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NUR: 718 > Male/Female GU Disorders > Flashcards

Male/Female GU Disorders Flashcards

1
Q

Normal physiologic changes (andropause)

A
  • average age = 45
  • prostate hypertrophy
  • testicular mass decreaes
  • testosterone decreases (gradually)
  • sclerosis of epididmyis, seminal vesicles, and prostate
  • changes in sexual response: decreased penile rigidity, lengthened excitement phase, lower ejaculatory volume, less well-defined sense of impending orgasm, shortening of ejaculatory event and orgasmic phase
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2
Q

Normal physiologic changes (menopause)

A
  • 12 months without period = menopause
  • average age = 45
  • vaginal dryness
  • dyspareunia (painful intercourse)
  • thinning of vaginal epithelial lining
  • decreased ovarian and uterine size
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3
Q

Adolescent Considerations

A
  • puberty onset (10 for girls, 11.5 for boys)

- tanner staging describes onset and progression of puberty changes

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4
Q

Hematuria - key characteristics

A
  • 5+ RBCs in 3/3 specimens obtained at least 1 week apart
  • gross or microscopic (3+ RBCs)
  • symptomatic or asymptomatic
  • transient or persisent
  • can be isolated or associated with proteinuria and other urinary abnormalities
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5
Q

Hematuria - symptomatology and hx

A
  • gross vs. microscopic
  • timing during urination
  • irritative voiding symptoms?
  • prior hx?
  • meds (+ duration of use)
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6
Q

Hematuria - Diagnostics

A
  • UA dipstick + UA with microscopy
  • if female, ask when LMP was (are they pregnant) are they on period)
  • other: coags, BUN/creatinine, urine cytology, CT, renal biopsy, cystoscopy (urology referral)
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7
Q

Hematuria - Management

A
  • Medical: asymptomatic (isolated) generally = no tx, associated with abnormal diagnostics = treat based on primary dx/cause
  • Surgical: may be necessary based on anatomic abnormalities (Ureter-Pelvic Junction (UPJ) obstruction, tumor, significant urolithiasis)
  • Consultation: required with urinary tract abnormalities or certain systemic diseases (systemic disease = nephrology consult)
  • Follow-up: persistent microscopic = 6-12 month intervals
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8
Q

Urinary Tract Infection - most common pathogen

A

E. coli

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9
Q

Urinary Tract Infection - risk factors

A
  • Reduced urine flow: outflow obstruction (ex: BPH, foreign body), neurogenic bladder, inadequate fluid intake
  • Colonization promotion: sexual activities, spermicide, antimicrobial agents
  • Facilitation of ascent: catheterization, incontinence, residual urine (post-void)
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10
Q

Uncomplicated UTI vs. complicated UTI

A

Uncomplicated: infection in healthy patient with anatomically and functionally normal urinary tract
Complicated: infection associated with factors increasing colonization, anatomic or structural abnormality, immunocompromised, multidrug resistant,, males are usually considered complicated

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11
Q

Recurrent vs. Reinfection vs. Persistent UTIs

A

Recurrent: occurs after documented infection that has resolved
Reinfection: new event with reintroduction of organism(s) into urinary tract
Persistent: UTI caused by same organism from focus of infection

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12
Q

UTI - key characteristics

A
  • rare in males < 50
  • always considered complicated in men because of length of urethra (tx assumes that infection of upper tract has occurred )
  • must more common in women
  • acute = single pathogen
  • chronic = 2+ pathogens
  • acute cystitis = infection of bladder
  • pyelonephritis = infection of bladder
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13
Q

UTI (acute cystitis) - key characteristics

A
  • dysuria
  • frequency and urgency
  • suprapubic pain
  • +/- hematuria
  • foul smelling urine
  • males may not present this way but with pyelonephritis symptoms
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14
Q

UTI (acute pyelonephritis) - key characteristics

A
  • acute cystitis symptoms plus any of the following
  • fever
  • chills
  • flank pain
  • n/v
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15
Q

UTI - exam findings

A
  • ask about previous UTIs, DM, HIV, on prednisone (immunosuppression), recent GU surgery)
  • VS (febrile, tachycardia)
  • flank pain/CVA
  • suprapubic tenderness
  • inguinal adenopathy
  • men may have inguinal tenderness or meatal discharge
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16
Q

UTI - diagnostics

A
  • UA: evidence of pyuria is most valuable diagnostic tool for UTI
  • pyuria = > 10 WBCs, most reliable indicator
  • absence of pyuria strongly suggests alternative dx
  • CBC (if worried about pyelonephritis, may see left shift)
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17
Q

UTI - management (non-pharm)

A
  • hydration
  • condom utilization
  • appropriate use of indwelling urinary catheters
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18
Q

UTI - management (pharm) for uncomplicated cystitis

A
  • Nitrofurantoin 100 mg BID
  • Bactrim PO BID
  • duration of treatment: women = 3 days, men = 7-14 days
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19
Q

UTI - management (pharm) for acute pyelonephritis

A
  • ciprofloxacin 500 mg BID or 1000 mg ER PO daily

- levofloxacin 500-750 mg PO daily

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20
Q

UTI - why admit to hospital?

A
  • isn’t able to take oral meds
  • dehydrated
  • elderly
  • unstable
  • unable to keep food down
  • symptoms aren’t improving
  • pregnant
  • immunocompromised
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21
Q

UTI - management (pharm) for hospitalized pts

A
  • fluoroquinolones such as IV levoquin
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22
Q

UTI - referrals and consultations

A
  • urology: males with structural abnormalities, recurrent UTIs
  • ID: unusual or resistant microorganisms
  • Pharmacokinetics: management of dosing antibiotics
  • repeat UA is not done routinely in women but is in men
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23
Q

Varicocele - key characteristics

A
  • BAG OF WORMS
  • dilation of pampiniform venous plexus and internal spermatic vein
  • cause of decreased testicular function
  • vast majority of cases is left testicle
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24
Q

Varicocele - symptomatology

A
  • dull, aching scrotal pain
  • testicular atrophy
  • infertility
  • usually asymptomatic (usually seeks tx after failed conception)
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25
Q

Varicocele - exam findings

A
  • BAG OF WORMS
  • grading:
    1. small (palpable only with valsalva maneuver)
    2. moderate (non-invisible upon inspection but palpable upon standing)
    3. large (visible on gross inspection
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26
Q

Varicocele - diagnostics

A
  • physical exam

- doppler ultrasound: when exam findings are questionable, this is diagnostic

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27
Q

Varicocele - management

A

Medical:
- no effective treatment
- older men who have completed reproduction and only present with minor scrotal discomfort = NSAIDs and scrotal support
- younger, fertile men = surgery may be needed
Surgery:
- veriocele ligation

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28
Q

Hydrocele - key characteristics

A
  • fluid collection with tunica vaginalis of scrotum or along spermatic cord
  • little risk of clinical consequence
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29
Q

Hydrocele - symptomatology

A
  • fullness of scrotum
  • swelling of scrotum
  • painless
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30
Q

Hydrocele - exam findings

A
  • soft, non-tender collection with hemiscrotum
  • may be able to palpate scrotal contents
  • may be massive and tense
  • TRANSILLUMINATES
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31
Q

Hydrocele - diagnostics

A
  • physical exam
  • transillumination
  • ultrasound - if findings show tenderness or fever, or there is a shadow seen during transillumination
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32
Q

Hydrocele - management

A

Medical:
- observation (asymmptomatic males with an isolated, non-communicating hydrocele) until they become symptomatic
Surgical:
- inguinal or scrotal approach

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33
Q

Prostatitis - 4 syndromes

A

I - acute bacterial
II - chronic bacterial
III - chronic/chronic pelvic pain syndrome (CPPS)
IV - asymptomatic inflammatory

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34
Q

Acute Bacterial Prostatitis - key characteristics

A
  • acute infection of prostate
  • very common
  • young/middle aged men
  • entry into prostate via urethra
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35
Q

Acute Bacterial Prostatitis - most common organism

A

E. COLI

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36
Q

Acute Bacterial Prostatitis - symptomatology

A
  • acutely ill

- c/o chills, fevers, malaise, irritative urinary symptoms, pain, cloudy urine, pain at tip of penis

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37
Q

Acute Bacterial Prostatitis - exam findings

A
  • warm, firm, edematous, very tender prostate
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38
Q

Acute Bacterial Prostatitis - diagnostics

A
  • *DRE - finding tender and edematous prostate + classic symptomatology usually establishes dx
  • UA + culture/gram stain
  • Imaging - reserved for pts in which findings aren’t showing anything, still having symptoms, no improvement despite medical tx
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39
Q

Acute Bacterial Prostatitis - management

A

ANTIMICROBIALS!

  • TMP/SMX (Bactrim) PO BID
  • Cipro 500 mg PO BID
  • Levofloxacin 500 mg PO daily
  • 6 weeks tx duration
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40
Q

Chronic Bacterial Prostatitis - key characteristics

A
  • *hallmark = reoccurring, relapsing UTI involving same pathogen
  • chronic/ recurrent urogenital symptoms with evidence of infection
  • young/middle aged men
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41
Q

Chronic Bacterial Prostatitis - common pathogen

A

E. COLI

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42
Q

Chronic Bacterial Prostatitis - symptomatology

A
  • subtle

- recurrent dysuria, frequency, urgency, perineal discomfort, low-grade temps

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43
Q

Chronic Bacterial Prostatitis - exam findings

A
  • may see prostatic hypertrophy, tenderness, edema, nodularity
  • prostate may be normal
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44
Q

Chronic Bacterial Prostatitis - diagnostics

A
  • DRE
  • UA + culture/grain stain
  • semen culture
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45
Q

Chronic Bacterial Prostatitis - management

A
  • prolonged antimicrobial therapy
  • *Cipro 500 mg PO BID
  • *Levofloxacin 500 mg PO BID
  • *4 week duration for fluoroquinolones
  • urology referral
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46
Q

Chronic/Chronic Pelvic Pain Syndrome (CPPS) - key characteristics

A
  • unexplained pelvic pain
  • constellation of symptoms: associated with irritative voiding and/or pain in groin, genitalia, or perineum in absence of pyuria and bacturia
  • need to have:
    1. long standing symptoms
    2. no objective explanation for symptoms
    3. no satisfactory tx or cure that is helping
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47
Q

Chronic/Chronic Pelvic Pain Syndrome (CPPS) - symptomatology

A
  • irritative voiding symptoms

- consider administering NIH-CPSI

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48
Q

Chronic/Chronic Pelvic Pain Syndrome (CPPS) - exam findings

A
  • prostate usually non-mildly tender

- thorough abdominal/pelvic exam

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49
Q

Chronic/Chronic Pelvic Pain Syndrome (CPPS) - diagnostics

A
  • DRE
  • UA + culture/stain
  • PSA
  • imaging?
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50
Q

Chronic/Chronic Pelvic Pain Syndrome (CPPS) - management

A
  • *alpha-blockers + antimicrobials
  • reassurance
  • consultations: urology, PT, psych
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51
Q

Asymptomatic Inflammatory Prostatitis (non-bacterial) - key characteristics

A
  • symptoms of prostatitis without positive cultures
  • may be caused by some other organism such as chlamydia, gonorrhea, fungi, etc.
  • may be non-infectious cause such as allergies, autoimmune
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52
Q

Asymptomatic Inflammatory Prostatitis (non-bacterial) - symptomatology

A
  • irritative voiding symptoms
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53
Q

Asymptomatic Inflammatory Prostatitis (non-bacterial) - exam findings

A
  • non-specific
  • normal vs. tender prostate
  • may see enlarged boggy prostate
  • may have pelvic trigger points
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54
Q

Asymptomatic Inflammatory Prostatitis (non-bacterial) - diagnostics

A
  • DRE
  • UA + culture/stain
  • expressed prostatic secretions
  • voiding cystourethrography
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55
Q

Asymptomatic Inflammatory Prostatitis (non-bacterial) - management

A

Trial of antimicrobials
- TMP/SMX, cipro, levofloxacin
- if improvement, proceed with full 4 week tx
STI testing
Analgesics
Adjuctive therapies - biofeedback, sitz bath, acupuncture

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56
Q

Acute Epididmyitis - key characteristics

A
  • inflammation of epididymis
  • most common cause of acute scrotal pain in adults in outpatient setting
  • most commonly infectious etiology
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57
Q

Acute Epididmyitis - symptomatology

A
  • gradual onset of scrotal pain and swelling (over days)
  • localized to one side
  • dysuria, frequency, and/or urgency
  • fever/chills
  • no n/v
  • may c/o urethral discharge preceding onset
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58
Q

Acute Epididmyitis - exam findings

A
  • induration and swelling of involved epididymis
  • exquisite tenderness
  • PREHN SIGN - RELIEF OF PAIN WHEN ELEVATING AFFECTED SIDE
    (if pain is worse (positive = torsion!)
  • may see scrotal wall erythema or reactive hydrocele in advanced cases
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59
Q

Acute Epididmyitis - diagnostics

A

Lab
- UA - should always be done in suspected cases (can be negative in those without urinary complaints)
- urine culture (if UA positive)
- consider urethral swab (if urethral discharge)
Ultrasound
- if concerned for torsion

60
Q

Acute Epididmyitis - management

A

combination of ceftriaxone, doxycycline, levofloxacin, ofloxacin

61
Q

Acute Epididmyitis - supportive therapy

A
  • reduction of physical activity and scrotal support/elevation
  • ice packs
  • NSAIDs
  • avoidance of urethral instrumentation
62
Q

Testicular torsion - key characteristics

A
  • torsion of spermatic cord and loss of blood supply to ipsilateral testicle
  • *UROLOGIC EMERGNECY!
  • predominately disease of adolescents and neonates
  • etiology spontaneous, sports/physical activity induced
  • *testicular viability significantly decreases after 6 hours!
63
Q

Testicular torsion - symptomatology

A
  • sudden onset severe unilateral scrotal pain
  • inguinal or scrotal swelling
  • pain may lessen as necrosis becomes more complete
  • gradual onset is uncommon
  • fever, n/v
64
Q

Testicular torsion - exam findings

A
  • very tender testicle
  • may see swollen, high-riding testis
  • loss of cremasteric reflex (or diminished)
  • *positive Phren sign (elevation of scrotum is more painful)
  • edema or enlargement of testicle
  • scrotal erythema
65
Q

Testicular torsion - diagnostics

A
  • clinical exam (diagnostics are not needed)
66
Q

Testicular torsion - TWIST scoring

A
  • testicular workup for ischemia & suspected torsion
67
Q

Testicular torsion - management

A
  • *SURGERY - immediate surgical exploration and detorsion is needed to salvage testis
  • analgesics and antiemetics
68
Q

Erectile dysfunction - types

A

Organic
Iatrogenic
Psychogenic

69
Q

Erectile dysfunction - Organic

A
  • Vascular: most common cause (atherosclerosis, venous insufficiency, venous leak)
  • Endocrine: hypogonadism, hyperprolactinemia
  • Neurogenic: 2nd most common cause (DM, stroke, Parkinson’s)
  • Primary penile disorder (priapism)
70
Q

Erectile dysfunction - Iatrogenic

A
  • Meds: antihypertensives, anticholinergics, antidepressants
  • Surgery: radical prostatectomy, pelvic surgery
  • Etoh, tobacco, illicit drugs
71
Q

Erectile dysfunction - Psychogenic

A
  • Pyschosocial - depression, performance anxiety
72
Q

4 Major categories of sexual dysfunction in older men

A
  1. erectile dysfunction (ED)
  2. low desire (libido)
  3. performance anxiety and other psychological problems
  4. inability to climax
73
Q

Erectile dysfunction - key characteritic

A

inability to achieve or maintain erection sufficient for satisfactory sexual performance

74
Q

Erectile dysfunction - Exam

A
  • emphasis on GU, vascular, and neurologic systems

- focused exam on BP, peripheral pulses, sensation, genitalia and prostate, testes, any penile abnormalities

75
Q

Erectile dysfunction - diagnostics

A
  • UA recommended to rule out infection
  • labs to consider: hormone testing, Hgb A1c, chemistry panel, lipid panel
  • injection of prostaglandin E1: direct injection into corpora cavernosa. if penile vasculature is normal, erection should develop within minutes
76
Q

Erectile dysfunction - management

A
  • identify underlying case
  • identify and treat CV risk factors (smoking, obesity, HTN, lipid disorder)
  • *medication: phosphodiesterase-5 inhibitors (Sildenafil, vardenafil). take on empty stomach about 1 hour before sex
  • contraindications to phosphodiesterase-5 inhibitors: men taking nitrates
77
Q

BPH - key characteristics

A
  • proliferation of cellular elements of prostate
  • common problem among older men
  • prostate weight increases after age 50
  • can lead to bladder outlet obstruction
78
Q

BPH - symptomatology

A
  • lower urinary tract symptoms: increased daytime frequency, nocturia, urgency, incontinence
  • voiding symptoms: slow stream, splitting/spraying of stream, intermittent stream, hesitancy, drippling
  • slow/insidious onset with progression over years
79
Q

BPH - exam

A

DRE - examin prostate for size, consistency, nodules, induration, and symmetry

80
Q

BPH - diagnostics

A
  • DRE
  • UA: should be obtained to detect blood or infection
  • creatinine
  • PSA
81
Q

BPH - management

A
  • *watchful waiting is recommended for mild symptoms

- behavioral modification: avoiding fluids before bedtime, reduction of etoh and caffeine, double voiding)

82
Q

Prostate cancer - key characteristics

A
  • most common non-cutaneous cancer in men in US
  • likelihood increases with age
  • ranges from microscopic well-differentiated to aggressive high-grade cancer with mets
83
Q

Prostate cancer - risk factors

A
  • tobacco use
  • african american
  • high fat diet
  • family hx
84
Q

Prostate cancer - symptomatology

A
  • asymptomatic (majority)
  • urinary complaints: frequency, urgency
  • retention
  • back pain
  • hematuria
  • advanced: weight loss, loss of appetite, bone pain, anemia, leg pain and/or edema
85
Q

Prostate cancer - diagnostics

A
  • DRE?: provider dependent, serial exams are best, nodule is suspicious and warrants evaluation
  • PSA + DRE findings
  • UA: should be done to check for hematuria or infection
  • *needle biopsy for elevated PSA and/or abnormal DRE. Use Gleason score
86
Q

Prostate cancer - most common type

A
  • *adenocarcinomas
87
Q

Prostate cancer - management

A
  • initial evaluation of tx discussion involves 2 things:
    1. patient’s life expectancy and health status
    2. biologic characteristics of tumor and predicted aggressiveness
  • active surveillance, watch and wait
  • radical prostatectomy if intermediate risk
88
Q

Bladder cancer - key characterisics

A
  • *highest rate of recurrence of any malignancy
  • occupational exposures associated with increased risk
  • incidence increases with age
89
Q

Bladder cancer - most common type

A
  • *transitional cell carcinoma
90
Q

Bladder cancer - most common cause

A
  • *tobacco
91
Q

Bladder cancer - symptomatology

A
  • *painless hematuria (gross or microscopic)
  • irritative voiding symptoms
  • often intermittent
92
Q

Bladder cancer - diagnsotics

A
  • UA + micro
  • urinary cytology: texts dx, suggestive urinary cytology findings suggests urologist to perform cystoscopy
  • cystoscopy: criterion standard for dx but invasive and expensive
  • urinary tumor markers
  • CT/MRI - rule in/out mets
93
Q

Bladder cancer - staging

A
  • *TNM system is used
94
Q

Bladder cancer - management

A
  • *non-muscle invasive: immunotherpay with BCG is most effective
  • *muscle-invasive: TURBT for early stages, chemo (Cisplatin is standard), for mets = platinum based combos
95
Q

Testicular Cancer - key characteristics

A
  • most common solid malignancy in males aged 19-35
96
Q

Testicular Cancer - most common type of tumor

A
  • *germ cell tumors (GCT)
97
Q

Testicular Cancer - symptomatology

A
  • *nodule or painless swelling of one testicle
  • commonly: dull ache or heavy sensation in lower abdomen, perianal, or scrotum
  • advanced: signs of mets (neck mas, cough, anorexia, n/v, back pain, bone pain)
98
Q

Testicular Cancer - exam findings

A
  • bimanual exam of scrotal contents: ovoid mass, firm, mixed, hard always suspicious
  • may find hydrocele
  • abdominal exam for nodal disease
  • lymph node exam
99
Q

Testicular Cancer - diagnostics

A
  • scrotal US

- *serum tumor markers: alpha fetoprotein (AFP), beta-HCG, LDH)

100
Q

Testicular Cancer - staging

A
  • *uses TNM staging
101
Q

Testicular Cancer - management

A
  • *diagnostic radical orchiectomy also serves as initial tx
  • *baseline sperm count and sperm banking
  • active surveillance post-tx
102
Q

Post-Coital Emergnecy Contraception

A
  • copper IUD
  • oral antiprogestins
  • oral levonorgesral (plan B)
  • all victims of sexual assault should be offered emergency contraception
  • should be taken 72-120 hours after
103
Q

Dysmenorrhea - primary

A
  • menstrual pain with menstrual cycle in ABSENCE OF PATHOLOGIC FINDINGS
  • tx: NSAIDS (start 1 day prior and continued 1-2 days after)
104
Q

Dysmenorrhea - secondary

A
  • menstrual pain with organic causes (ex: fibroids, endometriosis)
  • tx: depends on cause
105
Q

Amenorrhea - primary

A
  • absence of menses by age 16

- causes: congenital lack of uterus, chromosomal abnormalities, stress, vigorous exercise, dieting

106
Q

Amenorrhea - secondary

A
  • absence of menses for 3 months (for 6 months of women with irregular cycles)
  • causes: #1= PREGNANCY
107
Q

Amenorrhea - management

A
  • depends on cause

- refer

108
Q

Dysfunctional uterine bleeding

A
  • includes menorrhgia (heavy bleeding), metorrhagia (light, irregular bleeding between periods), and menometrorrhagia (heavy, irregular bleeding)
  • *big cause is endometriosis
  • check for anemia and coags if heavy bleeding
  • consider referral if patient is > 35 and/or exposure to unopposed estrogen
109
Q

PID Salpingitis - what is it?

A

Acute or chronic inflammation of upper female genital tract (into fallopian tubes) caused by bacterial infection

110
Q

PID Salpingitis - most common organism

A
  • *N. gonorrhoeae and C. trachomatis
111
Q

PID Salpingitis - presentation

A
  • Early: lower abdominal pain, menstrual cramp-type pain, low grade fevers
  • Later: more severe abdominal pain, higher fevers, purulent discharge
  • *Chandelier sign: cervical and uterine motion tenderness, marked tenderness of cervix, uterus, and adenexa
112
Q

PID Salpingitis - diagnostics

A
  • minimum critiera: female, sexually active, uterine or adenexal tenderness with cervical motion tenderness, temperature > 101, cervical or vaginal discharge, WBCs on vaginal microscopy, ESR, elevated CRP, positive gonococcal or chlamydia infection
113
Q

PID Salpingitis - treatment

A
  • *ceftriaxone 250 mg IM once + doxycycline 100 mg BID for 14 days (with/without metronidazole)
114
Q

Bacterial Vaginosis - most common pathogen

A
  • *overgrowth of gardnerella vaginalis
115
Q

Bacterial Vaginosis - when do we treat?

A
  • only if bothersome in non-pregnant women and always in pregnant women
116
Q

Bacterial Vaginosis - presentation

A
  • pruritus, vaginal irritation, pain, unusual/ malodorous discharge
117
Q

Bacterial Vaginosis - diagnostics

A
  • can usually treat without vaginal exam
  • Amsel criteria: requires 3 of the following -
    1. discharge
    2. *Clue cells present
    3. vaginal fluid pH > 4.5
    4. positive Whiff test (vaginal swab + KOH prep)
  • *gram stain = (gold standard lab method) - look for clue cells
118
Q

Bacterial Vaginosis - treatment

A
  • *metrondiazole 500 mg BID for 7 days
119
Q

Vulvovaginal candidiasis - presentation

A
  • thick, clumpy, white, cottage cheese discharge

- pruritus, erythema

120
Q

Vulvovaginal candidiasis - risk factors

A
  • pregnancy, on antibiotics, long-term steroids
121
Q

Vulvovaginal candidiasis - diagnostics

A
  • usually done just by clinical symptoms
  • gram stin
  • swab + KOH wet prep
122
Q

Vulvovaginal candidiasis - treatment

A
  • *fluconazole 150mg once

- also intravaginal agents

123
Q

Trichomonas vaginalis - presentation

A
  • frothy, gray or yellow/green discharge, malodorous

- *strawberry cervix (petechiae on cervix)

124
Q

Trichomonas vaginalis - most common pathogen

A
  • *trichomonas vaginalis
125
Q

Trichomonas vaginalis - diagnostics

A
  • *Nucleic Acid Amplification Test (NAAT) - swab, highly sensitive
126
Q

Trichomonas vaginalis - treatment

A
  • *metronidazole 2g PO once

- test for other STIs because if they have this they usually have something else going on

127
Q

Chlamydia - presentation

A
  • women: no symptoms in 70-80%, lower abdominal pain, discharge, dysuria
  • men: no symptoms in up to 50%, cloudy thick penile discharge, unilateral testicular pain and swelling
  • may have ulcerations, lesions, erythema on external genitalia
128
Q

Chlamydia - pathogen

A
  • *chlamydia trachomatis
129
Q

Chlamydia - diagnostics

A
  • *NAAT test
130
Q

Chlamydia - treatment

A
  • *azithromycin (Zithromax) 1g single dose
131
Q

Gonorrhea - presentation

A
  • asymptomatic or symptomatic
  • females: up to 80% asymptomatic, dysuria, frequency, labial pain, pharyngitis, discharge, systemic signs (later)
  • men: more symptomatic, whitish urethral discharge, dysuria, pharyngitis, *profuse purulent yellow/green discharge (later)
  • can lead to PID, ectopic pregnancy, and infertility if not treated
132
Q

Gonorrhea - pathogen

A
  • *N. gonorrhoeae
133
Q

Gonorrhea - diagnostics

A
  • *NAAT

- *identified on gram stain with use of modified thayer-martin medium

134
Q

Gonorrhea - treatment

A
  • *Ceftriaxone (Rocephin) 250 mg IM once + azithromycin 1g PO once
135
Q

Herpes Simplex Virus - presentation

A
  • vesicular eruptions clustered on lightly erythematous base
  • HSV type 1: most common, cold sores
  • HSV type 2: gential
  • can get sick with flu-like symptoms
136
Q

Herpes Simplex Virus - diagnostics

A
  • would see classic, painful vesicle eruptions

- HSV culture: test of choice now

137
Q

Herpes Simplex Virus - treatment

A
  • no cure but can treat symptoms

- *acyclovir (Zovirax) 7-10 days or until healing is complete

138
Q

Syphilis - stages

A

NEED TO KNOW

  • Primary: chancre - painless ulcer/sore, usually 3-4 weeks after exposure, may have regional lymphadenopathy
  • Secondary: dissemination, systemic, flu-like symptoms, rash on palms and soles of feet, wart-like lesions throughout body, will progress to latent stage of not treated
  • Latent: may be asymptomatic, can last 2-20 years, blood test remains positive for antigen
  • Tertiary: takes on many forms (neuro, CV, soft-tissue syphilis, etc)
139
Q

Syphilis - pathogen

A
  • *Treponema pallidum
140
Q

Syphilis - diagnostics

A
  • dx requires 2 tests (a non-treponemal test and treponemal test)
  • treponemal test looks for antibodies (VDRL and RPR)
  • non-treponemal test looks for damage (dark-field microscopy and direct fluorescent antibody test)
141
Q

Syphilis - treatment

A
  • *Benzathine penicillin G 2.4 million dose injection once and then follow up (primary and secondary)
  • titers monitored (don’t want increase)
  • 3 months and 6 months if necessary
142
Q

Human Papillomavirus - presentation

A
  • usually transient and without any clinical manifestations

- some get genital warts

143
Q

Human Papillomavirus - types

A
  • HPV-6 and HPV-11: low risk, more common, non-oncogenic

- HPV-16 and HPV-18: high risk, oncogenic, accounts for up to 70% of cervical cancers

144
Q

Human Papillomavirus - diagnostics

A
  • biopsy: if dx uncertain, patient is immunocompromised, if lesions don’t respond to standard tx
  • pap smear: usually how dx is found in women, sexually active women > 21
145
Q

Human Papillomavirus - treatment

A
  • no cure, just helps with symptoms
  • ointments and cryotherapy for warts
  • sometimes just leave them, they can come and go
146
Q

Expedited Partner Therapy

A
  • treating sex partners if patient is diagnosed with chlamydia or gonorrhea by providing meds to take to partner WITHOUT EXAMINATION OF PARTNER

NUR: 718 (8 decks)

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