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Clin Med- P > STIs > Flashcards

STIs Flashcards

1
Q

what is the most common STI?

A

chlamydia (1 in 4 people)

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2
Q

what aged people are the highest rates of gonorrhea and chlamydia?

A

females aged 15-19

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3
Q

5 P’s of Sexual hx to ask a pt

A

partners, prevention of pregnancy, protection from STDs, practices, and past hx of STDs

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4
Q

USPSTF and CDC recommend _________ sexual risk assessment to determine which patients are most likely to benefit from _______ _______

A

periodic; STD screening

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5
Q

what is the 2015 screening recommendation of USPSTF for chlamydia and gonorrhea? (females)

A

annually screen sexually active women aged 24 and younger for chlamydia (AND older women at an increased risk of infection for BOTH)

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6
Q

how do we define STD

“screening”

A

people at risk who DON’T have symptoms

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7
Q

what is the CDC’s recommendation for gonorrhea and chlamydia screening? (females)

A

screen sexually active females 25 years and younger every year for both diseases

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8
Q

what is the CDC’s and USPSTF’s screening guidelines for HIV? (females mostly)

A

CDC: everyone 13-64 yr should be tested once (male and female)
USPSTF: screen adolescents and adults at risk for infection

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9
Q

what is the ACOG’s and USPSTF’s screening guidelines for HPV? (females)

A

start cervical screening with Pap tests at age 21; every 3 yrs after (HPV/Pap every 5 years for people 30 yrs or older)

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10
Q

CDC and USPSTF don’t recommend screening for what 5 diseases? (females)

A

syphilis, trich, HSV, HCV, and HBV

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11
Q

should you screen for GC/chlamydia in asymptomatic MSM?

A

yes, some recommendations are for it

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12
Q

what is CDC and USPSTF chlamydia screening guidelines for men?

A

CDC: consider screening in clinical settings with high prevalence
USPSTF: insufficient evidence to recommend screening

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13
Q

Is gonorrhea screening recommended for men?

A

no (only asymptomatic MSM)

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14
Q

what are HIV screening guidelines for men?

A

screen those at a higher risk, including all persons who seek evaluation and tx for STDs

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15
Q

Is HPV infection common with WSW?

A

yes, especially if one woman has had sex with men previously

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16
Q

are there reliable resources of sexual health info for WSW?

A

no, few comprehensive and reliable resources on how to screen for STDs in WSW

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17
Q

if diagnosed with gonorrhea, when is the next screening interval?

A

re-test in 3 months after meds (test for cure)

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18
Q

what are screening guidelines for patients “at risk” with negative screen?

A

screen again in 12 months

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19
Q

for high risk pts, how often should they get an HIV screen?

A

annually

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20
Q

general STD symptoms for males?

A

often asymptomatic (penile discharge, itch, burning vesicles, painless chancres)

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21
Q

general STD symptoms for females?

A

most common compliant- vaginal discharge BUT often ASYMPTOMATIC (can have itch, burning vesicles, pelvic pain)

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22
Q

what are some general non-genital STD symptoms? (male and female)

A

skin rashes, arthritis, rectal/oropharyngeal infections

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23
Q

what is expedited partner therapy?

A

the clinical practice of treating the sex partners of pts diagnosed with chlamydia or gonorrhea by providing prescriptions or meds for the pt to take to his/her partner (carilion doesn’t support this but state of virginia does)

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24
Q

incubation time of chlamydia? are most cases diagnosed?

A

5-7 days; no because most are asymptomatic

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25
Q

men and women symptoms of chlamydia

A

men: common to be asymptomatic (clear discharge, normal urine)
women: common to be asymptomatic (70%), mild discharge is most common complaint (usually no odor), dysuria, maybe bleeding after sex

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26
Q

what happens in untreated chlamydia for females and males?

A

females: increase in PID, with scarring of the uterus which can lead to ectopic preg, premature rupture of membranes, miscarriage
males: non-gonococcal urethritis, inflammation of epididymis and prostate

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27
Q

gold standard of chlamydia dx

A

NAATS- nucleic acid amplification tests (urine-best for male/endocervical-best for women)
**same as PCR

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28
Q

self collected vaginal swabs for chlamydia have _____ S&S as provider collected

A

SAME

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29
Q

tx of chlamydia

A

azithromycin 1 gm (doxycycline less effective, azithro ESP for pregnant women)

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30
Q

is retesting after chlamydia tx recommended?

A

no

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31
Q

CDC says to test for ____, ____, and _____ in pts with chlamydia dx

A

GC, HIV, and syphilis

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32
Q

what is the 2nd most reported STI in the US

A

gonorrhea

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33
Q

symptoms of gonorrhea for men; what part of the GU tract can it affect?

A

mainly symptomatic (appears 2-5 days post contact): purulent drainage, burns when urinating, hurts like razor blades; any part of the GU tract

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34
Q

female symptoms of gonorrhea

A

copious cervical discharge, dysuria, frequency, moderate inflamed cervix (more symptomatic during menses)
** consider this in rape victims

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35
Q

gonorrhea in women can affect what part of the GU tract? it may progress to what disease?

A

affect any part; may progress to PID

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36
Q

gonorrhea dx gold standard and what’s normally done in clinical practice

A

GS: culture (99% specific) Practice: PCR/NAAT test (men: first void urine, females: cervical swab)

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37
Q

tx of uncomplicated GC

A

ceftriaxone (250 mg in US, 500 mg in Europe) plus azithromycin OR doxycycline (covers tx of chlamydia as well)

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38
Q

disseminated dz clinical manifestations

A

“hot joint”, fever, rash, mostly seems like an asymptomatic local infection

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39
Q

gold standard dx for disseminated dz

A

culture (must tap the joint for stain and culture)

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40
Q

tx for disseminated dz

A

hospital protocol: usually ceftriazone 1 g every 24 hrs for 1-2 days PLUS azithromycin 1 gm (oral agent then for 7 day total)

41
Q

____% of GC and chlamydia will develop PID; what is this usually do to?

A

10%; untreated or improper tx of GC/chlamydia

42
Q

three major signs of PID on physical exam

A

1) . shuffling gait: due to inflammation of infected organ
2) . cervical motion tenderness
3) . chandelier sign on pelvic exam

43
Q

what is dangerous about PID?

A

these pts can become septic if not tx asap (less life threatening: scarring leading to infertility/chronic pelvic pain)

44
Q

PID is an ___________ infection

A

ascending

45
Q

which pts should be treated outpatient for PID? (6)

A

temp, 101.5; WBC <11,000, minimal evidence of peritonitis, active bowel sounds, can take oral nourishment, RELIABLE

46
Q

which pts should be treated inpatient for PID? (6)

A

pregnant, non compliant, temp > 101.5, WBC > 11,000, dx uncertain, suspected abscess

47
Q

outpatient tx of PID

A

ceftriaxone IM plus doxycycline for 14 days (maybe metronidazole for 2 weeks too)

48
Q

what STD is the most common cause of genital ulcers?

A

HSV

49
Q

HSV I vs II

A

I: oral
II: genital

50
Q

can you transmit HSV when not having an outbreak?

A

yes

51
Q

2 main methods of transmission of HSV

A

sexual/oral contact & childbirth transmission

52
Q

70% of HSV transmission is when?

A

during asymptomatic shedding (hence epidemics)

53
Q

when is primary outbreak of HSV usually?

A

2-12 days after exposure

54
Q

are males or females at a greater risk of HSV?

A

females because they have increased mucosal surfaces

55
Q

what are the three types of HSV infection?

A

primary, non primary first episode, and recurrent

56
Q

what is primary HSV? what is the classic initial presentation?

A

primary refers to pts without previous infection; 1st episode is most painful BUT many people are asymptomatic (highly variable first presentation)

57
Q

Recurrent HSV: ________ symptoms, ______ and ________ prodromal symptoms, most people are _____________

A

fewer symptoms, tingling and pain are prodromal, most are asymptomatic

58
Q

usually see ________, __________ lesions in herpes infection, compared to syphilis where you have ________, ________ lesion,

A

multiple, painful lesions- herpes

syphilis- non-painful solitary lesion

59
Q

testing for herpes

A

overall, difficult and time consuming (nothing is great)

60
Q

tx of primary, recurrent, chronic suppression of herpes

A

primary: acyclovir 3x/day for 10 days
recurrent: acyclovir or famciclovir 5 days
chronic: acyclovir or famciclovir 2x for one day

61
Q

what is bad about herpes and pregnancy?

A

both HSV 1 and 2 can infect the fetus and induce congenital malformations (more likely to spread when mom is symptomatic)

62
Q

male and female symptoms for trich

A

males- typically asymptomatic
females- pruritic, copious discharge (“YELLOW, GREEN, FROTHY”), strawberry cervix, urethral and bladder colonization (topical tx doesn’t work)

63
Q

how to dx trich?

A

wet mount “wet prep”: see MOTILE organisms with flagellae

64
Q

tx of trich

A

tx both partners at the same time

oral metronidazole for a week (if tx fails, re-treat for another week)

65
Q

what is not a true STD but upset of normal vaginal flora? because of this, it can’t lead to _____

A

bacterial vaginosis (BV); can’t lead to PID

66
Q

what type of vaginal discharge does a pt with BV have?

A

malodorus: thin and gray/white

67
Q

dx of BV

A

wet prep (one slide with saline and one with KOH)- see clue cells and “whiff test”

68
Q

what is a positive whiff test?

A

ammonia smell with KOH

69
Q

what % of clue cells do you need for dx of BV?

A

need 20% or more for diagnosis

70
Q

tx of BV

A

oral metronidazole for 7 days OR metro gel for 5 days OR clindamycin cream for 7 days

71
Q

Chancroids are _________: _______ ulcers and is a differential for _______

A

uncommon, painful ulcers, herpes

72
Q

initial lesion of chancroid is at the site of _______

A

inoculation

73
Q

dx of chancroid

A

obtain culture (always test for syphilis and herpes as well)

74
Q

LGV is ___________: caused by types of __________, travel hx of ________, often characterized with __________ _________________, malaise, fever, chills, HA

A

uncommon; chlamydia; travel hx of tropics, painful lymphadenopathy

75
Q

symptoms for males and females for LGV

A

males: PAINLESS lesion, then lymphadenopathy
females: perirectal lymphadenopathy, bloody purulent discharge

76
Q

3 clinical phases of LGV

A

1) . shallow painless ulcer (extremely transient)
2) . painful adenopathy (1-4 weeks later)
3) . Buboes: greatly swollen lymph glands (*bubonic plague)

77
Q

tx of LGV

A

doxycycline for 3 weeks (except pregnancy then use erythromycin)

78
Q

genital warts are caused by _______. they are ____ and ______-________ in appearance. _________ contagious

A

HPV; soft and flesh-colored; highly contagious

79
Q

HPV is associated with _______ ___________ and ______

A

cervical dysplasia and cancer

80
Q

what do you use to prevent genital warts? tx of genital warts

A

prevention- condoms

tx- aldara/imiquimod

81
Q

pearly penile papules are a ________ _________ and therefore are NOT supposed to be treated

A

normal variant

82
Q

what STD is caused by treponema pallidum?

A

syphilis

83
Q

what are the four stages of syphilis?

A

1) . primary: local, sharply demarcated eruption where bug enters the skin (one, INDURATED & PAINLESS ulcer)
2) . secondary: skin rash (PALMS AND SOLES), “condyloma lata”
3) . Latent period: NO physical signs (can last years)
4) . tertiary: NEUROSYPHILIS

84
Q

nearly all cases of syphilis are spread by _______ _________. what are the three largest risk groups?

A

sexual contact; young urban black and Hispanic males, MSM

85
Q

what group of people are most likely to have primary and secondary syphilis?

A

MSM (54%)

86
Q

without tx of primary syphilis, does it resolve?

A

yes, resolves in 3-9 weeks

87
Q

tx of primary syphilis

A

benzathine penicillin IM (95-100% cure rate)

88
Q

when can you get latent syphilis?

A

hx of syphilis with inadequate tx

89
Q

________ of pts with untreated secondary syphilis will go on to develop tertiary

A

1/3

90
Q

what are two clinical syndromes of tertiary syphilis?

A

1) . tabes dorsalis: steppage gait, lightning pains, dec peripheral reflexes
2) . general paresis

91
Q

what three cardio problems can you have with tertiary syphilis?

A

dilated aorta, aortic valve regurg, non-atherosclerotic CAD

92
Q

what is the most common nontreponemal test of syphilis?

A

RPR: tests for antibodies (good for SCREENING)

93
Q

what two autoimmune disorders can give false positives on nontreponemal tests? how about one NOT autoimmune disease?

A

lupus and RA (up to 20% of cases); diabetes

94
Q

what is the confirmatory test of syphilis? what prototype is used?

A

treponemal: measures antibodies to T pallidum bacteria; FTA-ABS

95
Q

what are two other treponemals that can give false positive results?

A

lyme disease and heroin use

96
Q

what is lyme disease caused by?

A

spirochete but resembles syphilis (has primary, secondary, and tertiary stages too)

97
Q

in what female population are all screened for syphilis?

A

pregnancy (congenital syphilis can cause severe birth defects)

98
Q

what happened in the Tuskegee Study?

A

poor black sharecroppers with and without syphilis were studied how their disease progressed without tx

Clin Med- P (124 decks)

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