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6. Women's Health > 1- STI's > Flashcards

1- STI's Flashcards

1
Q

What are the 5 P’s of taking a sexual history?

A

Partners, Practices, Prevention of pregnancy, Protection from STIs, Past hx of STIs

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2
Q

What is the general term for disorders of the vagina caused by infection, inflammation, or changes in the normal vaginal flora?

A

Vaginitis

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3
Q

What are the sxs of vaginitis? (3)

A

Vaginal discharge, odor, pruritus/ discomfort

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4
Q

What are the most common causes of vaginitis? (3)

A

Candida vulvovaginitis, bacterial vaginosis, trichomoniasis

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5
Q

Vulvovaginal candidiasis (VVC) is aka what?

A

Yeast infection

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6
Q

Is vulvovaginal candidiasis (VVC) considered an STI?

A

No

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7
Q

What is the causative organism of vulvovaginal candidiasis (VVC)?

A

C. albicans (can also be other Candida species or yeast)

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8
Q

What is the dominant clinical feature of vulvovaginal candidiasis (VVC)?

A

Pruritus

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9
Q

Pt presents with vulvar soreness/ burning/ irritation, dysuria, dyspareunia, abn vaginal discharge and pruritus. What should you be concerned for?

A

Vulvovaginal candidiasis (VVC)

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10
Q

Upon PE you note erythema/ edema of the vulva and vaginal mucosa, discharge, and fissures/ excoriations. What should you be concerned for?

A

Vulvovaginal candidiasis (VVC)

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11
Q

Vaginal discharge that appears white, thick and curd-like (clumpy) and is adherent to vaginal walls is concerning for what?

A

Vulvovaginal candidiasis (VVC)

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12
Q

Aside from clinically, how is vulvovaginal candidiasis (VVC) diagnosed?

A

Wet mount (10% KOH)

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13
Q

On wet mount you note budding yeast, hyphae or pseudohyphae and measure a normal vaginal pH (<4.5). What should you be concerned for?

A

Vulvovaginal candidiasis (VVC)

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14
Q

When is treatment indicated for vulvovaginal candidiasis (VVC)?

A

Relief of sxs

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15
Q

What are the criteria for determining an uncomplicated infection for vulvovaginal candidiasis (VVC)? (sx severity, frequency, organism, host)

A

Sx severity- mild to mod, frequency- sporadic/ infrequent, organism- Candida albicans, host- healthy, non-preg, immunocompetent

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16
Q

What are the criteria for determining a complicated infection for vulvovaginal candidiasis (VVC)? (sx severity, frequency, organism, host)

A

Sx severity- severe, frequency- ≥ 4x/year, organism- nonalbicans, host- preg, poorly controlled DM, IMC, debilitation

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17
Q

What is the treatment for uncomplicated vulvovaginal candidiasis (VVC)?

A

Oral fluconazole 150mg PO x 1 OR topical azole- short course (1-3 days)

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18
Q

What is the treatment for complicated vulvovaginal candidiasis (VVC)?

A

Oral fluconazole 150mg PO q 72hrs x 2-3 doses OR topical azole- longer course (7-14 days)

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19
Q

When is maintenance treatment considered for vulvovaginal candidiasis (VVC)?

A

Recurrence

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20
Q

If a pt with vulvovaginal candidiasis (VVC) is pregnant, what is the treatment?

A

Topical (clotrimazole or miconazole x 7 days)

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21
Q

Is it recommended to treat the sexual partner of a pt infected with vulvovaginal candidiasis (VVC)?

A

No (but may benefit from tx if sx)

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22
Q

Is bacterial vaginosis considered an STI?

A

No

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23
Q

What is the most common cause of vaginal discharge in women of childbearing age?

A

Bacterial vaginosis

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24
Q

What is defined as the replacement of “healthy” vaginal flora with overgrowth of anaerobic bacteria?

A

Bacterial vaginosis

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25
Q

What is the most common causative organism of bacterial vaginosis (usually polymicrobial)?

A

Gardnerella vaginalis

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26
Q

Pt presents with vaginal discharge/ odor and occasional irritation. On PE you note a thin, off-white discharge and a “fishy odor”. What should you be concerned for?

A

Bacterial vaginosis (although often asx)

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27
Q

How is bacterial vaginosis most commonly diagnosed?

A

Clinical criteria (Amsel’s dx criteria)

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28
Q

What are Amsel’s dx criteria? (used for bacterial vaginosis) (4)

A
  1. thin, white, homogeneous discharge, 2. clue cells on saline wet mount, 3. vaginal pH > 4.5, 4. + whiff test (fishy odor when KOH added) (must have 3)
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29
Q

When should a pt with bacterial vaginosis be treated?

A

If sx (including sx if pregnant)

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30
Q

Is it recommended to treat the sexual partner of a pt infected with bacterial vaginosis?

A

No (not routinely)

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31
Q

What should be avoided while taking Metronidazole?

A

EtOH

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32
Q

What is the recommended treatment regimen for bacterial vaginosis?

A

Metronidazole 500mg PO BID x 7 days

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33
Q

What should be offered to all women diagnosed with bacterial vaginosis?

A

Testing for HIV and other STIs

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34
Q

What are the consequences of infection with bacterial vaginosis? (3)

A

↑ risk for preterm delivery, HIV, other STIs

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35
Q

BV is more common among women with what other condition? (independent risk factor)

A

PID

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36
Q

What is the most common nonviral STI worldwide?

A

Trichomoniasis (causative agent = trichomonas vaginalis)

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37
Q

Are most pts with trichomoniasis sx or asx?

A

Most have minimal or no sx

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38
Q

Coexistence is common between T. vaginalis and what other pathogens?

A

BV pathogens

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39
Q

Pt presents with vaginal discharge that is purulent, malodorous, frothy, and thin +/- vulvar irritation and postcoital bleeding. What should you be concerned for?

A

Trichomoniasis

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40
Q

On PE you note punctate hemorrhages on vagina and cervix/ “strawberry cervix” as well as a vaginal pH > 4.5. What should you be concerned for?

A

Trichomoniasis

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41
Q

What is the gold standard for dx of trichomoniasis?

A

NAAT

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42
Q

If you perform a wet mount (saline) for suspected trichomoniasis, what might you see?

A

Motile organisms

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43
Q

If trichomoniasis is left untreated, what might it lead to?

A

Urethritis or cystitis

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44
Q

What are the consequences of a trichomoniasis infection? (5)

A

PID, cervical neoplasia, infertility, HIV, pregnancy complications

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45
Q

What are the specific complications of pregnancy a/w trichomoniasis? (3)

A

Increased risk of premature membrane rupture, preterm delivery, low birth weight

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46
Q

When is treatment indicated for trichomoniasis?

A

Asx and sx pts

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47
Q

Is it recommended to treat the sexual partner of a pt infected with trichomoniasis?

A

Yes (Expedited Partner Therapy (EPT) available)

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48
Q

What is the recommended treatment regimen for trichomoniasis?

A

Metronidazole 2g (single dose) (same if pregnant)

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49
Q

What pt edu should be provided for trichomoniasis? (2)

A

Abstain from sex until 7 days after tx, test for other STIs (HIV included)

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50
Q

When should repeat testing (for reinfection not a test of cure) be performed for a pt with trichomoniasis?

A

3 months following initial tx

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51
Q

What populations should be screened for T. vaginalis? (3)

A

All HIV-infected women (annually and at prenatal visit), high prevalence settings, high risk pts

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52
Q

What is the most commonly reported bacterial infection in the US?

A

Chlamydia

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53
Q

Majority of women with chlamydia are sx or asx?

A

Asx

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54
Q

Patients with chlamydia are frequently co-infected with what?

A

Gonorrhea

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55
Q

Sx related to cervicitis such as change in vaginal discharge and intermenstrual or postcoital bleeding are associated with what conditions?

A

Chlamydia and gonorrhea

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56
Q

Sx related to urethritis such as dysuria and urinary frequency are associated with what conditions?

A

Chlamydia and gonorrhea

57
Q

PE of pt with chamlydia or gonorrhea will show what?

A

Cervicitis- mucupurulent endocervical discharge, cervix-friability, erythema, edema

58
Q

What is the diagnostic test of choice for both chamydia and gonorrhea?

A

NAAT (vaginal swab preferred)

59
Q

The following are complications of what conditions? PID, ectopic pregnancy, infertility, chronic pelvic pain

A

Chlamydia and gonorrhea

60
Q

Increased risk for premature rupture of membranes and preterm delivery are complications of pregnancy with what condition?

A

Chlamydia

61
Q

Transmission of chlamyida to the neonate during delivery typically manifests as what condition?

A

Conjunctivitis

62
Q

Transmission of gonorrhea to the neonate during delivery typically manifests as what condition?

A

Ophthalmia neonatorum

63
Q

What is the treatment for a non-pregnant pt with chlamydia?

A

Azithro 1gm PO single dose OR doxy 100mg PO BID x 7 days (treat pt and sex partner)

64
Q

What is the treatment for a pregnant women with chlamydia?

A

Azithro (avoid doxy), test of cure recommended

65
Q

How long should a pt infected with chlamydia avoid intercourse?

A

Until tx is completed and sx resolved, 7 days after single dose or completion of 7 day regimen

66
Q

A pt with chlamydia or gonorrhea should be tested for what?

A

Other STIs

67
Q

Repeat testing for reinfection with chlamydia or gonorrhea should be performed when?

A

3 months

68
Q

Who should be screened for chlamydia and gonorrhea?

A

Annual screening of all sexually active women < 25 yo and older women with RFs

69
Q

The following are RFs for what? New/ multiple sex partners, sex partner recently treated with STI, no/ inconsistent condom use, hx of STI, exchange sex for drugs/ money

A

RFs of chlamydia and gonorrhea for older women (should be screened anually)

70
Q

What is the 2nd most commonly reported communicable disease in the US?

A

Gonorrhea

71
Q

There is increasing concern for what with gonorrhea?

A

Antimicrobial resistance

72
Q

What dx study should be performed when antibiotic resistance is suspected for gonorrhea?

A

Culture

73
Q

What complication is specific to gonorrhea?

A

Disseminated gonococcal infection (DGI)

74
Q

Risk of preterm birth, low birth weight, and infection are pregnancy complications associated with what condition?

A

Gonorrhea

75
Q

What is the treatment for a both pregnant and non-pregnant pt with gonorrhea?

A

Ceftriaxone 250mg IM PLUS Azithro 1gm PO single dose (treat pt and sex partner)

76
Q

When is a test of cure recommended for a pregnant pt with gonorrhea?

A

If alternative tx regimen used (NOT Ceftriaxone 250mg IM PLUS Azithro 1gm PO single dose)

77
Q

How long should a pt infected with gonorrhea avoid intercourse?

A

7 days after tx and until sx resolved

78
Q

What condition is defined as an infection of the upper genital track (ascending infection)?

A

Pelvic inflammatory disease (PID)

79
Q

The majority of PID infections are associated with what 2 pathogens?

A

N. gonorrhoeae or C. trachomatis

80
Q

What disease represents a spectrum of infection and can present as any combination of endometritis, salpingitis, oophoritis, peritonitis, perihepatitis, and/ or tubo-ovarian abscess?

A

PID

81
Q

Women with a hx of PID may experience what future complication?

A

Difficulties getting pregnant

82
Q

Who is at the highest risk of getting PID?

A

Women with multiple partners

83
Q

Pt with an IUD is at greatest risk for PID when?

A

First 3 weeks after insertion

84
Q

Pts with a disruption of the normal vaginal flora (ex. BV) are at higher risk for what condition?

A

PID

85
Q

Although PID can present as a wide spectrum, what presentation is typical?

A

Acute, sx, over several days

86
Q

PID sxs can range from mild, vague pelvic sxs to tubo-ovarian abscess, sepsis, and possible perihepatitis, which is aka?

A

Fitz-Hugh Curtis Syndrome

87
Q

What is inflammation of the liver capsule and adjacent peritoneal surfaces?

A

Perihepatitis (Fitz-Hugh Curtis Syndrome)

88
Q

Pt with infection suspicious for PID presents with RUQ pain and “violin string” adhesions of the liver. What are you concerned for?

A

Perihepatitis (Fitz-Hugh Curtis Syndrome)

89
Q

Subclinical PID presents with sx not severe enough to present for care but severe enough to produce what?

A

Significant sequelae (tubal factor infertility)

90
Q

Pt presents with lower abd pain (onset during/ shortly after menses), abn vaginal discharge, abn uterine bleeding, dyspareunia, and fever. What should you be concerned for?

A

Acute sx PID

91
Q

On PE you note abd tenderness (lower quadrants), Chandelier sign, and purulent endocervical/ vaginal discharge. What should you be concerned for?

A

Acute sx PID

92
Q

Uterine, adnexal, and/ or cervical motion tenderness is what? (PID)

A

Chandelier sign

93
Q

What tests should be ordered for a pt with suspected PID? (5)

A

Pregnancy test, WBCs in vaginal discharge, NAATs, HIV screening, pelvic US (if uncertain)

94
Q

What 3 things lead to a presumptive dx of PID?

A

Sexually active young female, pelvic/ lower abd pain, evidence of cervical motion/ uterine/ OR adnexal tenderness

95
Q

When should treatment for PID be initiated?

A

As soon as the presumptive dx is made

96
Q

What is the treatment of PID if outpt (mild-mod)?

A

Ceftriaxone 250mg IM single dose PLUS doxy 100mg BID x 14 days (w/ or w/o metronidazole 500mg PO BID x 14 days)

97
Q

What is essential in the treatment/ management of a pt with PID?

A

Close f/u (48-72 hrs)

98
Q

What should you if: pt with PID + pregnancy, lack of response or tolerance to oral meds, concern for nonadherence to therapy, inability to take oral meds, severe clinical illness, complicated PID w/ pelvic abscess, or surgical EMs cannot be excluded?

A

Hospitalize

99
Q

What are common complications of PID? (4)

A

Hydrosalpinx, infertility, risk of ectopic pregnancy, chronic pelvic pain

100
Q

How long should a pt with PID abstain from sexual intercourse?

A

Therapy completed, sx resolved, partners tx

101
Q

Repeat testing after PID should be completed when?

A

3 months

102
Q

Human papillomavirus (HPV) is aka?

A

Condyloma acuminata (aka anogenital warts)

103
Q

What is the most common STI in the world?

A

HPV

104
Q

How is HPV transmitted?

A

Contact w infected skin or mucosa (sexual activity greatest RF)

105
Q

What types of HPV are detected in most cases?

A

6 and 11 (low oncogenic potential)

106
Q

What types of HPV are high-risk and have oncogenic potential?

A

16 and 18 (cause most cervical (and other) cancers and precancers)

107
Q

Pt who is asx or c/o pruritis w soft, flesh-colored, smooth or plaque like, cauliflower like lesions in the anogenital area is concerning for what?

A

Condyloma acuminata (aka anogenital warts)

108
Q

How is condyloma acuminata (HPV) diagnosed?

A

Visualize warts on PE (bx if dx uncertain)

109
Q

What are the 3 main treatment options for condyloma acuminata?

A

Cyto-destructive, immune-mediated, surgical

110
Q

What is the most common cyto-destructive treatment option for HPV?

A

Podofilox

111
Q

What are the most common immune-mediated treatment options for HPV?

A

Imiquimod, Sinecatechins

112
Q

Cryotherapy, laser, electrocautery, excision are all surgical tx options for what?

A

HPV

113
Q

What is the greatest form of prevention against HPV?

A

Vaccine (also condoms, limit sex partners)

114
Q

Does treatment of genital warts cure the virus itself? What effect does this have?

A

NO, recurrence common (duration of viral persistence unknown)

115
Q

What is important background info for genital herpes?

A

Chronic, life-long viral infection

116
Q

What are the causative organisms of genital herpes?

A

2 HSV serotypes (HSV-1 and HSV-2)

117
Q

Most cases of recurrent genital herpes are caused by what?

A

HSV-2

118
Q

HSV is transmitted through herpes lesions, mucosal surfaces, genital secretions, or oral secretions and is typically sx or asx?

A

Asx

119
Q

Majority of HSV transmission occurs during what viral period?

A

Asx HSV shedding

120
Q

What is a primary genital herpes infection?

A

Infection without preexisting antibodies to either HSV-1 or HSV-2

121
Q

What is a non-primary first episode of genital herpes?

A

Acquisition of genital HSV-2 with preexisting antibodies to HSV-1 (and visa-versa)

122
Q

What is a recurrent infection with genital herpes?

A

Reactivation of genital HSV

123
Q

What type of infection with genital herpes is of longer duration, increased viral shedding, systemic sxs, and sxs lasting 2-4 weeks if untreated?

A

Primary

124
Q

How does a pt present with a non-primary first episode of genital herpes? (general, not specific sxs)

A

Sxs that are usually milder than primary (fewer lesions and less systemic sxs)

125
Q

How does a pt present with a recurrent infection of genital herpes? (general, not specific sxs)

A

Less severe and shorter in duration (than both primary and non-primary first episode)

126
Q

Pt presents with painful genital ulcers, dysuria, fever, tender inguinal lymphadenopathy, and HA. What are you concerned for?

A

Primary infection with genital herpes (although can be mild or asx)

127
Q

What is the average incubation period after exposure to genital herpes?

A

2-12 days

128
Q

Pt presents with prodromal sxs such as tingling, itching, and burning but nothing on PE. What are you concerned for?

A

Recurrent infection

129
Q

What is the preferred dx test of choice for genital herpes?

A

Virologic tests (viral culture or PCR)

130
Q

What is the benefit/ limitation of performing serologic tests if suspicious for genital herpes?

A

Detects HSV-1 and HSV-2 specific antibodies, limitations = false negative if in early stage

131
Q

Presence of type-specific HSV-2 antibody implies what?

A

Anogenital infection

132
Q

Presence of HSV-1 antibody alone can be consistent with what?

A

Either anogenital or orolabial infection

133
Q

Is screening for HSV-1 and HSV-2 in the general population indicated?

A

No

134
Q

What meds are used in the tx of genital herpes?

A

Valacyclovir, famciclovir, or acyclovir

135
Q

What is the tx regimen for genital herpes if first episode?

A

7-10 day regimens, start w/i 72 hours

136
Q

What is the tx regimen for genital herpes if episodic tx for recurrent outbreaks?

A

1-5 day regimens

137
Q

What is the tx regimen for genital herpes for suppression? (reduces frequency of recurrences and risk of transmission)

A

1x daily - BID dosing (periodically reassess need)

138
Q

What is important in the counseling/ pt edu for genital herpes?

A

Counsel to prevent sexual transmission, edu for potential for clinical recurrence, edu about vertical transmission, test for other STIs

6. Women's Health (13 decks)

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