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Flashcards in STDs Deck (45):
1

In men, what is the best initial test for dx of urethritis?

Urethral swab for gram stain and WBC, look for intracellular gram negative diplococci for N.gonorrhea

2

What is the most accurate test for urethritis

Urine for nucleic acid (NAAT) detects gonorrhea and chlamydia

3

Organisms causing urethritis?

N.gonorrhea
Chlamydia
Mycoplasma genitalium
Ureaplasma

4

Best initial test for dx of urethritis in women?

Self administered vaginal swab

5

What is tx for urethritis?

One drug for gonorrhea and one for chlamydia
Gonorrhea: cefixime (resistant to quinolones) or ceftriaxone
Chlamydia: azithromycin or doxy

6

Cervicitis px

Cervical discharge, strawberry cervix

7

Cervicitis tx

Ceftriaxone or cefixime and azithromycin or doxy

8

Cervicitis dx

Self administered cervical swab for NAAT

9

PID is caused by which bugs?

Gonorrhea, chlamydia

10

PID presentation

Lower abdominal tenderness, fever, cervical motion tenderness (found on bimanual exam), leukocytosis

11

Most specific tests for PID

Culture, DNA probe or nucleic acid amplification (NAAT)
Clarify need for treating the partner

12

How to determine resistance of organisms causing PID?

Culture

13

When to use laparoscopy in PID and why?

It is the most accurate test, use only if the dx is unclear, sx persist despite tx or there is recurring episodes for unclear reasons
It is very rarely done

14

PID tx?

Inpatient: cefoxitin or cefotetan combined with doxy
Outpatient: ceftriaxone and doxy (possibly with metronidazole)

15

Patient has PID but anaphylaxis to penicillin, what is the tx?

Levofloxacin and metronidazole in outpatient
Clindamycin and gentamycin in inpatient

16

In ulcerative genital disease, how to make a ddx with px and hx?

Painless ulcer : syphillis
Painful ulcer : chancroid (hemophilus ducreyi)
Tender and supurrating lymph nodes : lymphogranuloma venereum
Painful ulcer with prior vesicules : herpes simplex

17

Best initial test for syphillis?

Dark field microscopy (best in primary) if positive, no further testing is necessary!, VDRL or PCR (75% sensitive only), FTA or MHA-TP (for confirmation only)

18

Dx test for chancroid?

Stain and culture (special media): pleomorphic gram neg coccobacillus

19

Dx test for lyphogranuloma venerum?

Complement fixation titers serology, nucleic amplification testing on swab

20

Dx for herpes simplex?

Tzank prep (best initial test): multinucleated giant cells
Viral culture : most accurate test

21

Tx for syphillis?

One dose IM benzathine penicillin

22

Tx for syphillis if the patient is allergic to penicillin?

Doxy

23

Tx for chancroid?

Single dose of azithromycin

24

Tx for lymphogranuloma venerium

Doxy

25

Tx for herpes simplex

Acyclovir, valacyclovir, famciclovir

26

How to detect aciclovir resistant herpes?

Viral sensitivity testing

27

What is the tx for aciclovir resistant herpes?

Foscarnet

28

Woman comes to the clinic with multiple painful genital vesicles, what is the next best step?

Go straight to tx (not tzank prep), gove acyclovir orally

29

Primary syphillis sx

Painless genital ulcer, can become painful is secondarily infected, painless adenopathy, chancres will heal spontaneously but use penicillin to prevent secondary/tertiary

30

Secondary syphillis sx and presentation

Rash on palms and soles
Alopecia areata
Mucous patches
Condylomata lata

31

Tertiary syphilis presentation

Neurosyphilis: meningovascular (stroke at a young age); tabes dorsalis (loss of position and vibratory sense, incontinence, cranial nerve), general paresis (memory and personality changes), argyll robertson pupil,
Gummas (skin and bone lesions)
Aortitis (aortic regurgitation, aortic aneurysm)

32

What could cause a false positive VDRL/RPR?

Infection, older age, injection drug use, AIDS, malaria, antiphospholipid syndrome and endocarditis

33

Titers for VDRL or RPR are reliable at?
Rarely false positive at?

Reliable at >1:8 (lower is often false positive)
Rarely false positive at >1:32

34

Treatment of primary and secondary syphilis

Single dose IM injection of penicillin, oral doxy if allergic

35

Tx of tertiary syphilis?

IV penicillin, desensitization if allergic

36

What is the Jarish-herxheimer reaction?

Fever, headache, myalgiad after treatment
Give aspirin and antipyretics, it is benign and will pass

37

When to desensitize patients that have syphilis?

In neurosyph if penicillin allergic or pregnancy only

38

How to diagnose genital warts (condylomata acuminata)

Visual appearance (no biopsy, serology or stains)

39

How to treat genital warts?

Remove it by cryotherapy, surgery if large, laser, podophyllin or trichloroacetic acid
imiquimod (apply locally): immunostimulant

40

How does pediculosis presents

Itchy little "black dots" , visible on hair baring areas (axilla, pubis)

41

How to treat crabs?

Permethrin

42

How do scabies present?

Visible burrows in web spaces (between fingers and toes), around nipples, near genitals

43

How to dx scabies?

Scrape and magnify

44

Tx for scabies?

Permethrin
If widespread scabies: oral ivermectin
Severe disease needs repeat dosing

45

What are the common sx between cystitis and urethritis and how to differentiate them based on symptomatology?

Dysuria, frequency and burning are common sx
Cystitis does NOT have discharge