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ObGyn Lecture > Lecture 9- STDs > Flashcards

Lecture 9- STDs Flashcards

1
Q

What STDs can you use expedited partner therapy for?

A

gonorrhea

chlamydia

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2
Q

What are the 2 immunizations to consider w/ STDs

A

Gardasil

Hep B

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3
Q

Who should be screened annually for STDs?

A

Sexually active women under 25 (book) 26 in CDC

older women with multiple sexual partners or a new partner

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4
Q

What is the most frequently reported infectious disease in the US?

A

Chlamydia trachomatis

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5
Q

What STD usually has less symptoms- chlamydia or gonorrhea?

A

gonorrhea

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6
Q

Is gonorrhea a reportable disease?

A

Yes, reportable disease in all states and sexual partners of infected individuals must be tested and treated

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7
Q

What are some screening diagnostics for discharge?

A

culture
microscopy
NAATs
EIA (immuno-assay)

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8
Q

What is NAATs?

A

nuclear acid amplification testing (can be rapid screens)

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9
Q

Name the condition: Recently on antibiotics, itchy white, curdy discharge, see hyphae and buds on microscope. Will have normal pH.

A

Candidasis albicans

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10
Q

What do you use to treat candidiasis albicans first line?

A

OTC intravaginal butoconazole (Femstat)
(any that end in “ole”)
use at bed time 3-5 nights

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11
Q

Name the condition: discharge, odor that is worse after intercourse. Thin homogenous, white, adherent discharge w/ fishy odor, positive whiff test. pH >4.5. On microscope there is clue cells

A

Bacterial vaginosis

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12
Q

How do you treat bacterial vaginosis?

A

Metronidazole (flagyl) 500 mg po BIDx 7

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13
Q

What are some precautions to take with metronidazole (flagyl) (treatment for BV, t. vaginalis) ?

A

Take with food
May have mild headache
No alcohol while taking it
May have a metallic taste

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14
Q

Name the condition: discharge, foul odor, dysuria, dyspareunia, vulvar itching and burning. Yellow-green discharge, frothy, “strawberry cervix” Will see protozoan on microscope.

A

Trich (T. vaginalis)

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15
Q

How do you treat t. vaginalis?

A

Metronidazole (flagyl) 2 grams po single dose

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16
Q

What is the progression with chlamydia trachomatis?

A

PID, ectopic, infertility

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17
Q

What does the cervix with chlamydia look like?

A

mucoprurulent cervicitis, friable cervix (bleed when touched)

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18
Q

What diagnostics do you do for chlamydia?

A

culture or liquid based cytology

urine based test (NAAT)

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19
Q

How do you treat chlamydia?

A

Azithromycin 1 gm po single dose

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20
Q

do partners needs to be treated with chlamydia?

A

yes

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21
Q

When do you do a test of cure with chlamydia?

A

Pregnant

Re-infection suspected

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22
Q

When should you do a test of cure?

A

Give at least 4 weeks after treatment

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23
Q

How far back do you have to treat partners of people who had chlamydia?

A

60 days

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24
Q

What is the sequelae with gonorrheae?

A

PID, ectopic, infertility

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25
How do you treat gonorrhoeae?
Ceftriaxone (Rocephine) 250 mg IM single dose plus azithromycin (zithromax) 1 g PO (covers co-existant chlamydia)
26
Where can gonorrhoeae present?
Cervix Rectum Pharynx Eye
27
What can cause PID?
N. gonorrhea, C. trachomatis, vaginal anaerobes
28
What is necessary for a diagnosis of PID?
``` Uterine, cervical or adnexal tenderness plus at least one of the following: T >101 F Mucopurulent discharge WBCs in vaginal fluid elevated sed rate elevated c-reactive protein documented GC or chlamydia ```
29
How do you treat PID in the non vomiting, non spetic or pregnant, non surgical abdomen.
Ceftriaxone 250 mg IM plus azithromycin 1 g Po single dose or doxycycline 100 mg BID x 7 days
30
For inpatient treatment of PID (those who fail to response w/in 24-72 hours outpatient Rx, TOA, can't do outpatient Rx) how do you treat it?
IV cephalosporin plus doxycycline
31
What is caused by the pox virus. Presents as umbilicated papules.
Molluscum
32
how do you treat molluscum?
Cryotherapy Laser Topicals
33
What is caused by human itch mite, rash ad burrows in belt area, intertriginous spaces.
scabies
34
How do you treat scabies?
Permethrin 5% (adult, egg) | Bedding, clothing and towels use hot water and hot dry cycle
35
How do you treat pubic lice?
Permethrin 5% (adult, egg) bedding, clothing, and towels use hot water dry cycle
36
What is the most common STD in the US?
HPV
37
What are the high risk types of HPV?
16, 18
38
How does HPV appear on a PE?
visible condyloma (flat, smooth, pedunculated): genitalia, anus, mouth
39
How do you treat visible condyloma?
Liquid nitrogen/ cryotherapy Patient applied imiquimod (Aldara) 5% cream Sinecatechins 15% ointment (Veregen) Podofilox
40
What is used for prevention of HPV?
Gardasil (quadrivalent) | Cervarix (bilvalent)
41
Where does HSV 1 occur?
Oral cold sores, fewer recurrences
42
where does HSV 2 occur?
Genital area, recurrent but less severe
43
With the first episode of HSV 2 what can happen?
Constitutional episode pelvic adenopathy lesions
44
What is a prodrome?
Presents with HSV, feel tingling, symptoms on a outbreak coming on
45
What are diagnostics for herpes?
Culture and PCR | type specific: HSV G1 and G2 (glycoprotein)
46
What can you use to treat the 1st episode of herpes?
Ancyclovir (Zovirax) 400 mg TID 2-10 days
47
To suppressive herpes what do you give?
Suppressive: Acyclovir 400 mg BID
48
For an episode of herpes what can you give?
Acyclovir 400 mg TID x 5 days
49
For discordant couples for herpes what do you give to treat?
Valacyclovir 500 mg qd (only to partner that is symptomatic)
50
What organism causes syphilis?
Treponema pallidum (spirochete organism)
51
What is the average time it takes for clinical signs for syphilis to occur?
3 weeks
52
What is the sign of the primary stage of syphilis?
Chancre (10-60 days post infection) | painless, punched out ulcer gone in 3-6 weeks, regional adenopathy.
53
When does secondary syphilis occur?
4-8 weeks after chancre, resolves spontaneously
54
What are some symptoms of secondary syphillis?
Rash will also include palms and soles fever, HA, malaise, sore throat Rah is contagious
55
What happens in the latent phase of syphilis?
No clinical S and S
56
What happens in tertiary syphilis?
Have gumma= nodular, granulomatous lesions | can be external or internal
57
What do you use to diagnose syphilis?
RPR (rapid plasma reagin) & FTA-ABS (fluorescent treponemal antibody absorption) If FTA is positive then def syphilis VDRL & HA-TP Serum/CSF/ Tissue : dark field (microscopy)
58
How do you treat syphilis?
Benzathine PCN G (Bicillin LA) 2.4 mu IM Single dose for primary, secondary and early latent Weekly X 3 weeks for late latent or unknown
59
How often do you monitor people with syphilis?
Monitor 6, 12, 24 months
60
What is considered treatment failure w/ syphilis?
Failure to decrease titer by 2 dilutions
61
How do you know if someone has been re-infected w/ syphilis?
4 fold increase in titer
62
What is the Jarisch - Herxheimer rxn?
HA, fever w/in 24 hours of injection | Due to die off of spirochete in blood
63
What are 2 other conditions to consider in the ddx for syphilis?
``` Lymphogranuloma venerum (LGV) Donovanosis ```
64
What condition has a break down of the lymph notes (bubos)?
Lymphogranuloma venerum (LGV)
65
How do you treat lymphogranuloma venerum and donovanosis?
doxycycline 100 mg BID x 21 days
66
What is a disorder often found in Australia, India, Africa with Painless, slow growing ulcerative lesions w/out LAD
Donovanosis
67
What presents with painful genital ulcer w/ tender, suppurative inguinal LAD. Prevelant in Africa, Caribbean?
Chancroid
68
How do you treat chancroid?
Azithromycin single 1 g dose
69
What are symptoms of HIV?
Fever, pharyngitis, lymphadenopathy (inguinal, axillary) rash, arthralgias, myalgias, HA
70
What are diagnostics for HIV/ AIDS?
Rapid screening confirmed with Western Blot
71
If the WB blot is positive what other information do you want to get?
Viral lode, CD4 count, CBC< CMP, other STDs, hep, TB, CXR
72
What is quantitative? RPR (rapid plasma reagin) or FTA-ABS (fluorescent treponemal antibody absorption)
RPR
73
What is the name for lesions associated with genital warts caused by HPV?
Condyloma acuminata
74
What is the name for white lesions associated w/ secondary syphillis?
Condylomata lata

ObGyn Lecture (21 decks)

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