OBGYN Infections

OBGYN Infections

Asymptomatic Bacteriuria

• Treatment:
  • Cephalexin 250mg po QID 7 day course
  • Don’t use ampicillin – high rates of resistance
  • Urine culture after therapy to ensure cure
    • identify patients with persistent or recurrent bacteriuria

Cervicitis

• Dx: 
  • 1. Physical
    
  • 2. NAAT= PCR
    
• Treatment:
  • GC: ceftriaxone IM
    
  • chla= doxy or azithro
    
  • Cervicitis can also be anything in vulvovaginitis

Vulvovaginitis

• Causes:
  
  • 1. Candida- thick white d/c
    
  • 2. BV-thin grey white discharge- fishy odor- clue cells
    
  • 3. Trichomoniasis- green- yellow d/c- ping ponging- treat both- flagellated

Group B Strep

• Path:
  • Mom => benign flora
  • Baby => Devastating
• Pt:
  • 1) + prenatal care (wk 10), asx screening (wk 35)
  • 2) No prenatal care, healthy normal, delivery = toxic baby
• Dx:
  • 1) UA, UCx
  • 2) Clinical
  • 3) Risk Factors +
    • – GBS baby in past or GBS screen + in past
    • – Prolonged ROM
    • – Intrapartum Fever
• Tx:
  • Ampicillin (1st time)
  • Cefazolin (PCN allergy)
  • Clinda (life threatening PCN allergy)
  • Vancomycin (last resort)
• F/U: C-section AND no ROM, no contractions, doesn’t need intrapartum antibiotics

HIV

• Path: Decreased CD4, Increased Mom’s Risk for opportunistic infections, increased viral load, increased infections
• Pt:
  • 1) Asx screen, + Prenatal care
  • 2) No prenatal care, unknown HIV status
• Dx:
  • 1st: Eliza
  • Best: Western Blot
  • VL: CD 4
• Tx: 2 + 1
  F/u:
  • At delivery viral load <1000 +/- (+) HAART) = vaginal
  • If viral load >1000 or (-) HAART then C-section GIVE AZT

Pelvic Inflammatory Disease

• Causes:
  • GC, Chla, Vaginal flora
• Dx: = clinical
  • 1. Pelvic or abd pain
    
  • 2. no other causes
    
  • 3. any 1 of: Cervical motion tenderness, adnexal tenderness, or uterine tenderness
• Treatment:
  • This is severe
  • In patient: Cefoitin + doxy
    
  • Out patient: ceftriaxone + doxy + metronidazole

TORCH infections

• Toxoplasmosis
  
• Other (syphilis)
  
• Rubella
  
• Cytomegalo Virus
  
• HSV

Toxoplasmosis

• Path: T. Gondii in cat feces, undercooked meat, cysts in soil
  
• Pt: “Mono-like” illness
  
• Baby: Brain calcifications, ventriclomegaly, seizures
  
• f/u: Too ab (+) = none
  
• Too ab (-) = Avoidance

Rubella

• Path: Primary Viremia
  
• Pt: + Prenatal care, not vaccinated, no prenatal care
  
• Baby = Blueberry muffin rash, petechia purport, cat acts, congenital heart malformation, deafness, Intrauterine growth restriction, abortion (1st trimester)
  
• Tx: Avoidnce
  
• f/u: MMRV Before Pregnancy

Syphilis

• Path: T. Pallidum (spirochete), STI
• Pt:
  • 1st = painless chancre
  • 2nd = targeted session on palms + soles EL/LL = + Test, no sxs
  • 3rd = Neruo sxs
• Dx:
  • 1st = dark field microscope
  • EL/LL = 2nd = RPR –> FTP-Abs
  • 3rd = CSF –> VDRL/RPR
• Tx:
  • 1st = IM PCN x 1
  • 2nd = IM PCN x 1
    • EL = IM PCN x 1
    • LL = IM PCN q wk x 3wks
  • 3rd = IV PCN q 4hrs x 7-10days
    
  • Give PCN even if PCN allergic
• f/u:
  • 1st = dead baby
  • 3rd = snuffles, sabber shins, saddle nose, hutchinson’s teeth

CMV

• Path: ds-DNA
  
• Pt: “Toxo” that is not toxo

HSV

• Path: HSV 1 and 2
  
  • 1st = viremia that cause congenital sxs
    
  • 2nd = reactivation infected
    
• Pt: Painful burning prodrome
  
• Vesicles on erytemadous base
  
• Dx: PCR from lesion
  
• Tx: Valcyclovir or acyclovir, c-section if active vesicles
  
• f/u: Congential syndrome
  
  • – IUGR
    
  • – Preterm delivery
    
  • – Blindness

Antibiotics in Pregnancy

• Safe
  • amoxicillin
  • ampicillin
  • clindamycin
  • erythromycin
  • penicillin
  • cephalosporins
• NOT Safe (Avoid)
  • tetracyclines
  • nitrofurantoin – only use when there’s no alternative
  • sulfonamides – only use when there’s no alternative