OBGYN Infections
Vaginal pH | Discharge | Microscopy | Culture | Treatment | |
Chlamydia Trachomatis | – | Thin watery | Cytoplasmic inclusion bodies inside epithelial cells | Obligate intracellular pathogen, cell culture | Azithromycin Doxycycline |
Neisseria Gonorrhea | – | Thick creamy, gray/white | Gram – diplococci, inside PMN | Thayer Martin | Ceftriaxone |
Trichomonas Vaginalis | > 4.5 | Yellow/green, profuse, bubbly, frothy | Trichomonads, motile, WBC’s > 10/hpf | Whiff test (amine odor) – foul | Metronidazole orally |
Bacterial Vaginosis | > 4.5 | Thin, white (milky), gray | Clue cells, adherent bacteria, no WBC’s | Whiff test (amine odor) – fishy | Metronidazole ora/topical, Clindamycin |
Vulvovaginal Candidiasis | < 4.5 (usually) | White, curdy, cottage cheese | Budding yeast, pseudohyphae, Germ tube test+ | yeast smell | Fluconazole |
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:
- Treatment:
Vulvovaginitis
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:
- Dx: = clinical
- Treatment:
TORCH infections
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
HSV
- Path: HSV 1 and 2
- 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
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