STI's Schoenwald Flashcards
(118 cards)
1
Q
Who is the Hep B vaccine recommended for?
A
recommended for all sexually active persons
2
Q
Who is the Hep A vaccine recommended for?
A
recommended for MSM
3
Q
Who is the HPV vaccine recommended for?
A
recommendation ages 9-26 (males & females)
4
Q
What should be included in the MSM annual screening?
A
- HPV screening-anal pap smear
- HBsAg testing (for active infection)
- Hep C Ab testing (annually)
5
Q
What are two painful genital ulcer diseases?
A
Chancroid, genital herpes simplex
6
Q
A patient complaints of 7-10 days of painful vesicles on erythematour base. Would could the pt have?
A
HSV 2
7
Q
What is the best way to test for herpes? What about if the patient has meningoencephalitis?
A
Viral studies-culture and PCR of CSF for meningitis
8
Q
Primary, recurrent or prodrome herpes sxs?
Associated with fever and bilateral adenopathy,
A
Primary (first occurrence)
9
Q
Primary, recurrent or prodrome herpes sxs?
no fever or adenopathy
A
Recurrent
10
Q
Primary, recurrent or prodrome herpes sxs?
tingling or burning 18- 36 hours prior lesion
A
Prodrome
11
Q
Best way to dx herpes?
A
Tzank smear
12
Q
Presence of multinucleated giant cells on Tzank smear is indicative of what?
A
HSV
13
Q
What is the duration of tx for herpes?
A
7-10 days
14
Q
What is the tx for a first episode of herpes?
A
Acyclovir 400 mg TID or 200 mg 5x/day or valacyclovir 1000 mg BID
15
Q
Episodic tx of herpes?
A
Acyclovir
16
Q
Tx for daily suppression of herpes?
A
Acyclovir, famcyclovir, valacyclovir
17
Q
Can you tx herpes in pregnancy?
A
Limited data but yes with acyclovir- C section recommended though if have to deliver baby and have sores present. Otherwise, can safely vag deliver
18
Q
How do you define early latent syphilis?
A
Reactive testing within 1 year of
infection-no symptoms (infection acquired within one year)
19
Q
How do you define late latent syphilis?
A
Reactive testing greater than 1 year after onset of infection or timing cannot be determined
-no sxs
20
Q
Treponema pallidum
A
Syphilis
21
Q
What is the GS test for syphilis?
A
Darkfield examination of exudate/tissue (gold standard)
22
Q
WHat is RPR
A
One of the blood tests for syphilis
23
Q
What is VDRL?
A
One of the CSF tests for syphilis
24
Q
Once + syphilis does it ever go back to normal?
A
NO
25
How do you confirm syphilis?
RPR ran and + then confirm with antibody test
26
What stage of syphilis is this (chancre)?
| Macule/papule that erodes?
Early
27
What is the syphilis incubation period?
10-90 days (avg 3 wks)
28
What stage of syphilis is this (chancre)?
| clean based, painless, indurated ulcer with smooth firm borders
Late
29
Is a chancre painful?
Yes
30
What is secondary syphilis?
Usually 2-8 wks after chancre and the patient will develop a maculopapular body wide rash on palms and soles, constitutional sxs, condylomata lata (anorectal syphilis)
31
Anorectal syphilis that looks like warts is called?
Condylomata lata
32
Treatment of tertiary syphilis (gumma and cardiovascular syphilis)
Penicillin G 2.4 million units IM q week x 3 weeks
33
Tx for tertiary neurosyphilis?
Treat with Aqueous Penicillin G 18-24 million units/day for 10-14 days (24 hr infusion)
34
What is a Jarisch-Herxheimer Rxn?
Basically a toxic reaction from the die off of bacteria in syphilis that occurs within 24 hrs of tx
• Acute febrile rxn
• Headache, myalgia, fever
35
Tx for Jarisch-Herxheimer Rxn
NSAID or APAP and anti-asthmatic (because anaphylaxis-like rxn)
36
Tx for primary, secondary, early latent syphilis?
Benzathine Penicillin G, 2.4 million units IM
37
Tx for syphilis with PCN allergy?
Doxycycline 100 mg twice daily x 14 days
38
What partners should be treated for syphilis?
ALL PARTNERS tx everyone even if no sxs
39
Tx for syphilis in pregnancy?
Benzathine penicillin 2.4 mu IM after the initial dose for primary, secondary, or early latent syphilis
40
Should you test for HIV in a newly diagnosed syphilis patient?
Yes I think they go hand in hand and if testing for HIV also test for syphilis
41
Painless chancre-papule that ulcerates
syphilis
42
Non-indurated painful vesicle or papule to pustule or ulcer that is soft
chancroid
43
Haemophilus ducreyi
chancroid
44
Combo of painful ulcer with tender inguinal adenopathy suggests chancroid
chancroid
45
Tx for chancroid?
Azithromycin 1 gm orally OR Ceftriaxone 250 mg IM
46
SHould you re-examine the pt after chancroid tx?
Re-examine 3-7 days after tx
47
Should you treat the partner if someone has a chancroid?
YES-> Examine and tx partner whether symptomatic or not if partner contact <10 days prior to onset
48
A patient presents with Unilateral painless papule, vesicle or ulcer with tender regional LAD that is unilateral what is the most likely dx?
Lymphogranuloma Venerum
49
What is the mc bug that causes Lymphogranuloma Venerum?
Chlamydia Trachomatis
50
What is the treatment for Lymphogranuloma Venerum? Name an alternative tx too?
TX: Doxycycline 100 mg BID x 21 days OR Erythromycin base 500 mg QID x 21 days
51
Painless papule that eventually ulcerates WITHOUT lymph node involvement
Granuloma Inguinale
52
Granuloma Inguinale is caused by what bug?
Klebsiella
53
Donovan bodies
Granuloma Inguinale
54
Tx for Granuloma Inguinale? And name an alternate tx?
Doxycycline 100 mg BID x 3 weeks OR Azithromyxin 1 gram qday x 3 weeks
55
What is the difference between Condyloma Acuminatum and condylomata lata?
Condyloma Acuminatum= anal warts
Condylomata Lata= Anorectal syphilis
56
These are symptoms of what in a male? Dysuria and urethral discharge (5% asymptomatic)
Urethritis
57
These are symptoms of what in a female?
Majority asymptomatic; may have vaginal discharge, dysuria, urination, labial pain/swelling, abd. pain
58
What is the TOC for gonorrhea?
NAAT on urine
59
What is the GS test for gonorrhea?
Gram stain
60
Gram stain-gram negative diplococci intracellular
Gonorrhea
61
Disseminated gonorrhea causes ______
joint pain and skin lesions
62
What is the tx for cervix, urethra, rectum and pharynx gonorrhea?
Ceftriaxone 250 mg IM single dose PLUS
| Azithromycin 1 gram po single dose
63
What is the new updated guideline tx for gonorrhea?
Ceftriaxone 500 mg IM x a single dose NO COMBO
64
WHat is the tx for pharyngeal gonorrhea?
Ceftriaxone 250 mg IM in a single dose PLUS
| Azithromycin 1 gram po single dose
65
What is the treatment for gonorrhea plus concurrent chlamydia tx?
Doxycycline x 7 days
66
Tx for disseminated gonococcal infection?
Ceftriaxone 1 gm IM or IV q 24 hr
67
What bug mostly is responsible for nongonoccal urethritis?
C. trachomatis
68
A patient presents with Mild dysuria, mucoid discharge. Urethral smear shows >5 PNMs. What is the most likely dx?
Nongonococcal urethritis
69
Tx for Nongonococcal urethritis?
Azithromycin 1 gm in a single dose
70
How do you test for chlamydia?
NAAT or cervical/urethral swab
71
Who should be screened for chlamydia?
- Annual screening of sexually active women <25
| - Annual screening of sexually active women >25 with risk factors
72
Treatment for Chlamydia?
Azithromycin 1 gm single dose or
Doxycycline 100 mg bid x 7d
(weighted more towards doxy)
73
Follow up for tx of chlamydia?
Rescreen women 3-4 months after treatment due to high prevalence of repeat infection
74
Treatment for Chlamydia in pregnant women?
Azithromycin 1 gram orally OR
| Amoxicillin 500 mg three times daily for 7 days
75
What is the minimum diagnostic criteria for PID?
Uterine/adnexal tenderness or cervical motion tenderness
76
Maximum diagnostic criteria for PID?
Oral temperature >101 F(38.3 C) Elevated ESR
Cervical CT or GC Elevated CRP
WBCs/saline microscopy Cx discharge
77
Parenteral tx A for PID?
Cefotetan 2 g IV q 12 hours
78
Parenteral tx B for PID?
Clindamycin PLUS Gentamycin
79
Oral regimen for PID?
Ceftriaxone PLUS Doxy with or without metronidazole
80
Should a patient's sex partner be treated for PID?
Male sex partners of women with PID should be examined and treated for sexual contact 60 days preceding pt’s onset of symptoms
81
Acute or chronic epididymitis?
| Pain, swelling and unilateral inflammation of epidydimis <6 weeks
acute
82
How long does it have to be for epididymitis to be chronic?
>3 months
83
Sexually active men <35, most
| likely what organism(s)?
gonorrhoeae or chlamydia
84
Age >35, most
| likely what organism(s)?
Enteric-e. coli
85
Tx for epididymitits caused by GC/Chlamydia?
Ceftriaxone PLUS doxy
86
Tx for epididymitits caused by E. Coli?
Levofloxacin
87
Acute swelling and inflammation of the
| prostate gland usually due to infection
Prostatitis
88
How do you diagnose prostatitis?
Diagnose with UA/culture pre and post prostate exam
-Pre will likely be - until you massage the prostate and release bacteria then it will be +
89
Treatment for prostatitis?
Same as epididymitis
Gc/C= Ceftriaxone PLUS doxy
E.Coli= levofloxacin
90
Wet prep-clue cells, positive whiff test
BV
91
BV treatment?
Metronidazole PO or cream
92
BV treatment in pregnancy?
Metronidazole PO NO TOPICAL
93
What is the tx for BV in pregnant woman in the 1st trimester?
Clindamycin
94
Is treatment of sex partner recommended for BV?
No
95
Is treatment of sex partner recommended for candidiasis?
No unless male has balanitis
96
What is the definition of Vulvovaginal Candidiasis?
Four or more symptomatic episodes/year
97
Treatment of Vulvovaginal Candidiasis?
Initial regimen of 7-14 days topical therapy or fluconazole 150 mg (repeat 72 hr)
98
Candidiasis treatment in pregnancy?
Only topical intravaginal regimens recommended x 7 days
99
Diffuse, malodorous yellow to green discharge
Trichomonas
100
What is the gold standard test for diagnosis for trichomonas?
NAAT
101
Flagella on wet prep
Trichomonas
102
Strawberry cervix
Trichomonas
103
What is the tx for trichomoniasis?
Metro
104
If you don't get better after the course of metronidazole for Trichomonas what should you do?
Re-treat with metronidazole 500 mg twice daily for 7 days
105
Do partners of an infected person with trichomoniasis need to be treated?
Yes
106
What are the high risk HPV strains?
16 & 18
107
What are the low risk types that cause warts?
6 & 11
108
How do you test for HPV?
Pap smear
109
What is the treatment goal for HPV?
Primary goal of treatment is to remove the visible warts with topicals or surgery but this might not eradicate the HPV obviously
110
How do you treat the warts?
Imiquimod or can do cryo or surgery
111
The HPV vaccine is recommended for what ages?
9-26 and approved up to age 45
112
Parasitic skin infection by the mite Sarcoptes scabiei that causes intense itching and pruritis >2 weeks
scabies
113
Treatment for scabies?
Permethrin 5% cream to all areas of body or Ivermectin PO
*Also check the fingernails of these patients
114
Who else should be treated for scabies?
Close contacts!!!
115
What are norwegian scabies?
Basically a more aggressive form of regular scabies that infects immunosupporessed patients and is resistant to monotherapy of scabicide or ivermectin
116
Treatment for norwegian scabies?
combination topical scabicide with ivermectin or repeated treatments with ivermectin
117
Pruritus or lice or nits on pubic hair
Pediculosis Pubis
118
Treatment for Pediculosis Pubis?
* Permethrin 1%
| * Lindane 1% shampoo
