WOMEN'S HEALTH EOR EXAM TOPICS WITH
CORRECT QUESTIONS AND ANSWERS.
sx of disseminated gonorrhea - ANSWER...triad of polyarthralgia, tenosynovitis, and dermatitis,
or purulent arthritis without dermatitis
may be septic
the major complication of gonorrhea in females - ANSWER...salpingitis
prevention and tx of gonorrhea - ANSWER...-abstain from sexual activity for 7 days after tx is
started
-re-examine after 3 weeks to rule out tx failure or reinfection
-use condoms
tx with 250mg ceftriaxone and (1g azithromycin or 100mg doxycycline bid x 7 days)
tx for disseminated gonorrhea - ANSWER...-admit
-ceftriaxone 1g IM or IV q24h or cefotaxime or ceftizoxime 1g IV q8h
-penicillin allergic spectinomycin 2g IM q12h
tx for infant born to untreated mother with gonorrhea - ANSWER...ceftriaxone 25-50mg/kg IV
or IM NTE 125mg once
the most commonly reported notifiable disease in the US - ANSWER...chlamydia
microbiology of chlamydia - ANSWER...obligate intracellular microorganisms
cell wall similar to gram negative
contain both DNA and RNA
divide by binary fission but grow intracellularly like viruses
can only be grown by tissue culture
risk factors for chlamydia - ANSWER...obvious stuff - younger age, sexually active without
barrier protection, lower status
OCP use INCREASES risk?
sx of chlamydia infection - ANSWER...may be asymptomatic
-mucopurulent cervical discharge
-hypertrophic cervical inflammation
,appearance of PID on US - ANSWER...ACUTE - "cogwheel sign" - incomplete septation of the
tubal wall
CHRONIC - "beaded string" - thin tubal wall
microbiology of syphilis - ANSWER...treponema pallidum
spirochete
primary syphilis presentation - ANSWER...treponemes enter mucous membrane or broken skin
10-90 days after, painless chancre develoeps
indurated, firm, painless papule or ulcer with raised borders
persists for 1-5 weeks and heals spontaensously
secondary syphilis presentation - ANSWER...2 weeks to 6 months (average 6 weeks) after
chancre appears
generalized cutaneous eruption heals spontaneously after 2-6 weeks
may involve palms and soles, macular, maculopapular, papular, or pustular
patchy alopecia
Condyloma Lata - moist papules in perineal area
tertiarty syphilis presetnation - ANSWER...4-20 years after primary
testing for syphilis - ANSWER...darkfield microscopy of lesion or immunoflurescence
serologic tests (VRDL) (RPR) every week for 6 weeks or until positive (usually 3-6 weeks after
infection or 2-3 weeks after chancre)
Treponemal antibody tests - FTA-ABS or MHA-TP are more sensitive and specific, but remain
positive despite therapy
presentation of latent syphilis - ANSWER...infectious in first 1-2 years of latency
early latent < 1 year, late latent > 1 yr
possible asymptomatic neurosyphilis (CSF examination recommended)
neurosyphilis prestnation - ANSWER...most common during latent syphilis
opthalmic and auditiory
CN palsy, meningeal signs
CSF for cell count, protein, VDARL and FTA-ABS
syphilis during pregnancy - ANSWER...the earlier in pregnancy the fetus is exposed, the more
severe to fetal infection, greater the risk of premature delivery or stillbirth
tx the same except no doxy, use penicillin despite allergy, consider inpatient
,syphilis treatment - ANSWER...tx any pt who had been exposed or is symptomatic despite
serological tests
Primary, secondary, and early latent all tx the same
-Benzathine penicillin G 2.4 million units IM once
alternative - doxycycline 100mg bid x 14 days
when should pregnant women be tested for syphilis - ANSWER...at first visit
repeat between 28 and 32 weeks in high risk areas
tx for late latent syphilis - ANSWER...for over 1 year or unknown duration except neurosyphilis
-Pen G 2.4 million unites IM weekly for 3 weeks
alternative - doxycycline 100mg bid x 14 days
tx for congenital syphilis - ANSWER...Pen G 50,000 U/kg IM once for asymptomatic
give aqueous crystalline pen G bid/tid for 10-14 days if symptomatic or neurosyphilis
Jarisch-Herxheimer reaction - ANSWER...febrile reaction in 50-75% of pts with early syphilis
tx with penicillin
occurs 4-12 hours after injection, complete by 24 hours
generally benign but may trigger labor or fetal distress
three most common causes of infectious vaginitis - ANSWER...trichomonas
bacterial vaginosis
candidiasis
microbiology of bacterial vaginosis - ANSWER...corynebacterium vaginale
gardnerella vaginalis
small nonmotile, nonencapsulated, pleomorphic rod
stains variably
fish odor due to anerobic bacteria
clinical criteria for dx of bacterial vaginosis - ANSWER...-homogeneous white
noninflammatory discharge
-clue cells > 20% (small dark particles)
-pH > 4.5
-fishy odor with or without KOH
tx for bacterial vaginosis - ANSWER...tx high-risk pregnancy or pre-op abdominopelvic surgery
even if asymptomatic
metronidazole 500mg bid x 7 days
, alternative metronidzole 2g single dose
Pregnant - 250mg tid x 7 days or clindamycin 300mg bid x 7 days
trichomonas microbiology - ANSWER...unicellular flagellate protozoan
larger than PMN but smaller than epithelial cells
the most prevalent nonviral STD in the US - ANSWER...trichomonas
trichomonas presentation - ANSWER...persistent vaginal discharge with or without secondary
vulvar pruritis
profuse, extremely frothy, greenish, foul smelling
pH > 5.0
"strawberry spots" multiple small petechiae
dx of trichomonas - ANSWER...wet mount shows PMNs with motile flagellates in 50-70%
Culture is the gold standard
tx for trichomonas - ANSWER...tx partners as well, use condoms or avoid sex until tx is
complete
single dose metronidazole 2g
also 500mg bid x 7 days
tx failure max dose is 2-4g daily for 10-14 days
types of HPV that cause condyloma acuminata - ANSWER...6 and 11
types of HPV that are oncogenic - ANSWER...16, 18, 31, 33, 35
HPV and dysplasia - ANSWER...punctate and mosiac pattern of blood vessels suggest vaginal
intraepithelial neoplasia
koilocytes is pathognomic, large perinuclear halo
aceotowhite changes
HPV and pregnancy - ANSWER...may infect laryngeal or vulvar of infant
HPV is NOT contraindication to vaginal delivery (unlike active HSV)
HPV tx in pregnancy - ANSWER...trichloroacetic acid may be used in the last 4 weeks of
pregnancy
electrocoagulation, cryotherapy, or laser therapy should be used prior to 32 weeks to avoid
posttreatment necrosis
CORRECT QUESTIONS AND ANSWERS.
sx of disseminated gonorrhea - ANSWER...triad of polyarthralgia, tenosynovitis, and dermatitis,
or purulent arthritis without dermatitis
may be septic
the major complication of gonorrhea in females - ANSWER...salpingitis
prevention and tx of gonorrhea - ANSWER...-abstain from sexual activity for 7 days after tx is
started
-re-examine after 3 weeks to rule out tx failure or reinfection
-use condoms
tx with 250mg ceftriaxone and (1g azithromycin or 100mg doxycycline bid x 7 days)
tx for disseminated gonorrhea - ANSWER...-admit
-ceftriaxone 1g IM or IV q24h or cefotaxime or ceftizoxime 1g IV q8h
-penicillin allergic spectinomycin 2g IM q12h
tx for infant born to untreated mother with gonorrhea - ANSWER...ceftriaxone 25-50mg/kg IV
or IM NTE 125mg once
the most commonly reported notifiable disease in the US - ANSWER...chlamydia
microbiology of chlamydia - ANSWER...obligate intracellular microorganisms
cell wall similar to gram negative
contain both DNA and RNA
divide by binary fission but grow intracellularly like viruses
can only be grown by tissue culture
risk factors for chlamydia - ANSWER...obvious stuff - younger age, sexually active without
barrier protection, lower status
OCP use INCREASES risk?
sx of chlamydia infection - ANSWER...may be asymptomatic
-mucopurulent cervical discharge
-hypertrophic cervical inflammation
,appearance of PID on US - ANSWER...ACUTE - "cogwheel sign" - incomplete septation of the
tubal wall
CHRONIC - "beaded string" - thin tubal wall
microbiology of syphilis - ANSWER...treponema pallidum
spirochete
primary syphilis presentation - ANSWER...treponemes enter mucous membrane or broken skin
10-90 days after, painless chancre develoeps
indurated, firm, painless papule or ulcer with raised borders
persists for 1-5 weeks and heals spontaensously
secondary syphilis presentation - ANSWER...2 weeks to 6 months (average 6 weeks) after
chancre appears
generalized cutaneous eruption heals spontaneously after 2-6 weeks
may involve palms and soles, macular, maculopapular, papular, or pustular
patchy alopecia
Condyloma Lata - moist papules in perineal area
tertiarty syphilis presetnation - ANSWER...4-20 years after primary
testing for syphilis - ANSWER...darkfield microscopy of lesion or immunoflurescence
serologic tests (VRDL) (RPR) every week for 6 weeks or until positive (usually 3-6 weeks after
infection or 2-3 weeks after chancre)
Treponemal antibody tests - FTA-ABS or MHA-TP are more sensitive and specific, but remain
positive despite therapy
presentation of latent syphilis - ANSWER...infectious in first 1-2 years of latency
early latent < 1 year, late latent > 1 yr
possible asymptomatic neurosyphilis (CSF examination recommended)
neurosyphilis prestnation - ANSWER...most common during latent syphilis
opthalmic and auditiory
CN palsy, meningeal signs
CSF for cell count, protein, VDARL and FTA-ABS
syphilis during pregnancy - ANSWER...the earlier in pregnancy the fetus is exposed, the more
severe to fetal infection, greater the risk of premature delivery or stillbirth
tx the same except no doxy, use penicillin despite allergy, consider inpatient
,syphilis treatment - ANSWER...tx any pt who had been exposed or is symptomatic despite
serological tests
Primary, secondary, and early latent all tx the same
-Benzathine penicillin G 2.4 million units IM once
alternative - doxycycline 100mg bid x 14 days
when should pregnant women be tested for syphilis - ANSWER...at first visit
repeat between 28 and 32 weeks in high risk areas
tx for late latent syphilis - ANSWER...for over 1 year or unknown duration except neurosyphilis
-Pen G 2.4 million unites IM weekly for 3 weeks
alternative - doxycycline 100mg bid x 14 days
tx for congenital syphilis - ANSWER...Pen G 50,000 U/kg IM once for asymptomatic
give aqueous crystalline pen G bid/tid for 10-14 days if symptomatic or neurosyphilis
Jarisch-Herxheimer reaction - ANSWER...febrile reaction in 50-75% of pts with early syphilis
tx with penicillin
occurs 4-12 hours after injection, complete by 24 hours
generally benign but may trigger labor or fetal distress
three most common causes of infectious vaginitis - ANSWER...trichomonas
bacterial vaginosis
candidiasis
microbiology of bacterial vaginosis - ANSWER...corynebacterium vaginale
gardnerella vaginalis
small nonmotile, nonencapsulated, pleomorphic rod
stains variably
fish odor due to anerobic bacteria
clinical criteria for dx of bacterial vaginosis - ANSWER...-homogeneous white
noninflammatory discharge
-clue cells > 20% (small dark particles)
-pH > 4.5
-fishy odor with or without KOH
tx for bacterial vaginosis - ANSWER...tx high-risk pregnancy or pre-op abdominopelvic surgery
even if asymptomatic
metronidazole 500mg bid x 7 days
, alternative metronidzole 2g single dose
Pregnant - 250mg tid x 7 days or clindamycin 300mg bid x 7 days
trichomonas microbiology - ANSWER...unicellular flagellate protozoan
larger than PMN but smaller than epithelial cells
the most prevalent nonviral STD in the US - ANSWER...trichomonas
trichomonas presentation - ANSWER...persistent vaginal discharge with or without secondary
vulvar pruritis
profuse, extremely frothy, greenish, foul smelling
pH > 5.0
"strawberry spots" multiple small petechiae
dx of trichomonas - ANSWER...wet mount shows PMNs with motile flagellates in 50-70%
Culture is the gold standard
tx for trichomonas - ANSWER...tx partners as well, use condoms or avoid sex until tx is
complete
single dose metronidazole 2g
also 500mg bid x 7 days
tx failure max dose is 2-4g daily for 10-14 days
types of HPV that cause condyloma acuminata - ANSWER...6 and 11
types of HPV that are oncogenic - ANSWER...16, 18, 31, 33, 35
HPV and dysplasia - ANSWER...punctate and mosiac pattern of blood vessels suggest vaginal
intraepithelial neoplasia
koilocytes is pathognomic, large perinuclear halo
aceotowhite changes
HPV and pregnancy - ANSWER...may infect laryngeal or vulvar of infant
HPV is NOT contraindication to vaginal delivery (unlike active HSV)
HPV tx in pregnancy - ANSWER...trichloroacetic acid may be used in the last 4 weeks of
pregnancy
electrocoagulation, cryotherapy, or laser therapy should be used prior to 32 weeks to avoid
posttreatment necrosis
