Sexually transmitted disease Flashcards
(166 cards)
1
Q
what is herpes
A
sexually transmitted disease (STD) caused by the herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2).
2
Q
How is HS2 virus spread
A
\HSV-2 infection are spread during genital contact with someone who has a genital HSV-2 infection.
3
Q
How is HS1 spread?
A
By receiving oral sex who have HS1
4
Q
Symptoms of Genital herpes?
A
s one or more vesicles, or small blisters presents in genitals, rectum or mouth
5
Q
Herpes- what happen when vesicles break.
A
painful ulcers occurs
that may take two to four weeks to heal after the initial herpes infection.
6
Q
Herpes- How bad is the first outbreak as compared to the recurrent outbreak?
A
. The first outbreak of herpes is often associated with a longer duration of herpetic lesions, increased viral shedding (making HSV transmission more likely) and systemic symptoms including fever, body aches, swollen lymph nodes, or headache.
Recurrent outbreaks of genital herpes are common, and many patients who recognize recurrences have prodromal symptoms, either localized genital pain, or tingling or shooting pains in the legs, hips or buttocks, which occur hours to days before the eruption of herpetic lesions.
7
Q
HERPES- recurrent outbreak or first outbreak is shorter?
A
Symptoms of recurrent outbreaks are typically shorter in duration and less severe than the first outbreak of genital herpes.
8
Q
Herpes and pregnancy? C section or normal delivery?
A
If herpes symptoms are present a cesarean delivery is recommended to prevent HSV transmission to the infant
9
Q
Can you give anti viral during third trimester of pregnancy
A
NO
10
Q
Name of the diagnostic test for herpes?
A
HSV nucleic acid amplification tests (NAAT)
11
Q
Treatment of herpes
A
There is no cure for herpes.
Antiviral medications can, however, prevent or shorten outbreaks during the period of time the person takes the medication.11
No vaccine
There is currently no commercially available vaccine that is protective against genital herpes infection. Candidate vaccines are in clinical trials.
12
Q
How antiviral work for herpes?
A
It reduces the likelihood of transmission to partners
13
Q
Can a person with herpes who don’t have symptoms transfer it?
A
Even if a person does not have any symptoms, he or she can still infect sex partners.
14
Q
Name of medication for herpes?
A
Daily treatment with valacyclovir decreases the rate of HSV-2 transmission in discordant, heterosexual couples in which the source partner has a history of genital HSV-2 infection
15
Q
vulvovaginal candiasis causative agent?
A
candida albicans
16
Q
How can you diagnose candida?
A
Saline 10% KOH of vaginal discharge demonstrates budding yeasts, hyphae, or pseudohyphae
Culture shows positive result for a yeast species
Ph less than 4.5
17
Q
Symptoms of vulvovaginal candiasis?
A
Typical symptoms of VVC include pruritus, vaginal soreness, dyspareunia, external dysuria, and abnormal vaginal discharge,(thick curdy vaginal discharge)
18
Q
Do you start treatment for candida who have absent symptoms of candida and have positive culture for candida?
A
Identifying Candida by culture in the absence of symptoms or signs is not an indication for treatment because approximately 10%–20% of women harbor Candida species and other yeasts in the vagina. T
19
Q
Treatment of uncomplicated Candida
A
Short-course topical formulations (i.e., single dose and regimens of 1–3 days) effectively treat uncomplicated VVC.
Treatment with azoles results in relief of symptoms and negative cultures in 80%–90% of patients who complete therapy
20
Q
Name of the medication for the treatment of Candida?
A
Clotrimazole 1% cream 5 g intravaginally daily for 7–14 days or Clotrimazole 2% cream 5 g intravaginally daily for 3 days or Miconazole 2% cream 5 g intravaginally daily for 7 days or Miconazole 4% cream 5 g intravaginally daily for 3 days or Miconazole 100 mg vaginal suppository one suppository daily for 7 days or Miconazole 200 mg vaginal suppository one suppository for 3 days or Miconazole 1,200 mg vaginal suppository one suppository for 1 day or Tioconazole 6.5% ointment 5 g intravaginally in a single application Prescription Intravaginal Agents Butoconazole 2% cream (single-dose bioadhesive product) 5 g intravaginally in a single application or Terconazole 0.4% cream 5 g intravaginally daily for 7 days or Terconazole 0.8% cream 5 g intravaginally daily for 3 days or Terconazole 80 mg vaginal suppository one suppository daily for 3 days Oral Agent Fluconazole 150 mg orally in a single do
21
Q
CANDIDA: Do you need to treat sex partner?
A
No. Sometimes, it is not sexually transmitted
22
Q
What are the symtptoms of oral ozoles?
A
nausea, abdominal pain, and headache
23
Q
Treatment of complicated Candida?
A
oral or topical azole therapy.
Initial dose: longer duration of initial therapy is needed. (e.g., 7–14 days of topical therapy or a 100-mg, 150-mg, or 200-mg oral dose of fluconazole every third day for a total of 3 doses [days 1, 4, and 7]) is recommended, to attempt mycologic remission, before initiating a maintenance antifungal regimen.
Maintainance dose: Oral fluconazole (i.e., a 100-mg, 150-mg, or 200-mg dose) weekly for 6 months is the indicated maintenance regimen. If this regimen is not feasible, topical treatments used intermittently can also be considered.
24
Q
A
25
What is the second most commonly reported **Bacterial communicable disease?**
**gonorrhea** is the second most commonly reported bacterial communicable disease.
26
Who needs annual gonorhea examination?
Annual screening for N. gonorrhoeae infection is recommended for all sexually active women aged \<25 year
and for older women at increased risk for infection (e.g., those aged ≥25 years who have a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has an STI
27
Risk factors for getting gonorhea?
Additional risk factors for gonorrhea include inconsistent condom use among persons who are not in mutually monogamous relationships, previous or coexisting STIs, and exchanging sex for money or drugs. substance abuse
28
What are the microorganism that is transmitted with sexual contact
* Caused by microorganisms transmitted during sexual contact:
* Viruses
* Bacteria
* Protozoa
Ectoparasites (e.g., lice)
29
what is chancroid?
30
What are the criteria to diagnose Chanroid?
Inguinal lymphadenitis typically occurs in \<50% of cases.
All of the following four criteria are met:
1) the patient has one or more painful genital ulcers;
2) regional lymphadenopathy are typical for chancroid;
3) the patient has no evidence of T. pallidum infection by darkfield examination or NAAT (i.e., ulcer exudate or serous fluid) or by serologic tests for syphilis performed at least 7–14 days after onset of ulcers; and
4) HSV-1 or HSV-2 NAAT or HSV culture performed on the ulcer exudate or fluid are negative
31
Causative agent for chancroid?
•Haemophilus ducreyi bacterium
32
Treatment of Chancroid?
Azithromycin and ceftriaxone offer the advantage of single-dose therapy
33
Special management with Chancroid?
Men who are uncircumcised and persons with HIV infection do not respond well to tretament.
Patients should be tested for HIV at the time chancroid is diagnosed.
If the initial HIV test results were negative, the provider can consider the benefits of offering more frequent testing and HIV PrEP to persons at increased risk for HIV infection
34
Chlamydial infection
35
Chlamydia infection causes
PID, ectopic pregnancy, and infertility.
36
Is chlamydia a annual examination?
Annual screening of C trachomitis for all sexually active women aged \<25 years is recommended, as is screening of older women at increased risk for infection (e.g., women aged ≥25 years who have a new sex partner, more than one sex partner, a sex partner with concurrent partners,
37
Do you need to test men for chlamydia?
Chlamydia screening for men should be considered only when resources permit, prevalence is high, and such screening does not hinder chlamydia screening efforts for women
38
What is the most sensitive test for C trachomitis?
. NAATs are the most sensitive tests for these specimens and are the recommended test for detecting C. trachomatis infection
39
What are the other ways, C. Trachomitis be diagnosed, with using NAAT?
For, women, C. trachomatis urogenital infection can be diagnosed by vaginal or cervical swabs or first-void urine. For men, C. trachomatis urethral infection can be diagnosed by testing first-void urine or a urethral swab. N
40
Recommended regimen for Chlamydia?
Recommended Regimen for Chlamydial Infection
Adolescents and Adults **Doxycycline 100 mg orally 2 times/day for 7 days**
**Alternative Regimens** Azithromycin 1 g orally in a single dose or Levofloxacin 500 mg orally once daily for 7 day
41
Other management for Chlamydia?
To minimize disease transmission to sex partners, persons treated for chlamydia should be instructed to abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a 7-day regimen and resolution of symptoms if present.
To **minimize risk for reinfection,** patients also should be instructed to abstain from sexual intercourse until all of their sex partners have been treated.
Persons who receive a diagnosis of chlamydia should be tested for HIV, gonorrhea, and syphilis.
MSM who are HIV negative with a rectal chlamydia diagnosis should be offered HIV PrEP.
42
Follow up Chlamydia?
Men and women who have been treated for chlamydia should be retested approximately **3 months after treatmen**t, regardless of whether they believe their sex partners were treated; scheduling the follow-up visit at the time of treatment is encouraged
If retesting at 3 months is not possible, clinicians should retest whenever persons next seek medical c**are \<12 months after initial treatment**
43
Anogenital wart is caused by?
nononcogenic HPV types 6 or 11
44
HPV type 6 and 11 is associated with .......................
HPV types 6 and 11 have been associated with conjunctival, nasal, oral, and laryngeal warts.
45
Where do you have anogenital warts?
* Anogenital warts occur commonly at certain anatomic sites, including around the vaginal introitus, under the foreskin of the uncircumcised penis, and on the shaft of the circumcised penis.
* * Warts can also occur at multiple sites in the anogenital epithelium or within the anogenital tract (e.g., cervix, vagina, urethra, perineum, perianal skin, anus, or scrotum).
* * Intra-anal warts are observed predominantly in persons who have had receptive anal intercourse; however, they also can occur among men and women who have not had a history of anal sexual contact
46
how does anogenital warts appear
They are usually flat, papular, or pedunculated growths on the genital mucosa.
47
Prevention of Anogenital wart
Use HPV vaccination
48
How do you diagnose anogenital wart?
* Diagnosis of anogenital warts is usually made by **visual inspection but can be confirmed by biopsy,** which is indicated if lesions are atypical (e.g., pigmented, indurated, affixed to underlying tissue, bleeding, or ulcerated lesions).
* Biopsy might also be indicated in the following circumstances, particularly if the patient is immunocompromised (including those with HIV infection): the diagnosis is uncertain, the lesions do not respond to standard therapy, or the disease worsens during therapy.
49
Recommended Regimens for Urethral Meatus Warts/cervical warts and intraanal warts?
Cryotherapy with liquid nitrogen or Surgical removal
50
Recommended Regimens for Vaginal Warts
Cryotherapy with liquid nitrogen
The use of a cryoprobe in the vagina i**_s not_** recommended because of the risk for vaginal perforation and fistula formation. or Surgical removal or Trichlorace
51
Diagnostic consideration of gonorhea?
**Culture, NAAT, and POC NAAT, such as GeneXpert** (Cepheid), are available for detecting genitourinary infection with N. gonorrhoeae (149); culture requires endocervical (women) or urethral (men) swab specimens. Culture is also available for detecting rectal, oropharyngeal, and conjunctival gonococcal infection.
52
Recommended Regimen for Uncomplicated Gonococcal Infection of the Cervix, Urethra, or Rectum Among Adults and Adolescents
**Ceftriaxone** 500 mg\* IM in a single dose for persons weighing \<150 kg
If chlamydial infection has not been excluded, treat for chlamydia with **doxycycline** 100 mg orally 2 times/day for 7 days.
\* For persons weighing ≥150 kg, **1 g ceftriaxone** should be administered.
53
Recommended Regimen for **Uncomplicated Gonococcal Infection of the Pharynx** Among Adolescents and Adults
Ceftriaxone 500 mg\* IM in a single dose for persons weighing \<150 kg
\* For persons weighing ≥150 kg, 1 g ceftriaxone should be administered.
54
Alternative Regimens if Ceftriaxone Is Not Available to treat gonorhea?
**Gentamicin** 240 mg IM in a single dose plus **Azithromycin** 2 g orally in a single dose or
**Cefixime**\* 800 mg orally in a single dose \* If chlamydial infection has not been excluded, providers should treat fo
55
Do other sex partner be treated for gonorhea?
To minimize disease transmission, persons treated for gonorrhea should be instructed to abstain from sexual activity for 7 days after treatment and until all sex partners are treated (7 days after receiving treatment and resolution of symptoms, if present)
56
What are other test should be done who have gonorhea?
All persons who receive a diagnosis of gonorrhea should be tested for other STIs, including chlamydia, syphilis, and HIV. Those persons whose HIV test results are negative should be offered HIV PrEP
57
Follow up for patient who were treated with uncomplicated gonorhea in the pharynx
Any person with pharyngeal gonorrhea should return 7–14 days after initial treatment for a test of cure by using either culture or NAAT; however, testing at 7 days might result in an increased likelihood of false-positive tests
58
Follow up for patient who have gonorhea?
Men or women who have been treated for gonorrhea should be retested 3 months after treatment regardless of whether they believe their sex partners were treated; scheduling the follow-up visit at the time of treatment is encouraged.
If retesting at 3 months is not possible, clinicians should retest whenever persons next seek medical care \<12 months after initial treatment
59
What is granuloma inguinale? What causes it?
Granuloma inguinale (donovanosis) is a genital ulcerative disease caused by the intracellular gram-negative bacterium Klebsiella granulomatis (formerly known as Calymmatobacterium granulomatis)
60
Symptoms of granuloma inguinale?
the disease is characterized as painless, slowly progressive ulcerative lesions on the genitals or perineum without regional lymphadenopathy; subcutaneous granulomas (pseudobuboes) also might occur
61
How is the lesion in granuloma inguinale
The lesions are highly vascular (i.e., beefy red appearance) and can bleed.
62
Labrotary work up for granuloma inguinale
K. granulomatis DNA exist, molecular assays might be useful for identifying the causative agent.
-giemasa-stained smear of ulcer
63
Recommended Regimen for Granuloma Inguinale (Donovanosis
**Azithromycin 1** g orally once/week or 500 mg daily for \>3 weeks and until all lesions have completely healed
64
Alternative Regimens for granuloma inguinale
Doxycycline 100 mg orally 2 times/day for at least 3 weeks and until all lesions have completely healed or Erythromycin base 500 mg orally 4 times/day for \>3 weeks and until all lesions have completely healed or Trimethoprim-sulfamethoxazole one double-strength (160 mg/800 mg) tablet orally 2 time/day for \>3 weeks and until all lesions have completely healed
65
How Hepatisi A is transferred?
HAV infection is primarily transmitted by the fecal-oral route, by either person-to-person contact or through consumption of contaminated food or water
66
Labs for Hep A?
serologic testing
hepatitis A vaccination
67
Treatment of HEP A?
supportive care, with no restrictions in diet or activity.
Hospitalization might be necessary for patients who become dehydrated because of nausea and vomiting and is crucial for patients with signs or symptoms of acute liver failure.
Medications that might cause liver damage or are metabolized by the liver should be used with caution among persons with HAV infection.
68
Where is the highest concerntration of HBV?
The highest concentrations of HBV are located in blood, with lower concentrations in other body fluids including wound exudates, semen, vaginal secretions, and saliv
69
What is the incubation period for HBV?
6 weeks to 6 months
70
Risk factors for Hep B?
The primary risk factors associated with infection among adolescents and adults are unprotected sex with an infected partner, having multiple partners, men having
71
Labs for hep b
Serological testing
72
What is Pelvic inflammatory disorder?
PID is a spectrum of inflammatory disorders of th**e upper female genital tract,** including any combination of endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis.
.
73
What are the other test women should go through for patient who have PID?
All women who are diagnosed with acute PID should be tested for HIV as well as gonorrhea and chlamydia using NAAT
74
What are the pathology of having PID
PID also may develop following an abortion, pelvic surgery, or delivery, menstruation or STD
75
Why sometimes PID is asymptomatic
PID caused by chlamydia is more commonly asymptomatic, it more often results in tubal obstruction from delayed diagnosis or inadequate treatment.
76
What are the complication of PID?
Short-term consequences include acute pelvic pain, tubo-ovarian abscess, tubal scarring, and adhesions.
Long-term complications include an increased risk (12%–16%) of infertility, ectopic pregnancy, chronic pelvic pain, dyspareunia, and recurrent episodes of PID
77
Symptoms of Pelvic inflammatory disorder?
Pelvic discomfort is exacerbated by Valsalva maneuver, intercourse, or movement.
complain of intermenstrual bleeding.
Symptoms of an STD in a woman’s partner(s) also should be noted.
Women may report various symptoms ranging from minimal pelvic discomfort to dull cramping and intermittent pain or severe, persistent,
Pelvic pain usually develops within 7 to 10 days of menses,
remains constant, is bilateral, and is most severe in the lower quadrants.
78
Other diagnostic test that are seen to diagnose PID?
Uterine/adnexal tenderness, or
Cervical motion tenderness
Oral temperature more than 101° F (more than 38.3° C)
Abnormal cervical or vaginal mucopurulent discharge
Most women with PID have either mucopurulent cervical discharge or evidence of white blood cells (WBCs) on microscopic evaluation of saline preparation of vaginal fluids (i.e., wet prep).
Elevated erythrocyte sedimentation rate Elevated C-reactive protein
Laboratory documentation of cervical infection with N. gonorrheae or C. trachomatis
The most specific criteria for diagnosing PID are: Endometrial biopsy with histopathologic evidence of endometriosis
Transvaginal sonography or magnetic resonance imaging techniques showing thickened, fluid-filled tubes with or without free pelvic fluid or tubo-ovarian complex
Laparoscopic abnormalities consistent with PID
79
What is most common with PID caused by gonoccocal infection
peritonitis
80
What should you have to have treatment started for PID?
two minimum criteria are present and if no other cause(s) of the illness can be identified:
(1) uterine or adnexal tenderness or
(2) cervical motion tenderness
81
ESR is elevated what does that mean in terms of PID
PID caused by chlmydia
82
PID- women with................................... \>24 hours of inpatient observation is recommended.
tubo-ovarian abscesses,
83
Recommended Parenteral Regimens for Pelvic Inflammatory Disease
IV treatment and may needed to be hospitalized.
Ceftriaxone 1 g IV every 24 hours
PLUS
Doxycycline 100 mg orally or IV every 12 hours
PLUS
Metronidazole 500 mg orally or IV every 12 hours
OR
Cefotetan 2 g IV every 12 hours
PLUS
Doxycycline 100 mg orally or IV every 12 hours
OR
Cefoxitin 2 g IV every 6 hours
PLUS
Doxycycline 100 mg orally or IV every 12 hours
84
Alternative Parenteral Regimens for PID?
Alternative Parenteral Regimens
Ampicillin-sulbactam 3 g IV every 6 hours
PLUS
Doxycycline 100 mg orally or IV every 12 hours
OR
Clindamycin 900 mg IV every 8 hours
PLUS
Gentamicin loading dose IV or IM (2 mg/kg body weight), followed by a maintenance dose (1.5 mg/kg body weight) every 8 hours; single daily dosing (3–5 mg/kg body weight) can be substituted
85
PID? Why you should give IM or Oral abt for PID?
IM or oral therapy can be considered for women with mild-to-moderate acute PID because the clinical outcomes among women treated with these regimens are similar to those treated with IV therapy Women who do not respond to IM or oral therapy within 72 hours should be reevaluated to confirm the diagnosis and be administered therapy IV.
86
Recommended Intramuscular or Oral Regimens for Pelvic Inflammatory Disease
Ceftriaxone 500 mg IM in a single dose\*
PLUS
Doxycycline 100 mg orally 2 times/day for 14 days
WITH
Metronidazole 500 mg orally 2 times/day for 14 days
OR
Cefoxitin 2 gm IM in a single dose and Probenecid 1 gm orally administered concurrently in a single dose
PLUS
Doxycycline 100 mg orally 2 times/day for 14 days
WITH
Metronidazole 500 mg orally 2 times/day for 14 days
OR
Other parenteral third-generation cephalosporin (e.g., ceftizoxime or cefotaxime)
PLUS
Doxycycline 100 mg orally 2 times/day for 14 days
WITH
Metronidazole 500 mg orally 2 times/day for 14 days
\*For persons weighing \>150 kg (~300 lbs.) with documented gonococcal infection, 1 gm of ceftriaxone should be administered.
87
PID: Do you treat sex partner and abstain from sex
To minimize disease transmission, women should be instructed to abstain from sexual intercourse until therapy is complete, symptoms have resolved, and sex partners have been treated (see Chlamydial Infections; Gonococcal Infections). All women who receive a diagnosis of PID should be tested for gonorrhea, chlamydia, HIV, and syphilis
88
Follow up for PID?
. All women who have received a diagnosis of chlamydial or gonococcal PID should be retested 3 months after treatment, regardless of whether their sex partners have been treated
If retesting at 3 months is not possible, these women should be retested whenever they next seek medical care \<12 months after treatment.
89
If the last sexual intercourse was \>60 days before symptom onset or diagnosis, the most----------------- should be treated.
Most recent sex partner
90
what causes syphilis?
Treponema pallidum, a motile spirochete.
.
91
Can a women with syphilis transmit to infant.
Transplacental transmission may occur at any time during pregnancy; the degree of risk is related to the quantity of spirochetes in the maternal bloodstream.
Women with early syphilis are most likely to transmit the disease to their infants
92
How syphilis is transmitted?
sexual intercourse.
The disease can also be transmitted through kissing, biting, or oral–genital sex.
93
what are the types of syphilis?
Primary
Secondary
94
How is the presentation of primary syphilis?
Primary syphilis is characterized by a primary lesion, a chancre that often begins as a painless papule at the site of inoculation and then erodes to form a nontender, shallow, indurated, clean ulcer several millimeters to centimeters in size. The chancre is loaded with spirochetes and is most commonly found on the genitalia, although other sites include the cervix, perianal area, and mouth.
95
How is the characterstics of secondary syphilis?
widespread, symmetrical maculopapular rash on the palms and soles and generalized lymphadenopathy.
The infected individual may experience fever, headache, and malaise.
Condyloma lata (wart-like infectious lesions) may develop on the vulva, perineum, or anus.
96
How is the characterstics of latent syphilis?
If secondary infection from syphilis is left untreated, about one third of the patients will develop tertiary syphilis.
Cardiovascular (chest pain, cough), dermatological (multiple nodules or ulcers), skeletal (arthritis, myalgia, myositis), or neurological (headache, irritability, impaired balance, memory loss, tremor) symptoms can develop in this stage.
Neurological complications are not limited to tertiary syphilis; rather, a variety of syndromes (e.g., meningitis, meningovascular syphilis, general paresis, and tabes dorsalis) may span all stages of the disease.
.
97
What are screening and diagnostic labs are for syphilis?
Dark-field examination and direct fluorescent antibody tests
of two serological tests: nontreponemal and treponemal.
The treponemal tests, fluorescent treponemal antibody absorbed, and microhemagglutination assays for antibody to T. pallidum are used to confirm positive results.
Treponemal antibody tests frequently stay positive for life regardless of treatment or disease activity; therefore, treatment is monitored by the titers of the VDRL or RPR.
98
When pregnant women be tested for syphilis?
All pregnant women should be screened for syphilis at the first prenatal visit and again in the late third trimester and at delivery for high-risk patients.or at delivery.
No infant should be discharged from the hospital without the syphilis serological status of its mother having been determined at least once during pregnancy.
99
Treatment for Syphlils for
Penicillin G 2.4 million IM single dose, administered parenterally, is the preferred drug for treating patients in all stages of syphilis.
100
Which penincilin is administered for syphilis?
Selection of the appropriate penicillin preparation is important because T. pallidum can reside in sequestered sites (e.g., the CNS and aqueous humor) that are poorly accessed by certain forms of penicillin.
. Reports have indicated that practitioners have inadvertently prescribed combination long- and short-acting benzathine-procaine penicillin (Bicillin C-R) instead of the standard benzathine penicillin product (Bicillin L-A) recommended in the United States for treating primary, secondary, and latent syphilis. Practitioners, pharmacists, and purchasing agents should be aware of the similar names of these two products to avoid using the incorrect combination therapy agent for treating syphilis
101
.................................................preparations are **not** considered appropriate for syphilis treatment
Combinations of benzathine penicillin, procaine penicillin, and oral penicillin
102
Some pregnant women treated for syphilis may experience a ................................This is an acute febrile reaction to the toxins given off by treponemes when killed rapidly by treatment; the reaction occurs within 24 hours after treatment with penicillin and is characterized by fever up to 105° F, headache, myalgia, and arthralgia that lasts 4 to 12 hours
Jarisch–Herxheimer reaction.
103
Women treated in the second half of pregnancy who experience a Jarisch–Herxheimer reaction are at risk of....................................................
preterm labor and delivery or fetal distress.
104
SYPHILIS-----
Penicillin allergy: What medication should be taken?
Doxycycline 100 mg orally four times per day for 28 days or tetracycline 500 mg orally four times per day for 28 daysa
105
Treatment for late latent and unknown duration ?
Late latent or unknown duration disease: Benzathine penicillin G 7.2 million units total, administered as three doses 2.4 million units IM each at 1-week intervals
106
Normal vaginal secretions are acidic, with a pH range of
3.8 to 4.2.
107
Define vaginitis?
Vaginitis, an inflammation of the vagina characterized by an increased vaginal discharge containing numerous WBCs, occurs when the vaginal environment is disturbed, either by a microorganism by a disturbance that allows the pathogens that are found normally in the vagina to proliferate.
108
Causes of vaginitis
Factors that can disturb the vaginal environment include douches, vaginal medications, antibiotics, hormones, contraceptive preparations (oral and topical), stress, sexual intercourse, and changes in sexual partners
109
What is vulva vaginitis?
Vulvo vaginitis or inflammation of the vulva and vagina may be caused by vaginal infection; copious amounts of leukorrhea, which can cause maceration of tissues; and chemical irritants, allergens, and foreign bodies, which may produce inflammatory reactions.
110
1............, 2,,,,,,,,,,,,,,,,,,, 3.................are the most common causes of abnormal vaginal discharge.
BV, vulvovaginal candidiasis (VVC), and trichomoniasis
111
Trichomonas vaginalis?
Trichomonas vaginalis vaginitis is the most prevalent **nonviral STD, affectin**g an estimated 3.7 million persons
112
What causes trichomoniasis?
Trichomoniasis is caused by T. vaginalis, an anaerobic one-celled protozoan with characteristic flagellae.
113
Where do the organism of trichomoniasis lives?
The organism lives in the vagina, urethra, and Bartholin’s and Skene’s glands in women, and in the urethra and prostate gland in men.
114
Main presentation of trichomoniasis ?
Although trichomoniasis may be asymptomatic, commonly women experience characteristically **yellowish to greenish, frothy,** mucopurulent, copious, malodorous discharge. (stronger than BV - FISHIY smell)
or both may be present, and the woman may complain of irritation and pruritis.
Dysuria and dyspareunia are often present.
Typically, the discharge worsens during and after menstruation. Often the cervix and vaginal walls will demonstrate the characteristic “**strawberry spots” or tiny petechia**e, and the cervix may bleed on contact.
PH at 5 to 6.
.
115
Pregnancy related to trichomoniasis?
Preterm has been associated with adverse pregnancy outcomes, especially premature rupture of the membranes, preterm delivery, and other adverse pregnancy outcomes in pregnant women, including low birth weight.
116
.......................is highly sensitive and can detect up to three to five times more T. vaginalis infections than wet-mount microscopy
.
NAAT test
117
Do you treat sex partner?
To avoid getting reinfected, all sex partners should get treated with antibiotics at the same time.
118
Recommended treatment for trichomoniasis vaginalis in women
Metronidazole 500 mg 2 times/day for 7 days
119
Recommended treatment for trichomoniasis vaginalis in man?
Metronidazole 2 g orally in a single dose
120
Alternative treatment for trichomoniasis vaginalis?
Tinidazole 2 g orally in a single dose
121
what are the difference between vaginolosis, candiasis, and trichomoniasis
122
Side effect of metronidazole.
sharp, unpleasant metallic taste in the mouth, furry tongue, central nervous system reactions, and urinary tract disturbances.
Donot drink alcoholic beverages, or she will experience severe abdominal distress, nausea, vomiting, and headache.
Metronidazole can cause gastrointestinal symptoms regardless of whether alcohol is consumed and can also darken urine.
The nurse practitioner should stress the importance of completing all medication even if symptoms disappear.
123
What is bacteria vaginosis?
Caused by Sex \* multiple partners, unprotected sex.
## Footnote
BV is a clinical syndrome in which normal H2O2-producing Lactobacilli are replaced with high concentrations of anaerobic bacteria
With the proliferation of anaerobes, the level of vaginal amines is raised, and the normal acidic pH of the vagina is altered.
Epithelial cells slough and numerous bacteria attach to their surfaces (clue cells). When the amines are volatilized, the characteristic fishy odor of BV occurs.
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failure to treat BV infection before insertion of an IUD is associated with increased incidence of .................. in the first month after insertion.
PID
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Symptoms of BV ( Bacterial vaginolosis?
The fishy odor may be noticed by the woman or her partner after heterosexual intercourse as semen releases the vaginal amines. When present, the BV discharge is usually increased, thin and white or gray, or milky in appearance.
Some women also may experience, experience mild irritation, vulvar pruritus, postcoital spotting, irregular bleeding episodes, or vaginal burning after intercourse while others complain of urinary discomfort. Many women have no symptoms at all.
Women's Health Care in Advanced Practice Nursing (p. 598). Springer Publishing Company. Kindle Edition.
Women's Health Care in Advanced Practice Nursing (p. 598). Springer Publishing Company. Kindle Edition.
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Clinical cruteria for BV?
Clinical criteria require three of the following symptoms or signs:
1. homogenous, thin white, greyish, watery and discharge that smoothly coats the vaginal walls;
2. clue cells on microscopic examination;
3. and a fishy odor of vaginal discharge before or after addition of 10% potassium hydroxide \*whiff test\*
4. pH of vaginal fluid \>4.5
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Recommended Regimens for Bacterial Vaginos
Recommended Regimens for Bacterial Vaginosis
Metronidazole 500 mg orally 2 times/day for 7 days
OR
Metronidazole gel 0.75% one full applicator (5 g) intravaginally, once a day for 5 days
OR
Clindamycin cream 2% one full applicator (5 g) intravaginally at bedtime for 7 days
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Alternative regimen for treating BV?
Clindamycin 300 mg orally 2 times/day for 7 days
OR
Clindamycin ovules 100 mg\* intravaginally once at bedtime for 3 days
OR
Secnidazole 2 g oral granules in a single dose†
OR
Tinidazole 2 g orally once daily for 2 days
OR
Tinidazole 1 g orally once daily for 5 days
\* Clindamycin ovules use an oleaginous base that might weaken latex or rubber products (e.g., condoms and diaphragms). Use of such products within 72 hours after treatment with clindamycin ovules is not recommended.
† Oral granules should be sprinkled onto unsweetened applesauce, yogurt, or pudding before ingestion. A glass of water can be taken after administration to aid in swallowing
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Do sex partner be treated who have BV?
Data from earlier clinical trials indicate that a woman’s response to therapy and the likelihood of relapse or recurrence **are not** affected by treatment of her sex partner. Therefore, routine treatment of sex partners is not recommended.
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What is lymphogranulom venerum
LGV is caused by C. trachomatis serovars L1, L2, or L3 (539,540).
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What are the difference between lymphogranulom vs C trachomatis serovars
LGV can cause severe inflammation and invasive infection, in contrast with C. trachomatis serovars A—K that cause mild or asymptomatic infection.
Clinical manifestations of LGV can include GUD, lymphadenopathy, or proctocolitis
oral ulceration
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What is prococolitis in the LGV?
proctocolitis, which is the most common presentation of LGV infection
and can mimic inflammatory bowel disease with clinical findings of mucoid or hemorrhagic rectal discharge, anal pain, constipation, fever, or tenesmus
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Lab for Lymphogranulpma venereum
Bacterial culture. nAAT
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Recommended Regimen for Lymphogranuloma Venereum
Recommended Regimen for Lymphogranuloma Venereum
Doxycycline 100 mg orally 2 times/day for 21 day
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Alternative treatment for lymphogranuloma vernerum
Azithromycin 1 gm orally once weekly for 3 weeks\*
OR
Erythromycin base 500 mg orally 4 times/day for 21 days
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Other management for lymphogranuloma venerum
Persons who receive an LGV diagnosis should be tested for other STIs, especially HIV, gonorrhea, and syphilis. Those whose HIV test results are negative should be offered HIV PrEP.
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Does the sexual partner with lymphogranuloma venerum be treated?
Persons who have had sexual contact with a patient who has LGV within the 60 days before onset of the patient’s symptoms should be evaluated, examined, and tested for chlamydial infection, depending on anatomic site of exposure. Asymptomatic partners should be presumptively treated with a chlamydia regimen (doxycycline 100 mg orally 2 times/day for 7 days).
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Define molluscum contagiosum lesion appear
small, raised, and usually white, pink, or flesh-colored with a dimple or pit in the center. They often have a pearly appearance. They’re usually smooth and firm. In most people, the lesions range from about the size of a pinhead to as large as a pencil eraser (2 to 5 millimeters in diameter). They may become itchy, sore, red, and/or swollen.
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How molluscum contagiosum is transmitted?
Molluscum contagiosum is an infection caused by a poxvirus (molluscum contagiosum virus).
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Where do molluscum contagiosum is found?
Face, neck, arms, legs, abdomen, and genital area, alone or in groups. The lesions are rarely found on the palms of the hands or the soles of the feet.
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How molluscum contagiosum is spread?
Molluscum can spread from one person to another by sexual contac
The virus that causes molluscum spreads from direct person-to-person physical contact and through contaminated fomites. Fomites are inanimate objects that can become contaminated with virus; in the instance of molluscum contagiosum this can include linens such as clothing and towels, bathing sponges, pool equipment, and toys. Although the virus might be spread by sharing swimming pools, baths, saunas, or other wet and warm environments, this has not been prov
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Can molluscum contagiosum spread by coughing?
The molluscum contagiosum virus remains in the top layer of skin (epidermis) and does not circulate throughout the body; therefore, it cannot spread through coughing or sneezing
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Risk factors for molluscum contagiosum?
1 to 10 years of age.
People at increased risk for getting the disease include:
People with **weakened immune systems** (i.e., HIV-infected persons or persons being treated for cancer) are at higher risk for getting molluscum contagiosum. Their growths may look different, be larger, and be more difficult to treat.
**Atopic dermatiti**s may also be a risk factor for getting molluscum contagiosum due to frequent breaks in the skin. People with this condition also may be more likely to spread molluscum contagiousm to other parts of their body for the same reason.
People who live **in warm, humid climate**s where living conditions are crowded.
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Treatment for molluscum contagiosum
ryotherapy (freezing the lesion with liquid nitrogen), curettage (the piercing of the core and scraping of caseous or cheesy material), and laser therapy
. Oral cimetidine has been used as an alternative treatment for small children
Podophyllotoxin cream (0.5%) is reliable as a home therapy for men but is not recommended for pregnant women because of presumed toxicity to the fetus.
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What is the causative agent for pediculosis pubis and how it is transmitted?
Pediculosis pubis is caused by the parasite Phthirus pubis and is usually transmitted by sexual contact
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How do you diagnose pediculosis?
Lice and nits can be observed on pubic hair.
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Recommended regimens for pediculosis pubis?
Recommended Regimens for Pediculosis Pubis
Permethrin 1% cream rinse applied to affected areas and washed off after 10 minutes
OR
Pyrethrin with piperonyl butoxide applied to the affected area and washed off after 10 minutes
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Alternative treatment for pediculosis pubis
Alternative Regimens
Malathion 0.5% lotion applied to affected areas and washed off after 8–12 hours
OR
Ivermectin 250 µg/kg body weight orally, repeated in 7–14 days
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Does the sex partner be treated with pediculosis pubis?
Sex partners within the previous month should be treated. Sexual contact should be avoided until patients and partners have been treated, bedding and clothing decontaminated, and reevaluation performed to rule out persistent infection.
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Other management for pediculosis pubis?
The recommended regimens should not be applied to the eyes.
Pediculosis of the eyelashes should be treated by applying occlusive ophthalmic ointment or petroleum jelly to the eyelid margins 2 times/day for 10 days.
Bedding and clothing should be decontaminated (i.e., machine washed and dried by using the heat cycle or dry cleaned) or removed from body contact for at least 72 hours.
Fumigation of living areas is unnecessary.
Pubic hair removal has been associated with atypical patterns of pubic lice infestation and decreasing incidence of infection
. Persons with pediculosis pubis should be evaluated for HIV, syphilis, chlamydia, and gonorrhea.
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Chlamydia presentation
Discharge for chlamydia is white creamy side
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Patient who have been infected with syphilis and dont know the history?
Penincilin for 3 dose
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HPV treatment and lesion (dont confuse with herpes)
Aldara
crysurgery to remove the lesion
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