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Women's health > Week 4 STIs > Flashcards

Week 4 STIs Flashcards

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1
Q

The FNP is examining a patient suspected of having pelvic inflammatory disease (PID). Which risk factor is most associated with this diagnosis?

A

Recent abortion, pelvic surgery, childbirth or IUD (within last month) are risk factors for PID.

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2
Q

Which of these infections is caused by Treponema pallidum?

A

Syphilis

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3
Q

Which of these conditions is treated with benzathine penicillin G?

A

Syphilis

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4
Q

A patient presents to the clinic with reports of a “greenish” vaginal discharge and vaginal itching. Upon examination, the FNP notes green, frothy vaginal discharge and inflammation of the vulva and vagina. Which diagnosis best supports these findings?

A

While some patients are asymptomatic, others with trichomoniasis will present with yellow/green, frothy discharge, dyspareunia, dysuria, inflammation of the vulva and vagina, and a “strawberry” cervix (Schuiling & Likis; Module 3).

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5
Q

Which priority teaching point should the FNP include when prescribing metronidazole to treat trichomoniasis?

A

Correct Answer Do not drink alcohol while taking this medication and 24 hours after the last dose.

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6
Q

What does a normal saline wet prep help look for?

A

Clue Cells in BV WBC Trcihomonads

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7
Q

What does KOH look for?

A

hyphae and beds for VVC Whiff test

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8
Q

What are the sti screening recommendations for people <24

A

• Annual GC, CT • Routine screen in pregnancy • As needed based on at-risk behaviors

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9
Q

what are the STI screening recommendations for people >25

A

• Current STI, previous STI, new or multiple partners • Partner with concurrent partners • Inconsistent use of condoms when not in monogamous relationship • Exchanging sex for drugs/money

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10
Q

What are the screening recommendations for MSM?

A

Annually

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11
Q

What are the 5Ps for taking a sexual history?

A

Partners practices Past history of STIs Pregnancy plans Prevention of STIs

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12
Q

What does a NAAT test? How do you collect for women? Men?

A

CT NG Trich Women -urine (dirty am) -vaginal swab (more accurate; self collect) -Cervical swab Men -urethral swab

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13
Q

For people with NG, CT, or trich…what partners do you treat?

A

all partners within 60 days are treated

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14
Q

How do you treat NG in pregnancy? CT? Trich?

A

NG = ceftriaxone CT = Azithromycin Trich = Metronidazole

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15
Q

If you are suspicious for Syphillus…what other STI are you testing for?

A

HSV

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16
Q

Risk factors for screening for STI for people over 25

A
  • • History of GC or PID within 2 years
  • • >1 partner in past year
  • • New partner last 90 days
  • • Yes to “Do you have any reason to believe that your partner is having sex with another person?”
  • • If patient concerned regarding STI exposure:
    • o Offer testing based on prevalence rates
    • o Inform her of all tests
  • • If has 1 STI should be screened for HIV and all other STIs
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17
Q

What are some of the bacterial causes of BV? What are other causes of BV?

A
  • Gardenerella,
  • Haemophilus,
  • cornyobactum
  • IUD Douching
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18
Q

What are BV risk factors

A

• Smoking • Douching • Menstruation • Sexual contact without condom • Low education • Oral/anal sex

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19
Q

What is BV associated with?

A

• Preterm birth • Premature membrane rupture in pregnancy • Low birth weight • Post-op infection • Endometriosis • STIs

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20
Q

What are the AMSEL criteria for BV diagnosis?

A

Homogenous discharge Clue cells pH >4.5 + whiff test need 3 for BV diagnosis

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21
Q

What is first line treatment for BV? What are other options and their side effects?

A

Metronidazole – Antabuse effect for 1-3 days after medication Clindamycin – Weakens latex condoms & diaphragms; metallic taste; N/V Tinidazole – less gi upset

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22
Q

What would you prescribe for someone who has “other type” of candida?

A

Terazol

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23
Q

What would a douche for Candida comprise of?

A

Cranberries, garlic, hydrogen peroxide

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24
Q

Who should be screened for chlamydia?

A

• All sexually active women <25 years • 21-29 if new partner • 2+ partners in preceding 2 months

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25
complications of chlamydia
* Salpingitis * PID * Rupture fallopian tube * Fetal/neonatal conjunctivitis & pneumonia * Increases risk ectopic pregnancy * Infertility * ALSO CAUSES: conjunctivitis, PNA, arthritis
26
Chlamydia exam findings
* Cervicitis “rawness” * Post coital bleeding * Mucoid/Purulent discharge * Lower Abdominal tenderness * Cervical motion tenderness * Adnexal fullness (chlamydia infections mimic UTI) \*\*PID is the most serious complication\*\*
27
Chlamydia treatment
Treatment: • All partners within 60 days • 1st line: Doxycycline 100 mg BID x7 days • 2nd line: Azithromycin 1g PO x1 (if pregnant) OR Levofloxacin 500mg PO daily x7days
28
How do you treat gonorrhea?
• 1st line: Ceftriaxone (gonorrhea) 500mg IM \<150kg or 1G IM \>150kg AND Doxycycline (Chlamydia) 100mg PO BID x7 days • 2nd line (PCN allergy): Gentamycin 240mg IM x1 AND Azithromycin 2g PO x1
29
Treatment for non gonoccoccal urethritis
• Non-Gonococcal Urethritis: Doxycycline 100mg BID x7 days OR Azithromycin 1gm PO x1
30
When do you do a test of cure?
2 weeks after treatment if they are pregnant or symptoms persist
31
When do you repeat gonorrhea infection testing?
3 months to check for reinfection
32
What would be seen on a microscopic exam with someone with PID?
WBC that are too numerous to count
33
What labs would you check for someone that was suspicious for PID?
ESR & CRP culture for NG and CT
34
How would you treat someone with PID
ceftriaxone & doxycycline & metronidazole -bed rest -pain kills -pelvic rest -HIV testing Not better within 3 days = hospitalization
35
When would you hospitalize someone with PID?
• Cannot take oral meds • Does not respond to oral meds after 3 days • Has abdominal emergency like appendectomy • Uncertain diagnosis • Severe initial presentation • \<18 years • Pregnant
36
Describe Primary Syphilis - time after exposure - infectious routes - clinical symptoms
3-90 days (usually 21) * Sexual * Verticle * Chancre **Symptoms**: * -Chancre - * Regional lymphadenopathy * Flu-like symptoms
37
Describe a Syphilitic Chancre
painless papule that erodes to form non tender, shallow, indurated, clean ulcer. port of entry for other STIs Heals spontaneously in 2-8 weeks and may go unnoticed Contains spirochaete & highly infectious
38
**Describe secondary syphilis** Time after exposure infectious routes clinical symptoms
4-10 weeks after exposure **Routes**: * -sexual * -vertical **Symptoms**: * -Chancre may still be present - * Maculopapular nonpruritic rash on soles & palms * -Patchy alopecia - * Condylomata lata - * Symptoms of systemic illness * Fever, malaise, weight loss, myalgia * Generalized Lymphadenopathy
39
**Describe Early Latent Syphilis** ## Footnote **Time after exposure** **infectious routes** **clinical symptoms**
**Time after exposure** ​\<1 year **Infectious routes** * Sexual * Vertical **clinical symptoms** Usually asymptomatic \*if remains untreated 1/3 patients will develop tertiary syphilis
40
**Describe Late Latent Syphilis** ## Footnote **time after exposure** **infectious routes** **clinical symptoms**
**time after exposure** \>1 year **infectious routes** Vertical **clinical symptoms** Asymptomatic
41
**Describe Tertiary Syphilis** ## Footnote **time after exposure** **infectious routes** **clinical symptoms**
**time after exposure** Years (15-30) **infectious routes** None **clinical symptoms** * Cardiovascular syphilis (aortitis) * Gummuatous lesions * Granulomas throughout body * Neurosyphilis (happens at any stage and irreversible) * CN dysfunction * meningitis * stroke * ams * auditory or ophthalmic abnormalities
42
What would you use for a presumptive syphillis diagnosis?
* _Non treponemal test:_ VDRL or RPR * sensitive but not specific (presumptive diagnosis) * Used to make sure numbers are trending down
43
What would you order for a definitive Syphilis diagnosis?
* _Treponemal Test_ fluorescent treponemal antibody absorption test (FTA-ABS) (remains positive for life) or passive particle agglutination assay (TP-PA) (confirmatory diagnosis)
44
What do you prescribe for primary, secondary and early latent syphilis? What is 2nd line?
1. Pen G 2. Doxcycline
45
What do you prescribe for latent syphilis or syphilis of unknown duration? How do you treat tertiary syphilis?
1. Pen G 1x/week for 3 doses 2. Tetracycline Tertiary: Refer to ID specialist
46
What is a Jarisch-Herxheimer reaction?
Reaction that occurs with penicillin and spirochete organisms Sudden fever within 24 hours of beginning treatment systemic symptoms: HA, myalgia
47
If a patient has syphilis, which partners get treated?
all partners within 90 days
48
What is the bacteria that causes syphilis?
Treponema Pallidum
49
How would follow up someone with early syphilis?
* VDRL or RPR at 1, 3, & 6 moths after treatment or until negative
50
how would you follow up someone with latent syphilis?
VDRL or RPR at 1, 2, and 3 months and then at 3 months intervals until negative…then yearly
51
What is a Chancroid? ## Footnote Cause Symptoms 4 Treatment Plan
**Cause:** Haemophilus ducreyi (Anaerobic bacillus bacteria) **Symptom:** * Soft, ext _painful_ irregularly/ill defined borders "punched out" shaped lesion NOT INDURATED * inguinal lymphadenopathy * \>\>progresses to Superative large lesion * \>\>\>ulcerates & becomes necrotic then scars over (buboes) **Treatment** * Rule out Syphilis & HSV * Localized infection & Curative: Azithromycin, Ceftriaxone, Ciprofloxacin, or Erythromycin * No long term effects
52
Who is HSV more common in?
females
53
Describe the initial or primary HSV infection characteristics
Usually starts 2 weeks after virus has been transmitted 1. Flu-like 1 week after exposure 2. Genital lesions tender/painful vesicles with possibly prodromal symptoms. Also develop * bilateral tender inguinal lymphadenopathy * vulvar edema * vaginal discharge * severe dysuria * cervicitis
54
Diagnose HSV
* Can confirm clinically without lab confirmation * **Labs** * PCR (low sensitivity if lesions crusted over) can take 2 to 3 months to grow * IgG type-specific glycoprotein G to confirm diagnosis and reveal subtype (tells you if you’ve ever been exposed) * IgA shows current infection (does not mean you got it from partner just means current outbreak)
55
When do you retest for Trich
Retest in 3 months d/t concern for reinfection
56
what are the 5 Ps of sexual health assessment
**5 P’s** **P**artners **P**ractices **P**ast history STIs **P**rotection **P**regnancy plans
57
How do you diagnose trich?
NAAT
58
What are the signs of disseminated gonococcal infection?
2 stages... **Stage 1** * Fever, chills, skin lesions **Stage 2** * Acute septic arthritis w effusions usually in wrists, knees, and ankles
59
what does unilateral labial pain and swelling indicate?
Bartholin gland infection
60
what does periurethral pain and swelling indicate?
infected skenes gland
61
What are symptoms of PID?
* abrupt onset of acute lower abdominal pain following menses (classic presenting symptom) * lower back pain * intermenstrual bleeding * fever, N/V * urinary frequency * pain exacerbated by Valsalva maneuver/intercourse/movement * Bilateral pelvic tenderness *
62
How to diagnose PID according to the CDC
1 or more: * cervical motion tenderness * Uterine tenderness * Adnexal tenderness 1 or more: * \>101 degrees * discharge * WBC in vaginal fluid * Elevated ESR/CRP * Lab documentation of CT or NG
63
When would someone with PID need hospitalization? #7
1. need to r/o surgical emergencies EX appendicitis 2. pregnancy 3. no response to oral antibiotics 4. cannot follow or tolerate the outpatient regimen (not better in 3 days) 5. severe illness 6. n/v/high fever 7. tubo-ovarian abscess
64
What is the treatment regimen for PID?
Ceftriaxone Doxycycline Metronidazole
65
What is the difference between vaginitis and vaginosis?
Vaginitis = inflamed vagina with numerous WBC Vaginosis = no increase in WBC
66
how would you diagnose candida?
Wet mount

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