Flashcards in Genital Tract Infections Deck (46)
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What are the 2 most common bacterial STIs?
1. Chlamydia
2. Gonorrhea
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What are the 2 most common viral STIs?
1. HPV
2. HSV
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What are the symptoms of Urethritis in men?
1. Dysuria
2. Discharge from the penis
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What are symptoms of Urethritis/cervicitis in women?
1. Vaginal discharge
2. Abnormal vaginal bleeding or spotting
3. Dyspareunia
4. Dysuria
5. Could be asymptomatic
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Which pathogens can cause Urethritis/cervicitis?
1. Chlamydia
2. Gonorrhea
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What comprises a relevant Hx for genital tract infections?
1. New partners?
2. Multiple partners?
3. High-risk partners?
4. Type of exposure: men, women, both?
5. Anal, vaginal, oral?
6. Frequency of condom use
7. Past STIs
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What methods are available for the Dx of STIs?
1. Clinical
2. Microscopy (Gram stain)
3. Culture
4. Ag detection
5. NAAT
6. Serology
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Dx method for Gonorrhea and Chlamydia
1. NAAT - can be done on urine
2. Can also do Gram stain and culture
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Tx for Gonorrhea
1. Increasing resistance
2. Cefixime or IM Ceftriaxone + azithromycin
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Tx for Chlamydia
1. Doxycycline or azithromycin
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What else is involved in the Tx of STIs besides drugs?
1. Reportable infection?
2. Partner notification
3. Counselling
4. Test for other STIs
5. Check vaccination status for Hep B and HPV
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What is PID?
PID = Pelvic Inflammatory Disease Infection of the female upper genital tract (endometrium, Fallopian tubes)
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What causes PUD?
1. Polymicrobial infection (STI + endogenous flora)
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What are the S/S's of PUD?
1. Abdominal pain
2. Fever
3. Lower abdominal tenderness
4. Cervical motion tenderness
5. Adnexal tenderness
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What is the Tx for PUD?
Antibiotics to cover STI + endogenous flora
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What complications arise from scarring due to PUD?
1. Infertility
2. Ectopic pregnancy
3. Chronic pelvic pain
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What elements are involved in the Dx of PUD?
1. Clinical
2. Test for Gonorrhea/Chlamydia
3. Imaging
4. Possible OR
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What are characteristics of Genital Ulcer Disease (GUD)?
1. Ulcers, erosive, vesicular
2. Lymphadenopathy
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What causes GUD?
1. HERPES SIMPLEX VIRUS (HSV-1 or HSV-2)
2. Syphilis - less common (Treponema pallidum)
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Presentation of primary HSV infection (genitals)
1. May be asymptomatic
2. Painful vesiculo-ulcerative lesions
3. Fever
4. Tender lymphadenopathy
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What is an atypical presentation of primary HSV infection (genital)?
1. Urethritis/cervicitis
2. Aseptic meningitis
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Where does HSV go during latency (genital)?
Sacral sensory ganglion
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What are some characteristics of recurrent genital HSV infections?
1. Prodromal symptoms (burning, itching, tingling)
2. Not as bad as primary episode
3. Become less frequent and less severe over time
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How do you Dx HSV?
1. Viral swab for HSV PCR
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What is the Tx for HSV infection?
1. Valacyclovir
2. Famiciclovir
3. Acyclovir
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What is characteristic of primary syphilis?
Painless chancres
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How do you Dx Syphilis?
1. Serology (RPR or VDRL)
2. Can take fluid from chancre for staining or PCR
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What is the Tx for Syphilis?
IM benzathine penicillin
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What are 3 causes of vaginal discharge?
1. Bacterial vaginosis
2. Vulvovaginal candidiasis
3. Trichomonas
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Bacterial vaginosis is the most common cause of vaginal discharge, what is it a result of?
Overgrowth of genital tract organisms
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What is Trichomonas?
1. Vaginal discharge caused by the protozoan Trichomonas vaginalis
2. This is an STI
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What diagnostics can be done for vaginal discharge?
1. Vaginal swab
2. Gram stain
3. ELISA for trichomonas Ag
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Tx for Vulvovaginal candidiasis
1. OTC antifungal cream
2. Fluconazole PO
3. Eliminate risk factors (i.e. antibiotics)
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Tx for Trichomonas
1. Tx pt and partners with Metronidazole
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When and how should you Tx Bacterial Vaginosis?
1. Tx if symptomatic and/or pregnant
2. Use Metronidazole or Clindamycin (PO or topical)
3. Don't Tx partners
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What causes Prostatitis?
1. Gram -ve bacilli (i.e. E. coli)
2. Not usually an STI
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How to Dx Prostatitis
1. Clinical - Hx and tender/mushy prostate on exam
2. Urine microscopy (WBCs)
3. Urine culture
4. Blood culture
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Tx for Prostatitis
1. Antibiotics that cover Gram -ve bacilli (cipro, TMP-SMX)
2. Tx for 4-6 weeks
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Clinical presentation of Prostatitis
1. Fever
2. Chills
3. Dysuria
4. Pelvic pain
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What should you screen all pregnant women for?
1. HIV
2. Hep B
3. Chlamydia
4. Gonorrhea
5. Syphilis
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What 2 things does HPV cause?
1. Warts
2. Cancer
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What HPV strains cause anogenital warts (AKA Condyloma acuminata)?
HPV 6 and 11
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Which HPV strains cause cervical cancer?
HPV 16 and 18
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What are the 2 HPV vaccine available?
1. Gardasil - (quadravalent) against 6, 11, 16, and 18
2. Cervarix - (bivalent) against 16, 18
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How can you Dx HPV?
1. Pap tests
2. HPV DNA
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