NR 602 Final
Colposcopy exam- - ANSprocedure that visualizes vaginal, vulvar, or cervical epithelium w/
magnification to id abnormal area to be bx
Dysmenorrhea - ANSpainful menstruation that prevents normal activity and requires medication
3 types: primary (no organic cause), secondary (pathologic cause) and membranous - causes
intense cramping pain due to passage of a cast of endometrium through undilated cervix
Dysmenorrhea treatment - ANSTx- NSAIDs/tyelnol, heat, antiprostaglandins, OCP w/ increased
estrogen- pain relief r/t absence of ovulation, decreased prostaglandin production; surgery
Dysmenorrhea mechanism - ANSprostaglandin activity
Cystocele - ANS-vaginal wall weakens and stretches and allows the bladder to bulge into the
vagina
Cystocele sx - ANSSx-felling of fullness or pressure in vagina, increased discomfort when you
strain/cough/bear down, feeling of incomplete empty, repeated bladder infection, pain or urinary
leak during sex, bulge of tissue into vaginal opening
Cystocele prevention - ANSkegels, prevent constipation, avoid heavy lifting, avoid wt gain
Rectocele - ANS-When thin tissue of vagina separates the vaginal and rectum allowing vaginal
wall to bulge
Rectocele sx - ANSSx- soft bulge of tissue in vaginal, difficult BM, sensation of rectal pressure,
incomplete emptying after BM, sexual concerns
Causes of rectocele - ANSCauses- constipation/strain, chronic cough, heavy lifting, overweight,
childbirth, age
Retocele prevention - ANSPrevention- kegels, prevent constipation, avoid heavy lifting, cough,
avoid wt gain
Uterine prolapse - ANS-pelvic floor muscles and ligaments stretch and weaken and no longer
provide support for uterus and protrude into vagina.
Uterine Prolapse causes - ANSCauses- pregnancy, large baby delivery, lower estrogen level
after menopause, obesity Common in postmenopausal and one or more childbirth
,Uterine Prolapse symptom - ANSSx- heaviness or pulling into pelvis, tissue protruding from
vagina, urinary probs (leakage, retention), trouble having BM, feeling of sitting on small ball,
sexual concerns
Uterine Prolapse prevention - ANSPrevention- kegels, treat constipation, correct lifting, avoid wt
gain
uterine prolapse treatment - ANSTx- pessary
Herpes simplex - ANSchronic viral infection caused by HSV1 or HSV2, relapsing
Herpes Simplex prevention - ANSPrevention: consistent condom use b/c viral shedding can
occur in asymptomatic periods and can lead to transmission. W/ symptoms- Valacyclovir 500
mg daily
Herpes Simplex sign and symptoms - ANSSx-multiple painful vesicular or ulcerative lesion on
genitals, can be absent. Virus lays dormant and can be reactivated
Herpes Simplex diagnosis - ANSlays dormant and can be reactivated
Dx-cell culture and PCR
Herpes Simplex treatment - ANSTx- systemic antiviral. Acyclovir 7-10 days for 1st episode,
suppressive 200 mg daily BID
Chancroid - ANS-Transmitted via sexual contact or on hands that have touched lesion. Caused
by Haemophillus ducreyi
-Reportable disease
Chancroid symptoms - ANS-Sx- erythematous papule that evolves into pustule and
degenerates into saucer shaped ragged ulcer that is circumscribed by inflammatory wheal.
Tender, heavy foul discharge that is contagious
Chancroid diagnosis - ANSDx-culture that grows H ducreyi
Chancroid treatment - ANSTx- Abx azithromycin 1 g PO one time, ceftriaxone 250 mg IM 1 x,
cipro 500 mg PO BID x3 days erythromycin 500 mg PO TID x7 days. Personal hygiene, clean
w/ soap and water, sitz bath
Syphilis - ANS-chronic, systemic disease caused by a sphirochete transmitted via contact with
infectious moist lesion. Sexually acquired or vertically transmitted from infected mom.
Reportable disease
Syphilis transmitted - ANS-Transmitted in primary and secondary stages
,Primary-mucus mem 10-90 days later. Secondary- 2 wks-6mo after primary lesion then
generalized cutaneous eruption of secondary may appear. Latent- may last a lifetime
Syphilis prevention - ANSPrevention- condom, wash w/ soap and water after sex, screen ppl @
high risk (men that have sex with men, drug trafficers, correctional facilities)
Syphilis symptoms - ANSSx- [Primary]- Chancre- indurated firm painless papule or ulcer w/
raised borders, women can have cervical or vaginal lesion....on any mucus mem.
[Secondary}-viral syndrome w/ diffuse lymphadenopathy AEB dermatitis, papulosquamous
lesion on palms and soles. Lesions on trunk will be macular or maculopapular popular or
pustular other systemic include patchy alopecia, hepatitis, nephritis. [Latent]- resolution of lesion
of primary and secondary or finding of serologic test w/o therapy
Syphilis Diagnosis - ANSDx- T pallidum sphirochetes on dark field exam of cutaneous lesion,
serologic testsing antibody titers
Syphilis treatment - ANSPenicillin G
Chlamydia trachomatis gold standard test - ANS. Gold standard test is NAT, not culture
Chlamydia trachomatis - ANSnegative whiff w/ mucupurulent d/c and + clue
cells.
Chlamydia trachomatis symtoms - ANSSx- dyspuria, intramenstrural spotting, postcoital
bleeding, pain w/ sex, vag d/c purulent d/c reddened congested cervix or can be asymptomatic.
Chlamydia trachomatis diagnoses - ANSDx-Urine or endocervix/vaginal swab
Chlamydia trachomatis tx - ANSTx- 1 gm Azithromycin OR doxy, erythro PLUS rocephin 250 or
cefixime Complications- salpingitis and PID, perihepatitis,
Gonorrhea - ANSSTI, first causes cervical infection and ascend to endometrium and fallopian
tube. Reportable
Gonorrhea prevention - ANSPrevention: Screen all high risk ppl sexually active women age 25
or less. Use condoms. Sex partner w/ in 60 days evaluate to tx that sex partner, > 60 days tx
most recent sex partner, NB receive erythro ointment after delivery
Gonorrhea symptoms - ANSSx-many are asymptomatic. inflamed and edematous cervix with
d/c coming from cervical os. Vag d/c urinary frequency, dysuria, unilateral swelling of intoitus,
anal itching, pain, pharyngitis, conjunctivitis, systematic triad (polyarthalgia, tenosynovitis, and
dermatitis)
, Gonorrhea diagnosis - ANSDx- endocervical vaginal or urine specimens Complications-
salpingitis- tubal scarring, infertility
Gonorrhea treatment - ANSTx- Rocephin 125 mg, cefixime OR azithromycin
No sex 7 days after therapy. Tx for chlamydia as well.
HSV-type 1 or 2. - ANSType 2 most common cause of genital herpes. Produces cervical lesion,
first vesicular then ulcers. After initial infection, virus continues to reside in nerve cells for life.
HPV- spread - ANSspread via skin to skin (genital warts)
Prevention- abstinence, condom use, treating affected partner @ same time
Trich - ANSCaused by flagellated protozoan, mobile
Trich prevention - ANSPrevention: condoms, decrease # of sex partners, vulvular hygiene
Trich symptoms - ANSSx- purulent malodorous d/c w/ burning itching, dysuria, frequency, and
painful sexl. Postcoital bleeding may occur foamy white green d/c, strawberry appearing cervix
trich diagnosis - ANSDx- motile flagellated organisms on saline wet smear, Affirm
Trich treatment - ANSTx-Metronidazole 2g PO single dose OR tinidazole 2 gm in single dose
Candida - ANSwhite curd like d/c
Candida diagnosis - ANSDx- potassium hydroxide prep---distinct presence of hyphae
Candida treatment - ANSTx- topical azole drugs or PO fluconazole
bacterial vaginosis - ANSmost prevalent vaginal infection. * Loss of lactobacilii and increase in
vaginal pH fishy odor
bacterial vaginosis risk factor - ANSRisk factors: multiple sex partner, douching, lack of condom
use, lack of vag lactobacilli
Bacterial vaginosis prevention - ANScondom use, no douching
bacterial vaginosis treatment - ANSTx- metronidazole 500 mg PO x7 days, metronidazole gel
0.75 %x5 days, clinda cream 2% x3 nights OR tinidazole PO x2 days
Bacterial vaginosis symtoms - ANSSx-3 of 4 Amsel criteria
Colposcopy exam- - ANSprocedure that visualizes vaginal, vulvar, or cervical epithelium w/
magnification to id abnormal area to be bx
Dysmenorrhea - ANSpainful menstruation that prevents normal activity and requires medication
3 types: primary (no organic cause), secondary (pathologic cause) and membranous - causes
intense cramping pain due to passage of a cast of endometrium through undilated cervix
Dysmenorrhea treatment - ANSTx- NSAIDs/tyelnol, heat, antiprostaglandins, OCP w/ increased
estrogen- pain relief r/t absence of ovulation, decreased prostaglandin production; surgery
Dysmenorrhea mechanism - ANSprostaglandin activity
Cystocele - ANS-vaginal wall weakens and stretches and allows the bladder to bulge into the
vagina
Cystocele sx - ANSSx-felling of fullness or pressure in vagina, increased discomfort when you
strain/cough/bear down, feeling of incomplete empty, repeated bladder infection, pain or urinary
leak during sex, bulge of tissue into vaginal opening
Cystocele prevention - ANSkegels, prevent constipation, avoid heavy lifting, avoid wt gain
Rectocele - ANS-When thin tissue of vagina separates the vaginal and rectum allowing vaginal
wall to bulge
Rectocele sx - ANSSx- soft bulge of tissue in vaginal, difficult BM, sensation of rectal pressure,
incomplete emptying after BM, sexual concerns
Causes of rectocele - ANSCauses- constipation/strain, chronic cough, heavy lifting, overweight,
childbirth, age
Retocele prevention - ANSPrevention- kegels, prevent constipation, avoid heavy lifting, cough,
avoid wt gain
Uterine prolapse - ANS-pelvic floor muscles and ligaments stretch and weaken and no longer
provide support for uterus and protrude into vagina.
Uterine Prolapse causes - ANSCauses- pregnancy, large baby delivery, lower estrogen level
after menopause, obesity Common in postmenopausal and one or more childbirth
,Uterine Prolapse symptom - ANSSx- heaviness or pulling into pelvis, tissue protruding from
vagina, urinary probs (leakage, retention), trouble having BM, feeling of sitting on small ball,
sexual concerns
Uterine Prolapse prevention - ANSPrevention- kegels, treat constipation, correct lifting, avoid wt
gain
uterine prolapse treatment - ANSTx- pessary
Herpes simplex - ANSchronic viral infection caused by HSV1 or HSV2, relapsing
Herpes Simplex prevention - ANSPrevention: consistent condom use b/c viral shedding can
occur in asymptomatic periods and can lead to transmission. W/ symptoms- Valacyclovir 500
mg daily
Herpes Simplex sign and symptoms - ANSSx-multiple painful vesicular or ulcerative lesion on
genitals, can be absent. Virus lays dormant and can be reactivated
Herpes Simplex diagnosis - ANSlays dormant and can be reactivated
Dx-cell culture and PCR
Herpes Simplex treatment - ANSTx- systemic antiviral. Acyclovir 7-10 days for 1st episode,
suppressive 200 mg daily BID
Chancroid - ANS-Transmitted via sexual contact or on hands that have touched lesion. Caused
by Haemophillus ducreyi
-Reportable disease
Chancroid symptoms - ANS-Sx- erythematous papule that evolves into pustule and
degenerates into saucer shaped ragged ulcer that is circumscribed by inflammatory wheal.
Tender, heavy foul discharge that is contagious
Chancroid diagnosis - ANSDx-culture that grows H ducreyi
Chancroid treatment - ANSTx- Abx azithromycin 1 g PO one time, ceftriaxone 250 mg IM 1 x,
cipro 500 mg PO BID x3 days erythromycin 500 mg PO TID x7 days. Personal hygiene, clean
w/ soap and water, sitz bath
Syphilis - ANS-chronic, systemic disease caused by a sphirochete transmitted via contact with
infectious moist lesion. Sexually acquired or vertically transmitted from infected mom.
Reportable disease
Syphilis transmitted - ANS-Transmitted in primary and secondary stages
,Primary-mucus mem 10-90 days later. Secondary- 2 wks-6mo after primary lesion then
generalized cutaneous eruption of secondary may appear. Latent- may last a lifetime
Syphilis prevention - ANSPrevention- condom, wash w/ soap and water after sex, screen ppl @
high risk (men that have sex with men, drug trafficers, correctional facilities)
Syphilis symptoms - ANSSx- [Primary]- Chancre- indurated firm painless papule or ulcer w/
raised borders, women can have cervical or vaginal lesion....on any mucus mem.
[Secondary}-viral syndrome w/ diffuse lymphadenopathy AEB dermatitis, papulosquamous
lesion on palms and soles. Lesions on trunk will be macular or maculopapular popular or
pustular other systemic include patchy alopecia, hepatitis, nephritis. [Latent]- resolution of lesion
of primary and secondary or finding of serologic test w/o therapy
Syphilis Diagnosis - ANSDx- T pallidum sphirochetes on dark field exam of cutaneous lesion,
serologic testsing antibody titers
Syphilis treatment - ANSPenicillin G
Chlamydia trachomatis gold standard test - ANS. Gold standard test is NAT, not culture
Chlamydia trachomatis - ANSnegative whiff w/ mucupurulent d/c and + clue
cells.
Chlamydia trachomatis symtoms - ANSSx- dyspuria, intramenstrural spotting, postcoital
bleeding, pain w/ sex, vag d/c purulent d/c reddened congested cervix or can be asymptomatic.
Chlamydia trachomatis diagnoses - ANSDx-Urine or endocervix/vaginal swab
Chlamydia trachomatis tx - ANSTx- 1 gm Azithromycin OR doxy, erythro PLUS rocephin 250 or
cefixime Complications- salpingitis and PID, perihepatitis,
Gonorrhea - ANSSTI, first causes cervical infection and ascend to endometrium and fallopian
tube. Reportable
Gonorrhea prevention - ANSPrevention: Screen all high risk ppl sexually active women age 25
or less. Use condoms. Sex partner w/ in 60 days evaluate to tx that sex partner, > 60 days tx
most recent sex partner, NB receive erythro ointment after delivery
Gonorrhea symptoms - ANSSx-many are asymptomatic. inflamed and edematous cervix with
d/c coming from cervical os. Vag d/c urinary frequency, dysuria, unilateral swelling of intoitus,
anal itching, pain, pharyngitis, conjunctivitis, systematic triad (polyarthalgia, tenosynovitis, and
dermatitis)
, Gonorrhea diagnosis - ANSDx- endocervical vaginal or urine specimens Complications-
salpingitis- tubal scarring, infertility
Gonorrhea treatment - ANSTx- Rocephin 125 mg, cefixime OR azithromycin
No sex 7 days after therapy. Tx for chlamydia as well.
HSV-type 1 or 2. - ANSType 2 most common cause of genital herpes. Produces cervical lesion,
first vesicular then ulcers. After initial infection, virus continues to reside in nerve cells for life.
HPV- spread - ANSspread via skin to skin (genital warts)
Prevention- abstinence, condom use, treating affected partner @ same time
Trich - ANSCaused by flagellated protozoan, mobile
Trich prevention - ANSPrevention: condoms, decrease # of sex partners, vulvular hygiene
Trich symptoms - ANSSx- purulent malodorous d/c w/ burning itching, dysuria, frequency, and
painful sexl. Postcoital bleeding may occur foamy white green d/c, strawberry appearing cervix
trich diagnosis - ANSDx- motile flagellated organisms on saline wet smear, Affirm
Trich treatment - ANSTx-Metronidazole 2g PO single dose OR tinidazole 2 gm in single dose
Candida - ANSwhite curd like d/c
Candida diagnosis - ANSDx- potassium hydroxide prep---distinct presence of hyphae
Candida treatment - ANSTx- topical azole drugs or PO fluconazole
bacterial vaginosis - ANSmost prevalent vaginal infection. * Loss of lactobacilii and increase in
vaginal pH fishy odor
bacterial vaginosis risk factor - ANSRisk factors: multiple sex partner, douching, lack of condom
use, lack of vag lactobacilli
Bacterial vaginosis prevention - ANScondom use, no douching
bacterial vaginosis treatment - ANSTx- metronidazole 500 mg PO x7 days, metronidazole gel
0.75 %x5 days, clinda cream 2% x3 nights OR tinidazole PO x2 days
Bacterial vaginosis symtoms - ANSSx-3 of 4 Amsel criteria
