] hormone | | | peak: **Peaks** before ovulation | | | at about days 9-14.When does | | | [Follicle-Stimulating]{.underline | | | } | | | Hormone peaks: **Peaks** day 14 | | | with ovulation | | | | | | When does [Ovulation] | | | occurs: **Occurs day 14** | | | | | | When would a patient experience | | | [premenstrual | | | syndrome:] Criteria | | | for diagnosis are symptoms and | | | signs in the 5 days prior to | | | menses for at least three | | | consecutive cycles, cessation of | | | symptoms and signs within 4 days | | | after onset of menses, and | | | interference with daily | | | activities | | | | | |  | | | | | | The Menstrual Cycle \| Medcomic | +-----------------------------------+-----------------------------------+ | 17. What is the best birth | **Levonorgestrel-releasing | | control for a patient taking | intrauterine system | | **Phenytoin** | (IUD/Cu-IUD)** or depot | | | medroxyprogesterone acetate | | | **(DMPA) injection | | | -Depo-Provera** | | | | | | [Oral contraceptives are **not** | | | recommended for patients taking | | | phenytoin] because | | | the drug reduces the | | | effectiveness of the ethinyl | | | estradiol in these | | | medications. Phenytoin can also | | | stop combined hormonal | | | contraceptives like the pill, | | | patches, and vaginal ring from | | | working. Bleeding between periods | | | may indicate that the pill is not | | | working | +-----------------------------------+-----------------------------------+ | 18. What [educational | The etonogestrel implant is a | | information] | thin, plastic rod that is placed | | would you provide for the | subcutaneously in the upper arm. | | **Nexplanon** | The progestin-only etonogestrel | | | implant (Nexplanon) is a highly | |  | flexible 4-cm single | | | hormone-containing rod that is | | | inserted sub-dermally in the | | | upper arm. The implant contains | | | 68 mg of etonogestrel released | | | slowly over 3 years. The implant | | | can be inserted at any time if | | | the patient is not pregnant; | | | however, backup contraception | | | should be used if insertion | | | occurs more than 5 days after the | | | start of menses. | | | | | | [Pt. Education:] | | | | | | [Side effect | | | profile], to include | | | changes in menses: pain, mood | | | changes, weight gain, ovarian | | | cysts, depression, emotional | | | lability, irregular bleeding. | | | Other side effects include | | | nausea, dizziness, headache, | | | acne, breast tenderness, hair | | | loss, vaginal irritation or | | | discharge, and lower sex drive. | | | | | | - Patient should be provided | | | with the information card | | | that comes with the device | | | | | | - If inserted within 5 days of | | | menses, no backup method is | | | required | | | | | | - If inserted at any other time | | | in menstrual cycle, backup | | | method contraception needed | | | for 7 days | | | | | | - Use of barrier method for | | | prevention of STDs | | | | | | [Risks of this contraceptive | | | method] outweigh its | | | benefits for patients with the | | | following conditions: cirrhosis, | | | liver tumors, systemic lupus | | | erythematosus, and unexplained | | | vaginal bleeding. Use of the | | | implant is [contraindicated | | | in] patients with | | | [breast cancer]. | +-----------------------------------+-----------------------------------+ | 19. **Chlamydia:** | **Chlamydia:** ***Chlamydia | | presentation/Dx-testing/Mngt/ | trachomatis*.** | | Pt. | | | Educations/long term | **Transmission**: sexual contact | | complications | | | | **Presenting S/S**: | | Gonorrhea & Chlamydia \| Quizlet | | | | - **Women**: | | | | | | - Often asymptomatic (85%) | | | | | | - Mucopurulent cervicitis | | | | | | - Edematous, congested, | | | friable cervix | | | | | | - Vaginal discharge and/or | | | vaginal bleeding, | | | breakthrough bleeding or | | | spotting | | | | | | - Discharge from | | | Bartholin's gland when | | | milked | | | | | | - Cervical motion | | | tenderness | | | | | | - Dysuria/pyuria (pain with | | | urination) | | | | | | - Urethritis | | | | | | - Pelvic pain/salpingitis | | | | | | - Higher risk of premature | | | rupture of membranes and | | | preterm delivery during | | | pregnancy | | | | | | - Proctitis | | | | | | - **Men**: | | | | | | - Dysuria (urethritis) | | | | | | - Proctitis | | | | | | - Epididymitis | | | | | | - Prostatitis | | | | | | - Penile discharge | | | | | | **Specific test**: | | | | | | - **Nucleic acid amplification | | | test (NAAT; gold standard)** | | | | | | - Aptima assay for *C. | | | trachomatis* | | | | | | - Antigen detection via | | | cervical or urethral swab or | | | first-catch urine; | | | sensitivity 80-95% compared | | | to culture | | | | | | - Urinalysis: positive for WBCs | | | | | | - Wet prep: \>20 WBCs per | | | high-powered field | | | | | | | | | | | | - **Management/treatments**: | | | ***First-line:*** | | | | | | - **azithromycin** (Zithrom | | | ax) | | | 1 g PO single dose | | | | | | - **doxycycline** (Vibramyc | | | in) | | | 100 mg PO BID for 7 days | | | | | | - **doxycycline** for 10-14 | | | days if epididymis | | | involved or for pelvic | | | inflammatory disease | | | | | | - Partner Tx. yes/no: **Yes** | | | | | |  | +-----------------------------------+-----------------------------------+ | 20. **Gonorrhea**: | **Gonorrhea**: *Neisseria | | presentation/Dx/Mngt/Pt. | gonorrhoeae* | | Educations/long term | | | complications | - **Transmission:** | | | | | Gonorrhea Symptoms Stock Photos | | | and Pictures - 591 Images \| | | | Shutterstock | - Sexual contact | | | | | ![15min read\] A Love that | - Vertical transmission from | | Lingers\.... - The History, | infected mother to infant | | Treatment, and Chemistry of | during childbirth | | Chlamydia and Gonorrhea! : | | | r/SAR\_Med\_Chem](media/image22.p | - Penile-rectal contact | | ng) | | | | | | | | | | - **Presenting S/S:** | | | | | | - Symptoms may manifest | | | within 10 days of | | | infection | | | | | | - **Men** | | | | | | - Urethritis: purulent | | | urethral discharge | | | | | | - Dysuria | | | | | | - Penile edema | | | | | | - Acute epididymitis: | | | testicular pain | | | (unilateral) | | | | | | - Prostatitis: | | | decreased stream, | | | trouble initiating | | | urine flow, | | | frequency, painful | | | ejaculation | | | | | | - **Women** | | | | | | - Endocervical/vaginal | | | discharge: thin, | | | purulent, and mildly | | | odorous; usually | | | minimal | | | | | | - Dysuria | | | | | | - Intermenstrual/abnorm | | | al | | | bleeding | | | | | | - Dyspareunia | | | | | | - Bartholin's gland | | | abscess | | | | | | - Symptoms of rectal | | | infection (40% of | | | infected women have | | | rectal infection) | | | | | | - Symptoms of pelvic | | | inflammatory disease | | | (PID): abdominal | | | pain, cervical motion | | | tenderness, adnexal | | | tenderness or | | | pain/fever | | | | | | - **Specific test**: | | | | | | - **Nucleic acid | | | amplification test (NAAT) | | | is most sensitive and | | | specific** | | | | | | - Thayer-Martin agar | | | culture (also called | | | chocolate agar culture) | | | | | | - Urinalysis | | | | | | - **Management/treatments:** | | | ALL cases of gonorrhea should | | | be treated with [two | | | antimicrobials with different | | | mechanisms of | | | action:] ideally, | | | a [third-generation | | | cephalosporin plus | | | azithromycin] | | | | | | - **Ceftriaxone** 250 mg IM | | | PLUS **Azithromycin** 1 g | | | PO | | | | | | - Partner Tx. yes/no: **Yes** | +-----------------------------------+-----------------------------------+ | 21. **Trichomoniasis:** | **Trichomonas:** STI caused | | presentation/Dx/Mngt/Pt. | by *Trichomonas vaginalis*, a | | Educations/long term | single-celled, flagellated | | complications | protozoan. Primarily infects the | | | squamous epithelium in the | | Trichomoniasis: Causes, Symptoms, | urogenital tract (vagina, | | Testing & Treatment | urethra, paraurethral glands, | | | prostate, cervix) | | ![TRICHOMONIASIS ALIVIO DEL DOLOR | | | - EXTRA STRENGTH - 120 Caps - | [Symptoms]: | | MADE IN USA \| | | | eBay](media/image24.jpeg) | **Women**: | | | | | | - Asymptomatic (up to 75%) | | | | | | - Vaginal discharge that is | | | frothy, copious, and pale | | | yellow to gray-green in color | | | | | | - Vulvovaginal irritation | | | | | | - Dysuria | | | | | | - Foul, fishy odor | | | | | | - Intense erythema of the | | | vaginal mucosa | | | | | | - Dyspareunia | | | | | | - Symptoms may worsen during | | | menstruation | | | | | | - Postcoital bleeding | | | | | | - Pruritus | | | | | | - Cervical petechiae | | | ("strawberry cervix") may be | | | visible secondary to tiny | | | hemorrhages | | | | | | **Men:** | | | | | | - Asymptomatic (up to 75%) | | | | | | - Urethral discharge | | | | | | - Urethral irritation | | | | | | - Dysuria | | | | | | - Epididymitis | | | | | | - Prostatitis | | | | | | - Balanoposthitis (inflammation | | | of the foreskin and glans in | | | uncircumcised men) | | | | | | [Diagnostic tests:] | | | | | | - **Wet prep:** trichomonads | | | are motile for 10-20 minutes | | | once on slide (identified in | | | 60-70% of wet preps) | | | | | | - Visualization of | | | trichomonads as | | | flagellated, motile cells | | | slightly larger than WBCs | | | | | | - **Polymorphonuclear | | | cells** | | | | | | - **Vaginal secretion | | | pH**: \>4.5 (usually 5.5-6.0) | | | | | | - **Pap smear** (1% false | | | positive rate) | | | | | | - **NAAT** (PCR is the **gold | | | standard** for diagnosis) | | | | | | - **Rapid antigen or nucleic | | | acid probe testing**: Affirm | | | VPIII, Osom Trichomonas Rapid | | | Test, Aptima Trichomonas | | | Assay, COBAS Amplicor, NuSwab | | | | | | - In men, **NAAT (PCR)** of | | | first fraction urine or | | | urethral swab recommended. | | | Saline microscopy has low | | | sensitivity and is not | | | recommended | | | | | | [Treatment:] | | | **Metronidazole** 2g SD, | | | **Tinidazole** 2g SD, and if | | | still symptomatic give | | | Metronidazole 500mg BID x7 | | | days. | +-----------------------------------+-----------------------------------+ | 22. **Syphilis:** | **Syphilis**: *Treponema | | presentation/Dx/Mngt/Pt. | pallidum* | | Educations/long term | | | complications | - **Transmission**: | | | | | Syphilis: Cause, Symptoms, | - *Treponema pallidum*, a | | Diagnosis, Treatment & Prevention | spirochete that | | | penetrates intact skin or | |  | intercourse] | | | | | | - *T. pallidum* [enters the | | | blood stream] | | | and is transported to | | | other tissues, where it | | | infects the central | | | nervous system and can | | | result in neurosyphilis | | | | | | - Congenital syphilis is | | | acquired [trans | | | placentally] | | | from an infected mother | | | | | | - **Presenting S/S:** | | | | | | - **Primary syphilis:** | | | | | | - [Chancre at site of | | | inoculation]{.underli | | | ne} | | | begins as papule, | | | then ulcerates with a | | | hard edge and clean, | | | yellow base; | | | indurated and | | | painless; usually | | | located on genitalia; | | | may be solitary or | | | multiple; persists | | | for 1-5 weeks and | | | heals spontaneously | | | | | | - Chancre may go | | | unnoticed in women | | | | | | - [Regional | | | lymphadenopathy]{.und | | | erline} | | | | | | - **Secondary syphilis:** | | | | | | - [Rash that is | | | bilaterally | | | symmetrical, | | | polymorphic, | | | nonpruritic, | | | frequently on soles | | | and | | | palms], | | | and usually persists | | | for 2-6 weeks before | | | resolving | | | spontaneously | | | | | | - [Condyloma | | | lata]: | | | moist, pink, | | | peripheral warty | | | lesions; may be | | | present on glans, | | | perianal and vulval | | | areas, and | | | intertriginous areas | | | | | | - [Mucous patches in | | | mouth, throat, and | | | cervix] | | | | | | - [Generalized | | | lymphadenopathy]{.und | | | erline} | | | | | | - Flu-like symptoms | | | | | | - Mild | | | hepatosplenomegaly | | | | | | - **Latent syphilis:** | | | | | | - Asymptomatic | | | | | | - **Tertiary syphilis:** | | | | | | - [Cardiovascular | | | manifestations:]{.und | | | erline} | | | aortic valve disease, | | | aneurysms | | | | | | - [Neurologic | | | manifestations]{.unde | | | rline}: | | | meningitis, | | | encephalitis, tabes | | | dorsalis, dementia | | | | | | - [Integumentary | | | manifestations]{.unde | | | rline}: | | | gumma | | | | | | - [Orthopedic | | | manifestations:]{.und | | | erline} | | | Charcot joints, | | | osteomyelitis | | | | | | - **Specific test**: **A | | | presumptive diagnosis of | | | syphilis requires use of two | | | tests: a nontreponemal test | | | and a treponemal test.** | | | | | | - **\*Nontreponemal tests | | | (presumptive test)** | | | | | | - Rapid plasma reagin | | | (RPR) | | | | | | - Venereal disease | | | research laboratory | | | (VDRL) | | | | | | - May require retest if | | | negative in 1-2 | | | weeks, due to high | | | incidence of false | | | negatives | | | | | | - **\*Treponemal tests | | | (usually positive for | | | life after treatment):** | | | | | | - Fluorescent | | | treponemal antibody | | | absorbed (FTA-ABS) | | | | | | - Micro | | | hemagglutination | | | assay for antibody | | | to* T. | | | pallidum* (MHA-TP) | | | | | | - Lumbar puncture for CSF | | | serologies when | | | neurologic symptoms are | | | present, if tertiary | | | syphilis is suspected, | | | and in all children | | | diagnosed after the | | | newborn period | | | | | | - Darkfield microscopy or | | | direct fluorescent | | | antibody test of exudate | | | or tissue (definitive | | | test for early syphilis) | | | | | | - Always suspect presence | | | of another STD if | | | positive for syphilis | | | | | | - Imaging studies for | | | tertiary symptoms | | | | | |