STDs AHHH!

Question 1

___-___ y/o account for 50% of all new STD infections

Answer 1

15-24 y/o

Question 2

What is the most common STD? 2nd most common? 3rd most common?

Answer 2

Most common: HPV

then HSV-2, then Trich

Question 3

Disruption of ___ and ____ make the transmission of HIV much easier

Answer 3

epithelial and mucosal barriers

Question 4

What factors facilitate HIV transmission?

Answer 4

1. Increase the # of HIV target cells in the genital tract
2. Increase expression of HIV co-receptors
3. Induce secretion of cytokines (increase HIV shedding)
4. HIV alters natural hx of some STIs

Question 5

Where are people most likely to seek care for a STD?

Are men or women more likely to seek care?

Answer 5

PCP

Women

Question 6

What STDs commonly present as sores?

Answer 6

Syphillis
Herpes (HSV1 or 2)

*uncommon in the USA–> Lymphogranuloma venereum, Chancroid, Granuloma inguinale

Question 7

What STD commonly present w/ discharge?

Answer 7

Gonorrhea
Chlamydia
Trichomonas vaginitis / urethritis
Candidiasis (not an STD)
Bacterial vaginosis (sexually associated, but not sexually transmitted!)

Other major concerns: genital HPV and caCAncer

Question 8

Just as birds of a feather, flock together…. so do ____

Answer 8

STDs

Question 9

What is the DDx of painful genital ulcers

Answer 9

Genital herpes simplex

Chancroid

Question 10

What is the DDx of PAINLESS genital ulcers?

Answer 10

Syphilis

Lymphogranuloma venereum (caused by chlamydia)
Granuloma inguinale (a sexually transmitted version of Klebsiella)

Question 11

What is the incubation phase for syphilis?

Answer 11

10-90 days (averge 3 weeks)

Question 12

A ___ is a painless, indurated ulcer w/ a clean base and smooth, firm border

What STD if this associated w/?

Answer 12

Chancre

Syphilis

Question 13

A chancre goes unnoticed in __-__ % of pts and resolves in ___-___ wks

Answer 13

Unnoticed in 15-30% of pts

Resolves in 1-5 weeks

Question 14

T/F: A chancre makes syphilis very infectious

Answer 14

True

Question 15

____ is the hematogenous dissemination of spirochetes that usually occurs 2-8 weeks after a chancre appears. S/s resolve in 2-10 weeks.

Answer 15

secondary syphilis

Question 16

What are common findings w/ secondary syphilis? (x4)

Answer 16

Rash - whole body (includes palms/soles)
Mucous patches
Condylomata lata - HIGHLY INFECTIOUS
Constitutional sxs

Question 17

What can you use to dx syphilis?

Answer 17

Darkfield

Serology

Question 18

What is the recommended tx for syphilis?

Answer 18

Benzathine PCN G (Bicillin), 2.4 million units IM x 1

Question 19

Transmission of HSV is through direct contact usually during (symptomatic/asymptomatic) shedding

Answer 19

asymptomatic

Shedding during the prodrome is common!

Question 20

The primary infection of HSV is commonly (symptomatic/asymptomatic)

Answer 20

Asymptomatic (mainly people dont know they have it)

Question 21

How do you dx HSV?

Answer 21

PCR
Cx
Serology (Type-specific; Western blot)

Question 22

How do you tx HSV?

Answer 22

Acyclovir
Valacyclovir
Famciclovir

Question 23

What is the dosing for acyclovir?

***MUST KNOW

Answer 23

400 mg PO q8hr for 7-10 days

or 200 mg PO q4hr while awake (5 times daily) for 10 days

Question 24

Tx is (longer/shorter) for primary infection and (longer/shorter) for recurrent infection

Answer 24

Longer

Shorter

Question 25

When may you consider chronic HSV suppression tx?

Answer 25

After 1 yr of infection (more likely to have recurrences at this time) If the pt is having 4+ recurrences/year

Question 26

_____ is an effective tx against STIs. When treating gonorrhea, ureaplasma urealyticum and chlamydia, take a dose of 1000mg (two 500mg tablets). When treating Mycoplasma genitalium, primary syphilis, and nonspecific urethritis, the dose should be increased to ____ mg

Answer 26

Zithromax 2000 mg

Question 27

What are the S/S of Gonorrhea in males?

Answer 27

"Drippy, Hurty PP" Dysuria and urethral discharge (5% asymptomatic)

Question 28

What are the S/S of Gonorrhea in Women?

Answer 28

Majority are asymptomatic may have... - vaginal discharge - dysuria, urination - labial pain/swelling - abdominal pain

Question 29

where is the primary site for urogenital infection in women with gonorrhea?

Answer 29

Endocervical canal | ***70-90% also colonize urethra

Question 30

what is the incubation phase for gonorrhea in men?

Answer 30

1-14 days | women maybe 10 days

Question 31

what is the etiology (bacteria) for Nongonococcal Urethritis

Answer 31

Unknown in ~50% cases 20-40% C. trachomatis 20-30% genital mycoplasmas (Mycoplasma genitalium, Ureaplasma urealyticum)

Question 32

What are s/s of Nongonococcal Urethritis

Answer 32

Mild dysuria | mucoid discharge

Question 33

What is the clinical Manifestations for chlamydia

Answer 33

Mostly asymptomatic (50% of men, 75% in women) ``` cervicitis urethritis proctitis lymphogranuloma venereum PID ```

Question 34

how can you dx Chlamydia

Answer 34

NAAT | can gram stain

Question 35

how can you tx Gonorrhea?

Answer 35

Cefitriaxone 250 mg IM x 1 + Azithromycin 1gm PO x 1 Or OR Doxycycline 100mg PO BID x 7d

Question 36

what complications are caused during delivery for infected women with chlamydia and transmits it to newborn

Answer 36

Conjunctivitis | PNA

Question 37

Chlamydia is an ____ ____ bacteria that infects columnar epithelial cells and survive by ____ and results in the death of the cell

Answer 37

obligatory intracellular bacteria replication

Question 38

How do you tx Chlamydia/NGU | **Know doses

Answer 38

Azithromycin 1gm po x 1 Or Doxycycline 100mg po BID x 7d ``` Alternative: Erythromycin base 500mg po QID x 7d Or Erythromycin EES 800mg po QID x 7d Or Levofloxacin 500mg po qd x 7d Or Ofloxacin 300mg po BID x 7d ```

Question 39

___ is a Sexually transmitted parasite

Answer 39

Trichomonas Vaginalis

Question 40

Trichomonas Vaginalis has an estimated prevalence os ___% in the general female population Prevalence (increases/decreases) with age Highest rates in __ (populaiton)

Answer 40

3.1% increases AA

Question 41

How do you dx trich?

Answer 41

wet mount (fastest) or OSOM test (trich rapid test)

Question 42

How do you treat Trich? | **know doses

Answer 42

Metronidazole 2gm PO x 1 dose Or Tinidazole 2gm PO x 1 dose Alternative: Metronidazole 500mg PO BID x 7d