STDs, UTI's and ulcerative genital diseases

Question 1

Urethritis presents similar to a UTI. What distinguishes it

Answer 1

Discharge only with this, dysuria may or may not be present and is common to both

Question 2

Urethritis and cervicitis have the same organisms, diagnostic studies, and treatments. What are they

Answer 2

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)

Question 3

If gonorrhea were to disseminate, what would the symptoms be

Answer 3

Polyarticular disease, petechial rash, and tenosynovitis

Question 4

Pelvic inflammatory disease is a worse form of urethritis/cervicitis. What are the symptoms

Answer 4

Dysuria/vaginal discharge but now also have abdominal pain, tenderness, fever, and cervical motion tenderness

Question 5

What is the algorithm for diagnosis of pelvic inflammatory disease

Answer 5

1. ) Pregnancy test - to exclude ectopic pregnancy

2. ) Cervical culture/DNA probe for chlamydia or gonorrhea

Question 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

Answer 6

1. ) Outpatient: Ceftriaxone and doxycycline - same as urethritis and cervicitis
2. ) Inpatient: Cefoxitin (IV) and doxycycline

Question 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

Answer 7

Less than 35: Ceftriaxone and doxycycline (same as PID outpatient and urethritis/cervicitis)

Over 35: Fluoroquinolone

Question 8

Cystitis is only treated if it is symptomatic. What is the definition and treatment of uncomplicated and complicated cystitis

Answer 8

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

Question 9

Pyelonephritis can be treated based on outpatient or inpatient. What is the treatments for both

Answer 9

Outpatient: Ciprofloxacin (gram negative)
Inpatient: Ampicillin/gentamicin

Question 10

What is a perinephric abscess, what is the best way to diagnose, and what is the treatment

Answer 10

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

Question 11

What is prostatitis, the best way to diagnose, and the treatment

Answer 11

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

Question 12

What is common to all ulcerative genital diseases

Answer 12

Enlarged lymph nodes

Question 13

What is a chancroid ulcer, it’s diagnostic studies, and treatment

Answer 13

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)

Question 14

What is lymphogranuloma venereum

Answer 14

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

Question 15

You can skip the diagnostic test for a specific kind of lesion. What is it

Answer 15

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

Question 16

What is the organism that causes syphilis, how does it present

Answer 16

Treponema pallidum - presents as painless ulcer with painless inguinal lymphadenopathy

Question 17

What is the different in symptoms between primary, secondary, and tertiary syphilis

Answer 17

Primary: Chancre, adenopathy

Secondary: Rash, alopecia areata, condylomata lata

Tertiary: Tabes dorsalis, argyll robertson pupil, general paresis, gumma or aortitis

Question 18

What is the difference in diagnostic testing for primary syphilis, secondary syphilis, and tertiary syphilis

Answer 18

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

Question 19

What is the difference in treatments between primary, secondary, and tertiary syhpilis

Answer 19

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

Question 20

How do you treat genital warts - condylomata acuminata, verrucous wart, molluscum contagiosum

Answer 20

Mechanical removal

Question 21

What is condylomata acuminata caused by, and you should skip diagnosis and proceed to treatment. What is treatment

Answer 21

Caused by HPV, treat with cryotherapy with liquid nitrogen, surgery for large ones, maybe podophyillin

Question 22

Pediculosis (crabs) and scabies have the same treatment. What is it

Answer 22

1.) Permethrin

If more widespread, give ivermectin