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STDs Flashcards

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1
Q

What is the gram stain and morphology of Haemophilus ducreyi?

A

Gram negative streptobacillus

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2
Q

In whom is Chancroid more common in?

A

Commercial sex workers or immigrants

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3
Q

What is the relationship of chancroid and HIV?

A

Cofactor for HIV transmission–should test at the time of diagnosis

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4
Q

What are the s/sx of chancroid?

A

painful genital ulcer

Inguinal LAD

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5
Q

How do you diagnose chancroid?

A

Culture media–there is no FDA approved test

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6
Q

What is the treatment for chancroid?

A

Azithromycin
Ceftriaxone
Cipro
Erythromycin

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7
Q

What is the most common STI in women?

A

HSV

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8
Q

How do you diagnose HSV?

A

PCR

Culture

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9
Q

True or false: HSV is usually asymptomatic

A

True

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10
Q

What is the nonprimary first episode of HSV infection?

A

They have HSV and antibodies to HSV, but not the type that they’re presenting with

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11
Q

What is the transmission risk for HSV in pregnancy with a primary episode? Nonprimary first episode? What about reactivation?

A

50% -primary
30% -nonprimary
4%-recurrent

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12
Q

What is a primary HSV infection?

A

Culture proven herpes, but not antibodies yet

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13
Q

What, generally, is the treatment for HSV?

A

Acyclovir

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14
Q

When should women avoid sex with HSV positive partners?

A

In the 3rd trimester

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15
Q

What should be done if a woman has active HSV or prodromal s/sx and is close to being due?

A

C-section

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16
Q

How do you diagnose syphilis?

A

VDRL RPR

FTA testing

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17
Q

What are the s/sx of primary syphilis?

A

Painless chancre at site

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18
Q

What are the s/sx of secondary syphilis?

A

Rash and mucocutaneous LAD

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19
Q

What are the s/sx of tertiary syphilis?

A

Aortitis
Iritis
Auditory abnormalities
Gummas

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20
Q

What is the treatment for latent syphilis if early (contracted in last 12 months)? Late?

A 
Early = PCN 2.4 IM x1
Late = same but x3
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21
Q

How long should neurosyphilis be treated for? What should be used?

A

10-14 days

aqueous crystalline PCN 18-24 MU QD

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22
Q

How often should CSF be obtained for neurosyphilis?

A

q 6 months until cell count is normal

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23
Q

What is the Jarisch-Herxheimer reaction? What is the significance of this in pregnancy?

A

Acute, febrile reaction with HA, myalgias, w/in 24 hours of treatment of syphilis

May induce labor or cause fetal distress

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24
Q

When should partner treatment for syphilis be started? (2)

A

Exposure within 90 days

or greater than 90 days if no testing available or unsure f/u

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25
True or false: if you have a patient that tests positive for syphilis, you should test them for HIV in 3 months
true
26
What should be done for patients who have neurological s/sx of syphilis? Eye?
LP for neuro s/sx | Ocular slit lamp for ophthalmic
27
How do you diagnose Chancroid?
Culture for H ducreyi
28
Although classically HSV-1 was an oral disease and HSV-2 was a genital disease, the difference is now 50/50. What is the significance of this?
HSV-1 has a lower risk of recurrence
29
When should patients who are treated for syphilis be reevaluated? What happens if they have persistent s/sx or a4 fold increase in titers?
6 and 12 months Assume failure of treatment, and retreat with PCN
30
What is the second line abx for syphilis?
Doxycycline
31
What is the treatment for syphilis in pregnancy? How do you follow these patients?
PCN orally | 28-32 wga follow titers, or monthly if high risk
32
If you begin treating syphilis within how many days of delivery is treatment most likely inadequate?
If within 30 days of delivery
33
What are the four US findings that can be seen with congenital syphilis?
- Hepatomegaly - Ascites - Hydrops - Thickened placenta
34
Mega-placenta is usually seen with what congenital condition?
Congenital syphilis
35
How do you evaluate a newborn for syphilis?
RPR or VDRL | CSF analysis
36
What are the s/sx of congenital syphilis? (6)
- Nonimmune hydrops - HSM - Jaundice - Pseudoparalysis of extremity - Rash - Rhinitis
37
What is the characteristic nose with syphilis? What characteristic symptom does this cause?
Saddle nose | "snuffles"
38
Hutchinson teeth = ?
Congential syphilis
39
What are the s/sx of vaginitis?
- Discharge - Malodor - Pruritus - Burning - Dysuria - Dyspareunia
40
How do you diagnose vaginitis?
- Vaginal pH - whiff test - KOH - DNA amp
41
What is the usual ddx for cervicitis?
- Chlamydia - Gonorrhea - Trichomonas - BV - Douching
42
What is the most frequently reported infectious disease in the US?
Chlamydia
43
What are the s/sx of chlamydia?
- Abnormal discharge - Cervicitis - Dysfunctional uterine bleeding
44
What percent of pts with chlamydia are asymptomatic?
75%
45
When should annual screening begin for chlamydia?
Less than 25 years
46
What are the sequelae of chlamydia?
PID Ectopic prego Infertility
47
What is the treatment for Chlamydia?
Azithromycin
48
What must patients who are being treated for chlamydia do?
Abstain from sex for 7 days from treatment, and until partner is treated
49
Can you prescribe abx to patient's partners without seeing them?
Yes
50
When should you retest for chlamydia after a patient gets prego?
3-4 weeks
51
What are the risk of neonatal chlamydia?
Conjunctivitis and pneumonia
52
What are the characteristics of the cough associated with neonatal pneumonia 2/2 chlamydia infection? CXR findings?
Repetitive staccato cough w/ tachypnea Hyperinflation and bilateral diffuse infiltrates
53
True or false: if a patient tests positive for Gonorrhea, then you should test for chlamydia as well
True--commonly acquired together
54
Why should patients with Chlamydia always have an additional gram of Azithromycin?
Decreases the resistance of gonrrhea
55
What is the treatment for Quinolone resistant Gonorrhea?
Ceftriaxone + Az
56
What are the s/sx of disseminated Gonococcal infections?
- Petechial or pustular acral rash - Asymmetrical arthralgia - Tenosynovitis - Septic arthritis
57
What are the ophthalmic complications from Gonococcal infections? How long does it take for this to manifest?
Perforation of the globe and blindness Acute illness manifests 2-5 days after birth
58
How do you diagnose PID? (3)
- Pelvic/lower abdo pain - No other cause of pain - Cervical motion tenderness or adnexal tenderness
59
True or false: PID is only caused by STDs
False-more common, but not necessary
60
What is the PPD of clinical ssx for salpingitis in PID?
65-90%
61
What is the most specific test to obtain for PID diagnosis?
Embx with endometritis
62
What are the US or MRI findings of PID? (2)
- Fluid filled tubes | - Doppler studies with tubal hyperemia
63
What is Fitz-hugh-curtis syndrome?
Rare adhesions between the uterus and the abdominal wall
64
Is there any difference in reproductive outcomes if PID is treated as an inpatient vs an outpatient?
No
65
What are the four organisms that you should cover when treating PID?
- GC - CT - Anaerobes - BV
66
What are the five criteria of admission for PID?
- Surgical emergency - Pregnant - Non-compliant - Unable to tolerate PO - Tuboovarian abscess
67
What is granuloma inguinale (donovanosis)?
Genital ulcerative disease caused by Klebsiella granulomatis
68
What are the s/sx of granuloma inguinale (donovanosis)?
Painless, progressive ulcerative lesions without regional LAD
69
How do you diagnose granuloma inguinale (donovanosis)?
Dark-staining donovan bodies
70
What is the treatment for granuloma inguinale (donovanosis)?
Doxy for donovano
71
Where is granuloma inguinale (donovanosis) usually found?
Tropics
72
What is lymphogranuloma venereum? What causes it/?
Painless ulcer with unilateral LAD (femoral/inguinal) Caused by the invasive serovars L1, L2, L2a or L3 of Chlamydia trachomatis
73
What are the HPV strains that cause condyloma? (2)
6 or 11
74
What are the HPV strains that cause cervical CA? (5)
``` 16 18 31 33 35 ```
75
How do you diagnose HPV?
Mostly clinical, but biopsy if uncertain or unresponsive to treatment
76
What is the screen for HPV?
Pap smear
77
What is the potential complication of having a kid when you have HPV?
Respiratory papillomatosis---significantly rare
78
Why do genital warts get worse with prego?
Slight immunosuppression
79
What are the s/sx of trichomonas?
Diffuse, malodorus, yellow-green discharge with vulvar irritation
80
How do you diagnose trichomonas?
Wet mount or culture
81
What is the treatment for Trichomonas? What is the classic adverse effect of this medication?
Metronidazole | Disulfiram effect
82
Strawberry cervix = ?
Trichomonas
83
What is the treatment for lice?
Permethrin
84
What is the treatment for scabies?
Permethrin cream
85
What is Molluscum contagiosum? How is it acquired? Treatment?
- Poxvirus that causes painless warts. - Commonly caused by skin contact - Self-limiting
86
What is the classic sign of a molluscum?
Umbilicated center
87
What are the four pathogens that classically cause UTIs?
- E.coli - Proteus mirabilis - Klebsiella pneumoniae - Staph saprophyticus
88
Why do UTIs become more common after menopause?
Tissue between the urethra and the vagina becomes thinner
89
When can the nitrite test on a UA falsely show a positive result?
After eating beets

Infectious Disease (18 decks)

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