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STIs Flashcards

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1
Q

clinical presentation

  • vaginal discharge
  • odor
  • pruritus
  • discomfort
A

vaginitis

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2
Q

what are the 3 most common causative agents of vaginitis

A
  • vulvovaginal candidiasis
  • bacterial vaginosis
  • trichomoniasis
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3
Q

is vulvovaginal candidiasis a STI

A

no, it is a common yeast infection

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4
Q

what is the most common causative agent of vulvovaginal candidiasis

A

candida albicans

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5
Q

clinical presentation

  • vulvar pruritus, external dysuria, burning, dyspareunia
  • thick, curd-like vaginal discharge
  • normal vaginal pH (4-4.5)
A

vulvovaginal candidiasis

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6
Q

what are the risk factors for getting vulvovaginal candidiasis

A
  • abx
  • immunosuppressed
  • pregnant
  • oral contraceptives
  • steroids
  • wearing tight clothes
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7
Q

how is vulvovaginal candidiasis diagnosed

A
  • wet prep (saline and 10% KOH)
    • visualize budding yeasts and hyphae
  • vaginal cultures for Candida
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8
Q

what characteristics classifies a vulvovaginal candidiasis infection as uncomplicated

  • symptom severity
  • frequency
  • organism
  • host
A
  • mild or moderate symptom severity
  • sporadic frequency, < or = 3 times per year
  • caused by candida albicans
  • healthy, non pregnant women
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9
Q

what characteristics classifies a vulvovaginal candidiasis infection as complicated

  • symptom severity
  • frequency
  • organism
  • host
A
  • severe
  • recurrent, > or = 4 x per year
  • nonalbicans species
  • pregnant, uncontrolled DM, immunosuppressed
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10
Q

tx for uncomplicated vulvovaginal candidiasis

A
  • topical azole 1-3 days
    • e.g. clotrimazole
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11
Q

tx for complicated vulvovaginal candidiasis

A
  • topical azole x 7-14 d or
  • oral fluconazole
    • if nonalbicans, avoid fluconazole
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12
Q

does male parterner need treatment if female partner is diagnosed with vulvovaginal candidiasis?

A
  • No, unless he has balanitis
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13
Q

Is bacterial vaginosis an STI

A
  • No
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14
Q

what is the most common cause of vaginal discharge in women of childbearing age

A
  • bacterial vaginosis
    • results from disruption of usual, healthy vaginal microflora (lactobacillus sp.)
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15
Q

causative agent of bacterial vaginosis

A
  • usually polymicrobial
    • ​often associated with Gardnerella vaginalis
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16
Q

clinical presentation

  • thin white or gray discharge
  • strong fishy odor
A

bacterial vaginosis

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17
Q

name risk factors for bacterial vaginosis

A
  • new or multiple sex partners
  • douching
  • can affect women that are not sexually active
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18
Q

how is bacterial vaginosis diagnosed

A
  • Amsel’s criteria- presence of at least 3
    1. ​think white homogenous discharge
    2. clue cells on microscopy
    3. vaginal fluid pH > 4.5
    4. fish odor of vaginal discharge before or after addition of 10% KOH
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19
Q

tx of bacterial vaginosis

A
  • treat symptomatic
  • metronidazole PO or metronidazole gel or clindamycin cream
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20
Q

does male partner need tx if female partner diagnosed with bacterial vaginosis

A

No

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21
Q

patients should not take when taking metronidazole

A
  • ETOH
    • cause Disulfiram-like reaction
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22
Q

complications of having bacterial vaginosis

A
  • increased risk of acquiring HIV, HSV-2, gonorrhea, and chlamydia
    • should be tested
  • increased risk of PID
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23
Q

is Trichomoniasis an STI

A
  • yes
  • most prevalent nonviral STI in the U.S.
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24
Q

causative organism of Trichomoniasis

A

trichomonas vaginalis

  • single celled protozoan parasite
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25
most patients (70-85%) infected with Trichomoniasis have what symptoms
* minimal or **no symptoms**
26
clinical presentation * vaginal pH \> 4.5 * vulvar irritation * **malodorous, frothy, yellow-green vaginal discharge** * may see **petechiae** on vagina and cervix ("**strawberry** cervix")
Trichomoniasis
27
how do symptomatic men present with Trichomoniasis
* urethritis * **clear or mucopurulent** urethral discharge and/or dysuria
28
how is Trichomoniasis diagnosed
* wet mount: motile organisms * nucleic acid amplification tests (NAATs) * culture
29
how is Trichomoniasis treated
metronidazole * treat patient and partners
30
pregnancy considerations for Trichomoniasis
* increased risk of premature rupture of membranes, preterm delivery, low birth * tx recommended for pt's with symptoms * lactating women should withhold breastfeeding while taking metronidazole
31
Trichomoniasis retesting protocol
* recommended for all sexually active women within 3 months following initial tx regardless of whether they believe their sex partners were treated
32
what pt population most commonly affected with chlamydia
\< or = 24 yo
33
majority of pts affected with chlamydia have what symptoms
asymptomatic
34
most frequently reported infectious disease in the US
chlamydia
35
causative organism of chlamydia
chlamydia trachomatis * gram -
36
chlamydia and gonorrhea screening recommendations
* women * yearly testing for sexually active women \< 25 yrs old * older women with risk factors * men * consider in clinical settings with high prevalence or in high risk populations * correctional facilities * MSM
37
risk factors for chlamydia
* new sex partner * more than 1 sex partner * sex partner with concurrent partners * sex partners with an STI
38
clinical presentation in women * **cervicitis** * purulent or mucopurulent vaginal discharge and or intermenstrual or postcoital bleeding * urethritis * dysuria, **urinary frequency** * PID
chlamydia
39
clinical presentation in men * **urethritis** * penile dx (**mucoid or watery**), dysuria * epididymitis * prostatitis
chlamydia
40
how is chlamydia and gonorrhea diagnosed
nucleic acid amplifciation testing (NAAT) * women: vaginal preferred * men: first-catch urine preferred
41
tx chlamydia
* azithromycin or doxycycline * treat patient and partner
42
consequences of trichomoniasis
* vaginitis * PID * infertility * HIV
43
complications of chlamydia and gonorrhea
* increased risk of HIV * if untreated, can cause PID, ectopic pregnancy, and infertility
44
chlamydia pregnancy considerations
* may lead to preterm delivery * transmittable to neonate during delivery * ophthalmia neonatorum * pna * **avoid doxycycline (cat D)**
45
majority of patients with gonorrhea present with what symptoms
asymptomatic
46
patients with chlamydia often have a co-infection with
gonorrhea (and vice versa)
47
causative organism of gonorrhea
* neisseria gonorrhoeae
48
clinical presentation in women * **cervicitis** * urethritis * **dysuria** * cervical mucosa often friable
gonorrhea
49
clinical presentation in men * urethritis * **purulent or mucopurulent penile dx** * dysuria * epididymitis
gonorrhea
50
how is gonorrhea treated
* **dual therapy** * **​ceftriaxone + azithromycin** * treat patient and partner
51
gonorrhea: pregnancy considerations
* treat with dual therapy * transmittable to neonate during delivery * ophthalmia neonatorum * sepsis * arthritis * meningitis
52
what are the two most common causes of nongonococcal urethritis (NGU)
* Chlamydia trachomatis * Mycoplasma genitalium
53
what is pelvic inflammatory disease
* refers to a **spectrum** of inflammatory disorders of the **upper female genital tract** * **​**endometriosis * salpingitis * tubo-ovarian abscess * pelvic peritonitis
54
causative organisms of pelvic inflammatory disease
* most common: chlamydia and gonorrhea * G. vaginalis, H. influenzae
55
Cervical motion tenderness is commonly seen with acute pelvic inflammatory disease. what is this called
chandelier's sign
56
risk factors of pelvic inflammatory disease
* age \< 25 * african american, black-caribbean ethnicity * early onset of sexual activity * multiple partners * IUD (within first 3 weeks) * prior STD * douching
57
how is pelvic inflammatory disease diagnosed
* clinical * sexually active women * pelvic or lower abd pain * chandelier's sign
58
complications of pelvic inflammatory disease
* recurrent PID * infertility * chronic pelvic pain * ectopic pregnancy * Perihepatitis: Fitz-Hugh–Curtis syndrome (RUQ pain and adhesions)
59
why is herpes simplex virus so common
* many infected are asymptomatic but can still transmit infection * viral shedding can occur when lesions are **not** present
60
how is genital herpes transmitted? average incubation period
* skin to skin contact * average incubation: 4 days
61
differentiate between primary, nonprimary first episode and recurrent genital herpes
* **primary**: infection in a patient without preexisting antibodies to HSV 1 or 2; **most severe** * **nonprimary first episode**: acquisition of HSV 2 with preexisting antibodies to HSV 1 (and vice versa) * **recurrent:** reactivation of genital HSV
62
clinical presentation * can be asymptomatic * multiple, extremely **painful**, genital vesicles/ulcers * local tingling, burning and or pruritis * dysuria * tender inguinal lympadenopathy
genital herpes: herpes simplex virus
63
how is herpes simplex virus diagnosed
PCR preferred
64
tx of herpes simplex virus: genital herpes
* treat with **cyclovir** * **​**must reduce dose in patients with renal insufficiency
65
herpes simplex virus: genital herpes pregnancy considerations
* transmission to neonate during labor and delivery * cesarean reduces risk * use antiviral meds during pregnancy (acyclovir) at 36 weeks gestation through delivery * 3 syndromes * localized skin, eye, mouth disease (SEM) * encephalitis * disseminated disease
66
how is HPV transmitted
* contact with infected genital skin, mucous membranes, body fluids
67
patients with human papillomavirus typically have what symptoms
asymptomatic
68
clinical presentation * visible genital warts **condyloma acuminata** * **​**soft, flesh colored * single or multiple, flat, cauliflower-like
human papillomavirus * precancerous/cancerous \*\*
69
what types of HPV are strongly associated with anogenital dysplasia and carcinoma
16, 18, 31, 33, 35
70
vaccines for human papillomavirus
* **cervarix** * girls * HPV 16, 18 * **gardasil** * girls and boys * 4vHPV: 16, 18, 6, 11 * 9vHPV * routinely given at 11-12 yo
71
causative organism of syphilis
bacterium treponema pallidum
72
clinical presentation * **painless chancre** * ulcer with a raised, indurated margian
primary syphilis
73
presentation of secondary symphilis
* appears 2-6 months after primary infection * often starts with **rash** * **​**non-pruritic * characteristically on **palms and soles of feet** * **condyloma lata** * **​**large, raised, flat topped lesions in anogenital region and mouth * **mucous patches** * **​**flat patches in oral cavity
74
differentiate between early and late latent stage of syphilis
* early latent: infection occured \< 1 yr ago * late latent: infection occured \> 1 yr ago * less contagious
75
what signs are characteristic of tertiary syphilis
* **neurosyphilis** * **gummas** * destructive, necrotic granulomatous lesions
76
how is syphilis diagnosed
* **direct** visualization of organism in clinical speciman * darkfield microscopy * **serologic** tests * **nontreponemal test** (screening) * _RPR_ and _VDRL_ (on CSF) * **specific treponemal test** (confirmatory) * fluorescent treponemal antibody absorption (FTA-ABS)
77
a complication of syphilis is jarisch-herxheimer reaction. what is this
* an acute febrile rxn with a HA and myalgias that occurs during PCN therapy
78
pregnancy considerations for syphilis
* transmission during gestation or intrapartum * treat with PCN * routine screening at 1st prenatal visit * residual stigmata * hutchinson teeth
79
What is lymphogranuloma venereum
* caused by chlamydia tranchomatis * self limited ulcer or papule at site of inoculation * causes systemic infection * **bubo** (unilateral, painful, inguinal lymph node)
80
Chancroid * causative agent? * description
* Haemophilus ducreyi * **painful** genital ulcer + tender suppurative inguinal adenopathy
81
What are the five P's: important questions to ask when patient presents with possible STI
* partners * prevention of pregnancy * protection from STIs * practices * kind of sex you have had recently? vaginal, anal, oral * past h/o STIs
82
retesting is recommended for what STIs
* chlamydia * gonorrhea * trichomonas
83
When should HIV be screened for
* 13-64 yo * all persons who seek evaluation and tx for STIs

women's health (5 decks)

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