STI and PID

Question 1

Chlamydia

Agent

Answer 1

bacteria Chlamydia trachomatis
Gram negative
Can be spread via intercourse, anal or oral sex

Question 2

Chlamydia

Tx (2)

Answer 2

Doxycycline 100 mg po bid x 7 days
Azithromycin 1-gram po x 1 dose
Can be used in pregnancy

Question 3

Chalmydia

Dx

Answer 3

Nucleic acid amplification tests (NAAT)
from urine or swab

Question 4

chlamydia

follow up

Answer 4

Test of cure within 3 weeks
Pregnant patients

Persistent symptoms
Rx with erythromycin or amoxicillin (suboptimal)

Question 5

Chlamydia

Screening

Answer 5

Regular screening recommended if you are high risk:
Under 25 years old
Pregnant
New or multiple partners
Have had chlamydia before

Question 6

Chlamydia

complications in females

Answer 6

PID: increased risk for chronic pelvic pain, infertility, ectopic pregnancy

Question 7

Chlamydia

Complicationns in pregnancy

Answer 7

Pregnancy: preterm delivery, neonatal conjunctivitis (blindness), neonatal pneumonia

Question 8

Chlamydia

complications in men

Answer 8

Men: Reduced fertility and pain, swelling, tenderness in testicles (epididymitis)

Question 9

Chlamydia

Complications in any gender

Answer 9

Reactive arthritis, Conjunctivitis

Question 10

Gonorrhea

agent

Answer 10

by bacteria Neisseria gonorrhoeae
Gram negative intracellular diplococci
Can be spread via intercourse, anal or oral sex

Question 11

Gonorrhea

prevalence

Answer 11

Second most common communicable disease in US
Highest rates among sexually active teenagers and adults

Question 12

chlamydia

prevalence

Answer 12

most common STD in US

Question 13

Gonnorhea

Sx in females

Answer 13

Often asymptomatic
White or yellow vaginal discharge,
Metrorrhagia (bleeding between periods) postcoital bleeding
PID: pelvic pain, fever, chills
Urethritis: UTI symptoms (frequency, dysuria)

Question 14

Gonorrhea

Sx for men

Answer 14

Sx more common here than for chlamydia
White or yellow penile discharge
Burning with urination
Testicular/scrotal pain or swelling

Question 15

Gonorrhea

Rectal symptoms

Answer 15

Anal discharge, pain, pruritis
Anal bleeding
Painful bowel movements

Can also include throat infection and pain

Question 16

Gonorrhea

PE in women

Answer 16

Mucopurulent discharge, friable cervix, SEVERE cervical motion tenderness

Question 17

Gonorrhea

PE in men

Answer 17

Mucopurulent urethral discharge

Question 18

gonorrhea

dx

Answer 18

NAAT with swab
Test for other infections

Question 19

gonorrhea

complications in females

Answer 19

PID: chronic pelvic pain, infertility, ectopic pregnancy

Question 20

gonorrhea

complications in infants

Answer 20

ophthalmia neonatorum (can cause perforation of globe and blindness), sepsis, meningitis, scalp abscesses

Question 21

gonorrhea

complications in men

Answer 21

scars in urethra, inflammation of testicles, infertility, chronic prostate pain

Question 22

gonorrhea

complications in all genders (4 areas)

Answer 22

Disseminated infection: septic arthritis, skin lesions, pericarditis, endocarditis, meningitis

Question 23

Syphilis

agent

Answer 23

Spirochete: Treponema pallidum

Question 24

Spirochete: Treponema pallidum

overview

Answer 24

Increasing incidence
Disproportionate disease burden disease in Black individuals
Association with HIV coinfection among MSM

Question 25

# Syphilis How is it spread

Answer 25

**Direct contact with lesion crosses placenta**

Question 26

# Syphilis Primary stage Sx and incubation

Answer 26

2 to 12 weeks after exposure; small, **painless** chancre develops and heals spontaneously (may go unnoticed)

Question 27

# Syphilis Secondary Stage when does it start, and what do you see?

Answer 27

~1 to 6 months after chancre healing; **raised rash appears on palms and soles** with generalized symptoms such as fever, adenopathy fatigue, myalgias, sore throat, eye and GI involvement

Question 28

# Syphilis Latent stage

Answer 28

Can move here if left untreated and has no symptoms; early and late stages

Question 29

# Syphilis Tertiary stage incubation and what areas are affected?

Answer 29

Can move here if left untreated 1 to 30 years after primary infection; cause damage with CNS, cardiovascular, nodular lesions

Question 30

# Syphilis Primary essentials of DX

Answer 30

**Painless** chancre ulcer on genitalia, perianal area, rectum, pharynx, tongue, lip, or elsewhere. “Classic” ulcer: nontender, nonpurulent, indurated Fluid expressed from ulcer contains T pallidum by immunofluorescence or darkfield microscopy Nontender enlargement of regional lymph nodes Serologic nontreponemal and treponemal tests may be positive.

Question 31

# Syphilis Maculopapular rash

Answer 31

some raised some not, on palms and soles.

Question 32

# Syphilis secondary essentials of Dx

Answer 32

Generalized maculopapular rash on palms and soles Mucous membrane lesions. Condylomata lata in moist skin areas-mistaken for genital warts Generalized nontender lymphadenopathy Fever may be present Meningitis, hepatitis, osteitis, arthritis, iritis Many treponemes in moist lesions by immunofluorescence or darkfield microscopy Positive serologic tests for syphilis

Question 33

# syphilis latent stages

Answer 33

Early latent syphilis: infection < 1 year Late latent syphilis: infection > 1 year still + for syph

Question 34

# syphilis Tertiary Syphilis Essentials of Dx

Answer 34

**Gummas:**infiltrative tumors of skin, bones, liver **Cardiovascular damage:** aortitis, aortic aneurysms, aortic regurgitation **CNS damage:**meningovascular and degenerative changes, paresthesias, abnormal reflexes, dementia, or psychosis May occur at any time after secondary syphilis, even after years of latency; rarely seen in developed countries

Question 35

# syphilis Neuro Sx

Answer 35

Can occur at any stage of disease Meningitis: Headache, stiff neck, fever ***Argyll-Robertson pupil: accommodates but does not react to light** Tabes dorsalis (Damaged posterior columns and dorsal roots of spinal cord)

Question 36

# Syph How do we dx Neuro Syph

Answer 36

Consider CSF evaluation for atypical symptoms or lack of decrease in nontreponemal serology titers. neuro exam

Question 37

Congenital Syphilis Diagnosis

Answer 37

maternal nontreponemal and treponemal antibodies can be transferred through placenta to fetus Miscarriage, stillbirth, early neonatal death Desquamating maculopapular rash of skin/mucus membranes; condylomas Serous rhinitis (snuffles) Saddle nose deformity due to damage to cartilage of nasal septum ***Hutchinson’s teeth** Chorioretinopathy and optic neuritis Deafness

Question 38

# syph Nontreponemal

Answer 38

**1st step** know this!! nonspecific, not definitive, but low cost, easy to perform, and quantifiable to follow response to therapy. Rapid plasma reagin (RPR) Venereal Disease Research Laboratory (VDRL) Toluidine Red Unheated Serum Test (TRUST) Amount of antibody present (IgM and IgG) reflects activity of infection. Positive tests reported as a titer of antibody (eg, 1:32, - detection of antibody in serum diluted 32-fold).

Question 39

# Syphilis Treponemal Dx

Answer 39

confirmatory if nontreponemal tests are reactive. Qualitative only - reported as "reactive" or "nonreactive“ Once positive, usually positive for life, not useful for confirming new diagnosis of syphilis in patient with prior treated disease. Increasingly used as initial screening test. Fluorescent treponemal antibody absorption (FTA-ABS) Microhemagglutination test for antibodies to T. pallidum (MHA-TP) T. pallidum particle agglutination assay (TPPA) T. pallidum enzyme immunoassay (TP-EIA) Chemiluminescence immunoassay (CIA)

Question 40

# Syph Tx

Answer 40

Penicillin G benzathine

Question 41

# Syph Jarisch-Herxheimer reaction

Answer 41

Acute worsening of symptoms and fever after treatment has started Here the toxins are released when treatment kills spirochetes and they blow apart, triggering cytokine release **know this**

Question 42

# Trich agent and overview

Answer 42

by protozoan: Trichomonas vaginalis Symptoms Can be asymptomatic in both male and females

Question 43

# Trich Female Sx

Answer 43

Females: Frothy discharge (yellow, green) with **foul fishy odor** Can be intensely pruritic- can be mistaken for yeast Swelling, pain, redness in vulva Dysuria **Strawberry cervix**

Question 44

# trich males Sx

Answer 44

urethral discharge

Question 45

# Trich PE in females

Answer 45

**females-strawberry cervix** Have high suspicion if pH >4.5, amine/fishy odor, many white blood cells (even if trich is not seen)

Question 46

# trich Tx

Answer 46

Treatment of both partners Metronidazole 500mg twice daily for 7 days

Question 47

Vulvovaginal Candidiasis agent and agent type

Answer 47

Candida albicans Not an STI Fungal

Question 48

# Vuvlovaginal candidiasis Sx

Answer 48

pruritis, thick white curd-like vaginal discharge without odor Vulvar erythema, edema, excoriation KOH prep shows spores and hyphae

Question 49

# Vulvovaginal Candidiasis Tx

Answer 49

Non-pregnant Vaginal topical azoles (1-3 day regimen) Miconazole, tioconazole Oral azoles (one time dose) Fluconazole 150mg oral tablet

Question 50

# Vuvlovaginal candidiasis Prgenant Tx

Answer 50

Vaginal topical azoles (longer course)

Question 51

# Vulvovaginal candidiasis risk factors

Answer 51

Diabetes mellitus Broad spectrum antibiotic use Increased estrogen: OCPs Pregnancy Corticosteroid usage Immunosuppression IUD? Vaginal Candida may form biofilm on IUD strings

Question 52

Pelvic Inflammatory Disease (PID)

Answer 52

External genitalia without skin lesions or edema/erythema. Vaginal mucosa without lesions or discharge. Cervix without erythema, lesions, contact bleeding, discharge. **Cervical motion tenderness present.** **Chandelier sign**

Question 53

PID definition

Answer 53

Polymicrobial infection of upper genital tract associated with sexually transmitted organisms N gonorrhoeae and Chlamydia trachomatis as well as endogenous organisms