Adolescent STIs Flashcards
1
Q
epidemiology
A
- 19 million new cases per year
- one half in ppl aged 15-24
- most asymptomatic and undiagnosed
- 1 in 4 female teens has an STI
- 2006- 1/3 of new infections were among people ages 13-29 (may be as high as 50%)
- economic costs 17 billion/ year
2
Q
confidentialitly
A
- all 50 states allow teens to consent to STI testing and diagnosis without telling their parents
- 32 states make it illegal for doctors to tell parents
3
Q
erica dysuria
A
- DDX is UTI, genital tract infection (cervicitis or vaginitis), skin related abnormalities/ mucosal perineal (herpes, trauma)
- need HPI OLDCAARTS- N/V/D, fever, chills, back pain, abd pain, sores, lumps, bumps, dyspareunia
4
Q
5 Ps for sexual history
A
- partners- genders, number
- prevention of pregnancy- contraception, EC
- protection from STIs- condom use
- practices- types of sex- anal,vaginal, oral
- past hx of STIs
5
Q
erica HPI
A
- 1 week
- intermittent burning with urination, yellowish discharge thats getting worse and some vaginal itchiness
- no fever, back, abd pain
- no frequent urination
- doesn’t know about bumps or lesions
- several episodes of unprotected sex in the last 2 months with one male partner- her only lifetime
- not on hormonal contraception but uses condoms most of the time
- engages in oral and vaginal sex
- no known history of STIs
6
Q
new DDX?
A
-STI
7
Q
exam findings
A
- normal external exam
- speculum exam- odorous, yellow discharge in vault but not os
- cervix looks like strawberry
- normal bimanual exam
- you suspect vaginitis
8
Q
common causes of vaginitis
A
- trichomonas
- bacterial vaginitis
- candida
9
Q
trichomonas infection symptoms
A
- females are 50% asymptomatic
- foul smelling, frothy discharge, vaginal itching/redness, dyspareunia
- urge to urinate and dysuria
- post coital bleeding
- excessive or prolonged menses
- males- most asymptomatic and often missed
- if symptoms occur can present as NGU
- consider trich in males with recurrent urethritis post adequate treatment
10
Q
bacterial vaginosis
A
- odorous discharge
- itching
- found in 24-47% of STI clinic patients
- sequelae-pregnancy complication
- possible increase in PID
11
Q
candidiasis
A
- females have genital itching or burning
- cottage cheese like discharge, fire red tissue
- males have itchy penile rash
12
Q
trich diagnosis
A
- culture- Sens- 85-90, spe 100
- antigen- sense 83, sp 97
- DNA probe- sens >83, sp >97
- wet mount- sens 60-70, sp 100- not good for males
13
Q
candida diagnosis
A
- wet mount sens 35-45, sp 97-99
- DNA probe- sens 80, sp 98
14
Q
bacterial vaginitis diagnosis
A
- amsels criteria- at least 3 of the following:
- Whiff pos test for fishy or musty odor when alkaline KOH solution added to smear
- clue cells- bacteria attached to borders of epi cells, over 20% of cells
- vaginal pH over 4.5
- a homogenous non IF discharge
15
Q
diagnose trich using lab?
A
-nucleic acid prob for t vaginalis, g vaginalis, c albicans
-vaginal secretions
sens >83, sp >97
-results in 45 min
-wet mount
16
Q
diagnose in clinic?
A
- doesn’t have hx/ PE for candida
- BV vs trich? pH, KOH, look under microscope?
- clinical diagnosis
- trt is same- metronidaole- different doses
- need to trt partner for trich
17
Q
other concerns
A
-risk for other STIs
18
Q
common causes of cervicitis?
A
-gonorrhea and chlamydia
19
Q
chlamydia symptoms
A
-females- up to 75% asymptomatic -heavy or prolonged menses-ABNORMAL PERIOD CAN BE AN STI! -spotting -dysmenorrhea -dyspareunia -vaginal discharge males-up to 50% asymptomatic -itchy penile rash
20
Q
gonorrhea symptoms
A
-females-50% are asymptomatic
-yellow or bloody vaginal discharge
-painful urination
-dysmenorrhea
males- up to 50% asymptomatic
-discharge from the penis with pain
-burning during urination
-swollen testicles
21
Q
2011 NYS Youth risk behavior surveillance suvey
A
- 43% of females and 45% of males have ever had sexual intercourse
- 4% of females and 7% of males had sexual intercourse for the first time before age 13
- 14% of females and 15% of males had sexual intercourse with 4 or more persons during their life
- 35% of females and 33% of males had sexual intercourse within the last 3 months (of survey adminstration)
- 40% of females and 30% of males did not use a condom during last sexual intercourse
22
Q
local
A
- lots of STDs
- age 10-19
- can look at it by county
23
Q
evaluating cervicitis
A
- nucleic acid amp test-NAAT- GOLD STANDARD
- markedly amplifies target nucleic acids
- self collected vaginal swabs offer another specimen
- can also use first 10-15 cc of urine specimens from men and women
- culture only for medical/legal purposes but not really anymore
24
Q
erica continued
A
- specimen and order NAAT
- for men- urine
- for women- you can get urine as last resort, but really should get vaginal- self is preferred unless person is already in there
- preg test- neg
- consider HIV, syphilis
- make sure vaccinated for Hep B and HPV
- counsel/motivational interviewing about protection against STI, protection against pregnancy, consensual relationship
