STI's

Question 1

What is the number one cause of vaginal discharge?

Answer 1

Bacterial vaginosis

Question 2

What are risk factors for BV?

Answer 2

• Multiple partners
• Female partners
• Not using condoms
• Douching
• HSV
• Menses
• Copper IUD

Question 3

What is the presentation of BV?

Answer 3

• Most patient’s are asymptomatic
• Discharge is milky with a fishy odor
• Worse after unprotected intercourse

Question 4

What is the work-up for BV?

Answer 4

KOH prep - positive if fishy amine odor present and clue cells

Question 5

What are the first line treatments for BV?

Answer 5

• Metronidazole PO or gel
• Clindamycin gel

Question 6

What are risks for untreated BV?

Answer 6

• Increased risk for STI’s, including HIV
• Increased risk for preterm birth (for pregnant women)
• Risk of candidiasis

Question 7

What is the epidemiology for gonorrhea?

Answer 7

• Highest incidence in ages 15-24
• Higher rates in Black patients
• Common co-infection with chlamydia
• Increased risk for HIV

Question 8

What is the presentation of gonorrhea?

Answer 8

*Often asymptomatic
Wide range of presenting sx:
- Dysuria
- Purulent discharge (white, green, yellow)
- Friable cervix
- Vaginal bleeding

Question 9

What is the diagnosis for gonorrhea?

Answer 9

• Nucleic acid amplification test (NAAT): Urine or swab
• Screening in sexually active patients

Question 10

What is the treatment for gonorrhea?

Answer 10

• Ceftriaxone IM single dose + Azithro or doxy for likely co-infection with chlamydia
• No intercourse for 7 days
• Test and treat partners
• Re-test in 3 months after treatment

Question 11

What are the complications associated with gonorrhea?

Answer 11

• PID
• Epididymitis (infertility)
• Mom-to-baby transmission (blindness, joint infections, sepsis)

Question 12

What is the epidemiology of chlamydia?

Answer 12

• Most frequent bacterial STI
• Highest in ages 15-24
• Highest rates amongst black patients and MSM

Question 13

What is the work-up for chlamydia?

Answer 13

• Nucleic acid amplification test (NAAT): urine or swab
• Screening recommended in sexually active patients

Question 14

What is the treatment for chlaymdia?

Answer 14

• Doxy 100mg x7 days

*consider addition of ceftriaxone IM single dose to cover gonorrhea

Question 15

What STI is associated with “frothy” discharge?

Answer 15

Trichomonas Vaginitis

Question 16

What is the diagnosis for trichomonas vaginitis?

Answer 16

Microscopy/wet mount (POC)
Nucleic acid type testing
Culture

Question 17

What is the treatment for trichomonas vaginitis?

Answer 17

Metronidazole PO

*gel can’t be used because it won’t reach theraputic concentrations

Question 18

What are complications of trichomonas vaginitis?

Answer 18

• Preterm labor
• PROM
• SGA status
• Increased cervical cancer risk
• HIV infection

Question 19

What patients are at higher risk for complicated candidiasis?

Answer 19

Diabetics or immunocompromised patients

Question 20

What are the vaginal discharge characteristics of candidiasis?

Answer 20

Thick, “curdy,” or “cottage-cheese” like

Question 21

What is the gold standard test for diagnosing candidiasis?

Answer 21

Culture

Question 22

Reliable diagnosis of PID includes which three findings?

Answer 22

• Cervical motion tenderness​
• Uterine tenderness​
• Adnexal tenderness

Question 23

What is the presentation of PID?

Answer 23

Abdominal or lower pelvic pain​

Suspect PID in any young, sexually active person AFAB with abdominal or pelvic pain​

Vaginal discharge​

Dyspareunia​

Abnormal vaginal bleeding

Question 24

What are the indications for admission of a patient with PID?

Answer 24

Need to r/o other surgical emergency​

Presence of tubo-ovarian abscess​

Patient is pregnant​

Severe infection (+n/v, temp >101)​

Patient can’t tolerate PO treatment​

No response to PO treatment

Question 25

What is the first line treatment for PID?

Answer 25

Ceftriaxone 1g IM or IV q24h​

PLUS Doxycycline 100mg PO or IV q12h​

PLUS Metronidazole 500mg PO or IV q12h