Flashcards in GU and STIs Deck (39):
Causes of Urethritis
C. trachomatis and N. gonorrhoeae (purulent discharge)
Symptoms of Urethritis
burning on urination, urethral discharge, erythema of urethral meatus
Dx of Urethritis
In many STD clinics, DNA probes of urethral samples or urine are used to diagnose. Also can use gram stain of urethral discharge, oil immersion (finding of 4 PMNs per immersion), urinalysis
What do you suspect with urethritis if you see a gram neg diplococci on immersion?
What is important to note about patients other conditions when they have urethritis?
most have other STDs
Tx of N. gonorrhoeae urethritis?
3rd gen cephalosporin or fluoroquinolone (cefixime, ciprofloxacin, ceftriaxone)
Tx of NGU
azithromycin or doxycycline
Tx of Urethritis
Use azithro and cipro together to make sure you get that shit
primarily a disease of young sexually active women. Can be the result of urethritis if tx was delayed or it was left untreated.
Cause of PID
spread of cervical microbes to the endometrium, all the goodies in the vagina. Menstration allows the vaginal flora to bypass the endocervical canal(protective barrier), and as a consequence, most causes of PID begin with in 7 days of menstration.
What is the role of the endocervical canal?
prevents vaginal flora from invading the endometrium
What is the primary transmission of community acquired PID?
What are the most common agents that cause PID?
N. gonorrhoeae and C. trachomatis
Risk factors of PID
younger, multiple partners, past history of PID
What is used in PID prevention?
condoms and spermicides
Signs and symptoms of PID
lower abdominal pain, 1/2 pts are febrile, uterine bleeding, discharge, dyspareunia, perihepatitis
Most common complaint of PID
lower abdominal pain (a/w menses)
What do you notice on physical exam in a patient with PID?
cervical motion tenderness and purulent discharge PLUS uterine tenderness
Dx of PID
do pregnancy test to r/o ectopic pregnancy, CBC (shows increased WBC), Increased ESR, Microscopic exam (3 or more WBC per section), urine analysis to exclude cysits or peritonitis.
What is the most sensitive test for PID?
Outpatient Tx of PID
outpatient: ofloxacin/levofloxacin PLUS metronidazole (or ceftriaxone PLUS doxycycline with or with out metronidazole
Inpatient Tx of PID
Cefoxitin/Cefotetan PLUS doxycycline/clindamycin PLUS gentamicin
What are the common etiologies of genital ulcers?
herpes (type II), syphilis, chancroid
Clinical manifestations of herpes genital ulcers
On the labia/penis: uniform ulcers in clusters with indurated boarder and clear base. VERY TENDER LN
Clinical manifestations of syphilis genital ulcers
On the vagina/penis: 1-2 ulcers with indurated boarder and clear base, RUBBERY, MILDLY TENDER LN
Clinical manifestations of chrancoid genital ulcers
On the labia/penis: ulcers vary in size(may form one giant lesion), have necrotic base, VERY TENDER, FLUCTUANT LN
Tx of herpes ulcers
Tx of syphilis ulcers
Tx of chrancoid ulcers
T. pallidum- spitochete that is long and thin. Cannot be visualized on regular microscopy (USE DARK FIELD). - Flexing motion for movement. Cannot be grown invitro. Transmitted Primarily via sexual intercourse. BUT can also be congenital.
3 stages of syphilis
primary, secondary, tertiary
after intercourse it penetrates skin and causes ulcerations, PAINLESS CHANCRE. Acute inflammation
In blood stream, Skin Rash (starting at trunk then to extremities), enlargement of epitrochlear LN. Involves palms and soles. CONDYLOMA LATA- gray plaque, alopecia "THE GREAT IMMITATOR"
3 syndromes: late neurosyphilis, CV syphilis, late beningn gummas
arteritis in small vessels of brain and spinal cord (direct damage to neural cells). General paresis, personality disorder, psych disturbance, neurological abnormality. ARGYLL ROBERTSON PUPIL, tabes dorsalis, charcot joints, stroke
dilation and calcification of aorta (leads to aortic regurg, CHF and coronary artery stenosis) - angina
Late benign Gummas
nonspecific granulomatas lesion. Common with AIDS. Forms a chronic non-healing ulcer. Lytic bone lesions
Dx of syphilis
Serological tests is primary dx, can use dark feild microscopy for primary or secondary.
VDRL and RRR vs FTA-ABS(antibodies)-does not predict active disease.