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Medicine II: Infectious Disease > GU and STIs > Flashcards

Flashcards in GU and STIs Deck (39):
1

Causes of Urethritis

C. trachomatis and N. gonorrhoeae (purulent discharge)

2

Symptoms of Urethritis

burning on urination, urethral discharge, erythema of urethral meatus

3

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

4

What do you suspect with urethritis if you see a gram neg diplococci on immersion?

gonococcal urethritis

5

What is important to note about patients other conditions when they have urethritis?

most have other STDs

6

Tx of N. gonorrhoeae urethritis?

3rd gen cephalosporin or fluoroquinolone (cefixime, ciprofloxacin, ceftriaxone)

7

Tx of NGU

azithromycin or doxycycline

8

Tx of Urethritis

Use azithro and cipro together to make sure you get that shit

9

PID

primarily a disease of young sexually active women. Can be the result of urethritis if tx was delayed or it was left untreated.

10

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.

11

What is the role of the endocervical canal?

prevents vaginal flora from invading the endometrium

12

What is the primary transmission of community acquired PID?

Sexual transmission

13

What are the most common agents that cause PID?

N. gonorrhoeae and C. trachomatis

14

Risk factors of PID

younger, multiple partners, past history of PID

15

What is used in PID prevention?

condoms and spermicides

16

Signs and symptoms of PID

lower abdominal pain, 1/2 pts are febrile, uterine bleeding, discharge, dyspareunia, perihepatitis

17

Most common complaint of PID

lower abdominal pain (a/w menses)

18

What do you notice on physical exam in a patient with PID?

cervical motion tenderness and purulent discharge PLUS uterine tenderness

19

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.

20

What is the most sensitive test for PID?

microscopic exam

21

Outpatient Tx of PID

outpatient: ofloxacin/levofloxacin PLUS metronidazole (or ceftriaxone PLUS doxycycline with or with out metronidazole

22

Inpatient Tx of PID

Cefoxitin/Cefotetan PLUS doxycycline/clindamycin PLUS gentamicin

23

What are the common etiologies of genital ulcers?

herpes (type II), syphilis, chancroid

24

Clinical manifestations of herpes genital ulcers

On the labia/penis: uniform ulcers in clusters with indurated boarder and clear base. VERY TENDER LN

25

Clinical manifestations of syphilis genital ulcers

On the vagina/penis: 1-2 ulcers with indurated boarder and clear base, RUBBERY, MILDLY TENDER LN

26

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

27

Tx of herpes ulcers

acyclovir, valacyclovir

28

Tx of syphilis ulcers

PCN

29

Tx of chrancoid ulcers

azithromycin

30

Syphilis

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.

31

3 stages of syphilis

primary, secondary, tertiary

32

Primary syphilis

after intercourse it penetrates skin and causes ulcerations, PAINLESS CHANCRE. Acute inflammation

33

Secondary Syphilis

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"

34

Tertiary Syphilis

3 syndromes: late neurosyphilis, CV syphilis, late beningn gummas

35

Late Neurosyphilis

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

36

CV syphilis

dilation and calcification of aorta (leads to aortic regurg, CHF and coronary artery stenosis) - angina

37

Late benign Gummas

nonspecific granulomatas lesion. Common with AIDS. Forms a chronic non-healing ulcer. Lytic bone lesions

38

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.

39

Tx of syphilis

IM benzathine PCN in all but neurosyphilis (aqueous PCN G) - Doxy if PCN allergy. Give prednisone too to prevent Jarisch-Herxheiman reaction)