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STDs/UTIs Flashcards

(61 cards)

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1
Q

Most likely diagnosis- urinary frequency and burning with urethral discharge?

A

urethritis

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2
Q

Best initial test for urethritis

A

urethral swab for gram stain. Additional tests- urine testing for nucleic acid amplification to detect gonorrhea and chlamydia, wbc, intracellular gram negative diplococci is sufficient evidence of Neisseria gonorrhoeae

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3
Q

Most accurate test for urethritis

A

urethral culture, DNA probe, nucleic acid amplification test for N. gonorrhoeae and Chlamydia.

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4
Q

Most common causes of urethritis

A

Chlamydia, gonorrhea, Neisseria, mycoplasma genitalium, ureaplasma

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5
Q

Tx for urethritis

A

cover for gonorrhea and chlamydia
gonorrhea- cefixime, ceftriazone
chlamydia- azithromycin, doxycycline

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6
Q

Are quinolones effective for gonorrhea/chlamydia

A

No, resistant

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7
Q

Cervicitis presentation

A

cervical discharge, inflamed “strawberry” cervix

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8
Q

Causes of cervicitis

A

Chlamydia, gonorrhoeae, trichomonas vaginalis, HSV

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9
Q

Tx of cervicitis

A

Tx for Gonorrhea (Cefixime, Ceftriazone) and Chlamydia (Azithromycin and Doxycycline)

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10
Q

PID presents with

A

lower abd tenderness, lower abd pain, fever, cervical motion tenderness, leukocytosis

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11
Q

Initial test in patient with suspected PID

A

Pregnancy

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12
Q

Diagnostic test for PID

A

Cervical swab for culture, DNA probe, or nucleic acid amplification to confirm etiology.

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13
Q

Most accurate test for PID

A

Laparoscopy. Required only if diagnosis is unclear, symptoms persist despite therapy, or there are recurrent episodes for unclear reasons

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14
Q

PID tx

A

Inpatient- Cefoxitin or cefotetan with doxy

outpatient- Ceftriazone and doxy (possibly with metronidazole)

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15
Q

PID tx in pt with PCN anaphylaxis

A

outpatient- levofloxacin and metronidazole

inpatient- clindamycin and gentamicin

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16
Q

Most likely diagnosis- Painless genital ulcers

A

Syphilis

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17
Q

Most likely diagnosis- Painful genital ulcers

A

Chancroid (Haemophilus ducreyi)

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18
Q

Most likely diagnosis- Inguinal lymph nodes tender and suppurating

A

lymphogranuloma venereum

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19
Q

Most likely diagnosis- Vesicles prior to ulcer and painful

A

Herpes simplex

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20
Q

Diagnostic test for syphilis

A

Dark field microscopy (If positive for spirochetes no further testing necessary), VDRL or RPR (75% sensitive in primary syphilis), FTA or MHA-TP (confirmatory).

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21
Q

Diagnostic test for Chancroid (Haemophilus ducreyi)

A

Stain and culture on specialized media

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22
Q

Diagnostic test for Lymphogranuloma venereum

A

Complement fixation titers in blood, nucleic acid amplification testin on swab

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23
Q

Diagnostic test for Herpes simplex

A

Tzanck prep is the best initial test, viral culture is most accurate

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24
Q

Syphilis tx

A

Single dose of IM benzathine PCN, Doxy if PCN allergy

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25
Chancroid (Haemophilus ducreyi) tx
Azithromycin (single dose)
26
Lymphogranuloma venereum tx
Doxycycline
27
Herpes simplex tx
Acyclovir, valacyclovir, famciclovir. Foscarnet for acyclovir resistant herpes
28
A woman comes to the clinic with multiple painful genital vesicles. What is the next step in management? a. acyclovir PO b. acyclovir topical c. Tzanck prep d. viral culture e. serology f. PCR
A. If clear for herpes no testing necessary. Topical acyclovir is not helpful. Viral culture is most accurate, serology is not useful.
29
Primary syphilis presentation
painless genital ulcer with heaped up indurated edges. (painful if secondarily infected with bacteria. Painless adenopathy.
30
Secondary syphilis presentation
rash (palms and soles), alopecia areata, mucous patches, condylomata lata
31
Tertiary syphilis presentation
Neurosyphilis- meningovascular (stroke from vasculitis), Tabes dorsalis (loss of position and vibratory sense, incontinence, cranial nerve), general paresis (memory and personality changes), argyll robertson pupil aortitis- aorticregurgitation, aortic aneurysm gummas (skin and bone lesions)
32
Is PCN required for chancres to heal?
No, PCN prevents later stages
33
Sensitivity of VDRL or RPR is best in
secondary (99%), then Tertiary (95%), Primary (75-85%)
34
Sensitiity of FTA-ABS is best in
Secondary (100%), then tertiary (98%), Primary (95%)
35
False positive VDRL/ABS most common in
infection, older age, injection drug use and AIDS, malaria, antiphopholipid syndrome, and endocarditis. Titers are reliable at greater than 1:8. Lower titer is more often falseley positive. High titers (greater than 1:32) are rearely false positive.
36
Syphilis tx
Primary and Secondary syphilis: single IM injection of PCN. Oral Doxy if PCN allergic. Tertiary syphilis: IV PCN, Desensitizeif PCN allergic.
37
Jarisch-Herxheimer reaction
Fever and worse symptoms after tx, give asa and antipyretics; it will pass
38
Condylomata Acuminata cause
papillomavirus
39
Condylomata acuminata dx
visual appearance. Wrong answers include biopsy, serology, stain, smear and culture.
40
Condylomata acuminata tx
Remove via physical means such as cryotherapy with liquid nitrogen, surgery for large ones, laser, or melting them with podophyllin or trichloroacetic acid. Imiquimod is a locally applied immunostimulant that leads to the sloughing off of the lesion.
41
Found on hair earing areas (axilla, pubis), causes itching, visibleon the surface
Pediculosis (crabs)
42
Pediculosis tx
Permethrin; lindane is equal in efficacy but more toxic
43
Found in web spaces between fingers and toes or at elbows,found around the nipples or near the genitals, burrows visible, but smaller than pediculosis
Scabies
44
Scabies dx
Scrape and magnify
45
Scabies tx
Tx with permethrin. Widespread disease responds to ivermectin; severe disease needs repeat dosing
46
UTI PEARLS
present with dysuria and fever UA shows increased WBCs E.coli is most common. Quinolones are the best initial therapy
47
Anatomic defects that lead to UTIs
Stones, strictures, tumor or prostate hypertrophy, diabetes. Any form form of obstruction of or foreign body in the urinary system. Foley catheter is a foreign body. Neurogenic bladders is an obstruction.
48
Frequency vs polyuria
Frequency means multiple episodes of micturation. Polyuria is an increase in the volume of urine.
49
Cystitis presents with dysuria and
Suprapubic pain/ discomfort, mild or absent fever
50
Cystitis best initial test
UA with >10WBCs
51
Cystitis most accurate test
urine culture
52
Cystitis tx
TMP/SMZ if local resistance low Cipro Cephalexin (all beta-lactams considered safe in pregnancy) Nitrofurantoin, especially in pregnant patients
53
A 36yo generally healthy woman comes to the office with urinary frequency and burning. The UA shows more than 50 WBCs per high power field. What is the most appropriate next step in management? a. TMP/SMZ for 3days b. TMP/SMZ for 7days c. Urine culture d. US of urinary system e. CTscan of urinary system
A. culture and imaging only required if there are frequent episodes of cystitis or failure to respond to therapy. Three days is sufficient for uncomplicated cystitis. . Seven days required if there is an anatomic abnormality.
54
Pyelonephritis presents with
dysuria, flank or CVA tenderness, high fever, occasionally with abd pain from an inflamed kidney. US shows increased WBCs. Imaging studies are not done
55
Pyelonephritis tx
Any drug for for gram- negative bacilli would be effective. Ampicillin and gentamicin until culture results known. Cipro
56
Acute prostatitis presents with
dysuria with perineal pain, tender prostate on exam
57
Acute prostatitis dx
Urine culture, greatly increased diagnostic yield with prostate massage.
58
Acute Prostatitis tx
Ampicillin and gentamicin until cultures. Cipro
59
Chronic prostatitis tx
TMP/SMZ for 6-8wks
60
Pyelonephritis that does not resolve with appropriate therapy
Perinephric abscess
61
Perinephric abscess dx and tx
US or CT imaging when pyelonephritis is associated with persistent fever after 5-7d. Drainage of the fluid collection is mandatory with culture of the infected fluid.

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