Flashcards in STDs, UTI's and ulcerative genital diseases Deck (22):
1
Urethritis presents similar to a UTI. What distinguishes it
Discharge only with this, dysuria may or may not be present and is common to both
2
Urethritis and cervicitis have the same organisms, diagnostic studies, and treatments. What are they
Diagnostic studies: Swab for gram stain, culture, WBC count etc or do a nucleic acid amplification test
Organisms: Gonorrhea and chlamidya
Treatments: Ceftriaxone and azithromycin (or doxycycline but not in pregnant people)
3
If gonorrhea were to disseminate, what would the symptoms be
Polyarticular disease, petechial rash, and tenosynovitis
4
Pelvic inflammatory disease is a worse form of urethritis/cervicitis. What are the symptoms
Dysuria/vaginal discharge but now also have abdominal pain, tenderness, fever, and cervical motion tenderness
5
What is the algorithm for diagnosis of pelvic inflammatory disease
1.) Pregnancy test - to exclude ectopic pregnancy
2.) Cervical culture/DNA probe for chlamydia or gonorrhea
6
With pelvic inflammatory disease, you can either treat them as outpatient or admit them and treat them as inpatient. What is the treatments for both
1.) Outpatient: Ceftriaxone and doxycycline - same as urethritis and cervicitis
2.) Inpatient: Cefoxitin (IV) and doxycycline
7
Epididymitis or orchitis presents with painful or tender testicle with normal position. Its treatment actually depends on age (35 is the cut off). What do you give if less than 35, and if more than 35
Less than 35: Ceftriaxone and doxycycline (same as PID outpatient and urethritis/cervicitis)
Over 35: Fluoroquinolone
8
Cystitis is only treated if it is symptomatic. What is the definition and treatment of uncomplicated and complicated cystitis
1.) Uncomplicated: Bactrim orally for 3 days, no diagnostic studies even required
2.) Complicated: Anatomic abnormality such as stone, stricture, tumor, or obstruction causing it. Give bactrim for 7 days or ciprofloxacin, and make sure you did ultrasound in diagnosis
9
Pyelonephritis can be treated based on outpatient or inpatient. What is the treatments for both
Outpatient: Ciprofloxacin (gram negative)
Inpatient: Ampicillin/gentamicin
10
What is a perinephric abscess, what is the best way to diagnose, and what is the treatment
Definition: Complication of pyelonephritis who doesn't respond to therapy for 5 to 7 days with white cells still on urinalysis
Diagnosis: Biopsy
Treatment: Ciprofloxacin (gram negative) + staph coverage such as oxacillin or nafcillin
11
What is prostatitis, the best way to diagnose, and the treatment
Definition: Will experience same symptoms as UTI but with perineal/sacral pain and "boggy" prostate
Diagnosis: Urinalysis initial, urine WBC's after massage is best
Treatment: Ciprofloxacin (just like pyelonephritis and cystitis) but do much longer than those two
12
What is common to all ulcerative genital diseases
Enlarged lymph nodes
13
What is a chancroid ulcer, it's diagnostic studies, and treatment
Painful ulcer, caused by Haemophilus ducreyi
Initial test: Gram stain - shows gram negative coccobacilli
Best test: Culture - use nairobi medium or mueller hinton agar
Treatment: IM shot of ceftriaxone or single oral dose of azithromycin (same as urethritis/cystitis and initial PID)
14
What is lymphogranuloma venereum
Ulcer is present, but now have large tender lymph nodes too that can form draining sinus tract
Diagnosis: Serology for chlamydia trachomatis (remember that this is not seen on gram stain)
Treatment: Aspirate the bubo (lymph node). Treat with doxycycline and azithromycin
15
You can skip the diagnostic test for a specific kind of lesion. What is it
Genital herpes - skip to acyclovir, valaclovir, famciclovir for 7 to 10 days
If failure, proceed to tzanck prep or viral culture )most accurate)
If acyclovir resistant, replace with foscarnet
Pearls
1.) Acyclovir is safe during pregnancy
2.) Serology is useless
16
What is the organism that causes syphilis, how does it present
Treponema pallidum - presents as painless ulcer with painless inguinal lymphadenopathy
17
What is the different in symptoms between primary, secondary, and tertiary syphilis
Primary: Chancre, adenopathy
Secondary: Rash, alopecia areata, condylomata lata
Tertiary: Tabes dorsalis, argyll robertson pupil, general paresis, gumma or aortitis
18
What is the difference in diagnostic testing for primary syphilis, secondary syphilis, and tertiary syphilis
1.) Primary: Do Darkfield, then VDRL and RPR after
2.) Secondary: RPR and FTA
3.) Tertiary: RPR and FTA, lumbar puncture testing VDRL and FTA
19
What is the difference in treatments between primary, secondary, and tertiary syhpilis
1.) Primary and secondary give IM penicillin
2.) Tertiary give IV penicillin
If allergic in primary and secondary, give doxycycline
If allergic in tertiary, desensitize them and give penicillin
- Desensitization should only be performed in neurosyphilis and pregnant women
20
How do you treat genital warts - condylomata acuminata, verrucous wart, molluscum contagiosum
Mechanical removal
21
What is condylomata acuminata caused by, and you should skip diagnosis and proceed to treatment. What is treatment
Caused by HPV, treat with cryotherapy with liquid nitrogen, surgery for large ones, maybe podophyillin
22