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64 Cards in this Set
- Front
- Back
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What is the normal pH level for the vagina?
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3.8-4.2
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What is the histology of the epithelium in the inner vulva and vagina?
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Statified squamous epithelium
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What does the vaginal epithelium synthesize? What two hormones promote this synthesis?
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Estrogen and progesterone stimulate the vaginal epithelium to synthesize glycogen.
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What is glycogen a nutrient for?
What is this role of this organism? |
Lactobacilli metabolize glycogen into lactic acid, responsible for the normal low vaginal pH 3.8 - 4.2
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What is the main symptom of vaginitis?
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Discharge
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What are 3 common infectious causes of vaginal discharge?
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Gardnerella
Candida Trichomonas |
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What infection would you see Clue cells on a wet mount?
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Gardnerella
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What infection has a discharge that is scant grayish to milky white, with malodorous fishy discharge
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Gardnerella
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What symptoms accompany the discharge in Gardnerella
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Itchy & Burning
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What is the amine test?
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Small amount of discharge + KOH --> if its gardnerella will release malodorous fishy smell
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What is the most common cause of bacterial vaginitis?
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Gardnerella
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Is the Gardernella organism usually present in the vagina?
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Yes, but in small amounts; infection is when there is an inbalance and overgrowth
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What is 2nd most common cause of vaginitis?
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Candida
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Thick curdlike (cheesy) discharge is indicative of what infection?
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Candida
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What is the most prevalent non-viral STI in the US
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Trichomonas
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Profuse, frothy greenish, foul-smelling discharge is indicative of what?
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Trichomonas
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When would you expect to see be cervico-vaginal petechial lesions (“strawberry spots”)?
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Trichomonas
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How do you treat Trichomonas?
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Metronidazole to treat patient & partner(s)
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What is trichomonas?
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Uniflagellate protozoan
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What is the most common symptom in Gonorrhea?
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Many patients are asymptomatic.
However, Urethritis (more common in males) with copious pus-like discharge from glands of the lower genital tract is common symptom. |
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What is the danger of untreated gonorrhea?
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PID
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What percent of those w/ PID will develop infertility?
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10%
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What is the most common BACTERIAL STI in the US
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Chlamydia
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Which Servovars of Chlamydia cause PID?
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D-K
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Which Servovars of Chlamydia cause Painless papule followed by inguinal lymphadenopathy?
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L1-L3
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What is Lymphogranuloma venereum (LGV) and where is it common?
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Painless papule followed by inguinal lymphadenopathy
Asia, Africa, S.America |
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Is Chlamydia intracellular or extracellular?
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Obligate intracellular bacterium
Unique in that it exhibits both intracellular and extracellular forms |
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What is risk of untreated chlamydia?
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PID
with resultant fallopian tube scarring, increased risk for ectopic pregnancy, and adhesion formation and associated chronic pelvic pain |
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What are systemic symptoms of Lymphogranuloma venereum (LGV)?
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May have systemic manifestation: fever, myalgia, arthralgia
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What are complications of Lymphogranuloma venereum (LGV)?
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If untreated, may develop complications: ulceration and hypertrophy of genitalia, arthritis, fistula formation of rectum, bladder, vagina or vulva
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How do you treat LGV?
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Treat with antimicrobials
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A painless Chancre is the primary lesion of what?
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Syphilis!
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Maculopapular rash on trunk and extremities (palms + soles) or whitish lesions (condylomata lata) on mucous membranes
Is indicative of what? |
Secondary Syphilis!
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What is Treponema pallidum
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Syphilis
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How long after the primary infection would one see secondary syphilis dissemination?
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4-10 weeks
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What is the cause of a chancroid?
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Hemophilus ducreyi
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if you saw a "school of fish" on a gram stain, what would you suspect
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Chancroid
Hemophilus ducreyi |
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What are buboes and what are they associated with?
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Inguinal lymph nodes may swell and break through skin forming abscesses
Indicative of chancroid |
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When do you see Donovan Bodies?
Where would you expect to see this? |
Granuloma inguinale from Klebsiella granulomatis
common in tropical regions |
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What is the gold standard for diagnosis of Granuloma Inguinale
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Wright-Giemsa stain is gold standard for diagnosis
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What is most common cause of genital lesions in the US?
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HSV 2
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What smear is used to show Herpes?
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Tzank smear
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What is RPR used to screen for? What are its drawbacks?
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Syphilis
Biological false positives in pregnancy, alcoholism and other conditions. |
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What is gold standard for diagnosisng GC?
When would you use this diagnosis? |
Culture still gold standard. Very fastidious, needs CO2. Transport an issue.
USE CULTURE IF RAPE OR ABUSE!!! |
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What are NAAT molecular tests most often used for?
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Gonorrhea & chlamydia
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What is gold standard for chlamydia infections?
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Culture
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How do you diagnose Trichomoniasis?
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Dx by wet mount or culture
Rapid Antigen POC Test |
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What are the high risk strains of HPV?
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16 &18
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Which viral genes does HPV know and what is their action?
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E6 causes degradation of p53 protein, and E7 interferes with Cyclin A, P107, and p105 RB proteins (regulators of cell cycle progression).
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What is the mechanism of HPV
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Integration of viral DNA into host DNA disrupts viral genes E6, E7, leading to overexpression of these viral proteins.
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What are DFA tests used for?
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DFA tests can differentiate HSV 1 from HSV 2
(rapid) |
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Is trichomoniasis more or less common than GC and Chlamydia?
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More common
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What is the diagnostic test for trichomoniasis?
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Wet mount or culture
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What is Lichen sclerosus?
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Most common vulvar dermatologic disorder. A type of vulvar dystrophy.
Patchy white, thin skin “parchment paper skin” |
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What are some of the symptoms of Lichen Sclerosus?
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Pruritus, painful intercourse, introital stenosis, flattening & fusion of labial folds
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How do you treat Lichen Sclerosus?
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Corticosteroids
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Skin showing epidermal thinning,
with loss of rete ridges, and superficial dermal sclerosis is indicative of what? |
Lichen sclerosus
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Where is a high incidence area
for development of intraepithelial (precancerous) lesions? |
TRANSFORMATION ZONE: SQUAMOUS ENDOTHELIUM MEETS THE GLANDULAR
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What are risk factors for cervical intraepithelial neoplasia (CIN)?
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Risk factors: sex early age, multiple sex partners, high-risk male partner, multiple pregnancies, early age first marriage, unstable marriage, low socioeconomic status, cigarette smoking, immunosuppression, Hx of STI, especially HPV.
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What percent of women w/ CIN have HPV
What percent of women w/ cervical cancer have HPV? |
HPV found in >80% of CINs and 99.7% cervical cancers.
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What are the key viral proteins that get disrupted in HPV
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E6 & E7
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What are the 3 tiers in Cervical Dysplasia and what defiens them?
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Mild: 1/3 of eithelium
CIN I: Abnormal maturation involving lower 1/3 of epithelium CIN II : lower 1/3-2/3 CIN III: abnormal maturation involving over 2/3rds or full thickness of epithelium |
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Does CIN III regress or progress to CIS?
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It can both regress or progress to carcinoma in situ
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What age has the highest incidence of dysplasia?
What age has the highest incidence of cervical cancer |
25 - dysplasia
35 Cancer 10 year lag! |
