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Flashcards in 29 STDs Goad Deck (55):
1

What STDs are condoms more effective against?

Urethritis (GC). Discharge (BV, Trich, VVC, GC). Blood/fluid (HIV, Hep B, Hep C)

2

What STDs are condoms less effective against?

Ulcerative disease (HSV, HPV, Syphilis)

3

What are the CURABLE STDs?

Gonorrhea, Chlamydia, Syphilis, Chancroid, Trichomonas, BV, Candidiasis, Pubic lice

4

What are the NON-CURABLE STDs?

HIV, HPV, HSV, Hep B, Hep A, Hep C

5

What is the most common bacterial STD?

Chlamydia

6

What is Chlamydia trachomatis?

Most common bacterial STD in US. Obligate intracellular coccoid bacteria. Can cause PID, ectopic pregnancy, infertility, and pregnancy complications

7

What are the symptoms of Chlamydia?

Male: Dysuria, discharge (white), penile itching. Female: Vagina pain, pain/itching, discharge, dysuria

8

What is screened for when using NAATS (most common test for Chlamydia) for Chlamydia?

Nucleic acid amplification tests. PCR or LCR. Swabs or urine. < 1/2 young women screened at PAP

9

What is the etiology of Nongonococcal Urethritis?

C. trachomatis (20-40%). Genital Mycoplasmas (20-30%). Occasional Trichomonas vaginalis, HSV. Unknown in ~50% of cases

10

What are the symptoms of Nongonococcal Urethritis?

Mild dysuria, mucoid discharge

11

What are the antibiotics to be used for Chlamydia?

DOC: Azithromycin 1g orally in a single dose. OR. Doxycycline 100mg orally twice a day for 7 days. These have a 97-98% cure rate

12

What are the alternative choices for Chlamydia treatment?

Erythromycin base 500mg PO QID x7 days. OR. Erythromycin ethylsuccinate 800mg PO QID x7 days. OR. Ofloxacin 300mg PO BID x7 days. OR. Levofloxacin 500mg PO x7 days

13

What is Gonorrhea?

Gram (-) diplococci. Second most common bacterial STD in US. Usually symptomatic in males, often asymptomatic in women. Can cause cervicitis, urethritis, proctitis, and PID. High prevalences reported from non-genital sites among MSM (oropharynx and rectum). "The Clap"

14

What is screen with NAATS for Gonorrhea?

Nucleic acid amplification test. PCR or LCR. Swabs or urine

15

Which ethnic group has the highest rates of STDs?

African Americans

16

What is the recommended treatment for Uncomplicated Gonococcal Infections of the Cervix, Urethra, and Rectum?

Ceftriaxone (250mg IM once) + Azithromycin (1g PO once) or Doxycycline (100mg PO BID x7 days). The other one added is because we're treating presumptively for a co-infection for Chlamydia

17

What is the recommended treatment for Uncomplicated Gonococcal Infections of the Cervix, Urethra, and Rectum for a patient allergic for CEPHs?

Azithromycin (2g PO once) + Test of cure in 1 week

18

What is Treponema pallidum?

Spirochete (primary, secondary, tertiary). "The great imitator"

19

What screening is done for Treponema pallidum?

RPR (rapid plasma reagin) test. VDRL (Venereal Disease Research Laboratory) test

20

What are the definitive tests for Treponema pallidum?

The fluorescent treponemal antibody-absorption (TFA-ABS). T. pallidum hemagglutination assay (TPHA) test

21

Which group of people have the highest rate of Syphilis infection?

MSM

22

What is Late Syphilis Sequelae Tertiary?

About 1/3 of untreated cases will develop late syphilis disease manifestations: Gummatous syphilis, Cardiovascular syphilis, Neurosyphilis

23

What is the recommended regimen for Primary, Secondary, Early Latent Syphilis?

Benzathine Penicillin G (Bicillin LA): 2.4 million units IM, don't use Bacillin C-R, watch for Jarisch-Herxheimer reaction (can occur within hours of first dose)

24

What is the recommended regimen for Primary, Secondary, Early Latent Syphilis in patients with a Penicillin Allergy?

Doxycycline (100mg BID x14 days). OR. Ceftriaxone (1g IM/IV QD x8-10 days). OR. Azithromycin (2g single PO dose)

25

What is Trichomonas vaginalis?

Flagellated protozoan. One of the most common STIs. Females - symptomatic (common: vaginitis with purulent discharge (yellow or green; sometimes frothy), uncommon: vulvar and cervical lesions, abdominal pain, dysuria and dyspareunia. Males - usually asymptomatic

26

What is done for the diagnosis of Trichomonas vaginalis?

Wet mount. Troph form

27

What is the recommended regimen for Trichomoniasis treatment?

Metronidazole 2g PO x1 dose. OR. Tinidazole 2g PO x1 dose. Caution: No EtOH 24hrs after metro and 72hrs after Tinidazole

28

What are some alternative regimens for Trichomoniasis treatment?

Metronidazole 500mg BID x7 days. Pregnancy: Metronidazole 2g PO in a single dose. Note: Don't use Metrogel during pregnancy

29

What is Bacterial Vaginosis?

Polymicrobial (mostly Gardenerella vaginitis - anaerobic bacteria). Controversy: is it an STD? Tx during pregnancy eradicates infection, but does not affect pregnancy complications

30

What is the presentation of Bacterial Vaginosis?

Excessive, thin gray or white vaginal discharge that sticks to the vaginal walls. Fishy or musty, unpleasant vaginal odor, most noticeable after sex. Vaginal itching and irritation

31

What is the testing for Bacterial Vaginosis like?

Vaginal fluid contains "clue cells". "Whiff test" - 10% KOH

32

What is the treatment for Bacterial Vaginosis?

Metronidazole (500mg BID x 7 days). OR. Tinidazole (2g PO QD x2 days or 1g PO QD x5 days). OR. Metronidazole Gel (0.75%, 5g intravaginally QD x5 days). OR. Clindamycin Cream 2% (5g intravaginally QHS x7 days)

33

What are the BV Treatment Considerations with Clindamycin Cream?

Don't use w/ latex condoms for 5 days. Don't use in the 3rd trimester

34

What are the BV Treatment Considerations with Metronidazole or Tinidazole PO?

No EtOH for 24-72 hrs after

35

Which vaginal infections have a fishy smell?

BV. Trichomonas Vaginitis

36

What is an overview of Herpes Simplex Virus (HSV)?

HSV 1: orolabial herpes. HSV 2: genital herpes. Both symptomatic and asymptomatic infections are common. Can cause serious complications

37

What are the first clinical episodes of Genital Herpes like?

Primary: First infection ever with either HSV type. Non-Primary: Newly acquired infection with HSV-1 or HSV-2 in a person seropositive to the other virus

38

What are the recurrent episodes of Genital Herpes like?

Antibody is present to the same viral serotype when symptoms appear. Patient may not be aware of previous episodes

39

What are the asymptomatic infections of Genital Herpes like?

Serum antibody is present; no history of clinical outbreaks. Can spread even with no lesions

40

What are the clinical manifestations of Genital Herpes Simplex?

Direct contact - may be with asymptomatic shedding. Primary infection commonly asymptomatic; symptomatic cases sometimes severe, prolonged, systemic manifestations. Vesicles --> painful ulcerations --> crusting. Recurrence a potential

41

What is used in the diagnosis of Genital Herpes Simplex?

Culture. Serology (Western blot). PCR

42

What is Genital HSV-2 in males like?

Peak age 15-29. Incubation 2-12 days. Burning, tingling. Transmission: symptomatic, asymptomatic

43

What is Herpetic Whitlow?

HSV-1 or 2 recurrent infections. Autoinoculation. Establishes latency

44

What medications are used for the First Clinical Episodes of Genital Herpes?

Acyclovir 400mg TID. OR. Famciclovir 250mg TID. OR. Valacyclovir 1000mg BID. Duration of therapy: 7-10 days

45

What is Human Papillomavirus Virus (HPV)?

DNA tumor virus. Estimated to be one of the most common STDs; exact numbers are impossible since HPV is not a reportable STD. >50% of all sexually active adults likely infected with at least one HPV type. Vast majority of infections resolve spontaneously. Minority of HPV infections will progress to cancer

46

What are the High Risk HPV types?

16, 18

47

What are the Low Risk HPV types?

6, 11

48

What is the Patient-Applied HPV Wart Therapy?

Podofilox 0.5% solution or gel. OR. Imiquimod 5% cream

49

What is the Provider-Administered HPV Wart Therapy?

Cryotherapy. OR. Podophyllin resin 10-25%. OR. Trichloroacetic or Bichloroacetic acid 80-90%. OR. Surgical removal

50

What are the issues with HPV Wart Therapy?

NO treatment cures HPV, may reduce infectivity, up to 3 months may be needed. Podophyllin (antimitotic, resin in tincture of benzoin; compound in petrolatum). Imiquimod (immune response modifier). TCA and BCA (caustic to tissue (and wart), use petrolatum to "wall off" the application area)

51

What are the HPV vaccines used?

11-26 yo. Gardasil: inactivated, quadrivalent vaccine (covers 6, 11, 16, 18). Cervarix: inactivated, bivalent vaccine (covers types 16, 18)

52

What is Gardasil approved for?

HPV: Prevention of cervical, vaginal, and vulvar cancers (in female patients) and anal cancer and genital warts (in both female and male patients)

53

What is Cervarix approved for?

HPV: Prevention of cervical cancer in female patients

54

What are the recommended regimens for Pediculosis Pubis (lice)?

Permethrin 1% (leave on 10 minutes). Pyrethrins with piperonyl butoxide (10 minutes)

55

What is the recommended regimen for Scabies?

Permethrin cream 5% (leave on 8-14 hrs)