Chapter 153: Sexually Transmitted Disease Flashcards
(43 cards)
What consists of Reiter’s syndrome
- urethritis
- Conjunctivitis
- rash
when to consider urethral chlamydial infection as differential diagnosis
(+) sterile pyuria
preferred test for diagnosing Clamydia
Nucleic acid amplification testing
*Encourage women to be retested approximately 3 months after treatment because of high incidence of recurrence
Treatment for Chlamydia
single-dose azithromycin 1 gram PO OR doxycycline 100mg 2x/day for 7 days
*Azithromycin is safe for pregnant women
*Amoxicillin is safe alternative in pregnancy
*Refer partners for testing and treatment if there was sexual contact in the last 60 days
*avoid sexual contact until 7 days have elapsed after completion of antibiotic treatment and their symptoms resolved
Second most commonly reported STI
Gonorrhea (caused by Neisseria gonorrhea) - gram-negative diplococcus
Most common presenting symptoms of Gonorrhea in men
- Dysuria
- profuse, purulent penile discharge
Signs and symptoms of disseminated gonococcal infection
- petechial or pustular acral skin lesions on an erythematous base
- asymmetric arthralgias
- tenosynovitis/septic arthritis
- fever/general malaise
gram stain result for gonorrhea
In men, a Gram stain of urethral secretions that demonstrates polymorphonuclear leukocytes with the classic intracellular diplococci confirms the diagnosis
*not recommended as screening tool. absence of this finding is not sufficient to rule out the gonococcal infection
Treatment for Gonorrhea
dual therapy :
1) Ceftriaxone 250mg IM
PLUS
2) Azithromycin 1 gram PO
*Disseminated gonorrhea: higher doses of ceftriaxone - 1 gram IM or IV every 24 hours for 1 to 2 days FOLLOWED BY Cefixime 400mg PO 2x/day for minimum of 1 week
nongonococcal urethritis is usually caused by
Chlamydia trachomatis
Others: Ureaplasma urealyticum, Mycoplasma genitalium, Trichomonas vaginalis, herpes simplex virus, and adenovirus
most sensitive and specific test for Trichomoniasis
Culture
*wet-mount microscopy - poor sensitivity
Treatment for Trichomonas infection
Metronidazole, 2 grams PO in a single dose or 500 milligrams PO twice daily for 7 days
Patients must avoid alcohol when taking metronidazole because of what reaction?
disulfiram-like reaction
Drug of choice for treating pregnant patients with Trichomonas
Metronidazole 2g single dose
*some avoid oral treatment in first trimester
Causative agent for Syphilis
Treponema pallidum
Stage of infection in syphilis characterized by absence of clinical manifestations but positive serologic testing
Latent syphilis
Stage of infection in syphilis: painless chancre with indurated borders on the penis which resolves spontaneously
Primary syphilis
Stage of infection in syphilis: characterized by rash and lymphadenopathy; non specific symptoms; resolves spontaneously
Secondary syphilis
Stage of infection in syphilis: involvement of the nervous and cardiovascular systems, with widespread granulomatous lesions (gummata)
Tertiary syphilis
TRUE OR FALSE: Diagnostic test for T. pallidum is culture
FALSE: T. pallidum cannot be cultured in the laboratory, and there is no single optimal test
*Direct visualization of the organism using darkfield microscopy is diagnostic however, failure to visualize the organism does not exclude syphilis
*VDRL and rapid plasma reagin tests -screening tests and also, once diagnosis is made, to assess disease activity and response to treatment
non specific antibodies released as a result of Trichomonas infection
Cardiolipin
*for secondary syphilis, nontreponemal antibody tests are nearly 100% sensitive with high specificity
TRUE OR FALSE: Patients who develop disease and have a reactive result on a specific treponemal antibody test will have a reactive test result for life regardless of disease activity or treatment
TRUE
treatment for Syphilis
Primary and secondary: Penicillin G benzathine 2.4 million units IM in a single dose
*Doxycycline 2x/day for 2 weeks if allergic to penicillin
Tertiary: Penicillin G benzathine 2.4 million units IM weekly for 3 weeks
*follow all patients for repeat serologic testing at 6 and 12 months
TRUE OR FALSE: Pregnant women should be treated with parenteral penicillin G; if allergic, medication should be discontinued and proceed with alternative medication
FALSE: Pregnant women should be treated with parenteral penicillin G; if allergic, they should be desensitized and then given this medication
