STIs Flashcards
1
Q
Epidemiology of STIs and Young People
A
- 19 million new cases per year: one half occur in people ages 15-24, most asymptomatic and undiagnosed
- new research: 1 in 4 teen has an STI
- 2006: one third of new infections were among people ages 13-29 (may be as high as 50%)
- economic costs- $17 billion/year
2
Q
Confidentiality and STIs
A
- confidentiality ensures better care
- ACOG ‘88 ( American College of Obstetrics and Gyn)
- Society for Adolescent Health and Medicine ‘92
- American Medical Association ‘92
- American Associated of Family Practititioners -89
- American Association of Pediatrics ‘89
- teenagers have the right to confidential care of STIs- diagnosis and treatment
3
Q
What is the differential diagnosis of dysuria (painful urination)
A
- urinary tract infection
- genital tract infection- cervicitis or vaginitis
- skin related abnormalities/ mucosal or perineal- herpes or trauma
4
Q
What additional information do you need in addition to dysuria symptom?
A
- onset and duration of symptoms
- description of symptoms
- associated symptoms: nausea/vomiting, fever/chills, abdominal pain, back pain, sores, lumps, bumps, dyspareunia (pain with sex)
5
Q
What are the Five Ps of Sexual History?
A
- Partners- Gender(s), Number (three months, lifetime)
- Prevention of pregnancy (Contraception, Emergency Contraception)
- Protection from STIs- Condom use
- Practices- Types of sex: anal, vaginal, oral
- Past history of STIs
6
Q
Female patient with history of dysuria, some vaginal itching, yellowish discharge, symptoms began a week ago. Several episodes of unprotected sex. DD?
A
- UTI- highly unlikely because symptoms don’t fit
- GTI- getting very likely with history
- Skin related problem- you’ll have to look on physical exam
7
Q
What is the differential diagnosis of vaginitis?
A
- trichomonas
- bacterial vaginitis
- candida vaginitis
8
Q
Trichomonas Infection
A
- Females: 50% symptomatic
- foul-smelling, frothy discharge, vaginal itching or redness, dyspareunia, urge to urinate and dysuria, post-coital bleeding, excessive or prolonged menses***
- strawberry cervix
- pH >4.5
- Male: most are asymptomatic and often missed
- if symptoms occur can present as NGU (non-gonococcal urethritis)
- consider trich in males with recurrent urethritis post adequate treatment
9
Q
Bacterial Vaginosis
A
- symptoms: odorous discharge, itching
- prevalence- found in 24-47% of STI clinic patients
- sequelae- pregnancy complications, possible increased in PID
- often positive KOH whiff test
- clue cells
- pH >4.5
10
Q
Candidiasis Symptoms
A
- Females: experience genital itching or burning, cottage cheese like discharge; fire-red tissue
- Males: itchy penile rash
- pH <4.5
11
Q
Trichomans Diagnosis
A
- Culture: Sensitivity 85-90%, Specificity 100%
- Antigen Detection: Sensitivity 83%, Specificity 97%, OSOM Rapid Test
- DNA Probe: Sensitivity 60-70%, Specificity: 100%, Affirm VP III
- Wet Mount: Senstivity 83%, Specificity 97%
- no good test for males so often unteted
12
Q
Candida Diagnosis
A
- largely a clinical diagnosis
- women can take themselves to any pharmacy and treat themselves
- DNA probe: Sensitivity 80%, Specificity 98%
- Wet Mount- Sensitivity 35-45, Specificity 97-99%
13
Q
Bacterial Vaginitis Diagnosis
A
- Amsel’s Criteria- Presence of at least 3/4
- whiff test positive for fishy or musty odor when alkaline KOH solution added to smear
- clue cells (bacteria attached to borders of epithelial cells, >20% of epithelial cells) (so gram stain is gold standard)
- vaginal pH > 4.5
- a homogenous non-inflammatory discharge
14
Q
Chlamydia Symptoms
A
- Females: Up to 75% asmymptomatic
- heavy or prolonged menses
- spotting
- dysmenorrhea
- dyspareuria
- vaginal discharge
-males: up to 50% asymptomatic- itchy penile rash
15
Q
Gonorrhea Symptoms
A
- Females: 50% are asymptomatic
- yellow or blood vaginal discharge
- painful urination
- dysmenorrhea
Males: up to 50% asymptomatic
- discharge from the penis with pain
- burning during urination
- swollen testicles
