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GYNECOLOGICAL INFECTIONS . . . CONT.

• continue IV antibiotics for at least 48 hours after symptoms have improved • then doxycycline 100 mg PO bid to complete 14 days • percutaneous drainage of abscess under US guidance • when no response to treatment, laparoscopic drainage • if failure, treatment is surgical (salpingectomy, TAH-BSO) outpatient if • typical findings • mild to moderate illness • oral antibiotics tolerated • compliance ensured • follow-up within 48-72 hours possible • recommended treatment • ceftriaxone 250 mg IM + doxycycline 100 mg bid for 14 days remove IUD after a minimum of 24 hours of treatment reportable disease treat partner(s) re-culture for cure 2 weeks later

HIV IN WOMEN (see Infectious Disease Section) 8% of AIDS occurs in women incidence in women increasing greatest risk factor is IV drug use, followed by contact with high risk male suspect if refractory moniliasis risk of vertical transmission to the fetus is 25% – this can be reduced to 8% when AZT given during pregnancy, labor, delivery and to the neonate Pap smear every six months as can have increased incidence of cervical dysplasia

TOXIC SHOCK SYNDROME

multiple organ system failure due to S. aureus exotoxin rare associated with:

• tampon use • diaphragm, cervical cap or sponge use • wound infections • post-partum infections early recognition and treatment of syndrome is imperative as incorrect diagnosis can be fatal

Clinical Presentation sudden high fever sore throat, headache, diarrhea erythroderma signs of multisystem failure refractory hypotension exfoliation of palmar and plantar surfaces of the hands and feet 1-2 weeks after onset of illness

Management remove potential sources of infection • foreign objects and wound debris debridement of necrotic tissues adequate hydration penicillinase-resistant antibiotics - cloxacillin steroid use controversial but if started within 72 hours, may reduce severity of symptoms and duration of fever

SURGICAL INFECTIONS AND PROPHYLAXIS

Post Operative Infections in Gynecological Surgery (see General Surgery Notes) urinary tract infections respiratory tract infections phlebitis wound infections necrotizing fascitis pelvic cellulitis • common post hysterectomy

MCCQE 2000 Review Notes and Lecture Series

Notes

Gynecology 31

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