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Exam 1 - STIs Flashcards

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1
Q

What are the 5 P’s of taking a sexual history?

A
  • Partners
  • Practices
  • Prevention of pregnancy
  • Protection from STIs
  • Past hx of STIs
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2
Q

Which special population accounts for half of all new STIs?

A

Youth (ages 15-24)

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3
Q

What is usually the causative agent of Vulvovaginal Candidiasis?

A

C. albicans

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4
Q

What are some common symptoms and exam findings consistent with Vulvovaginal Candidiasis?

A
  • Pruritis
  • Vulvar soreness/burning/irritation
  • Erythema of vulva
  • White, thick, curd-like vaginal discharge (adherent to vaginal walls)
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5
Q

How can you diagnose Vulvovaginal Candidiasis?

A
  • Clinical diagnosis

- Wet mount with 10% KOH (budding yeast, hyphae)

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6
Q

When would you obtain a vaginal culture for Vulvovaginal Candidiasis?

A

Complicated infection

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7
Q

What classifies a Vulvovaginal Candidiasis infection as complicated?

A
  • Severe signs/symptoms
  • Recurrent (> 4 years)
  • Nonalbicans species
  • Pregnancy, poorly controlled DM, immunosupression
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8
Q

What is the treatment for uncomplicated Vulvovaginal Candidiasis?

A

Oral fluconazole (Diflucan) 150 mg PO x 1

OR

Short course (1-3 days) of topical azole such as Clotrimazole

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9
Q

What is the treatment for an albicans complicated Vulvovaginal Candidiasis?

A

Oral fluconazole (Diflucan) 150 mg PO q 72 hours x 2-3 doses

OR

Treat with longer duration (7-14 days) with topical azole such as Clotrimazole

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10
Q

What is the treatment for a non-albicans complicated Vulvovaginal Candidiasis?

A

Nonfluconazole azole drug

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11
Q

What is the most common cause of vaginal discharge in women of childbearing age?

A

Bacterial Vaginosis

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12
Q

What is the cause of Bacterial Vaginosis?

A

Overgrowth of anaerobic bacteria

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13
Q

What is the causative organism of Bacterial Vaginosis?

A
  • Usually polymicrobial

- Often associated with Gardnerella vaginalis

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14
Q

What is the clinical presentation associated with bacterial vaginosis?

A
  • Most often asymptomatic

- Thin, off-white malodorus/”fishy” vaginal discharge

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15
Q

What is the clinical criteria for diagnosis bacterial vaginosis?

A

Amsel’s criteria - presence of at least 3 of the following:

  • Thin, white homogenous discharge
  • Clue cells on saline wet mount
  • Vaginal fluid pH > 4.5
  • (+) whiff test
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16
Q

What is the recommended treatment options for symptomatic Bacterial Vaginosis?

What should you be aware of in regards to patient education with this medication?

A

Metronidazole (Flagyl) 500 mg PO BID x 7 days

Avoid alcohol while taking Metronidazole

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17
Q

What is the CDC recommendation in regards to testing if a patient is positive for BV?

A

All women with BV should be offered testing for HIV and other STIs

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18
Q

What is the most common nonviral STI worldwide?

A

Trichomoniasis

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19
Q

What is the clinical presentation associated with Trichomoniasis?

A
  • Most have minimal or no symptoms
  • Purulent, malodorous, frothy, thin vaginal discharge
  • Burning, dysuria, dyspareunia
  • Postcoital bleeding can occur
  • May see punctate hemorrhages on vagina and cervix (“strawberry cervix”)
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20
Q

What is the gold standard diagnostic test for Trichomoniasis?

A

Nucleic Acid Amplification Test (NAAT)

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21
Q

What is the treatment for Trichomoniasis in a non-pregnant female?

A

Treat both asymptomatic and symptomatic

  • Metronidazole (Flagyl) 2 g x 1
  • Abstain from sex until patient and sex partners are treated
  • Abstain from sex for at least 7 days following treatment and until asymptomatic
  • Test for other STIs including HIV
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22
Q

What is the treatment for Trichomoniasis in a pregnant female?

A
  • Metronidazole 2 gm x 1

- Metronidazole 500 mg BID x 5-7 days (if N/V)

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23
Q

What is important to note regarding the follow up for Trichomoniasis treatment?

A

Repeat testing within 3 months following initial treatment to assess for re-infection

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24
Q

What is the CDC recommendation in regards to screening for Trichomoniasis?

Study These Flashcards
A

Screen in all HIV-infected women annually and at initial prenatal visit

25
What are some clinical presentations associated with chlamydia and gonorrhea?
- Most are asymptomatic - Change in vaginal discharge - Intermenstrual or postcoital bleeding - Dysuria, urinary frequency
26
What are some classic exam findings associated with cervicitis/chlamydia/gonorrhea?
- Mucopurulent endocervical discharge | - Cervix-friability, erythema, edema
27
How is the diagnostic test of choice for chlamydia?
NAAT via vaginal swab
28
What are some complications of pregnancy associated with chlamydia?
- Increased risk for premature rupture of membranes, preterm delivery - Transmittable to neonate during delivery (conjunctivitis)
29
What is the medication treatment for chlamydia?
Treat patient and sex partners - Azithromycin 1 gm PO x 1 OR - Doxycycline 100 mg PO BID x 7 days (avoid in pregnancy)
30
Other than medication, what else is recommended for the treatment of chlamydia and gonorrhea?
- Avoid sex for 7 days after treatment and until resolution of symptoms - Test for other STIs - Repeat testing for re-infection at 3 months
31
Who should be screen for chlamydia and gonorrhea?
Annual screening of all sexually active women aged < 25 years old
32
How is gonorrhea diagnosed?
NAAT via vaginal swab
33
What are some complications that can occur from chlamydia and gonorrhea?
- PID, ectopic pregnancy, infertility, chronic pelvic pain | - Disseminated gonococcal infection from gonorrhea specifically
34
What are some complications of pregnancy associated with gonorrhea?
- Risk of preterm birth, low birth weight, infection (chorioamnionitis) - Transmittable to neonate during delivery (ophthalmia neonatorum)
35
What is the medication treatment for gonorrhea?
Treat patient and sex partners - Ceftriaxone 250 mg IM PLUS - Azithromycin 1 gm PO x 1 ***same treatment regimen for pregnant women
36
What is the most commonly reported bacterial infection in the U.S.?
Chlamydia
37
What is perihepatitis (Fitz-Hugh Curtis Syndrome) and what is it characterized by?
Inflammation of the liver capsule and adjacent peritoneal surfaces PID with RUQ pain and "violin string" adhesions of the liver
38
What are some clinical presentations associated with acute symptomatic PID?
- Lower abdominal pain - Abnormal vaginal discharge, uterine bleeding - Fever, dyspareunia - Uterine, adnexal, and/or CMT (Chandelier sign)
39
What is the outpatient treatment for mild to moderate PID?
- Ceftriaxone 250 mg IM x 1 PLUS - Doxycycline 100 mg BID x 14 days - Close follow-up in 48-72 hours ***with or without Metronidazole 500 mg PO BID x 14 days
40
When should you consider hospitalization for PID?
- Pregnancy - Lack of response or tolerance to oral meds - Concern for nonadherence to therapy - Inability to take oral meds due to N/V - Severe illness (high fever, n/v, severe pain) - Complicated PID with pelvic abscess
41
What is the most common STI in the world?
HPV
42
Which types of HPV are detected in most cases of Condyloma Acuminata and have low oncogenic potential? Which have high oncogenic potential?
Low-risk: HPV types 6 and 11 High risk: HPV types 16 and 18
43
What are some clinical presentation associated with Condyloma Acuminata (Anogenital Warts)?
- Typically asymptomatic, but may be pruritic - Soft, flesh-colored, smooth, or plaque-like - Cauliflower-like more common
44
What is the treatment for Condyloma Acuminata (Anogenital Warts)?
- Cyto-destructive (Podofilox) - Immune-mediated (Imiquimod, Sinecatechins) - Surgical
45
What is the causative organism of most cases of recurrent genital herpes?
HSV-2
46
What is a primary genital herpes infection?
- Infection in patient without pre-existing antibodies to either HSV-1 or HSV-2 - Longer duration, increased viral shedding and systemic symptoms - Symptoms last 2-4 weeks if untreated
47
Describe a non-primary first episode of genital herpes?
- Acquisition of genital HSV-2 in a patient with pre-existing antibodies to HSV-1 - Symptoms usually milder than primary infection
48
What is the clinical presentation of a primary genital herpes infection?
- Painful, genital ulcers - Tender inguinal lymphadenopathy - Some may be asymptomatic
49
What is the clinical presentation of a recurrent genital herpes infection?
- Prodromal symptoms such as tingling, burning, or itching before eruption - Symptoms are less severe than primary infection
50
What is the preferred diagnostic testing for genital herpes?
Virologic tests: - Viral culture - PCR
51
What does the presence of type-specific HSV-2 antibodies imply?
Anogenital infection
52
What is the treatment for a first episode of genital herpes?
Valacyclovir, famciclovir, or acyclovir for 7-10 days
53
What is the episodic treatment for recurrent outbreaks of genital herpes?
Valacyclovir, famciclovir, or acyclovir for 1-5 days
54
Which diseases require repeat testing within 3 months of treatment?
Chlamydia, gonorrhea, and trichomonas
55
Based on the following clinical presentation, what is your presumptive diagnosis? - Vaginal pruritis - Vulvar soreness/burning/irritation - Erythema of vulva - White, thick, curd-like vaginal discharge (adherent to vaginal walls)
Vulvovaginal Candidiasis (yeast infection)
56
Based on the following clinical presentation, what is your presumptive diagnosis? - Most often asymptomatic - Thin, off-white malodorus/"fishy" vaginal discharge - Presence of Clue cells
Bacterial Vaginosis
57
Based on the following clinical presentation, what is your presumptive diagnosis? - Purulent, malodorous, frothy, thin vaginal discharge - Burning, dysuria, dyspareunia - Postcoital bleeding can occur
Trichomonaisis
58
Punctate hemorrhages on vagina and cervix ("strawberry cervix") is associated with what STI?
Trichomonaisis
59
Lower abdominal pain and CMT (Chandelier Sign) is commonly associated with what disease process?
PID

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