ObGyn Ch 16 Infections of the Lower female Reproductive Tract

a. RPR and VDRL

a. TPPA or FTA-ABS

a. Benzathine penicillin.

a. IV pcn.

a. Jarisch-Herxheimer reaction.
b. Seen most commonly in treatment of secondary syph.

a. HSV-1.

a. Haemophilus ducreyi.

a. Manifests as a painful, demarcated genital ulcer
b. Often w/suppurative non-indurated inguinal w/lymphadenopathy.
c. Can be difficult to diagnose as neither culture nor Gram’s stains have been particularly consistent.
d. Usually just a single ulcer, but multiple ulcers and occasionally extragenital infections have been known to occur.

a. PO azithromycin or IM ceftriaxone.
b. Many options exist.
c. 1 dose of either.
d. Alternatives include Cipro 500 2x/day for 3 days or
e. Erythromycin 500 4x/day for 7 days.

a. Gardnerella (can be polymicrobial).

a. Metronidazole (Flagyl) for 7 days.

12. Note: 75% of sexual partners of those w/Trichomonas will also be colonized and should be presumptively treated w/Metronidazole 2g orally single dose.

a. Cervicitis
b. PID
c. TOA
d. Bartholin abscess.

a. Ceftriaxone 125 mg IM or cefixime 400 mg orally single dose.
b. Tx should include azithromycin 1 g orally for chlamydia.

a. 1 time 1 g oral dose of azithromycin.

Reaction to tx of syphilis.
An acute febrile reaction frequently accompanied by fever, chills, HA, myalgia, pharyngitis, rash, and other s that usually occur in first 24 hours (usually first 8) after therapy for syphilis.
Happens in up to 90% of secondary syph tx!

Injured or dead organsims release endotoxins into the circulation marked by systemic release of cytokines.
Seen w/other spirochete tx's as well. i.e. lyme.

Chlamydia trachomatis L-serotypes (L1,L2, L3).

Primary stage: A local lesion that may either be a papule or shallow ulcer.
Often painless, transient, and can go unnoticed.

Secondary stage: (inguinal syndrome): painful inflammation and enlargement of inguinal nodes "lymphogranuloma".
With fever, HA, malaise, and anorexia.

Anogenital syndrome (tert stage): Proctocolitis,
Rectal stricture, rectovaginal fistula, elephantias of sac (Lymphatic filariasis).
Initially anal pruritis will develop w/concomitant mucous rectal discharge.

Docy or erythromycin

Pox virus

Small, domed papule with an umbilicated center. Also known as water warts.
Lesions contain a waxy material that reveal intracytoplasmic molluscum bodies under microscopic exam.
Lesions are often asymptomatic and resolve on their own.

Wright stain or Giemsa stain.

Anywhere on skin EXCEPT palms and soles.
These

Local excision and/or treatment of the nodule base w/trichloroacetic acid or cryotherapy.

Complement fixation

Gram's stain w/"school of fish appearance

Dark-field microscopy RPR/MHA-TP/FTA-ABS

Ceftriaxone or azithromycin

Doxy

syph and LGV
These are also the 2 that are single in presentation.

HSV and chancroid.

Chancroid is 1-3.
HSV is multiple