27. Sexually Transmitted Diseases

Question 1

STI is an infection, disease is when it causes a physiological dysfunction, venereal disease is an old term for STD/STI

Answer 1

STI/STD difference

Question 2

HIV, chlamydia, gonorrhea, syphilis, hepatitis C

Answer 2

included in typical STI screening

Question 3

brand new diagnosis of STI, pregancy, men who have sex with men whose partners are HIV positive or HIV status unknown, IV drug users, persons who exchange money for sex or drugs, persons who are ***, persons who have sex with partners whose HIV status is unknown, persons in correctional facilities

Answer 3

other indications for STI screening

Question 4

HIV, chlamydia, syphillis, gonorrhea

Answer 4

STIs requiring mandatory reporting

Answer 5

STIs not requiring mandatory reporting

Question 6

atypical, drippy drippy burns when I pee, classic dysuria and urethritis can occur but also may not, up to 85% of women may not have symptoms, men will have urethritis, dysuria, and penile discharge, however between 40-90% of male patients will not have symptoms at all, more complicated symptoms include pelvic inflammatory disease characterized by abdominal pain and pelvic pain, can also scar fallopian tubes if asymptomatic, also associated in pregnancy causing premature birth, can cause fitz-hugh-curtis syndrome which can affect the liver, in men can cause prostatitis or **, screening is not formally recommended but GC/chalmydia swab can be offered, can also add a vaginal/cervical swab for a nucleic acid amplification test, **, treated with 1g azithromycin, if allergy, doxycycline but risk of tearing achilles tendon

Answer 6

chlamydia

Question 7

urethritis, penile discharge but up to 60% of men have no symptoms, due to different locations, uterine cervix is the most common site in women, possibly no symptoms, vaginal pruritis, discharge, dysuria present in sexually active women, also causes pelvic inflammatory disease but at a lower rate than chalmydia, prostatitis and epidydimitis can also occur in men, can spread to joints, triad of tensynovitis, polyarthralgias, ***, testing with NAAT on vaginal swab paired with chlamydia, treated with 1g of ceftriaxone cures 98-99% of gonococcal infection, even if positive for gonorrhea you must also treat them for chlamydia, but vice versa is still up to debate

Answer 7

gonorrhea

Question 8

multiple bilateral ulcerating and pustular lesions that are painful, infection may or may not appear, **, primary infection causes fever, headache, malaise, myalgias, also occasionally lymphadenopathy and dysuria, recurrent outbreaks are the general problem, lesions are not as bad as the primary infection but are the most uncomfortable for the patient, screening is problematic due to 16% of population seropositive for HSV-2 because infection is symptomatic, diagnosis must be done by viral polymerase chain reaction on an active lesion, have discussion about asymptomatic passing between partners since viral shedding can occur in asymptomatic lesions, occurs more frequently in symptomatic patients, suppresive therapy can reduce asymptomatic viral shedding with acyclovir or valcyclovir **, asymptomatic viral shedding seems to be more frequent in HSV-2 than HSV-1, occurs in 7 days from an outbreak, reduced longer the ifnection occurs, **, treatment with acylcovir and valcyclovir **

Answer 8

genital herpes

Question 9

HPV associated with warts are not high risk for cervical cancer, patient applied therapy includes imiquinone not tested in pregnancy and podophylox not safe in pregnancy, provider provided therapy is cryotherapy which is safe in pregnancy, scissors and electrocautery also safe in pregnancy which may need a nerve block because painful, podophyllum contraindicated in pregnancy

Answer 9

genital warts/hpv/condylomata acuminata

Question 10

is associated with high risk HPV serotypes, any female partner of a male who is positive needs to be screened for HPV serotypes

Answer 10

bowenoid papulosis

Question 11

tuskegee, one of the torch diseases, can spread through secretions to any tissue through an infected lesion, mucous membranes and condyloma lata, primary phase characterized by a painless, nonbleeding ulceration lesion called chancre, should go away between 3-6 weeks, if still there is not syphilis, rash shows somewhere besides the genital, remember condyloma lata, tertiary or late syphylis can show up 1-8 years after infection presenting with gummatous lesions, or if no symptoms can be latent sphyilis in which patients are not infectious but can pass it along to the baby, neurosphyilis occurs when it enters the CNS and is not cleared, includes paralysis, dementia, but often presents as personality change, can be considered during dementia work up, diagnosis and testing is by trepnomenal testing, also includes screening is by VDRL and RPR test, treatment is by penicillin

Answer 11

syphilis

Question 12

caused by haemophilus ducreyi, ***, painful lesion with painful lymphadenopathy, you will creyi because it’s painful, note the difference between syphilis, no screening, diagnosis and testing

Answer 12

chancroid

Question 13

painless nodule bleeding regularly, no screening because so rare, donovan bodies present ***

Answer 13

donovanosis/granuloma inguinale