11. Three stages of lesions in HSV:
1. Vesicle with or without pustule formation,
which last about a week
2. Ulceration
3. crusting
12. HSV1 HSV2
Gold standard for diagnosis → tissue
culture
But
HSV1 & HSV2 antibodies testing ≥ 96 percent
&
PCR is 1.5 to 4 times more sensitive than
culture
13. Rx
First clinical episode
Episodic therapy for recurrent disease
Oral suppressive therapy option
14. First Clinical Episode
Acyclovir 400 mg x3 times daily for 7- 10 days
Episodic Therapy for recurrent Disease
Acyclovir 4oo mg x3 times daily for 5 days
Oral Suppressive Therapy Option
Acyclovir 400 mg x2 times daily
15. Acyclovir
C-group in pregnancy
DNA polymerase inhibitor activity
After an hour 50% in CSF above the plasma
concentration
16. HPV
HPV 16 → the dominant cancer− related HPV
so interested in squamous cell
BUT
HPV 18 → a dominant role in Rapid Transit
Cervical cancer (within 1-3 years)
17. RX
HPV
HPV vaccination
a quadrivalent vaccination against
types 6, 11, 16 & 18
or
a bivalent HPV 16/18 vaccine
routinely to girls 11-12 Y/O
or
anybody in 9-26 Y/O
24. Klebsiella
encapsulated
mildly contagious
requires repeated exposures
has a long incubation period of weeks to months
25. RX
Granuloma Inguinale
Doxycycline 100 mg twice daily for a
minimum of 3 weeks and until lesions have
completely healed
or
Azithromycin 1 g orally once a week as
above
or
Ciprofloxacin 750 mg orally twice daily as
39. RX
Condyloma acuminata
electrosurgical, cryotherapy, laser ablation
Alternatively
5%-imiquimod cream (Aldara, 3M)
or
A biologically active extract of Podophyllin
0.5% Gel or solution (Condylox)
40. Chlamydia
symptoms of Chlamydia are usually mild or
absent, serious complications that cause
irreversible damage, including infertility, can
occur "silently" before a woman ever
recognizes a problem.
41. Chlamydia can be transmitted •
Chlamydia can also be passed fro
.
42. If the infection spreads from the cervix to
the fallopian tubes, some women still have
no signs or symptoms; others have:
lower abdominal pain, low back pain,
nausea, fever, pain during intercourse, or
bleeding between menstrual periods.
Chlamydial infection of the cervix can
spread to the rectum.
43. nucleic acid amplification tests
(NAATs)
as a screen test for both Chlamydia &
Gonorrhea enzyme immunoassays
(EIAs)
direct fluorescent antibody
(DFA)
44. RX
Chlamydia
Azithromycin 1 g orally once
or
Doxycycline 100 mg twice daily orally daily
for 7 days
54. Gonorrhea
This sexually transmitted disease (STD) is often
asymptomatic, but if left untreated, it can lead to long-
term health consequences, including chronic pelvic
pain, ectopic pregnancy, and infertility.
Gonorrhea can also increase the risk of contracting
and transmitting HIV.
55. Any genital symptoms such as
An unusual sore, discharge with odor,
burning during urination, or bleeding
between menstrual cycles could mean an
STD infection
56. RX
Gonorrhea
Ceftriaxone 250 mg as a single dose
+
Azithromycin 1 gram as a single dose
or
Doxycycline 100 mg twice daily for
57. For patients sensitive to cftriaxone or when
it is not available
Cefexim 400 mg orally + Azithromycin 1gr. Orally
or
Doxycycline 100mg twice daily for 7 days
63. RX
Lymphogranuloma Venereum
Cap. Doxycycline 100 mg for 21 days
Alternatively
Cap. Erythromycin 500 mg four times
daily the same duration
64. Azithromycin
B-group in pregnancy
Form of drug: Cap. 250 mg
Bacteriostatic & Bactericide
Effect on Aerobic & anaerobic Bacteria
Gram +, -
Trachoma, Pneumonia, Borrelia
It can not reach to CNS.
Indications:
Urethritis (Gonorrhea & ungonorrhic),
Chlamydia Cervicitis,
Side effects: Vomit, Diarrhea, Abdominal pain, ↑Cr.,
AST, ALT
65. Doxycycline
D-group in pregnancy
Form of drug: Cap. 100 mg.
Bacteriostatic
Indications;
Acute Gonorrhea, Primary & Secondary Syphilis
Side effects: GI tract effects, Loss or reduction of
smelling, Esophagit
66. Metronidazol
B-group in pregnancy
Form of Drug: Infu. 500 mg, Tab. 250mg,Vag.
Bactericide
Indications:
Anaerobic infections in abdomen, Liver, Peritonitis,
Side effects: Vomit, Metal taste, Psuedomembrane
Colitis, Neuropathy
67. Ceftriaxone Sodium
B-group in pregnancy
Bactericide
Indications:
Gonorrhea, Cervicitis, Septicemia
Mode of administration:
Single dose 125mg up to 250 mg IM
Side effect: PT↑, CBC abnormalities……
68. Squamous metaplasia is a normal
process and occurs most actively
immediately to the original SCJ,
creating a zone (TZ), between the
original SCJ and the columnar
epithelium.
69. Theoretically, cervical cells
undergoing
metaplasia are particularly
vulnerable to the oncogenic
effects of HPV and co-
carcinogens.
70. Metaplasia is most active during
adolescence and pregnancy.
This may explain why early age of sexual
activity and first pregnancy are known risk
factors for cervical cancers.
71. Genital HPV is the most common sexually
transmitted infection.
The Centers for Disease Control and
Prevention (2002) estimates that the risk of a
woman acquiring genital HPV by age 50 is
greater than 80 percent.
72. –
AnyAA women with unexplained
postcoital bleeding should undergo
colposcopic examination if no
other obvious source of bleeding is
identified.
73. Dysfunctional Uterine Bleeding
80% to 90% because of dysfunction of
hypothalamic-pituitary-ovarian axis
10% to 20% of women with DUB, ovulation occurs
cyclically
74. Differences between:
Anovulatory DUB
NO Progesterone, Persistent proliferative endometrium
Ovulatory DUB
Alterations in vascular architecture, Predominantly from
vascular dilatation alone
76. Management of acutely menorrhagia
by COCs
4 Pills → every 6 hours for at least 24 hours
reduce it to 3 pills up to next 3 days
reduce it to 2 pills up to next 3 days
then
fix it to 1 pills daily up to next 21 days!
77. The American College of OB & GYN:
Endometrial assessment in any woman
older than 35 years with abnormal bleeding
and ………
78. Hyperplasia
>5 mm endometrial thickness
↓
SIS, hysteroscopy, endometrial biopsy
≤4 mm for exclusion of endometrial cancer
(Its sensitivities up to 95%-97%)
79. When there is a heterogeneous endometrial
echogenicity or fluid collection
endometrial biopsy or hysteroscopy should
be performed
80. DUB due to systemic causes
Renal disease
Liver disease
Thyroid disease
CoagulopathyThrombocytopenia
Von Willebrand disease
81. RX of Von Willebrand disease
Desmopressin ( a vasopressin analog promotes release of vWF from
storage sites in patients with the common type 1 vWD)
It is available in an IV infusion & a concentrated intranasal form)
83. Pathophysiology of Lichen Sclerosus
Unknown, may be genetic, infection, hormonal &
autoimmune etiologies
Hallmark of it:
Vulvar pruritus which results from inflammation
local terminal nerve fibers
84. RX
Patient education
Topical Corticosteroids
( the best of them Clobetasol ointment 0.05% )
Topical estrogen
Retinoids
(improves dysplastic changes, stimulates collagen &
glycosaminoglcan synthesis and induces local angiogensis)
Surgery
85. Intertrigo (friction between moist opposed skin surfaces)
Atopic Eczema (in the first 5 years of life)
Psoriasis ( T- cell-mediated inflammatory reactions are linked with
keratinocyte hyperproliferation)
91. IUDs
Copper T, Mirena, LNG-IUS
Failure rate respectively: 0.8% & 0.1%
Advantages of Mirena: ↓ PID, for
women with contraindications to COCs
92. Disadvantages of IUDs
Silent perforation, Cramping & Bleeding,
Menorrhage, Infection, Pregnancy with retained IUD
93. ParaGard T 380A contraindications:
Any Copper allergy
Mirena contraindications:
Hypersensitivity to any component of
this product
Known or suspected carcinoma of the
breast
Acute liver disease or tumor
94. Procedures of Insertion
FDA requirement: the woman must be given
detailed brochure about side effects & apparent risks
from its use
Postpartum insertion?..........?
95. Cystic Ovarian Mass
Symptoms
Diagnosis
Management:
Observation, Surgical Excision
96. Premenopausal women (<50 years):
CA 125 >200 U/ml
Ascites
Evidence of abdominal or distant metastasis
Positive of breast or ovarian cancer
Postmenopausal Women(≥50 years)
CA 125 > 35 U/ml
Ascites
Nodule or fixed pelvic mass
Evidence of abdominal or distant metastasis
Positive of breast or ovarian cancer
97. Serum alpha-fetoprotein (AFP)
Endodermal sinus tumor or Embryonal cell
carcinoma
ß-hCG
a mixed germ cell or Embryonal cell carcinoma
CA (19-9)
Mucinous epithelial ovarian carcinoma
98. Management of ovarian mass found
with imaging
Premenopausal
-Simple cyst ( hemorrhagic or unhemorrhagic)
≤3 cm diameter & >3 cm diameter
Postmenopausal woman
≤5 cm diameter & >5 cm diameter
-Complex mass
-Solid or predominantly solid-appearing mass
99. Expectant management
1. Sonographic evidence of a thin-walled,
unilocular cyst
2. Cyst diameter less than 5 cm
3. No cyst enlargement during surveillance
4. Normal serum CA125 levels
100. Overactive Bladder (OAB)
Urgency: a sudden, compelling desire
to pass urine, which is difficult to defer
102. The normal urge to void:
It appears to be mediated by heterogeneous
activity in muscle bundles
The presence of urgency in the absence of
increased intravesical pressure may result from
enhanced coupling between bundles, resulting in a
wave of diffuse activity and producing an
involuntary bladder contraction