STD (lec 1) Flashcards Preview

Q4 Women's Health > STD (lec 1) > Flashcards

Flashcards in STD (lec 1) Deck (53):
1

Vulvovaginal Candidiasis (VVC) is?

yeast infec (Not STD)
(U) c. albacans

2

VVC presentation?

itching, burning
dyspareunia (painful sex)
thick, white d/c

3

VVC diagnostics?

Wet prep = buds/hyphae
Cx = candida

4

VVC tx?

Uncomplicated:
1-3 d topical azole

Complicated (≥4/yr, non-albican, DM, immuncomp):
7-14 d topical or
oral fluconazole

**if non-albicans, NO fluconazole (choose other azole)

5

VVC tx men?

Recurrent/difficult?

Preggos?

Not neces u/l blanitis

eval for DM, HIV

topical only

6

Bacterial Vaginosis (BV) is?

disruption in N flora, Not STD
(U) gard. vaginalis/mobiluncus G-var anaerobes

7

BV presentation?

Risks?

fishy, gray d/c

(P) ↑ risk HIV, HSV, gonor, chlam

8

BV diagnostics?

Amsel's (3 of 4):
thin/white d/c
clue cells
vag pH >4.5
fishy KOH

Gram Stain = anaerobes and ↓ lactobacilli

9

BV tx?

Tx all symptomatic pts:
DOC: Oral Metro 7d (avoid etoh)
or Topical Metro 5d
or Clindamycin

**Preggos use ORAL!

No partner tx

10

Trichomoniasis caused by?

Presentation?

t. vaginalis

vag pH > 4.5
irrit, odor, yellow-green froth
petechiae cervix/vagina

11

Trichomoniasis diagnostics?

In men?

Wet mount = motile protoz
Nuc Acid Amp test (NAAT), esp for male

Difficult
5-20% of non-gon urethritis is trich

12

Trichomoniasis tx?

Treat pt and partners:
Oral Metro
No sex until well

Preggos -> tx if sxs

13

Trichomoniasis complications?

↑ risk HIV
Preggos -> preterms (tx doesn't reduce risk)
No breast feeding during tx

14

Chlamydia (CT) screening?

yearly for under 26 yo or high risk
all preggos

frequent co-inf w/ gonorr

15

CT presentation?

(C) asympt
oral or rectal also P

Women:
CERVIX d/c, bleeding, low abd pain, fever/chills

Men:
urethritis, d/c, dysuria

16

CT diagnostics?

NAAT:
Swab
Urine
Pap
Pharynx/rectal

17

CT tx?

Treat all pts/partners:
Doxy 7d or Azith 1d
No sex for at least 7d
Retest 3-4 mo

Preggos:
NO doxy
Retest 3 wks post tx

18

CT complications?

↑ risk HIV
PID
Epididy

Preterms
Neonate eye inf/PNA

19

Gonorrhea (GC) screening?

at risk (prior inf, > partners, sex workers)
(C) co-inf w/ CT

20

GC sxs?

Diag?

like CT, more severe

like CT

21

GC tx?

Treat all pts/partners:
ceftriaxone IM + azith or doxy
No sex
Retest 3-4 mo

22

GC complications?

same as CT

Neonate also meningitis, endocard

23

Non-gono Urethritis (NGU) caused by?

anything other than gonorr
(U) chlamy

24

NGU diagnostics?

Tx?

test for GC/CT

azith or doxy

25

PID is?

inflamm disorders of up genital tract
(U) from STDs (ascending infection)
(P) h. flu

26

PID presentation?

Acute:
d/c, low abd pain, cervical motion tenderness, fever

Chronic:
from insuff tx
vague sxs

27

PID risk factors?

< 25 yo
blacks
x partners
IUD
prior PID

28

PID diagnostics?

Serum quant HCG (pregnancy)
GC/CT
WBCs in vag fluid
CBC, ESR, CRP

US -> r/o ectopic, abscess

29

PID tx?

F/U?

Emphiric while waiting for tests

Outpt:
Ceftri IM +
Doxy 14d +
Metro 14d

Inpt:
IV

48 hr f/u

30

PID hospitalize when? (5)

can't r/o ectopic, append, etc
preggos
no abx response 48 hrs
tubo-ovarian cysts
looks ill

31

Fitz-Hugh-Curtis is?

(P) complication of PID
perihepatitis w/ RUQ pain/adhesions

32

HSV diagnostics?

Swab cx (standard):
P false +, requires lesion

Ab serology:
Ab not present until 3 wks post
+ result not definitive for genital herp

33

HSV tx?

clovirs
Initial outbreak 7-10d
Recurrent 1-5d
Suppression daily

34

Neonatal HSV syndromes? (3)

1) Skin/Eye/Mouth (localized)
2) CNS (long-term morbidity)
3) Disseminated (organ involv)

35

Neonate HSV prevention?

Supression @ 36 wks for active/recurrent

C-section for active or prodrome

36

HPV diagnostics?

Visible warts
Pap smear
No test for men

37

HPV tx?

treat dzs caused by HPV, no cure

Destruction:
LN2, TCA
Podofilox
Imiquimod

Vaccine:
Cervarix (girls)
Gardasil (girls/boys)

38

HPV complications?

CA, esp cervical (U) types 16/18

rare transmission to neonate

39

Syphillis caused by?

At risk?

trep. pallidum
direct contact w/ lesion

(U) M 20-29yo

40

°Syphilis presents?

painless chancre 4-6 wks

41

2° Syphilis presents?

U 2-6 wks

No itch rash (U) includes palms/soles

Condyloma lata (moist warts)
(U) intertriginous areas
CONTAGIOUS

Mucous patches, not painful
mouth/genitals
CONTAGIOUS

Malaise, LAD

42

Latent Syphilis?

asympt
not transmittable
can last yrs

43

Late Syphilis?

yrs post infection
Neurosyphilis

44

Syphilis diagnostics?

Darkfield for chancre
Rapid Plasma Reagin -> titer = dz (confirm w/ FTA-ABS Ab test)

Neurosyphilis:
Lumbar punct -> VDRL test

45

Syphilis tx?

Treat all pts/partners:
Benazthine PCN-G IM single dose unless had dz for > 1 yr, then multi dose

Oral Doxy for PCN allergy

Confirm clearance w/ RPR titer 3, 6, 12, 24 mo
(4 x DECREASE = cleared)

46

Syphilis in preggos:

Complications? (4)

Screen?

stillbirths
deafness
neuro defects
bone deformities

screen at 1st visit
high risk again 28 wks and delivery

Close serology monitoring

47

Chancroid caused by?

Presentation?

h. ducreyi

Painful genital ulcer
Foul, contagious d/c
Inguinal adenitis/Buboes

48

Chancroid diagnostics?

r/o syphilis
report to county health

49

Lymphogranuloma Venereum (LGV) caused by?

Most at risk?

chlamydia trachomatis

MSM

50

LGV presentation? (5)

Systemic infection,
Unilateral inguinal bubo (swollen node),
Self-limit ulcer/papule
Anal d/c or bleeding,
Groove sign

51

LGV diagnostics?

r/o syphilis
report

52

Pediculosis Pubis tx?

Treat pt/partner:
permethrin 1% crm

53

STD screening for Pregnancy?

1st visit:
HIV, syphilis, Hep B, GC/CT
Hep C if risk
Hx for HSV