Lecture 13: STIs

Question 1

STI screening:

1. Who gets screened for HIV
2. Who gets annual chlamydia screening
3. What 4 STIs do preg women get screened for
4. What 2 STIs do HIV+ women get screened for annually
5. how often should MSM be screened

Answer 1

1. Who gets screened for HIV - EVERYONE
2. Who gets annual chlamydia screening
   - ALL sexually active women < 25
3. What 4 STIs do preg women get screened for
   - Syphillis, HIV, Chlamydia, HBV
4. What 2 STIs do HIV+ women get screened for annually
   - Trichomonas, HPV
5. how often should MSM be screened
   - annually

Question 2

What are the 5 P’s of risk assessment for STIs?

Answer 2

1. Partners
2. Practices
3. Prevention of preg
4. Prevention of STIs
5. Past h/o STIs

Question 3

What is the main cause of sterility and PID in women?

Answer 3

Chlamydia

Question 4

Female pt comes in w/urethritis w/mild urethral d/c complaining of pruritus, dyspareunia, and hematuria. She also complains of cervicitis (d/c). Dx? Tx of ToC?

Male presentation: Urethritis (dysuria, mild d/c)

Other presentations: pharyngitis, Reactive arthritis

Answer 4

Dx = Chlamydia

Tx = single dose of 1g Azithromycin

Question 5

Dx ToC for Chlamydia?

Answer 5

NAAT (PCR is best)

Question 6

3 complications of chlamydia in men? women?

Answer 6

Men

1. epidymitis
2. prostatitis
3. Proctitis

Women

1. Endometritis
2. Salpingitis
3. PID

Question 7

What 2 the presentations of an infant w/chlamydia

Answer 7

1. Conjunctivitis
2. PNA

TX IMMEDIATELY for opthalmic G/C

Question 8

Other option for Txing Chlamydia? Why is it CI in preg?

Answer 8

Doxycycline x 7 days

- CI in preg –> causes teeth problems in baby

Question 9

What type of organism is Neisseria gonorrhea?

What type of people most often report this dz

Answer 9

gram negative diplococci

most cases reported in gay men (b/c Sxs)

Question 10

What 3 Sxs of Gonorrhea are common to both men and women?

Part 2: how does d/c differ from Chlamydia?

Note: most cases resolve w/out Tx (less serious than Chalmydia)

Answer 10

1. Purulent D/C
2. Urethritis
3. Dysuria

• Gonorrhea = d/c is more purulent than chlamydia

Question 11

How does newborn w/gonorrhea present? (where is infection, when does it show up)

Answer 11

conjunctivitis (eye) - purulent exudate w/in 1 wk of delivery

Question 12

What is the disseminated dz of Gonorrhea called?

3 Other complications of gonorrhea inf?

Answer 12

Arthritis-dermatitis Syndrome

• migratory poly-arthritis
• hemorrhagic papules/pustules

1. Ascending inf
2. Acute epididymitis
3. Septic arthritis

Question 13

What Dx test for gonorrhea is specific for a genital infxn in men? why wont it work in women?

ToC for gonorrhea is same as chlammydia…what is it?

Other method for detecting G/C = culture… what special culture used for G/C

Answer 13

Gram stain
- women normally have gonorrhea in their vagina

ToC for Dx = NAAT (PCR best)

chocolate agar culture

Question 14

What 2 drugs used Tx for Gonorrhea? (include dose) – hence what MUST you also Tx for?

Answer 14

IM Ceftriaxone 250 mg single dose

PO Azithromycin 1 g single dose (Tx for chlamydia)

Question 15

What type of infxn is PID? 2 MC causes together?

Answer 15

ascending infxn

MC caused by mixed combo of G/C

Question 16

Pt comes in w/pelvic pain, purulent cervical d/c, adenexal tenderness, CMT/Chandelier’s sign and fever > 101F (38.3 C) what is Dx?

Answer 16

Dx = PID

Question 17

What 2 drugs used to Tx PID outpatient? (sim to G/C)

2 drugs for inpatient?

Who must you also Tx

Answer 17

Outpatient

1. IM Ceftriaxone
2. PO Doxycycline

Inpatient

1. IV Cefotetan
2. PO Doxy

Tx PARTNERS

Question 18

Cause of syphillis/shape?

What is unique about transmission of syphillis

Answer 18

Treponema pallidum - spirochete (corkscrew appearance)

can cross placenta (transplacental transmission)

Question 19

1. Main presentation of primary syphilis?
2. Main presentation (general) of secondary syphilis
3. Main presentation of tertiary syphilis?
4. What is seen in CV sypilis?
5. What is seen in late benign syphilis

Answer 19

1. primary = chancre
2. secondary = rash
3. tertiary = neurosyphilis
4. CV = endarteritis (cardiac probs)
5. Late benign = gummas (granulomatous lesions)

Question 20

Painless, papule w/ raised borders that ulcerates and erodes

• heals on its own
• cervix, mouth, perinanal area
• a/w regional LAD near the site

What is it?

Answer 20

Chancre

Question 21

2ndary syphilis:

1. When does it occur?
2. what type of painless rash is it? what areas are highly suggestive for Dx?
3. papules coalesce –> _____
   - wart like lesions, gray/white, greasy, highly infectious

Answer 21

1. after primary (chancre) –> 2-8 wks after
2. Maculopapular rash - highly suggestive if on palms/soles
3. Form condyloma lata

Question 22

Enlargement of epitrochelar nodes is highly suggestive for what dz?

Answer 22

Syphilis

Question 23

Tertiary/Neurosyphilis:

1. in Asx Dz what values seen w/CSF, WBC, protein, glucose and VDRL
2. 2 types of Symptomatic Dz

Answer 23

1. incr CSF/WBC/protein, decr glucose, + VDRL

2. Endarteritis olbiterans and parenchymatous/degeneritive Dz

Question 24

Two eye findings a/w parenchymatous/degeneritive Dz?

Answer 24

1. Argyll Robertson pupil (pupil constricts w/accomodation but not light)
2. Optic atrophy

Question 25

Tertiary syphillis: Ataxic gait, foot drop, paresthesia, incontinence, impotence, charcots joints are seen w/what?

Answer 25

Tabes dorsalis = demyelination of dorsal root ganglia

Question 26

What type of examination is the definitive method for Dx syphilis?

Answer 26

Darkfeld examination

Question 27

What type of syphilis are serological tests (VDRL and RPR) most reliable for?

Answer 27

secondary syphilis

Question 28

What are the two non-treponal testing for and what are they? Which is used for screening and which used for neurosyphilis? What decr in titer is considered signif After doing non-treponal testing what type of testing need to confirm results?

Answer 28

- testing for Abs 1. RPR - for screening 2. VDRL - for neurosyphilis 4 fold decr in titer = signif Confirm w/treponemal test

Question 29

Treponemal Testing 1. what are the 3 specific tests?

Answer 29

1. FTA-ABS | - TPHA or TP-PA

Question 30

What two tests MUST be done for neurosyphilis? Which test when positive indicates CNS involvement? (but also if negative cannot r/o neurosyphilis)

Answer 30

RPR and VDRL tests Which test when positive indicates CNS involvement - but also if negative cannot r/o neurosyphilis --> VDRL

Question 31

Tx for early dz syphilis (< 1 yr) What is the only option for Tx of Neurosyphillis

Answer 31

Pen G Benzathine Neurosyphillis --> IV PCN

Question 32

If you see lice on the eyelashes and pruritus what should you suspect?

Answer 32

Pediculosis pubis (pubic lice)

Question 33

Name for bluish-gray, irreg shaped macules on lower abd wall, butt, upper thighs seen w/pubic lice (pathonogmonic)

Answer 33

Maculae Ceruleae (taches bleues)

Question 34

3 tx options for pubic lice

Answer 34

1. Permethrin 2. Malathion 3. Lindane

Question 35

Permethrin Tx for Pubic Lice - name for OTC and Rx ? 1. once applied when do you wash off? 2. when must you reapply it?

Answer 35

Permethrin - OTC = Nix, Rx = Elminite 1. wash off after 10 min 2. reapply 7-14 days later

Question 36

Malathion Tx for pubic Lice 1. how long applied 2. when is it indicated

Answer 36

1. applied 8-12 hrs | 2. indicated if fail permethrin

Question 37

Lindane 1. how long should shampoo be applied then washed off? 2. when CI (2)

Answer 37

1. 4 min --> wash off | 2. CI in preg, breastfeeding