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STIs Flashcards

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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
HSV-2: triggers
other viral or bacterial infections menstrual periods stress
26
HSV lesions
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
herpetic whitlow
translocation to fingertips HSV-1: 60% HSV-2: 40%
28
herpes: labs/Dx
gold standard: culture from a lesion NAAT from a lesion
29
herpes: management
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
Syphillis: pathogen
treponema pallidum, a spirochete
31
primary syphilis
3 weeks after exposure Often missed Lesions may be hidden on/around genitals, anus, mouth Chancre indurated and painless Regional lymphadenopathy
32
secondary syphilis
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
early latent syphilis
<12 months
34
late latent syphilis
>12 months
35
tertiary syphilis
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
syphilis: serologic tests
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
primary, secondary, early latent syphilis: treatment
benzathine penicillin G 2.4 million units IM x1 dose
38
late latent, indeterminate length, tertiary syphilis: treatment
benzathine penicillin G 2.4 million units IM weekly x3 weeks
39
neurosyphilis, ocular syphilis, otosyphilis: treatment
aqueous crystalline penicillin G 18-24 million units/day (3-4 million units IV Q4h or continuous infusion for 10-14 days)
40
early latent syphilis treatment if penicillin allergy
doxycycline 100mg PO BID x14 days OR tetracycline 500mg PO QID x14 days
41
late latent syphilis treatment if penicillin allergy
doxycycline 100mg PO BID x28 days OR tetracycline 500mg PO QID x28 days
42
vulvovaginitis
inflammation or infection of the vulva and vagina most commonly caused by bacteria, protozoa, and/or fungi
43
trichomoniasis s/sx
malodorous, frothy yellow-green discharge pruritis vaginal erythema petechiae ("strawberry patches") on cervix and vagina dyspareunia dysuria
44
bacterial vaginosis s/sx
watery, gray, fishy-smelling discharge vaginal spotting
45
candidiasis: s/sx
thick, white, curd-like discharge vulvovaginal erythema with pruritis
46
trichomoniasis: Dx
microscopic wet-prep; may use NAAT or vaginal culture normal saline mixture shows motile trichomonas
47
bacterial vaginosis: Dx
microscopic wet-prep; may use NAAT or vaginal culture normal saline mixture shows irregularly-shaped vaginal epithelial cells (I.e. clue cells)
48
candidiasis: Dx
microscopic wet-prep; may use NAAT or vaginal culture KOH mixture shows pseudohyphae
49
trichomoniasis: management
metronidazole - women: 500mg PO BID x7 days - men: 2g PO x1 alternative: tinidazole 2g PO x1
50
bacterial vaginosis: management
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
candidasis: management
OTC intravaginal agents: -clomitrazole -miconazole -tioconazole Rx intravaginal agents: -butoconazole -terconazole Oral: -fluconazole (contraindicated in pregnancy)
52
Prophylaxis of opportunistic infections in HIV+ persons: CD4 <200
Pneumocystis jiroveci pneumonia: TMP-SMX double strength 1 tab daily or dapsone 100mg PO daily
53
Prophylaxis of opportunistic infections in HIV+ persons: CD4 <100
Toxoplasma gondii: TMP-SMX double strength 1 tab daily or dapsone 100mg PO daily
54
HSV testing for asymptomatic partners of persons with genital herpes
Counseling Type-specific serologic testing for HSV infection
55
HIV: S/Sx
flu-like symptoms earliest S/Sx: fever, night sweats, weight loss
56
When does AIDS occur?
When the CD4 count is <200 cells/mcl and/or an opportunistic infection is present in an HIV+ patient
57
HIV: labs/Dx (screening and monitoring)
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
normal CD4 count
500-1200 cells/mm3
59
HIV: management
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
Indications for PrEP
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
Agents with indications for PrEP
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
most common cause of cervicitis and urethritis
chlamydia
63
AIDS transmission
blood semen vaginal secretions breast milk

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