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Men's Health Module > STI's > Flashcards

STI's Flashcards

(85 cards)

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1
Q

“5 P’s” of sexual history

A 
Partners
Practice
Past history of STI
Pregnancy plans
Protection from STI

*ask about partner’s hx and partners too

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2
Q

Chlamydia commonly co-infected with _________.

A

gonorrhea

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3
Q

Non-reportable STI

A

HPV

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4
Q

Signs of HPV infection

A

most asymptomatic

genital warts main sign

  • smooth papules
  • flat papules
  • Kerratotic warts (resemble common wart)
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5
Q

Main HPV treatment

A

Podofilox 0.5% gel applied to warts BID x 3 days

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6
Q

HPV transmission

A

skin to skin contact

sex primarily (but doesn’t have to be) - intercourse, genital contact

fomites???

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7
Q

How to prevent condylomata acuminata and cervical cancer?

A

HPV vaccine (quadrivalent 6, 11, 16, 18 = Gardisil)

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8
Q

When is HPV vaccine given? shot series?

A

recommended in males 11 or 12 yo (can be given 9-26 yo)

3 shot series: dose 1, then 2 mon, then 6 mon

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9
Q

2 kinds of herpes

A

HSV 1 = oral

HSV 2 = genital

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10
Q

Most common STI in the U.S.

A

HPV

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11
Q

When should genital warts be biopsied?

A
  • atypical appearance of warts
  • pt immunocompromised
  • warts don’t resolve or worsen with standard treatment
  • persistent ulceration/bleeding
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12
Q

herpes transmission

A

sexual and vertical (mother to fetus)

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13
Q

HSV-1 symptoms

A

cold sores or fever blisters

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14
Q

Progression of herpes lesions

A

burning/stinging skin -> papules -> painful vesicles -> fills with pus -> ulcers -> crusts -> healed

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15
Q

herpes keratitis

A

complication of HSV-1 where it gets on eye; emergency because may cause blindness

vesicular lesions on tip of nose & dendritic lesions on eye

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16
Q

Complications of HSV

A 
blindness
neonatal herpes
herpes encephalitis
aseptic meningitis
radicular pain
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17
Q

Recurrence of herpes triggered by what?

A

stress, fatigue, exposure to sun, skin trauma

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18
Q

Gold standard diagnosis for HSV

A

viral culture of lesion (can be typed but doesn’t change tx)

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19
Q

Best HSV treatment for first episode, episodic, and chronic suppression?

A

First episode (w/i 24 hrs of sx’s):
◦ Acyclovir 800 mg TID x 7-10 d
◦ Valacyclovir 1000 mg BID x 7-10 d

Episodic; 1-5 days:
◦ Acyclovir x 3-5 d
◦ Valacyclovir x 5 d
◦ Famciclovir x 1 d

Chronic suppression (1-2 per month); year:
◦ Acyclovir (safe for 5 yrs)
◦ Famiciclovir (1 yr)
◦ Valacyclovir (1 yr)

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20
Q

What test is no longer used as gold standard for herpes?

A

Tzanck smear

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21
Q

Most commonly reported notifiable disease in U.S.? 2nd most common?

A
  1. Chlamydia

2. Gonorrea

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22
Q

Age group most affected by chlamydia and gonnorhea

A

20-24 yo

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23
Q

transmission of chlamydia

A

body fluids; highly transmissible

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24
Q

Signs/sx of Chlamydia

A

85% asymptomatic

mild dysuria, burning urination, watery penile discharge, conjunctivitis, erythematous oropharynx, joint pain (Reiters syndrome), abd pain

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25
How to dx Chlamydia and Gonorrhea?
nucleic acid amplification (NAAT) of dirty urine or of swab culture (kids and used in all legal matters)
26
Chlamydia treatment
Azithromycin 1 g PO x 1 dose (doxy if allergic) ALWAYS treat for gonorrhea too! TREAT PARTNER
27
Patient education about STIs
Discuss prevention strategies: abstinence, monogamy, limit # of sex partners, barrier methods
28
Sex partners should be evaluated, tested, and treated if they had sexual contact with STI patient during what time frame?
previous 60 days
29
STI's with vertical transmission
herpes, gonorrhea, syphilis
30
Urban residence is a risk factor for what STI?
Gonorrhea
31
Signs of Gonorrhea
``` urethritis epididymitis (scrotal pain, edema) yellow discharge of erythema of oropharynx proctitis (common MSM) prostatitis ```
32
STI with yellow purulent discharge of urethra and erythematous throat?
Gonorrhea
33
Differences in discharge of Chlamydia and Gonorrhea
Chlamydia - mucoid watery Gonorrhea - yellow purulent
34
Rare and serious complication of Gonorrhea
DGI = disseminated gonococcal infection red maculopapular skin lesions, arthralgias, tenosynovitis, arthritis, hepatitis, myocarditis, endocarditis, and meningitis ADMIT!
35
Gonorrhea treatment
Ceftriaxone 250 mg IM x 1 dose PLUS Azithromycin 1 g to cover for Chlamydia Treat partners
36
Etiology of trichomoniasis
T. vaginalis (protozoa)
37
Trichomoniasis treatment
Metronidazole 2 g PO x 1 dose No ETOH x 24 hrs after treatment
38
Man who is asx, but has grayish green penile discharge with some mild dysuria
Trichomoniasis
39
How to dx Trich
Wet mount - trophozoites with tail on microscope culture to confirm
40
How long to wait after STI treatment to return to sex?
7 days after post treatment or until both partners no longer have sx's
41
Patient history and symptoms that indicate Granuloma Inguinale
- Live in tropical or developing country - initially painless ulcer that later becomes painful (beefy red, discharge) - scars from lesions
42
Donovan bodies on biopsy =
Granuloma Inguinale
43
Granuloma Inguinale treatment
Doxy or Bactrim x 3-4 wks
44
- Painless ulcer on penis | - Purple painful inguinal lymph nodes (=Bubos)
Lymphogranuloma Venereum
45
How to test for Lymphogranuloma Venereum?
culture lesion or bubo aspiration
46
Lymphogranuloma Venereum treatment
Doxy
47
STI's seen in South America and Caribbean? (in addiction to Asia and Africa)
Lymphogranuloma Venereum
48
PAINFUL genital ulcers. Commonly seen in Asia, Africa, and Caribbean.
Chancroid
49
Chancroid treatment
Cefriaxone IM or Azithromycin
50
Who needs to be treated for STI with longer course?
HIV+
51
STI's with bubos
Chancroid and Lymphogranuloma Venereum
52
bluish/red lesions in pubic region with areas of excoriation. What should you look for?
pubic lice
53
Pubic lice treatment
Permethrin (Elimite) rinse 1% x 10 min OR cream 5% x 8 hr
54
Healthy young adult comes in with pearly, umbilicated papules on groin region.
Molluscum Contagiousum
55
Etiology of Molluscum Contagiosum
Pox virus
56
Molluscum Contagiousum treatment
Imiquimod (Aldara) 5% x 1-3 mon on lesions Cryotherapy, curettage, or electrodessication if painful
57
What STI is known as "great masquerader?" Why?
Syphilis | variable presentations
58
All patients with syphilis should be tested for ______.
HIV
59
Most STI's highest in ages 20-24, but _______ is slightly older 25-29.
Syphilis
60
Signs of primary syphilis?
Lesion appears 10-20 days (can be up to 90 days) after infection CHANCRE = painless lesion with smooth raised border and clean non-necrotic base Heals spontaneously within 1-6 wks
61
Signs of secondary syphilis?
Occur 3-6 weeks after primary chancre Rash on palms, soles, face; Lymphadenopathy; mucocutaneous lesions
62
Timing of primary and secondary syphilis
Primary appears 10-20 days (can be up to 90 days) after infection Secondary occur 3-6 weeks after primary chancre primary and secondary may overlap (chancre AND Mucocutaneous lesions) NEVER go back to primary. only one onset of Chancre
63
When can latent syphilis occur?
- between primary and secondary stages - between secondary relapses - after secondary stage
64
Duration of early and late latent syphilis
Early latent: < 1 year | Late latent: >/= 1 year
65
Hallmarks of tertiary (late) syphilis
*1-20 years after infection* Gummatous lesions: destruction of nasal bone/septum Cardiovascular Syphilis: aneurysms, aortic regurg, Coronary Artery Disease
66
tabes dorsalis =
syphilitic myelopathy seen in later neurosyphilis
67
What are signs that syphilis has crossed into CNS (Neurosyphilis)?
``` Early NS (mon-yrs) cranial nerve dysfunction, meningitis, stroke, altered mental status, loss of vibration sense, and auditory or ophthalmic abnormalities ``` ``` Late NS (yrs-decades; very rare) tabes dorsalis (syphilitic myelopathy) dementia paralytica = emotional lability, delusions, inappropriate social or moral behavior, megalomania ```
68
How to analyze fluid of lesions from suspected syphilis?
Darkfield Microscopy: + if treponemes seen Direct Fluorescent Antibody – T. Pallidum (DFA TP) + if treponeme seen Comparable to Darkfield 1-2 day turnaround
69
Serologic tests for syphilis
Nontremponemal: VDRL, RPR Tremponemal: FTA-ABS (fluorescent treponemal antibody absorption test)
70
Best way to dx syphilis if Chancre/lesion present
Darkfield Microscopy + RPR (or VDRL)
71
Best way to dx syphilis if no lesion present
RPR (or VDRL) and FTA-ABS, TP-PA or EIA
72
Criteria for early latent syphilis
+ testing within last 12 months 4-fold increase in comparison with titer obtained within year preceding your eval Unequivocal symptoms of primary or secondary syphilis reported by patient in past 12 months Contact with a partner with a documented case of Syphilis
73
When to test for neurosyphilis?
Neurologic or ophthalmic signs Evidence of active tertiary syphilis (e.g., aortitis, gumma, and iritis) Treatment failure HIV infection with late latent syphilis or syphilis of unknown duration
74
How to test for neurosyphilis?
Serology positive + VDRL-CSF + LP (elevated protein levels in CSF)
75
Primary, Secondary, and early latent syphilis treatment
IM Benzathine penicillin G 2.4 million units x 1 dose * if PCN allergic, then doxy or tetracycline
76
Treatment of neurosyphilis
Hospitalization with IV abx | Aqueous crystalline PCN G
77
Treatment of late latent (or latent unknown duration) and tertiary syphilis
IM Benzathine penicillin G x 3 doses
78
Self-limited reaction to anti-treponemal (syphilis) therapy; includes fever, malaise, N/V, rash...
Jarisch-Herxheimer Reaction
79
Syphilis titers usually highest at what stage of disease?
secondary syphilis
80
What phase of syphilis can neurosyphilis occur?
can occur at any stage
81
If HPV is a clinical diagnosis, how do we rule out the possibility of it being a wart from syphillis?
HPV lesions are painful vesicular lesions on an erythematous base Syphilitic lesions are an open sore (chancre) that is painless Primary a clinical differentiating, but may do HSV culture of the lesion and order an RPR/VDRL
82
What labs confirm primary syphilis?
T. pallidum on Darkfield microscopy | RPR and serology tests may be unreactive
83
How to treat syphilis in pregnant mother with allergy to PCN?
desensitized in the hospital and treated with penicillin; prevents vertical transmission no alternative med
84
How should syphilis be followed up if lesion seems to be healing and no ADRs to therapy?
- Repeat HIV antibody test at 3 months | - VDRL or RPR 6 and 12 months after therapy (measure response to therapy)
85
How should gonorrhea and chlamydia patient's sexual partners be managed?
test and treat all contacts within prior 60 days most recent partner should ALWAYS be treated regardless of of time or test results avoid intercourse until therapy completed

Men's Health Module (10 decks)

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