STI/epididymitis/VVC

Question 1

what is the most common cause of testicular pain?

Answer 1

epididymitis, 80%

Question 2

when do you treat with fluoroquinolones?

Answer 2

age > 35 or hx condomless anal insertive sex

Question 3

what are some causes of chronic epididymitis?

Answer 3

trauma
prolonged sitting
prior scrotal/inguinal hernia
immunosuppresion
vasectomy
Bechet's disease
travel to a place w/ mumps or bucellosis 
amiodarone

Question 4

what specific examination might support the dx epididymitis?

Answer 4

+ prehn’s

Question 5

acute vs chronic epidimimytis

Answer 5

< 6 weeks

> 6 weeks

Question 6

Red Flags (or ddx not to miss) for epididimytis

Answer 6

Systemic symptoms
Incarcerated hernia
Fournier’s gangrene (necrotizing fasciitis of perineum: acute scrotal pain, severe pain in anterior abdo wall spreading to gluteal muscles, scrotum, penis)
pain unrelieved with elevation (testicular torsion)
Testicular cancer

Question 7

tx epididymitis for age < 35 and no insertive anal sex

Answer 7

GC/CT w/ cefixime or ceftriaxone X 1 dose and doxy X 10-14 days

Question 8

tx for epididymitis for insertive anal sex

Answer 8

cefixime X 1 and levofloxacin X 10-14 days

Question 9

tx for epididymitis > 35 years and no condomless sex or no risk factors for GC/CT

Answer 9

levofloxacin

Question 10

common organism in BV (polymicrobial)

Answer 10

gardnerella vaginalis

Question 11

BV is higher prevalence in what population?

Answer 11

WSW

Question 12

risk factors for BV

Answer 12

IUD
smoking
new sexual partners, etc

NOT associated w/ DM or immunosuppression

Question 13

what bacteria normally prevent overgrowth of microbes that cause BV?

Answer 13

lactobacilli

Question 14

what percentage of BV are asymptomatic

Answer 14

50-75%

Question 15

recurrent BV is defined as:

Answer 15

2+ 4 weeks

4+ one year

Question 16

s/s trich

Answer 16

dyspareunia, pruritis, not a lot of d/c, vulva can look inflamed…. really it’s QUITE similar to BV or yeast

Question 17

amsel’s criteria for BV

Answer 17

3 or more: 
pH > 4.5 
moderate-profuse grey-white non-clumping d/c
\+ KOH whiff
Lab smear + for clue cells 

DCPW (discharge, clue cells, pH, whiff test)

Question 18

treat asymptomatic pts if:

Answer 18

pregnant
having gyne surgery/abortion/D+C
PID

Question 19

tx for BV

Answer 19

flagyl gel!!! -.75% (5g) daily X 5 days
clinda 2% (5g) daily X 7 days
** oil based will weaken condoms!!

Question 20

STI age highest prevalence

Answer 20

15-29

Question 21

LVG

Answer 21

lymphogranuloma venereum

Question 22

define multiple partners

Answer 22

> 2 in last 12 months

Question 23

LGV 3 stages

Answer 23

1) primary = painless small papules that ulcerate
2) 2nd within 2-6 weeks = lymphadenopathy, proctitis… may have systemic symptoms (fever/chills/malaise)
3) chronic inflammatory lesions

Question 24

Duration of tx for LGV

Answer 24

21 days

Question 25

Incubation for CT and GC

Answer 25

CT 2-3 weeks
GC 2-7 days
** consider window period for post-exposure testing!!

Question 26

GC TOC

Answer 26

persistent sx, reinfection, pregnant or chest feeding, pharyngeal infections, tx w/ 2nd line, PIDm etc… NAAT 2-3 weeks, culture 3-7 days (post completion of treatment)