GU and STIs

Question 1

Causes of Urethritis

Answer 1

C. trachomatis and N. gonorrhoeae (purulent discharge)

Question 2

Symptoms of Urethritis

Answer 2

burning on urination, urethral discharge, erythema of urethral meatus

Question 3

Dx of Urethritis

Answer 3

In many STD clinics, DNA probes of urethral samples or urine are used to diagnose. Also can use gram stain of urethral discharge, oil immersion (finding of 4 PMNs per immersion), urinalysis

Question 4

What do you suspect with urethritis if you see a gram neg diplococci on immersion?

Answer 4

gonococcal urethritis

Question 5

What is important to note about patients other conditions when they have urethritis?

Answer 5

most have other STDs

Question 6

Tx of N. gonorrhoeae urethritis?

Answer 6

3rd gen cephalosporin or fluoroquinolone (cefixime, ciprofloxacin, ceftriaxone)

Question 7

Tx of NGU

Answer 7

azithromycin or doxycycline

Question 8

Tx of Urethritis

Answer 8

Use azithro and cipro together to make sure you get that shit

Question 9

PID

Answer 9

primarily a disease of young sexually active women. Can be the result of urethritis if tx was delayed or it was left untreated.

Question 10

Cause of PID

Answer 10

spread of cervical microbes to the endometrium, all the goodies in the vagina. Menstration allows the vaginal flora to bypass the endocervical canal(protective barrier), and as a consequence, most causes of PID begin with in 7 days of menstration.

Question 11

What is the role of the endocervical canal?

Answer 11

prevents vaginal flora from invading the endometrium

Question 12

What is the primary transmission of community acquired PID?

Answer 12

Sexual transmission

Question 13

What are the most common agents that cause PID?

Answer 13

N. gonorrhoeae and C. trachomatis

Question 14

Risk factors of PID

Answer 14

younger, multiple partners, past history of PID

Question 15

What is used in PID prevention?

Answer 15

condoms and spermicides

Question 16

Signs and symptoms of PID

Answer 16

lower abdominal pain, 1/2 pts are febrile, uterine bleeding, discharge, dyspareunia, perihepatitis

Question 17

Most common complaint of PID

Answer 17

lower abdominal pain (a/w menses)

Question 18

What do you notice on physical exam in a patient with PID?

Answer 18

cervical motion tenderness and purulent discharge PLUS uterine tenderness

Question 19

Dx of PID

Answer 19

do pregnancy test to r/o ectopic pregnancy, CBC (shows increased WBC), Increased ESR, Microscopic exam (3 or more WBC per section), urine analysis to exclude cysits or peritonitis.

Question 20

What is the most sensitive test for PID?

Answer 20

microscopic exam

Question 21

Outpatient Tx of PID

Answer 21

outpatient: ofloxacin/levofloxacin PLUS metronidazole (or ceftriaxone PLUS doxycycline with or with out metronidazole

Question 22

Inpatient Tx of PID

Answer 22

Cefoxitin/Cefotetan PLUS doxycycline/clindamycin PLUS gentamicin

Question 23

What are the common etiologies of genital ulcers?

Answer 23

herpes (type II), syphilis, chancroid

Question 24

Clinical manifestations of herpes genital ulcers

Answer 24

On the labia/penis: uniform ulcers in clusters with indurated boarder and clear base. VERY TENDER LN

Question 25

Clinical manifestations of syphilis genital ulcers

Answer 25

On the vagina/penis: 1-2 ulcers with indurated boarder and clear base, RUBBERY, MILDLY TENDER LN

Question 26

Clinical manifestations of chrancoid genital ulcers

Answer 26

On the labia/penis: ulcers vary in size(may form one giant lesion), have necrotic base, VERY TENDER, FLUCTUANT LN

Question 27

Tx of herpes ulcers

Answer 27

acyclovir, valacyclovir

Question 28

Tx of syphilis ulcers

Answer 28

PCN

Question 29

Tx of chrancoid ulcers

Answer 29

azithromycin

Question 30

Syphilis

Answer 30

T. pallidum- spitochete that is long and thin. Cannot be visualized on regular microscopy (USE DARK FIELD). - Flexing motion for movement. Cannot be grown invitro. Transmitted Primarily via sexual intercourse. BUT can also be congenital.

Question 31

3 stages of syphilis

Answer 31

primary, secondary, tertiary

Question 32

Primary syphilis

Answer 32

after intercourse it penetrates skin and causes ulcerations, PAINLESS CHANCRE. Acute inflammation

Question 33

Secondary Syphilis

Answer 33

In blood stream, Skin Rash (starting at trunk then to extremities), enlargement of epitrochlear LN. Involves palms and soles. CONDYLOMA LATA- gray plaque, alopecia “THE GREAT IMMITATOR”

Question 34

Tertiary Syphilis

Answer 34

3 syndromes: late neurosyphilis, CV syphilis, late beningn gummas

Question 35

Late Neurosyphilis

Answer 35

arteritis in small vessels of brain and spinal cord (direct damage to neural cells). General paresis, personality disorder, psych disturbance, neurological abnormality. ARGYLL ROBERTSON PUPIL, tabes dorsalis, charcot joints, stroke

Question 36

CV syphilis

Answer 36

dilation and calcification of aorta (leads to aortic regurg, CHF and coronary artery stenosis) - angina

Question 37

Late benign Gummas

Answer 37

nonspecific granulomatas lesion. Common with AIDS. Forms a chronic non-healing ulcer. Lytic bone lesions

Question 38

Dx of syphilis

Answer 38

Serological tests is primary dx, can use dark feild microscopy for primary or secondary.
VDRL and RRR vs FTA-ABS(antibodies)-does not predict active disease.

Question 39

Tx of syphilis

Answer 39

IM benzathine PCN in all but neurosyphilis (aqueous PCN G) - Doxy if PCN allergy. Give prednisone too to prevent Jarisch-Herxheiman reaction)