STI Flashcards by Scion Rajaram

Diagnose and treat Chlamydia

NAAT

Doxycycline 100 mg BID x 7 days

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Diagnose and treat trichomoniasis

Naat or Wet mount

Metronidazole (Flagyl) 5000 mg BID x 7 days

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Diagnose and treat Syphillis

FTA-ABS

Benzathine penicillin G 2.4 million units IM once

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Diagnose and treat Gonorrehea

NAAT or culture on Thayer Martin media

ceftriaxone (Rocephin) 500 mg IM once

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Diagnose and treat HSV

Viral culture/PCR or serum type specific

Acyclovir 400 mg po tid x 7 -10 days

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Diagnose and treat Human Papilloma virus-condylomata acuminata

Visual observation, confirmed by biopsy if necessary

imiquimod 5% cream

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Diagnose and treat HIV

Westernblot
Truvada 200/300mg 1 tab PO daily

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Treatment for BV

metronidazole (Flagyl) 500 mg po bid x 7 days

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Treatment for Candida

miconazole 2% vaginal cream 5 gm intravaginally x 3 days

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5 P’s of sexual history

Partners

Prevention of Pregnancy

Protection of STIs

Practices

Past hx of STIs

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Signs and sx of Chancroid

Single painful ulcer,
Erythematous,
Unilateral painful abscess
painful lymphadenopathy

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signs and sx of chlamydia

Most will not report symptoms
May describe mucopurulent discharge
bleeding with intercourse
dysuria
Bartholin gland infection

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signs and sx of Gonorrhea

Usually asymptomatic

Purulent Yellow/green discharge

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signs and sx of nongonococcal urethritis (males)

Dysuria and urethral discharge

Mucoid penile discharge after milking penis

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Signs and sx of syphillis

Primary-painless indurated ulcer at initial site with adenopathy

Secondary-maculopapular rash on palms and soles, flat wart-like lesions, adenopathy

Tertiary- cardiac neurological, auditory and gummatous lesions

Latent infection: No symptom

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Signs and sx of HSV

Flu-like symptoms,
tingling before outbreak
painful vesicular lesions
white exudate centrally

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Signs and sx of HIV

Fever
Malaise
adenopathy
rash in first few weeks
Blood diarrhea

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signs and sx of HPV

May be asymptomatic
Fleshy
soft
pale-colored growths

signs and sx of trichomonas

itching

yellow/green discharge

postcoital bleeding

intramenstrual bleeding

friable cervix
strawberry spots

Treatment for molloscum contagious

cryotherapy with liquid nitrogen

Signs and sx of molloscum contagious

light colored papules
umbilicate centers

Retest for chlamydia

non-pregnant women should be retested in 3 months or at the next possible outpatient visit

Pregnant women should be should be retested no sooner than 3 weeks after tx
and
then rescreened again 3 months later or in the 3rd trimester

Bacterial STI

Chlamydia (Chlamydia trachomatis)

Gonorrhea (Neisseria gonorrhoeae)

Syphilis (Treponema pallidum)

Chancroid (Haemophilus ducreyi)

Lymphogranuloma venereum (Chlamydia Trachomatis serovars L1, L2, L3

Granuloma inguinale (Klebsiella granulomatis)

Molluscum contagiosum

Viral STI

Human Papillomavirus (HPV)

Herpes simplex virus (HSV 1 and HSV 2)

Human immunodeficiency virus (HIV)

Zika virus

Protozoal and Parastic sti

Trichomoniasis (trichomonas vaginalis) Pubic lice/crabs (phthirus pubis) Scabies (Sarcoptes scabiei)

STI presents with increased discharge

Chlamydia Gonorrhea Trichomoniasis

STI presents with sores

Herpes Syphilis Chancroid Lymphogranuloma venereum Granuloma inguinale

STI presents with lesions

Genital warts Condyloma acuita (HPV) Condylomata lata (Treponema pallidum)

Gonorrhea retest

rescreen 3 months after tx for possible reinfection or at next health care visit after 3 mo.

Test for syphilis (info)

VDRL or RPR (these are non-treponemal tests) they look for the NON-specific antibodies that develop during syphilis have a high false-positive rate It is sensitive, not specific Factors for false-positive: pregnancy autoimmune disorders acute bacterial or viral infections if no chancre is present, there may be a false-negative for 1st few weeks of infection.

Next step if VDRL or RPR are positive to diagnose

if positive VDRL or RPR: need a confirmatory treponemal test - VERY important to confirm Diagnosis- Pos VDRL or RPR is a screen only

What are the treponemal tests for syphilis

(FTA-ABS) fluorescent treponemal antibody absorption test or passive particle agglutination assay (TP-PA) or enzyme immunoassays (EIAs) or chemiluminescent immunoassays (CLIAs)

6 months to 1 year following tx, VDRL or RPR (non-treponemal tests) titers should decrease 4-fold with adequate tx ex: 1:128 down to 1:32 an increase in titers following tx indicates treatment failure or reinfection offer HIV screening tx all sexual partners from the last 90 days presumptively for syphilis if the person has secondary or early latent syphilis, previous sex partners in the last year may need to be notified Reportable disease to the health department

What is Lymphogranuloma Venereum

caused by C. trachomatis different subtypes than those that cause chlamydial infection of the vagina distinct disorder than Chlamydia primarily an infection of the lymphatic system

Subjective complains of Lymphogranuloma venereum

unilateral painful inguinal lymphadenopathy or pelvic pain about 1/3 of infected individuals recall having a nontender genital lesion rectal infection is common symptoms --constipation, anal pain, tenesmus & bloody & mucoid anal discharge

Clinical presentation for lymphogranuloma venereum

unilateral, painful, inguinal lymphadenopathy lymph nodes may be fluctuant and rupture on compression

Subjective sx of Granduloma Inguinale

painless beefy-red lesions that bleed on contact genital lesions progressive spread across the anogenital and inguinal areas

objective findings for Granduloma Inguinale

ulcerative lesions that are red and bleed easily

Treatment for Granduloma Inguinale

Azithromycin Z-pak 1 g orally /week once

What are the main subtypes of HPV that causes genital warts

6, 11 causes 90% of genital wart

Objective findings for genital wart (HPV)

on Physical exam fleshy papules or pedunculated warty lesions on the vulva, introitus, perineum, anus, cervix and vaginal walls Large warts = condylomata acuminata cauliflower-like appearance may bleed when abraded

Patient's applied treatment for warts

Imiquimod

Provider applied treatment for warts

Cryptotherapy with liquid nitrogen

CDC recommendation for PID treatment f/u

within 72 hours