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Foundations- ID/Derm > STIs > Flashcards

STIs Flashcards

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1
Q

high risk populations for STIs ?

A

youth (15-24 y/o)

racial & ethnic minorities

MSM > syphilis

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2
Q

Causative organisms for thichonomiasis?

A

Trichomonas vaginalis - single celled protozoan parasite

MC non-viral STI in US

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3
Q

thichonomiasis presentation

A

usually asxs

men: <10% urethritis, epididymitis, prostatitis
women: frothy DC, purulent green/yellow DC, starberrry cervix, increased vag PH

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4
Q

Dx trichomoniasis?

A

visualize motile organisms on wet mount

-swab for culture, nuclei acid amplification test

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5
Q

If you have a pt who has trichomoniasis on pap should you treat?

A

NO

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6
Q

Tx for trichomoniasis?

A

tx pt + sexual partners

Rx: Metronidazole (Flagyl)

abstain from sex until tx completed

retest in 3 mos

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7
Q

Comps for trichomoniasis?

A

increase risk of acquiring and transmitting HIV

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8
Q

What is the MC bacterial STI in US?

A

chlamydia

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9
Q

Causative organism for chlamydia?

A

Chlamydia trachomatis - gram neg bacterium

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10
Q

Who should be screen for chlamydia?

A

women <25

older women with RFs

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11
Q

Patients with chlamydia are often co-infected with…

A

gonorrhea

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12
Q

Presentation for chlamydia

A

MC: asxs

women: dysuria, burning pain, cervical DC, lower abd pain

Men: dysuria, urethritis

can also cause oral and rectal infx

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13
Q

Dx of chlamydia?

A

specimen from first catch urine
-NAAT

pharynx or rectal swab

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14
Q

Tx for chlamydia?

A

tx everyone!

Azithromycin (single dose)
OR
Doxycycline for 7 days

abstain from sex

consider tx

retest in 3-4 months

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15
Q

Who needs a test of cure 3 weeks after therapy completion for chlamydia?

A

pregnant pts

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16
Q

Comps of chlamydia

A

increase risk of HIV

if untx > can cause PID

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17
Q

Pregnancy consideration for clamydia?

A

preterm delivery

can transmit to neonate during delivery

avoid doxy

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18
Q

Causative organism of gonorrhea? when do sxs typically occur?

A

Neisseria gonorrhea - gram neg diplococci bacterium

1-4 days after exposure

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19
Q

Screening for gonorrhea?

A

Targeted annual screening for all sexually active women <25 years old is recommended

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20
Q

Presentation for gonorrhea

A

large amounts of purulent DC

Women: usually asxs

typically worse in men

can cause oral and rectal infx

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21
Q

Dx of gonorrhea

A

Same as chlamydia

Suspected or documented treatment failure = culture and sensitivity

Gram stain: PMN leuks with intracellular Gram-negative diplococci

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22
Q

Tx for gonorrhea?

A

Tx everyone!

Ceftriaxone (Rocephin) 250mg IM

+ Azithromycin 1g PO or doxy

abstain from sex during tx

retest in 3-4 months

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23
Q

Comps of gonorrhea?

A

increase risk of HIV

PID

conjunctivitis, meningitis, endocarditis, disseminated disease

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24
Q

pregnancy consideration for gonorrhea

A

transmittable to neonate during delivery

-causes conjunctivitis: ophthalmia neonatorum for all neonates

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25
What is PID?
Refers to spectrum of inflammatory disorders of the upper genital tract causes: STIs, other pathogens
26
Patho of PID?
Ascending infection from vagina or cervix to upper genital tract
27
RF for PID?
``` Age < 25 African American race Early onset of sexual activity Multiple partners Douche IUD (only within 3 wks of insertion) Prior history of PID ```
28
Presentation of PID?
may have subtle or mild sxs low abd pain/pelvic pain, CMT, uterine or adnexal tenderness, dyspareunia, cervicial friability
29
When can chronic PID infx occur?
due to insufficient tx
30
testing for PID?
``` Serum quantitative HCG GC & chlamydia test Check for WBCs on saline microscopy of vaginal fluid CBC, ESR, CRP Ultrasound endometrial bx laparoscopy ```
31
Tx for PID?
consider empiric tx: Rocephin for gonorrhea Doxy for chlamydia abstinence until tx completed FU in 48 hrs Hospitalize if emergencies can't be r/o or other comp
32
comps of PID?
infertility ruptured tubo-ovarian abscess chronic pelvic pain increased risk of ectopic Fitz hugh curtis syndrome
33
What is Fitz Hugh Curtis syndrome?
Perihepatitis characterized by RUQ pain & adhesions
34
HSV2 usually causes...
genital herpes
35
most people infx with herpes have...
minimal or no sxs commonly acquired from an asxs partner
36
4 designations for herpes?
Primary: no herpes abs Non-primary 1st episode: type 1 abs, then exposed to type 2 or vice versa Recurrent: already had abx Asymptomatic viral shedding: no sxs but can transmit
37
Transmission of genital herpes?
contact with lesions viral shedding when lesions not present virus remains latent in nerve root ganglion -can be reactivated by a change in immune status
38
presentation of genital herpes
Prodrome of burning, tingling and/or pruritus followed by outbreak of painful vesicles on erythematous base Initial (primary) outbreak tends to be the most severe
39
Dx of genital herpes?
clinical confirm with labs swab of active lesions Cytologic detection of cellular changes = Tzanck preparation Serology (blood test): test for HSV1 and HSV2
40
When do HSV1 and HSV2 abs appear?
3-4 wks after exposure
41
Tx for genital herpes
Antiviral: Acyclovir Initial outbreak: 7-10 days Recurrent outbreak: 1-5 days Suppression
42
Preg considerations for genital herpes
vertical transmission -C section put on antiviral prior to delivery Most (70-95%) infants with neonatal HSV are born to mothers with no known history of genital HSV -avoid sex (vaginal/oral) with partners with suspected or have herpes
43
What are the 3 possible neonatal HSV syndromes?
Localized Skin, Eye, Mouth (SEM) disease ``` CNS disease (eg. encephalitis) -Long-term morbidity common (eg. mental retardation) ``` Disseminated disease -high mortality
44
How can we prevent neonatal HSV?
offer women suppressive viral therapy or c-sec if outbreak at time of delivery
45
HPV can infect...
genital area incl. skin of vulva, lining of vagina, penis, anus Can also infect mouth, throat MC STI
46
presentation of HPV?
most asxs visible genital warts (condyloma acuminate) -soft, flesh colored -single or multiple preCA/CA changes
47
Dx of HPV
visualize warts - vinegar solution: warts may turn white - biopsy abn pap no test for men
48
Tx for HPV?
no cure destruction of warts tx precancerous/cancerous changes
49
comps of HPV?
15 types lead to cervical CA 16& 18 = 70%
50
Prevention of HPV?
vaccination | -9 valent HPV (Gardasil 9)
51
Preg considerations for HPV?
not usually transmitted during delivery c-sec -if pelvic outlet obstructed or vag delivery would result in excessive bleeding
52
Causative agent for syphilis? patho?
Bacterium Treponema pallidum Transmitted through direct contact with infected lesion (genitals, anus, lips, mouth) Bacteria enter the skin & in 10-90 days create a painless chancre
53
syphilis presentation
"the great imitator" Primary Secondary: Latent Late (Tertiary)
54
Primary syphilis presentation?
Primary: painless chancre, papule that ulcerates. Raised indurated border.
55
Secondary syphilis presentation?
multiple manifestations: weeks to a few months after chancre Constitutional symptoms Lymphadenopathy - epitrochlear Rash (very common) Diffuse, symmetric, macular or popular, usually non-pruritic Characteristically on palms & soles of feet condyloma lata mucous patches
56
Describe condyloma lata
Moist, heaped, wart-like papules Occur in intertriginous areas (most commonly gluteal folds, perineum, perianal area) Highly contagious
57
Describe mucous patches
Painless flat patches involving the oral cavity, pharynx, genitals - not painful (pt may be unaware of patches) Highly infectious
58
presentation of latent syphilis?
asxs Syphilis no longer sexually transmittable May persist for yrs
59
presentation of late syphilis?
May appear 10-20 yrs after infection acquired Develops in 15% of those untreated Causes neurologic deficits
60
presentation of neurosyphilis?
can happen at any stage Cranial nerve dysfunction, auditory or ophthalmic abnormalities, meningitis, stroke, altered mental status, loss of vibratory sense
61
Dx of syphilis?
bacteria (from chancre) under dark field microscopy serology non treponemal serological assays > treponemal serological assays- confirms
62
What do you need to test if you are concerned for neurosyphilis?
CSF testing
63
Tx of syphilis
tx everyone Benzathine PCN G if PEN all: Oral doxycycline FU clinical and serological eval retreatment: weekly benzathine PCN G 2.4 mu IM x 3 weeks
64
Tx for PCN all pts who have HIV or are pregnant?
PCN
65
Comps of syphilis?
HIV late syphilis
66
preg considerations?
congenital syphilis | -stillbirth, neonatal death, infant disorders
67
Prevention of congenital syphilis?
screen preg women at 1st prenatal visit if high risk, sexual hx again at 28 wks & at delivery if pt is PCN allergic consider desensitization with oral PCN monitor serology to confirm tx success
68
Presentation of congenital syphilis early v. late?
Early congenital syphilis Asymptomatic at birth Symptom onset – usually about 5 weeks Manifestations prior to 2 years Late congenital syphilis Manifestations after 2 years
69
sxs of congenital syphilis?
``` Placenta/umbilical cord abnormalities Hepatomegaly Jaundice Nasal discharge Rash Generalized lymphadenopathy Deformed bones ```
70
What is Hutchinson triad?
highly specific for congenital syphilis? Hutchinson teeth- wide spaced Interstitial keratitis Sensorineural hearing loss
71
Comps of tertiary syphilis?
Multi- organ involvement i.e. brain, nerves, eyes Gummatous syphilis Cardiovascular syphilis
72
Causative agent of chancroid?
Haemophilus ducreyi
73
presentation of chancroid?
Painful tender genital ulcer Lesion produces foul-smelling discharge (that’s contagious) Inguinal adenitis (buboes)
74
dx of chancroid?
Rule out syphilis, herpes If Chancroid suspected, contact County Health Dept
75
Causative organism of Lymphogranuloma venereum (LGV)? presentation?
Chlamydia trachomatis
76
What STIs should be screened for in all preg. patient?
HIV, syphilis, HBsAg

Foundations- ID/Derm (5 decks)

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