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Board Exam > STIs > Flashcards

STIs Flashcards

1
Q

Five P’s of sexual health

A

Partners (men, women, both? how many? do they have other partners?)
Practices (vaginal, oral, anal)
Prevention of pregnancy
Protection from STIs
Past history of STIs

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2
Q

chancroid

A

painful superficial non-indurated ulcers
often with regional lymphadenopathy

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3
Q

chancroid: pathogen

A

Hemophilus ducreyi, a gram-negative bacillus

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4
Q

chancroid: S/Sx

A

women: usually asymptomatic
men: single or multiple painful ulcers surrounded by an erythematous halo
Ulcers may be necrotic or severely erosive

Involves genitalia and unilateral bubo (swollen inguinal lymph node) or both

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5
Q

chancroid: Dx

A

Probable diagnosis is usually a matter of exclusion
T. palladium (syphilis) and HSV (by inspection or culture) ruled out

Definitive diagnosis of chancroid is made morphologically

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6
Q

chancroid: treatment

A

azithromycin 1g PO x1
OR
ceftriaxone 250mg IM x1
OR
ciprofloxacin 500mg PO BID x3 days

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7
Q

chlamydia: pathogen

A

chlamydia trichromatis
parasitic, resembles gram-negative bacteria

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8
Q

chlamydia: complications

A

females: PID, infertility, ectopic pregnancy
men: epididymitis, prostatits

most common cause of cervicitis and urethritis

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9
Q

chlamydia: cause

A

chlamydia trachomatis

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10
Q

chlamydia: S/Sx

A

Females: often asymptomatic
- dysuria
- intramenstrual spotting
- postcoital bleeding
- dyspareunia
- vaginal discharge

Males: often asymptomatic
- dysuria
- thick, cloudy penile discharge
- testicular pain
- rectal tenesmus

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11
Q

chlamydia: labs/Dx

A

NAAT to detect bacteria DNA or RNA (most specific & sensitive)
- women: vaginal or cervical swabs or first-void urine
- men: first-void urine or urethral swab
- women and men: detection by rectal swab (not first choice)

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12
Q

chlamydia: treatment

A

doxycycline 100mg PO BID x7 days

alternatives:
-azithromycin 1g PO x1 dose
-levofloxacin 500mg PO daily x7 days

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13
Q

gonorrhea

A

bacterial

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14
Q

gonorrhea: cause

A

neisseria gonorrhoeae, gram-negative diplococci

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15
Q

gonorrhea: complications if untreated

A

women: PID, fallopian tube damage, infertility or increased risk of ectopic pregnancy
men: may lead to epididymitis, infertility (rare)

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16
Q

gonorrhea: transmission

A

sexual
perinatally during childbirth

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17
Q

gonorrhea: S/Sx

A

Females: often asymptomatic
- dysuria
- urinary frequency
- mucopurulent vaginal discharge, green/yellow
- labial pain/swelling
- lower abdominal pain
- fever
- dysmenorrhea
- N/V

Males: often asymptomatic
- dysuria
- frequency
- white/yellow-green penile discharge
- testicular pain

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18
Q

gonorrhea: labs/Dx

A

NAAT urine sample
POC NAAT: GeneXpert (Cepheid)
culture: endocervical (female) or urethral (male)

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19
Q

gonorrhea: treatment

A

<150 kg: ceftriaxone 500mg IM x1
>150kg: ceftriaxone 1g IM x1

pregnant: ceftriaxone + azithromycin

if chlamydia not ruled out: ceftriaxone + doxycycline 100mg PO BID x7 days

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20
Q

herpes

A

viral
painful vesicles or ulcers

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21
Q

Herpes: transmission

A

direct contact with active lesions or by virus containing fluid (e.g. saliva or cervical secretions)

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22
Q

HSV-1: S/Sx

A

painful, sore blisters on lips and sometimes mouth/nose

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23
Q

HSV-1: triggers

A

stress, lack of sleep, too much exposure to sunlight, cold weather, hormonal changes (women)

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24
Q

HSV-2: S/Sx

A

headache
fever
body aches
malaise
joint pain

First outbreak is usually the worst; recur with additional outbreaks but less severe and shorter duration

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25
Q

HSV-2: triggers

A

other viral or bacterial infections
menstrual periods
stress

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26
Q

HSV lesions

A

group/cluster of painful, itching, burning blisters or ulcers
appear on the buttocks, anus or thighs, the vulva or vagina, or on the penis or scrotum

Prodrome often before the lesions appear: tingling or burning where the lesions will develop
Can be noticed during urination
Itching or discomfort in the genital area
Cannot tell the difference between the sores of HSV-1 and HSV-2 on physical exam (can have HSV-1 on genitals and HSV-2 in the mouth)

27
Q

herpetic whitlow

A

translocation to fingertips
HSV-1: 60%
HSV-2: 40%

28
Q

herpes: labs/Dx

A

gold standard: culture from a lesion
NAAT from a lesion

29
Q

herpes: management

A

No cure
Symptomatic:
-docosanol (Abreva) for HSV-1 to shorten healing time
-1st line: Acyclovir for topical, oral, IV
-famciclovir
-valacyclovir: especially useful for reducing symptomatic viral shedding of HSV-2

30
Q

Syphillis: pathogen

A

treponema pallidum, a spirochete

31
Q

primary syphilis

A

3 weeks after exposure
Often missed

Lesions may be hidden on/around genitals, anus, mouth
Chancre indurated and painless
Regional lymphadenopathy

32
Q

secondary syphilis

A

Occurs 2-8 weeks later
flu like symptoms
generalized lymphadenopathy
generalized maculopapular rash, especially on the palm and soles, also trunk, mouth, vagina, anus

33
Q

early latent syphilis

A

<12 months

34
Q

late latent syphilis

A

> 12 months

35
Q

tertiary syphilis

A

10-30 years after exposure
leukoplakia (white patches in the mouth)
cardiac insufficiency: aortitis, aneurysms, aortic regurgitation
infiltrative tumors of skin, bones, liver
CNS involvement: meningitis, hemiparesis, hemiplegia

36
Q

syphilis: serologic tests

A

Screening: non-treponema antibody tests: VDRL and/or rapid plasma reagin (RGR) (many clinics do a combination)

Confirmed with a treponemal test:
-treponema pallidum particle agglutination assay (TP-PA)
-fluorescent treponemal antibody absorption (FTA-ABS)

37
Q

primary, secondary, early latent syphilis: treatment

A

benzathine penicillin G 2.4 million units IM x1 dose

38
Q

late latent, indeterminate length, tertiary syphilis: treatment

A

benzathine penicillin G 2.4 million units IM weekly x3 weeks

39
Q

neurosyphilis, ocular syphilis, otosyphilis: treatment

A

aqueous crystalline penicillin G 18-24 million units/day (3-4 million units IV Q4h or continuous infusion for 10-14 days)

40
Q

early latent syphilis treatment if penicillin allergy

A

doxycycline 100mg PO BID x14 days
OR
tetracycline 500mg PO QID x14 days

41
Q

late latent syphilis treatment if penicillin allergy

A

doxycycline 100mg PO BID x28 days
OR
tetracycline 500mg PO QID x28 days

42
Q

vulvovaginitis

A

inflammation or infection of the vulva and vagina most commonly caused by bacteria, protozoa, and/or fungi

43
Q

trichomoniasis s/sx

A

malodorous, frothy yellow-green discharge
pruritis
vaginal erythema
petechiae (“strawberry patches”) on cervix and vagina
dyspareunia
dysuria

44
Q

bacterial vaginosis s/sx

A

watery, gray, fishy-smelling discharge
vaginal spotting

45
Q

candidiasis: s/sx

A

thick, white, curd-like discharge
vulvovaginal erythema with pruritis

46
Q

trichomoniasis: Dx

A

microscopic wet-prep; may use NAAT or vaginal culture
normal saline mixture shows motile trichomonas

47
Q

bacterial vaginosis: Dx

A

microscopic wet-prep; may use NAAT or vaginal culture
normal saline mixture shows irregularly-shaped vaginal epithelial cells (I.e. clue cells)

48
Q

candidiasis: Dx

A

microscopic wet-prep; may use NAAT or vaginal culture
KOH mixture shows pseudohyphae

49
Q

trichomoniasis: management

A

metronidazole
- women: 500mg PO BID x7 days
- men: 2g PO x1

alternative: tinidazole 2g PO x1

50
Q

bacterial vaginosis: management

A

Metronidazole 500mg PO BID x7 days
OR
metronidazole gel 0.75% 1 applicator intravaginally daily x5 days
OR
clindamycin cream 2% 1 applicator intravaginally at bedtime x7 days

51
Q

candidasis: management

A

OTC intravaginal agents:
-clomitrazole
-miconazole
-tioconazole

Rx intravaginal agents:
-butoconazole
-terconazole

Oral:
-fluconazole (contraindicated in pregnancy)

52
Q

Prophylaxis of opportunistic infections in HIV+ persons: CD4 <200

A

Pneumocystis jiroveci pneumonia: TMP-SMX double strength 1 tab daily or dapsone 100mg PO daily

53
Q

Prophylaxis of opportunistic infections in HIV+ persons: CD4 <100

A

Toxoplasma gondii: TMP-SMX double strength 1 tab daily or dapsone 100mg PO daily

54
Q

HSV testing for asymptomatic partners of persons with genital herpes

A

Counseling
Type-specific serologic testing for HSV infection

55
Q

HIV: S/Sx

A

flu-like symptoms
earliest S/Sx: fever, night sweats, weight loss

56
Q

When does AIDS occur?

A

When the CD4 count is <200 cells/mcl and/or an opportunistic infection is present in an HIV+ patient

57
Q

HIV: labs/Dx (screening and monitoring)

A

Initial screening: HIV-1/HIV-2 antigen/antibody combination immunoassay
-if positive, HIV-1/-HIV-2 antibody differentiation immunoassay

Monitoring:
-absolute CD4 lymphocyte count
-viral load

58
Q

normal CD4 count

A

500-1200 cells/mm3

59
Q

HIV: management

A

Prevention of opportunistic infections
-bactrim for pneumocystis pneumonia and toxoplasmosis prevention
-azithromycin for mycobacterium avian complex
-monitor for CMV

Antiretroviral treatment
-combination therapy to start at the time of HIV+ diagnosis, regardless of CD4 count

60
Q

Indications for PrEP

A

Anal or vaginal sex within the past 6 months and:
-a sexual partner with HIV
-not consistently used a condom
-been diagnosed with an STD in the past 6 months

People who inject drugs and:
-have an injection partner with HIV
-share needles or other equipment

People who have been prescribed nonoccupational post-exposure prophylaxis (PEP) and
-repeat continued risk behavior
-have used multiple courses of PEP

61
Q

Agents with indications for PrEP

A

Truvada
-recommended to prevent HIV for all people at risk through sex or injection drug use
-can cause significant renal and bone density effects d/t increased plasma concentrations

Descovy
-recommended for people at risk through sex, except those who receive vaginal sex
-improved renal/bone safety

Apretude
-recommended for at-risk adults and adolescents
-injected every 2 months

62
Q

most common cause of cervicitis and urethritis

A

chlamydia

63
Q

AIDS transmission

A

blood
semen
vaginal secretions
breast milk

Board Exam (18 decks)

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