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GYNECOLOGICAL INFECTIONS . . . CONT.

  • >

    60 subtypes of which > 20 are genital subtypes

classified according to risk of neoplasia and cancer types 16, 18, 45, 36 (and others) associated with increased incidence of cervical and vulvar intraepithelial hyperplasia and carcinoma diagnosis

  • cytology (Pap smear)

    • koilocytosis = nuclear enlargement and atypia with perinuclear halo

  • biopsy of visible and acetowhite lesions at colposcopy

  • detection of HPV DNA using nucleic acid probes not routinely done

treatment (see Gynecological Oncology Section)

  • chemical

    • trichloroacetic acid (podophyllin, 5-FU)

  • physical

    • cautery, cryotherapy, laser

condyloma should be treated early during pregnancy if not successful then C-section should be considered cannot be prevented by using condoms

Molluscum Contangiosum epithelial proliferation caused by a growth-stimulating poxvirus (Molluscipoxvirus)

  • mildly contagious

symptoms

  • occasionally mild pruritis

clinical presentation

  • multiple nodules up to 1 cm diameter on vulva and

perineum with umbilicated center treatment

  • chemical

    • carbonic acid, TCA, or silver nitrate

  • physical

    • curette

Herpes Simplex (see Colour Atlas F12) Herpes Simplex virus type II (genital) (90%), type I (oral) (10%) initial symptoms

  • present 2-21 days following contact

  • prodromal symptoms

    • tingling, burning, pruritus

  • multiple, painful, shallow ulcerations with small vesicles

    • these lesions are infectious

    • lesions appear 7-10 days after initial infection

  • inguinal lymphadenopathy, malaise, fever often with first infection

  • dysuria and urinary retention if urethral mucosa affected

  • may be asymptomatic

  • recurrent infections

    • less severe, less frequent and shorter in duration

diagnosis

  • viral culture

  • cytologic smear

    • multinucleated giant cells

    • acidophilic intranuclear inclusion bodies

  • virus seen on electron microscopy

treatment

  • symptomatic

  • acyclovir 200 mg 5 times a day for 5 days decreases duration and severity of acute phase

  • treat secondary infection

    • famciclovir, less frequent dosing and shorter duration of treatment for recurrent genital herpes

  • consider suppressive therapy if 6-8 attacks per year

  • education regarding transmission

    • avoid contact from prodrome until lesions have cleared

    • use barrier contraception

MCCQE 2000 Review Notes and Lecture Series

Notes

Gynecology 27

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