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Foundations II Exam 6 (Jess) > STIs > Flashcards

STIs Flashcards

(54 cards)

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1
Q

What populations are at high risk for STIs?

A
  • Youth (15-24)
  • Racial/ethnic minorities
  • MSM
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2
Q

What population accounts for 85% of reported primary/secondary syphilis cases?

A

MSM

- 50% dx are also HIV +

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3
Q

What is the most prevalent non-viral STI in the US?

A

Trichomoniasis (T. vaginalis)

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4
Q

How does trichomoniasis present?

A
  • MC = asx

- Can have sx 1-4wks after

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5
Q

What are sx of trichomoniasis in men?

A

Only 10% have sx

  • Urethritis
  • Epididymitis
  • Prostatitis
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6
Q

How does trichomoniasis present in women?

A
  • ↑ vaginal ph > 4.5
  • vaginal irritation & malodorous frothy yellow-green discharge
  • petechiae on cervix or vagina (“strawberry cervix”)
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7
Q

How do you dx trichomoniasis?

A
  • Wet mount
  • Swab (culture or NAAT)
  • Pap (incidental finding)
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8
Q

What is a NAAT?

A
  • technique used to detect genetic material of an organism

- faster than culture, sensitive

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9
Q

How do you tx trichomoniasis? When do you retest?

A
  • Tx pt & sexual partners
  • Metronidazole oral
  • Abstain from sex until tx complete
  • Retest within 3 mos
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10
Q

What is a complication of trichomoniasis?

A

Increases risk of acquiring/transmitting HIV

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11
Q

Trich: What are pregnancy considerations?

A
  • Increases risk of premature rupture of membranes, preterm delivery, & low birth wt
  • Lactating women should hold breastfeeding 12-24 hrs after metronidazole dose
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12
Q

What is the MC BACTERIAL STI in the US?

A

Chlamydia (C. trachomatis)

Gram -

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13
Q

What are general demorgraphics/features of chlamydia?

A
  • Peaks in late teens (20s)
  • Women ≤ 25 should be screened (or older women w/ RFs)
  • Co-infection w/ gonorrhea is common
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14
Q

What are sx of chlamydia?

A
  • MC = asx
  • Sx may occur 1-3 wks after
  • W: Cervical discharge, vag bleeding, low abd pain, F/C, adnexal tenderness
  • M: Irritated urethra, penile discharge, dysuria
  • Oral/rectal infections
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15
Q

How do you dx chlamydia?

A
  • 1st catch urine specimen, endocervix or vagina (NAAT)

- Pharynx or rectal swab (NAAT)

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16
Q

How do you tx chlamydia? When do you retest?

A
  • Tx pt & sexual partners
  • Azithro or doxy for 7 days
  • Abstain from sex during tx
  • Consider tx for gonorrhea
  • Retest in 3-4 mos
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17
Q

How do you tx pregnant pts w/ chlamydia?

A
  • Avoid doxy (category D)

- Perform test-of-cure 3 wks after therapy completion

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18
Q

What are complications of chlamydia?

A
  • Increased risk of acquiring/transmitting HIV

- If untx –> PID

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19
Q

What are complications of chlamydia in pregnant pts?

A
  • Preterm delivery

- Can transmit to baby –> conjunctivitis or pneumo

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20
Q

What are characteristics of gonorrhea?

A
  • N. gonorrhea
  • Sx occur 1-14 days after
  • Annual screen women ≤ 25
  • Can cause oral/rectal infections
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21
Q

What is the clinical presentation of gonorrhea in women?

A
  • MC = asx

- Vag discharge, low abd pain, fever, cervical motion tenderness

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22
Q

What is the clinical presentation of gonorrhea in men?

Study These Flashcards
A
  • Irritated urethra, white/yellow/green discharge, dysuria
23
Q

How do you dx gonorrhea/

Study These Flashcards
A
  • Same as chlamydia
  • Tx failure –> culture & sensitivity
  • Gram stain: PMN leuks w/ gram - diplococci
24
Q

What are complications of gonorrhea?

Study These Flashcards
A
  • Increased risk of acquiring/transmitting HIV
  • If untx –> PID
  • Conjuctivitis, meningitis, endocarditis, & disseminated disease
25
What are pregnancy considerations in gonorrhea?
Transmittable to baby - Conjunctivitis --> perforation of the globe/blindness - Requires neonatal prophylaxis - In newborns w/ sx: ocular specimens should be tested
26
What is PID? What organisms cause it?
- Inflammatory disorders of upper genital tract - Chlamydia, gonorrhea - Anaerobes, H. influenzae
27
What is the patho of PID?
Ascending infection from vagina/cervix to upper genital tract
28
What are the RFs for PID?
- < 25 - AA race - Early sexual activity - Multiple partners - Douche - IUD - Prior hx of PID
29
What is the clinical presentation of PID?
- Subtle or mild sx | - Low abd/pelvic pain, cervical motion tenderness (chandelier sign), uterine or adnexal tenderness
30
When does chronic infection occur in PID? What are the sx?
- Insufficient tx | - Vague sx
31
How do you dx PID?
- HCG - Test for GC & chlamydia - WBCs on microscopy - CBC, ESR, CRP - U/S - Endometrial biopsy - Laparoscopy
32
What is the tx for PID? When do you f/u?
- Begin prior to results - Ceftriaxone (covers GC) - Doxy (covers chlamydia) - W/ or w/out metronidazole (covers trich) - Abstinence until tx complete - F/u in 48 hrs
33
Hospitalize for PID if...
- surgical emergencies cannot be r/o - pt is pregnant - pt is not responding to abx - pt has tuba-ovarian abscess - Pt is ill: fever (>102.2), N/V
34
What are complications of PID?
- Infertility - Ruptured tuba-ovarian abscess (emergency) - Chronic pelvic pain - Increased risk of ectopic pregnancy - Fitz-Hugh-Curtis syndrome (perihepatitis w/ RUQ pain)
35
What are characteristics of herpes genitalis?
- Minimal or no sx - 4 designations: primary, non-primary 1st episode, recurrent, asx viral shedding - Commonly acquired from asx partner
36
What is the patho of genital herpes?
- shedding can occur when lesions NOT present - virus remains latent in ganglion - virus reactivated by change in immune system
37
What is the clinical presentation of genital herpes?
- Prodrome: burning, tingling, pruritus - Painful vesicles on erythematous base - 1st outbreak = most severe
38
How do you dx genital herpes?
- Clinically! confirm w/ tests - Swab of active lesions (culture, NAAT) - Cytologic detection of cell changes = Tzanck prep - Serology
39
How do you tx genital herpes? What is the duration?
- Acyclovir, valacyclovir, famiciclovir - 1st outbreak: 7-10 days - recurrent: 1-5 days
40
What are pregnancy considerations in herpes genitalis?
- Vertical transmission before, during, & after delivery - During vag delivery = MC - Most infants w/ HSV are born to mother w/ no known hx of genital HSV
41
What are 3 syndromes in neonates caused by genital herpes?
- Localized skin, eye, mouth disease (SEM) - CNS disease (encephalitis) - Disseminated disease
42
How do you prevent HSV in neonates?
- Suppressive viral therapy at or beyond 36wks gestation | - Perform C-section
43
What is the MC STI?
HPV | > 40 types
44
What is the clinical presentation of HPV?
- MC = asx - Genital warts (condyloma acuminata) - PreCA/CA changes
45
How do you dx HPV?
- Visualize warts - Abnormal pap - No test for men
46
How do you tx HPV?
- Destruction of warts (pt or provider applied) | - Tx preCA/CA changes
47
What are complications of HPV?
- 15 types --> cervical CA | - Type 16 & 18 account for 70% of cervical CA
48
How do you prevent HPV?
9-valent HPV (Gardais 9) - < 15 = 2 doses at 0 & 6-12 mos - > 15 = 3 doses at 0, 1-2, & 6 mos
49
What are pregnancy considerations in HPV?
- Rarely transmitted to neonate | - Consider C-section if pelvic outlet obstructed or if vag delivery could result in excessive bleeding
50
What are characteristics of syphilis?
- T. pallidum "Great imitator" - Increasing prevalence - Direct contact w/ infected lesion - Enters skin in 10-90 days --> painless chancre
51
What is the clinical presentation of primary syphilis?
- Incubation: 21 days - Painless chancre - Raised indurated border - Persists 3-6 wks
52
What is the clinical presentation of secondary syphilis?
- Wks to pos after chancre - lymphadenopathy - epitrochlear - Rash (common) - Condyloma lata - Mucous patches
53
What is the presentation of latent syphilis?
- Asx - No longer transmittable - May persist for yrs
54
What is the presentation of LATE syphilis?
- May appear 10-20 yrs after - Develops in 15% of those untx - Causes neuro deficits & damage to internal organs

Foundations II Exam 6 (Jess) (4 decks)

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