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GYNECOLOGICAL INFECTIONS . . . CONT.

Notes

GYNCOLOGICAL SEXUALLY TRANSMITTED DISEASES

Chlamydia Chlamydia trachomatis most common STD often associated with N. gonorrhea risk factors • < 25 years old • history of previous STD • new partner in last 3 months • multiple partners • not using barrier contraception • contact with infected person symptoms • asymptomatic • muco-purulent endocervical discharge • urethral syndrome • dysuria, frequency, pyuria, no bacteria • pelvic pain • post-coital bleeding complications • acute salpingitis, PID • infertility - tubal obstruction from low grade salpingitis • perinatal infection - conjunctivitis, pneumonia • ectopic pregnancy • Fitz-Hugh Curtis syndrome (liver capsule infection) • arthritis, conjunctivitis, urethritis (Reiter syndrome - male predominance) diagnosis • cervical culture or monoclonal antibody • obligate intracellular parasite - require tissue culture for diagnosis treatment • doxycycline 100 mg bid for 7 days or azithromycin 1 g orally in a single dose • erythromycin 500 mg qid for 7 days if pregnant • treat partners • reportable disease screening • high risk groups • during pregnancy

Gonorrhea Neisseria gonorrhea symptoms and risk factors as with Chlamydia diagnosis • Gram stain shows gram-negative intracellular diplococci • cervical and rectal and throat culture treatment • single dose of ceftriaxone 250 mg IM or cefixime 800 mg PO or ciprofloxacin 500 mg PO • plus doxycycline 100 mg bid for 10 days to treat for concomitant chlamydial infection • erythromycin 500 mg qid for 7 days if pregnant • treat partner(s) • reportable disease screening as with Chlamydia

Condylomata Acuminata (see Colour Atlas D7) human papillomavirus (HPV) clinical presentation • latent infection • no visible lesions • detected by DNA hybridization tests • asymptomatic • subclinical infection • visible lesion only after 5% acetic acid applied and magnified • clinical infection • visible wartlike lesion without magnification • hyperkeratotic, verrucous or flat, macular lesions • vulvar edema lesions tend to get larger during pregnancy

Gynecology 26

MCCQE 2000 Review Notes and Lecture Series

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