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Women's Health Exam 1 > STIs > Flashcards

STIs Flashcards

1
Q

Sexual history

A

(5 P’s)
Partners: men/women, #, last time u had sex
Practices: anatomic sites of exposure
Prevention of pregnancy: desired? contraception?
Protection from STI’s: frequency of condom use
Past hx of STIs: patient and their partners

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2
Q

Special STI populations

A 
Youth (15-24)
Men who have sex w/ men (MSM)
Pregnant women
HIV-infected patients
Individuals entering correctional facilities
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3
Q

Symptoms of vaginitis

A

d/c
odor
pruritus and/or discomfort

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4
Q

Most common causes of vaginitis

A

Candida vulvovaginitis
BV
Trichomoniasis

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5
Q

Cause of yeast infection

A

C. albicans (most common)

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6
Q

Presentation of vulvovaginal candidiasis

A 
pruritus!
external dysuria
vulvar soreness
dyspareunia
abnormal vaginal d/c
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7
Q

PE for yeast infection

A

white, thick, curd-like d/c (adherent to vaginal walls)

may seem vulvar erythema, edema, fissures, excoriations

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8
Q

Risk factors for yeast infections

A

DM
Abx use
increased estrogen levels
Immunosuppressed

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9
Q

Dx of vulvovaginal candidiasis

A 
Wet mount (10% KOH) - budding yeast, hyphae, pseudohyphae
Normal pH (<4.5)
Others: vaginal culture
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10
Q

uncomplicated candidiasis

A

mild-mod sx
sporadic/infrequent
caused by candida albicans
healthy, non-prego

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11
Q

Complicated candidiasis

A

severe
recurrent
nonalbicans species
prego, poorly controlled DM, immunosuppression

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12
Q

Tx for uncomplicated candidiasis

A

1-3 days of topical Clotrimazole (OTC)

oral fluconazole 150 mg po x 1

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13
Q

tx for complicated candidiasis

A

topical azole 7-14d

oral fluconazole 150 mg po q 72 hours x 2-3 doses (if nonalbicans, avoid fluconazole)

maintenance for recurrent

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14
Q

Tx of candida in pregos

A

topical clotrimazole x 7 days

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15
Q

Most common cause of d/c in women of chidlbearing age

A

BV

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16
Q

Etiology of BV

A

polymicrobial: gardnerella vaginalis, mobiluncus, prevotella

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17
Q

Presentation of BV

A

asymptomatic

Symptomatic: d/c & odor (thin, white gray d/c with fishy smell)

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18
Q

Risk factors for BV

A 
sex (new/multiple partners)
presence of other STIs
African-American, Mexican-American
Douching
Smoking
Lack of condom use
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19
Q

Dx of BV

A

Amsel’s diagnostic criteria
Gram stain
DNA probe

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20
Q

Amsel’s diagnostic criteria

A
  1. Thin, white homogenous discharge
  2. Clue cells on saline
  3. pH >4.5
    • whiff test
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21
Q

Tx of BV

A

Only treat symptomatic

  • Metro 500 mg PO BID x 7 days
  • Metro gel 0.75% vaginally QD x 5 days
  • Clinda cream 2% intravaginally QHS x 7 d
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22
Q

Complications of BV

A

increased risk of acquiring/transmitting HIV, and other STIs

more common in those w/ PID

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23
Q

Most common nonviral STI

A

trichomoniasis

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24
Q

Often coexist

A

BV and trich

Chlamydia + gonorrhea

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25
Presentation of trich
vaginal d/c +/- vulvar irritation Malodorous, frothy, yellow-green d/c Burning/pruritus/dysuria/dyspareunia Postcoital bleeding
26
PE for trich
punctate hemorrhages on vagina/cervix ("strawberry cervix" | pH >4.5
27
Strawberry cervix
trich
28
Dx of trich
``` Wet mount (motile organisms) NAAT - gold standard (vaginal, endocervical, urine) ``` Culture (rarely used) Rapid antigen and DNA hybridization probes
29
Trich complications
urethritis/cystitis PID (those w/ HIV) Cervical neoplasia infertility increased risk of acquiring/transmitting HIV Prego: premature rupture, preterm delivery, LBW
30
Tx for trich
symptomatic & asymptomatic - treat sex partners (EPT) - Metro (or Tinidazole) 2g (single dose) - metro = pregnancy
31
education for trich tx
wait 7 days after treatment for sex Test for other STIs Repeat testing in 3 months (reinfection high)
32
Repeat testing
Trich Chlamydia Gonorrhea
33
Screening for trich
HIV infected High prevalence settings (STI clinics, correctional facilities) Asymptomatic @ high risk of infection
34
Most frequently reported STI
chlamydia
35
Age group for chlamydia
<24 hours
36
sx of chlamydia
cervicitis (d/c, intermenstrual/postcoital bleeding) | Sx of urethritis (frequency & dysuria)
37
PE for chlamydia
mucopurulent endocervical d/c | friability, erythema, edema
38
Dx of chlamydia
NAAT (test of choice) | - Vaginal swab (preferred), endocervical swab, urine
39
Complications of chlamydia
``` PID ectopic pregnancy infertility chronic pelvic pain Prego: premature rupture, preterm deliver, conjunctivitis in newborn ```
40
Tx for chlamydia
pt + sex partner Azithro 1 gm PO single dose OR Doxy 100 mg PO BID x 7 days Prego: only azithro
41
Screening for chlamydia
``` annually <25 YO Older w/ risk factors: - new/multiple sex partners - sex partner recently treated for STI no or inconsistent condom use outside of monogamous relationship - hx of prior STI - exchange for drugs/money ```
42
Presentation of gonorrhea
Cervicitis sx | urethritis
43
PE for gonorrhea
mucopurpulent cervcal d/c | friability, erythema, edema
44
Dx of Gonorrhea
NAAT (vaginal swab preferred) | Culture (abx resistance)
45
Complications of gonorrhea
PID, ectopic preg, infertility, chronic pelvic pain Disseminated gonococcal infection (DGI) Preg: LBW, preterm, infection (chorioamnionitis), transmit to neonate (opthalmia neonatorum)
46
Tx for gonorrhea
Ceftriaxone 250 mg IM + azithro 1 gm PO single dose
47
Screening for gonorrhea
same as chlamydia
48
PID spectrum
endometritis salpingitis tubo-ovarian abscess pelvic peritonitis
49
Risk of PID
``` sexually active (multiple partners) Younger <25 Partner w/ STI Hx of prior PID or STI IUD (1st 3 weeks after insertion) Disruption of normal vaginal flora (BV) ```
50
Sx of PID
``` lower abdominal pain (during or shortly after menses) Abnormal vaginal d/c abnormal uterine bleeding dyspareunia fever ```
51
PE for PID
ab/uterine/adnexal tenderness Cervical motion tenderness (chandelier sign) Purulent endocervcal d/c and/or vaginal d/c
52
Eval for PID
``` Pregnancy test Microscopy of d/c (wet mount) - WBC (leukorrhea >10 WBC) NAAT for chlamydia/gonorrhea NAAT for mycoplasma genitalium HIV screen, syphilis CBC, ESR, CRP UA Pelvic US, CT/MRI ```
53
Dx PID
presumptive: sexually active, pelvic/lower ab pain, cervical motion, uterine OR adnexal tenderness on exam
54
Findings supporting clinical dx of PID
temp >10 abnormal cervical/vaginal d/c or friability WBC on wet mount elevated ESR/CRP Documented infection of chlamydia/gonorrhea
55
Tx of PID
ceftriaxone 250 mg IMI + doxy 100 mg BID x 14 d Outpatient: w/wo metronidazole (500mg PO BID x 14 days) F/u 48-72 hours
56
Hospitalize for PID
pregnancy lack of response to oral (w/i 72 hours) concern for nonadherence inability to take PO due to N/V severe illness (high fever, n/v/, ab pain) Complicated w/ abscess Surgical emergencies (appendicitis ) cannot be excluded
57
Complications of PID
infertility chronic pelvic pain risk of ectopic perihepatitis (Fitz-Hugh-Curtis syndrome)
58
Perihepatitis
RUQ pain & adhesions
59
Condyloma Acuminata
HPV (anogenital warts)
60
Most common STI in US
HPV
61
Most common types of HPV
6 and/or 11
62
Risk factors of HPV
sex smoking immunosuppression (more severe/malignant)
63
Types of HPV associated w/ malignancy
6 or 11
64
Presentation of HPV
asymptomatic, may be pruritic flesh colored, plaque-like single or multiple, flat cauliflower like
65
Dx for HPV
visualize warts on PE (anoscopy, speculum exam) | bx if uncertain
66
Tx for HPV
Cyto-destructive (pdofilox, trichloracetic acid or bicloracetic acid) Immune-mediated (imiquimoid, sinecatechins) Surgical (cryo, laser, electrocautery, excision)
67
Vaccine
HPV
68
Genital herpes caused by
HSV-2
69
Primary HSV infection
no preexisting antibodies longer duration, increased viral shedding & systemic sx sx last 2-4 weeks if left untreated
70
Non-primary first episode
acquisition of HSV-2 in patient w/ preexisting antibodies to HSV-1 Milder sx
71
Recurrent HSV
reactivation of HSV | less severe/shorter
72
Sx of primary infection
painful genital ulcers! dysuria, fever, tender local inguinal LAD, h/a some mild/asymptomatic
73
Sx of recurrent infection
prodrome before eruption (tingling) | less severe sx
74
Dx of herpes
``` Viral culture (good early) PCR (more sensitive than culture) ``` Serologic tests - HSV1/2 antibodies
75
Limitations to serologic tests for herpes
false negative frequent in early stages of infection
76
Tx for herpes
1st episode: Valacyclovir, famciclovir, or acyclovir 7-10 d (start w/i 72 hours) Recurrent outbreak: 1-5 day regiment Suppression: QD or BID dosing

Women's Health Exam 1 (5 decks)

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