STIs

Question 1

3 most common types of vaginitis

Answer 1

• Bacterial vaginosis
• Vulvovaginal candidiasis
• Trichomoniasis

Question 2

Vaginitis usually involves these sx’s, regardless of etiology

Answer 2

Itch & discharge

Question 3

Bacterial vaginosis is mostly due to ________

Answer 3

Gardnerella vaginalis

Question 4

Vulvovaginal candidiasis is mostly due to _______

Answer 4

Candidiasis albicans

Question 5

Sx’s associated with bacterial vaginosis

Answer 5

• Asymptomatic
• Malodorous, fishy smell
• Pruritic discharge
• Thin, milky-white/grey discharge

Discharge esp. after sex or menses

Question 6

Sx’s associated with Candidiasis

Answer 6

• Dysuria

- Thick, cottage cheese-like discharge

Question 7

Sx’s associated with trichomoniasis

Answer 7

• Mostly asx
• Frothy, malodorous discharge
• Strawberry cervix (cervical petechiae)

Question 8

Identify etiology of vaginitis by vaginal pH

Answer 8

≤4.5 = Normal or candidiasis 
>4.5 = Bacterial vaginosis or trichomoniasis

Question 9

Dx bacterial vaginosis

Answer 9

Amsel criteria → 3+ of the following:

• Vaginal pH >4.5
• > 20% “clue cells” per high-power field on wet mount
• Positive amine or “whiff” test
• Homogenous, non-viscous milky discharge adherent to vaginal walls

+Affirm VPIII for G. vaginalis DNA
Vaginal sialidase activity test (OSOM PV test)

Question 10

Dx candidiasis

Answer 10

Mostly clinical (cottage cheese discharge)

• Pseuodohyphae & budding yeast on KOH prep
• Few to many WBCs on wet mount

If both negative or recurrent → culture

Question 11

Dx trichomoniasis

Answer 11

• Nucleic acid amplification test (Aptima) via urine/genital swab
• Rapid antigen test (Affirm VPIII) or nucleic acid probe test (DNA hybridization)
• Wet mount: Motile flagellated protozoa, many WBCs
• Vaginal Cx

Question 12

Tx gonorrhea

Answer 12

ceftriaxone 250mg IM x1 PLUS azithromycin 1g PO x1

Question 13

Tx chlamydia

Answer 13

azithromycin 1g PO x1 OR doxycycline 100mg PO bid x7d

Question 14

Treat GC/chlamydia w/ epididymitis (i.e. complicated)

Answer 14

ceftriaxone 250mg IM x1 PLUS doxy 100mg bid x10-21d

Question 15

Tx GC/chlamydia with proctitis (i.e. complicated)

Answer 15

ceftriaxone 250mg IM x1 PLUS doxy 100mg bid x7-21d

Question 16

Repeat testing after tx for GC/chlamydia in pregnant pt

Answer 16

NAAT re-test in 3wks

Question 17

Repeat testing after tx for GC/chlamydia in nonpregnant pt

Answer 17

In 3-4 months AND screen at next health care visit

No test of cure unless compliance is in question, sx’s persist, or re-infection

Question 18

Counseling for GC/chlamydia pt

Answer 18

• Avoid sex until pt and partners are cured (asx for 7 days)

- Tx partners within last 60 days

Question 19

Sx’s of GC/chlamydia in women

Answer 19

Dysuria, mucopurulent discharge, CMT, pruritic/tender uterus, PID sx’s, bleeding, cervicitis (red/friable)

Question 20

Sx’s of gonorrhea in men

Answer 20

• White, yellow, or green discharge +/- penile edema

Question 21

Sx’s of chlamydia in men

Answer 21

Clear mucoid or watery urethral discharge, maybe only w/ milking

Question 22

Most cases of PID are ______

Answer 22

Polymicrobial - N. gonorrhoaea & C. trachomatis

Question 23

Risk factors of PID

Answer 23

• Adolescence
• Low socioeconomic status
• Multiple partners
• Hx of GC/chlamydia
• Bacterial vaginosis
• Current douching
• IUD
• OCP (some cases)

Question 24

Si/Sx’s of HPV infection

Answer 24

Most cases have are transient, with no manifestations

• Dyspareunia, pruritus, burning, bleeding
• Genital warts → condylomata acuminata, smooth/flat papules, keratotic
• Pap abnormalities

Question 25

Tx HPV

Answer 25

Pt-applied → podofilox gel/solution, imiquimod, or sinecatachins ointment (not in HIV pts) Provider-applied → cryotherapy, podophyllin resin in benzoin, trichloracetic acid, bichloracetic acid, surgical removal **Thearpies reduce but don't eliminate infectivity

Question 26

When do HPV sx's clear?

Answer 26

Many recur within 6-12 wks of tx but clear by 6 months

Question 27

HSV-1 vs. HSV-2

Answer 27

HSV-2 more common in women and more prone to recur

Question 28

T or F: antiviral therapy dramatically reduces HSV shedding in asx pt but doesn't completely eliminate it

Answer 28

True

Question 29

HSV tx

Answer 29

Valacyclovir → partially controls sx's but does NOT eradicate latent virus; does NOT affect recurrence - 1st ep → 1g PO bid x7-10d - Suppressive → 1g PO qd - Episodic → 500mg PO bid x3days OR 1g PO qd x5days

Question 30

Patient education/counseling for HSV

Answer 30

- Natural hx of infection, tx options, transmission, neonatal prevention - Prodromal sx's for episodic tx - Emphasize potential for recurrence, asx viral shedding/transmission - Inform all sex partners - Abstinence when lesions/prodrome present

Question 31

Stages of syphilis

Answer 31

Primary vs. Secondary vs. Latent vs. Tertiary (Late)

Question 32

High-risk population of syphilis

Answer 32

MSM, esp. blacks

Question 33

Sx's associated w/ primary syphilis

Answer 33

Chancre - painless indurated lesion w/ non-exudative clean base; heal spontaneously in 3-6wks Serology may not be positive during early phase

Question 34

Sx's associated w/ secondary syphilis

Answer 34

Palmar/plantar rash, may last for months Serology highest in this stage

Question 35

Sx's associated w/ latent syphilis

Answer 35

No lesions, only positive serology Early latent → <1 yr duration Late latent → ≥1 yr duration or unknown

Question 36

Sx's associated w/ late/tertiary syphilis

Answer 36

Gummatous lesions, CV syphilis - may occur at any point up to 30 yrs after primary infection

Question 37

Dx syphilis

Answer 37

Serology - must use more than one test - Darkfield microscopy - Non-treponemal (Reagin Ab) → can measure tx efficacy - Treponemal (antibody) → more specific but can't measure tx efficacy

Question 38

When should you screen for syphilis?

Answer 38

1st prenatal visit of pregnant women, esp. if hx stillborn after 20wks Anyone else suspicious