STDs

Question 1

Most common types of vaginitis

Answer 1

• bacterial vaginosis (most common cause)
• vulvovaginal candidiasis
• trichomoniasis (most prevalent nonviral STI)

Question 2

Bacteria that causes bacterial vaginosis

Answer 2

gardnerella vaginalis

Question 3

What is bacterial vaginosis linked to

Answer 3

=premature rupture of membranes

• post op gyn infection
• premature delivery
• STDs/HIV

Question 4

Trichomoniasis is assosicated with

Answer 4

• preterm rupture of membranes and preterm delivery

- HIV leads to increased risk

Question 5

What two things need to be present for bacterial vaginosis to occur

Answer 5

overgrowth of bacteria species normally present
AND
decrease of loss of protectine lactobacilli

Question 6

Role of hydrogen peroxide in the vagina

Answer 6

helps maintain a low pH which inhibits bacteria overgrowth

Question 7

When does symptomatic clinical candidiasis infection occur

Answer 7

with the excessive growth of yeast

Question 8

Caues of candidiasis

Answer 8

disruption of normal vaginal ecology or host immunity

Question 9

Trichomonas vaginalis is the only ___ that infects the genital tract

Answer 9

protozoan

Question 10

Risk factors for bacterial vaginosis

Answer 10

• african american
• new sexual partner
• douching
• no condoms
• absence/ decrease lactobacilli (H2O2 producing)

Question 11

Risk factors for candidiasis

Answer 11

• diabetes
• immunosuppression
• abx use
• prolonged exposure to damp underwear
• non cotton underwear
• douching

Question 12

Risk factors for trichomoniasis

Answer 12

• multiple sexual partners
• low socioeconomic status
• hx of STI
• no condom

Question 13

Signs and sx of bacterial vaginosis

Answer 13

• can be asymptomatic
• malodorous or fishy smell
• pruritic discharge
• thin, milky white discharge

Question 14

Signs and sx of candidiasis

Answer 14

• pruritic discomfort
• dysuria
• thick cottage cheese like discharge

Question 15

Signs and sx of trichomoniasis

Answer 15

• can be asymptomatic
• pruritic discharge sometimes green, yellow/green, frothy
• strawberry cervix

Question 16

Vaginal PH of <4.5 would be ___. >4.5 would be ___

Answer 16

• candidiasis or normal

- BV or trichomoniasis

Question 17

Bacterial vaginosis on wet prep

Answer 17

• clue cells

- no/few WBCs

Question 18

Candidiasis on wet prep

Answer 18

few to many WBCs

Question 19

Triachomoniasis on wet prep

Answer 19

• motile flagellated protozoa

- mmany WBCs

Question 20

What is Amsel Criteria use to diagnose? What is it?

Answer 20

bacterial vaginosis
Must have at least three of the following
-pH >4.5
-presence of >20% per HPF of clue cells on wet mount
-positive amine or “whiff” test
-homogenous, non viscous, milky white discharge adherent to vaginal walls

Question 21

Tx of bacterial vaginosis

Answer 21

• metronidazole 500mg BID for 7 days
• metronidazole gel 0.75% for 5 days
• clindamycin 2% cream for 7 days

Question 22

Candidiasis tx

Answer 22

-fluconazole 150mgx1

repeat in 72 hours for severe cases

Question 23

Tx for trichomoniasis

Answer 23

-metronidoazole 2g PO single dose
       OR
metronidazole 500mg BID x7 days
       OR
-tinidazole 2g PO single dose

Question 24

Symptoms of chlamydia/gonorrhea in women

Answer 24

• dysuria
• mucopurulent discharge
• cervical motion tenderness
• pruritis
• tender uterus
• PID sx
• intermenstrual bleeding

Question 25

Symptoms of gonorrhea in men

Answer 25

• dysuria
• white, yellow or green discharge
• +/- penile edema

Question 26

Symptoms of chlamydia in men

Answer 26

• mucoid or watery urethral discharge

- clear discharge sometimes seen only when milking the penis

Question 27

Treatment of gonorrhea

Answer 27

ceftriaxone 250mg IM (single dose)
     PLUS
azithro 1g PO single dose
        or
doxy 100mg PO BID for 7 days

Question 28

Treatment of chlamydia

Answer 28

azithro 1g PO single dose
OR
Doxy 100mg PO BID x 7 days