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Clinical medicine > STIs > Flashcards

STIs Flashcards

1
Q

What is the vaginal flora?

A

lactobacilli predominate

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2
Q

What factors alter vaginal microflora?

A

abx, douching, sex

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3
Q

What does a fishy or amine odor indicated?

A

trich or BV

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4
Q

What does epithelial cells w/ irregular, granular edges suggest?

A

clumped bacteria on cell wall, highly suggests BV if in more than 20% of cells

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5
Q

What are 90% of vaginitis cases caused by?

A

Bacterial vaginosis (40-50%), vulvovaginal candidiasis, trich

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6
Q

What is mucopurulent cervicitis caused by?

A

chlamydia, neisseria gonorrhoea, mycoplasma, BV associated

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7
Q

What is the most common cause of bacterial discharge?

A

BV- gardnerella vaginalis

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8
Q

What are risk factors of getting BV?

A

new sexual partner, smoking, intrauterine device, and frequent douching

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9
Q

What are frequent features of BV discharge?

A

profuse, milky, nonadherent discharge that demonstrates an amine or fishy odor after alkalization with drop KOH, clue cells

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10
Q

What is the Amsel criteria?

A

characteristic vaginal discharge, elevated pH>4.5, clue cells, fishy odor

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11
Q

What is the gold standard for diagnosis using nugent or hal/ison criteria?

A

gram stain

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12
Q

What is not useful for diagnosing BV?

A

pap smear

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13
Q

What can happen if a pregnant woman gets BV?

A

preterm delivery

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14
Q

What is BV a risk factor for?

A

HIV and herpes simplex virus Type 2, gonorrhea, chlamydia, trich

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15
Q

What is the treatment for BV

A

resolves spontaneously in 1/3 of non pregnant, and 1/2 of pregnant women, otherwise, nonpreg- Flagyl 500mg bid x 7 days or clindamycin 2% cream dailyx7 days, if pregnant- clindamycin 300 mg BID 7 days, or flagyl 500mg BID 7 days

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16
Q

What are the common species for Vulvovaginal candidiasis?

A

candida albicans and candida glabrata

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17
Q

How many women acquire VVC in their life?

A

75%

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18
Q

What are risk factors for recurrent VVC?

A

high dose oral contraceptives, diaphragm, DM, ABX, pregnancy, immunocompromised, tight clothing

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19
Q

What is the classical presentation of VVC?

A

itching, burning, irritation, postvoiding dysuria, thick, curdy discharge with pH less than 4.7

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20
Q

Why would you get a fungal culture if you suspect VVC?

A

if the women has significant clinical findings but a normal wet-mount prep

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21
Q

What is the first line treatment of VVC?

A

azoles, diflucan oral, nystatin 100,000 units bid

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22
Q

What is the most common non viral STI?

A

trich

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23
Q

What is trich caused by?

A

protozoan T. vaginalis

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24
Q

How many people with trich infection are asymptomatic?

A

50%

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25
Q

What is the classical sx of trich?

A

green-yellow, frothy vaginal discharge with a musty odor, sometimes dyspareunia, vulvovaginal irritation, dysuria, strawberry cervix

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26
Q

What is the treatment of Trich?

A

flagyl, 2 g dose or 500 mgx4, or 500 mg BID x7 days

27
Q

When should you retest for trich?

A

2 weeks after treatment

28
Q

What happens if trich goes untreated?

A

adverse reproductive outcomes, cervical neoplasm, posthysterectomy cuff cellulitis or abcess, PID and infertility

29
Q

What if untreated in pregnant woman?

A

premature rupture of membranes, preterm delivery or delivery of LBW infant

30
Q

What is the appearance of atrophic vaginitis?

A

pale in color, usually older women

31
Q

What is the treatment of atrophic vaginitis

A

moisturizers and lubricants, topical estrogen, premarin cream

32
Q

What can help improve atrophic vaginitis?

A

sex with lubricants, vaginal dilators, pelvic PT

33
Q

How many people infected with herpes know they are infected?

A

10-20%

34
Q

What is primary infection of HSV?

A

fever, malaise, HA, painful genital lesions, dysuria, sx can last 2-4 weeks, will reoccur ~4 times per year without treatment

35
Q

What is the clinical presentation of HSV?

A

multiple, bilateral, painful anogenital vesicles or ulcers w/ erythematous base, heal without scarring in 2-3 weeks

36
Q

What are lab tests to diagnose HSV?

A

viral culture of lesion, PCR, type-specific serologic test for HSV abs

37
Q

What are goals of treating HSV?

A

symptoms relief, accelerated lesion healing, decrease frequency or recurrence

38
Q

What are the treatment options for HSV?

A

acylclovir 400 mg TID or 200 mg 5/day for 7-10 days, Famciclovir 250 mg TID 7-10 days, valacyclovir 1000 mg BID 7-10 days

39
Q

What are suppressive options for HSV?

A

acyclovir 400 mg BID, famciclovir 250 mg BID, valacyclovir 500 mg/1000 mg daily

40
Q

What are pearls of early syphillis

A

occurs within 1 year, chancre at site of inoculation, then develop systemic illness, (rash, fever, HA, malaise, anorexia, diffuse lympadenopathy

41
Q

At which stage of syphilis is it not transmissible?

A

the late latent, except pregnant women who can continue to transmit to fetus for four years

42
Q

What are pearls of late syphilis?

A

can appear 1-30 years after primary infection, CNS involvement, CV, gummatous syphilis with nodular lesions skin and bones

43
Q

Who should be screened for syphilis?

A

pt with suspected disease, high risk populations (inmates, multiple sexual partners), women attending antenatal or family planning clinics

44
Q

What is the DOC for early/late syphilis?

A

penicillin G benzathine 2.4 million units once for early x21 days for late, or doxycycline 100 mg BID x 14 days for early, x4 weeks for late

45
Q

What is the DOC for neuro syphilis?

A

penicillin G procaine 2.4 million units IM daily and probenacid 500 mg QID for 10-14 days

46
Q

What is the cause of chancroids

A

haemophilus ducreyi bacterium, a gram negative rod the forms “school of fish” chains, co-infection with HIV is common

47
Q

What is the appearance of chancroids?

A

open, red and painful sores, papule evolves into pustule then ulcer, it bleeds when scraped

48
Q

How is chancroids diagnosed?

A

pt has one or more painful genital ulcers, with no evidence T. pallidum infection by dark field exam of ulcer exudate or by serologic testing, also negative test for HSV, identification of H. Ducreyi on special culture

49
Q

Treatment of chancroids

A

treat for chancroids and syphilis, Ceftriaxone 250 mg, Azithromycin 1 g both once, erythromycin 500 mg QID x7 days, bactrim, cipro 500 mg PO BID x 3 days

50
Q

about how many adults will be infected with HPV?

A

75%

51
Q

Presentation of HPV

A

warty growths called condylomata acuminata on vulva, vagina, cervix, urethra or perianal area

52
Q

What are the HPV vaccines?

A

gardasil (serotypes 6,8,16,18), and a high risk vaccine (serotypes 16,18,31,33 ,35, 39, 45….), the vaccine are 95% effective

53
Q

What diagnostic test is done in women w/ HPV?

A

cervical cancer screening, after age 30 if have had normal pap smears, retest every 5 years

54
Q

What is the treatment of HPV?

A

symptomatic and screenin, life style modifications, smoking cessation, wt lose, exss, eat well, vitamins

55
Q

What infection has highest incidence of any bacterial STI in US?

A

chlamydia, 70% of infected females an d50% of males have no symptoms

56
Q

What are the symptoms of chlamydia?

A

mucopurulent cervicitis, mucopus, yellow discharge coming from swollen, red, friable cervix that bleeds easily, acute urethritis w/ dysuria but minimal freq and urgency and neg urine culture

57
Q

Diagnostic test for chlamydia?

A

swab female cervix, male urethra and sumbit for testing or collect urine, nucleic acid amplification, culture

58
Q

What is the prognosis for females w/ chlamydia?

A

can lead to PID, perihepatitis, pregnancy complications, proctitis, infertility

59
Q

What is the prognosis for males with chlamydia?

A

urethritis, epididymitis, prostatitis, proctitis, reactive arthritis

60
Q

Treatment of chlamydia

A

azithromycin, 1g orally, or doxycycline 100 mg BIDx7 days, treat all sexual contacts w/in last 60 days, test for other STIs, abstain from sex x7 days

61
Q

Treatment of gonorrhea?

A

ceftriaxone 250mg IM x1, treat chlamydia too, reat all sexual contacts, no sex during treatment, test for other STDs

62
Q

How often will PID develop in inadequately treated gonorrhea or chlamydia?

A

15-30%

63
Q

Women with PID are more likely to have what?

A

ectopic pregnancy and infertility

64
Q

SX of PID

A

lower abd pain, esp w/ walking or coitus, abs vaginal discharge, fever, uterine and adnexal tenderness to palpation and motion, mucopurulent cervicitis, cervical motion tenderness

Clinical medicine (19 decks)

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