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Thera VII > 29 STDs Goad > Flashcards

29 STDs Goad Flashcards

1
Q

What STDs are condoms more effective against?

A

Urethritis (GC). Discharge (BV, Trich, VVC, GC). Blood/fluid (HIV, Hep B, Hep C)

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2
Q

What STDs are condoms less effective against?

A

Ulcerative disease (HSV, HPV, Syphilis)

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3
Q

What are the CURABLE STDs?

A

Gonorrhea, Chlamydia, Syphilis, Chancroid, Trichomonas, BV, Candidiasis, Pubic lice

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4
Q

What are the NON-CURABLE STDs?

A

HIV, HPV, HSV, Hep B, Hep A, Hep C

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5
Q

What is the most common bacterial STD?

A

Chlamydia

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6
Q

What is Chlamydia trachomatis?

A

Most common bacterial STD in US. Obligate intracellular coccoid bacteria. Can cause PID, ectopic pregnancy, infertility, and pregnancy complications

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7
Q

What are the symptoms of Chlamydia?

A

Male: Dysuria, discharge (white), penile itching. Female: Vagina pain, pain/itching, discharge, dysuria

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8
Q

What is screened for when using NAATS (most common test for Chlamydia) for Chlamydia?

A

Nucleic acid amplification tests. PCR or LCR. Swabs or urine. < 1/2 young women screened at PAP

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9
Q

What is the etiology of Nongonococcal Urethritis?

A

C. trachomatis (20-40%). Genital Mycoplasmas (20-30%). Occasional Trichomonas vaginalis, HSV. Unknown in ~50% of cases

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10
Q

What are the symptoms of Nongonococcal Urethritis?

A

Mild dysuria, mucoid discharge

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11
Q

What are the antibiotics to be used for Chlamydia?

A

DOC: Azithromycin 1g orally in a single dose. OR. Doxycycline 100mg orally twice a day for 7 days. These have a 97-98% cure rate

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12
Q

What are the alternative choices for Chlamydia treatment?

A

Erythromycin base 500mg PO QID x7 days. OR. Erythromycin ethylsuccinate 800mg PO QID x7 days. OR. Ofloxacin 300mg PO BID x7 days. OR. Levofloxacin 500mg PO x7 days

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13
Q

What is Gonorrhea?

A

Gram (-) diplococci. Second most common bacterial STD in US. Usually symptomatic in males, often asymptomatic in women. Can cause cervicitis, urethritis, proctitis, and PID. High prevalences reported from non-genital sites among MSM (oropharynx and rectum). “The Clap”

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14
Q

What is screen with NAATS for Gonorrhea?

A

Nucleic acid amplification test. PCR or LCR. Swabs or urine

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15
Q

Which ethnic group has the highest rates of STDs?

A

African Americans

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16
Q

What is the recommended treatment for Uncomplicated Gonococcal Infections of the Cervix, Urethra, and Rectum?

A

Ceftriaxone (250mg IM once) + Azithromycin (1g PO once) or Doxycycline (100mg PO BID x7 days). The other one added is because we’re treating presumptively for a co-infection for Chlamydia

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17
Q

What is the recommended treatment for Uncomplicated Gonococcal Infections of the Cervix, Urethra, and Rectum for a patient allergic for CEPHs?

A

Azithromycin (2g PO once) + Test of cure in 1 week

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18
Q

What is Treponema pallidum?

A

Spirochete (primary, secondary, tertiary). “The great imitator”

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19
Q

What screening is done for Treponema pallidum?

A

RPR (rapid plasma reagin) test. VDRL (Venereal Disease Research Laboratory) test

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20
Q

What are the definitive tests for Treponema pallidum?

A

The fluorescent treponemal antibody-absorption (TFA-ABS). T. pallidum hemagglutination assay (TPHA) test

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21
Q

Which group of people have the highest rate of Syphilis infection?

A

MSM

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22
Q

What is Late Syphilis Sequelae Tertiary?

A

About 1/3 of untreated cases will develop late syphilis disease manifestations: Gummatous syphilis, Cardiovascular syphilis, Neurosyphilis

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23
Q

What is the recommended regimen for Primary, Secondary, Early Latent Syphilis?

A

Benzathine Penicillin G (Bicillin LA): 2.4 million units IM, don’t use Bacillin C-R, watch for Jarisch-Herxheimer reaction (can occur within hours of first dose)

24
Q

What is the recommended regimen for Primary, Secondary, Early Latent Syphilis in patients with a Penicillin Allergy?

A

Doxycycline (100mg BID x14 days). OR. Ceftriaxone (1g IM/IV QD x8-10 days). OR. Azithromycin (2g single PO dose)

25
Q

What is Trichomonas vaginalis?

A

Flagellated protozoan. One of the most common STIs. Females - symptomatic (common: vaginitis with purulent discharge (yellow or green; sometimes frothy), uncommon: vulvar and cervical lesions, abdominal pain, dysuria and dyspareunia. Males - usually asymptomatic

26
Q

What is done for the diagnosis of Trichomonas vaginalis?

A

Wet mount. Troph form

27
Q

What is the recommended regimen for Trichomoniasis treatment?

A

Metronidazole 2g PO x1 dose. OR. Tinidazole 2g PO x1 dose. Caution: No EtOH 24hrs after metro and 72hrs after Tinidazole

28
Q

What are some alternative regimens for Trichomoniasis treatment?

A

Metronidazole 500mg BID x7 days. Pregnancy: Metronidazole 2g PO in a single dose. Note: Don’t use Metrogel during pregnancy

29
Q

What is Bacterial Vaginosis?

A

Polymicrobial (mostly Gardenerella vaginitis - anaerobic bacteria). Controversy: is it an STD? Tx during pregnancy eradicates infection, but does not affect pregnancy complications

30
Q

What is the presentation of Bacterial Vaginosis?

A

Excessive, thin gray or white vaginal discharge that sticks to the vaginal walls. Fishy or musty, unpleasant vaginal odor, most noticeable after sex. Vaginal itching and irritation

31
Q

What is the testing for Bacterial Vaginosis like?

A

Vaginal fluid contains “clue cells”. “Whiff test” - 10% KOH

32
Q

What is the treatment for Bacterial Vaginosis?

A

Metronidazole (500mg BID x 7 days). OR. Tinidazole (2g PO QD x2 days or 1g PO QD x5 days). OR. Metronidazole Gel (0.75%, 5g intravaginally QD x5 days). OR. Clindamycin Cream 2% (5g intravaginally QHS x7 days)

33
Q

What are the BV Treatment Considerations with Clindamycin Cream?

A

Don’t use w/ latex condoms for 5 days. Don’t use in the 3rd trimester

34
Q

What are the BV Treatment Considerations with Metronidazole or Tinidazole PO?

A

No EtOH for 24-72 hrs after

35
Q

Which vaginal infections have a fishy smell?

A

BV. Trichomonas Vaginitis

36
Q

What is an overview of Herpes Simplex Virus (HSV)?

A

HSV 1: orolabial herpes. HSV 2: genital herpes. Both symptomatic and asymptomatic infections are common. Can cause serious complications

37
Q

What are the first clinical episodes of Genital Herpes like?

A

Primary: First infection ever with either HSV type. Non-Primary: Newly acquired infection with HSV-1 or HSV-2 in a person seropositive to the other virus

38
Q

What are the recurrent episodes of Genital Herpes like?

A

Antibody is present to the same viral serotype when symptoms appear. Patient may not be aware of previous episodes

39
Q

What are the asymptomatic infections of Genital Herpes like?

A

Serum antibody is present; no history of clinical outbreaks. Can spread even with no lesions

40
Q

What are the clinical manifestations of Genital Herpes Simplex?

A

Direct contact - may be with asymptomatic shedding. Primary infection commonly asymptomatic; symptomatic cases sometimes severe, prolonged, systemic manifestations. Vesicles –> painful ulcerations –> crusting. Recurrence a potential

41
Q

What is used in the diagnosis of Genital Herpes Simplex?

A

Culture. Serology (Western blot). PCR

42
Q

What is Genital HSV-2 in males like?

A

Peak age 15-29. Incubation 2-12 days. Burning, tingling. Transmission: symptomatic, asymptomatic

43
Q

What is Herpetic Whitlow?

A

HSV-1 or 2 recurrent infections. Autoinoculation. Establishes latency

44
Q

What medications are used for the First Clinical Episodes of Genital Herpes?

A

Acyclovir 400mg TID. OR. Famciclovir 250mg TID. OR. Valacyclovir 1000mg BID. Duration of therapy: 7-10 days

45
Q

What is Human Papillomavirus Virus (HPV)?

A

DNA tumor virus. Estimated to be one of the most common STDs; exact numbers are impossible since HPV is not a reportable STD. >50% of all sexually active adults likely infected with at least one HPV type. Vast majority of infections resolve spontaneously. Minority of HPV infections will progress to cancer

46
Q

What are the High Risk HPV types?

A

16, 18

47
Q

What are the Low Risk HPV types?

A

6, 11

48
Q

What is the Patient-Applied HPV Wart Therapy?

A

Podofilox 0.5% solution or gel. OR. Imiquimod 5% cream

49
Q

What is the Provider-Administered HPV Wart Therapy?

A

Cryotherapy. OR. Podophyllin resin 10-25%. OR. Trichloroacetic or Bichloroacetic acid 80-90%. OR. Surgical removal

50
Q

What are the issues with HPV Wart Therapy?

A

NO treatment cures HPV, may reduce infectivity, up to 3 months may be needed. Podophyllin (antimitotic, resin in tincture of benzoin; compound in petrolatum). Imiquimod (immune response modifier). TCA and BCA (caustic to tissue (and wart), use petrolatum to “wall off” the application area)

51
Q

What are the HPV vaccines used?

A

11-26 yo. Gardasil: inactivated, quadrivalent vaccine (covers 6, 11, 16, 18). Cervarix: inactivated, bivalent vaccine (covers types 16, 18)

52
Q

What is Gardasil approved for?

A

HPV: Prevention of cervical, vaginal, and vulvar cancers (in female patients) and anal cancer and genital warts (in both female and male patients)

53
Q

What is Cervarix approved for?

A

HPV: Prevention of cervical cancer in female patients

54
Q

What are the recommended regimens for Pediculosis Pubis (lice)?

A

Permethrin 1% (leave on 10 minutes). Pyrethrins with piperonyl butoxide (10 minutes)

55
Q

What is the recommended regimen for Scabies?

A

Permethrin cream 5% (leave on 8-14 hrs)

Thera VII (37 decks)

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