B8.053 Update on Sexually Transmitted Diseases

Question 1

criteria that justify routine screening

Answer 1

1. serious health disorder that can be detected before symptoms develop
2. treatment more beneficial when begun before symptoms develop
3. reliable, inexpensive, acceptable screening test
4. costs of screening are reasonable in relation to anticipated benefits

Question 2

sites/sources of screening for STDs

Answer 2

cervix
urine
vaginal (self collected)
serum
saliva (HIV)
male urethra

Question 3

technologies for STD screening

Answer 3

antibody response: syphilis
NAAT: chlamydia, HSV
culture: help with resistance panels for gynococci
microscopy

Question 4

vaccines for STDs

Answer 4

HBV
HPV
mayyybe GC (coming)

Question 5

characterize chlamydia trachomatis

Answer 5

gram indeterminate (most closely related to gram -)
unique biphasic life cycle
-elementary bodies transmit the disease
-reticular body infective form (intracellular growth within host cells)

Question 6

diseases caused by chlamydia

Answer 6

urethritis
cervicitis
PID

Question 7

long term sequelae of chlamydia

Answer 7

fallopian tube damage
infertility
ectopic pregnancy

Question 8

why is chlamydia the silent epidemic

Answer 8

most are asymptomatic

don’t need symptoms to still suffer from long term sequelae

Question 9

how is chlamydia trending in the US?

Answer 9

going up

Question 10

who should be screened for chlamydia

Answer 10

women under 25 presenting for a regular office visit

Question 11

recommended treatment of chlamydia

Answer 11

azithromycin 1g PO single dose

doxycycline 100 mg po BID for 7 days

Question 12

alternative ttx for chlamydia

Answer 12

erythromycin 500 mg po QID for 7 days
ofloxacin 300 mg po BID for 7 days
levofloxacin 500 mg po q d for 7 days

Question 13

does screening help prevent chlamydia associated sequelae?

Answer 13

yup

canadian study

Question 14

what % of women who should be screened for chlamydia actually get screened

Answer 14

50ish percent or less

Question 15

gonorrhea on gram stain

Answer 15

gram neg diplococci

Question 16

gonorrhea discharge

Answer 16

white, purulent

women can be asymptomatic

Question 17

culture medium for gonorrhea

Answer 17

thayer-martin
chocolate
look for abx resistance

Question 18

is gonorrhea going up in the US

Answer 18

yup

Question 19

what is stressful about treating gonorrhea

Answer 19

rapidly develops resistance
when we use one antibiotic a lot, we can’t use it indefinitely
dont want to hit 5% elevated MIC

Question 20

treatment of gonorrhea

Answer 20

ceftriaxone 250 mg in a single IM dose
PLUS
azithyomycin 1 g PO in a single dose
OR
doxycycline 100 mg PO BID for 7 days

Question 21

characterize HPV

Answer 21

small DNA virus

>100 types, 20 infect genital tract

Question 22

cancer causing HPV

Answer 22

16, 18

Question 23

wart causing HPV

Answer 23

6, 11

Question 24

description of HPV genital warts

Answer 24

raised, dry
no exudate
not much induration

Question 25

patient applied treatment for genital warts

Answer 25

podofilox, imiquimod, or sinecatechins

Question 26

provider applied treatment for genital warts

Answer 26

podophyillin cryotherapy trichloroacetic acid

Question 27

syphilis primary chancre

Answer 27

``` 8-10 mm sore indurated firm lots of lymphocytes no exudate "clean" ```

Question 28

who do you see syphilis chancres on?

Answer 28

men | women are usually inside vagina or on cervix, not visualized and asymptomatic

Question 29

secondary syphilis sign

Answer 29

palmar, plantar rash | blanches with pressure (vasculitis)

Question 30

what does the increase in congenital syphilis parallel

Answer 30

increase in women with primary and secondary syphilis

Question 31

treatment of syphilis

Answer 31

benzathine penicillin G 2. 4 million units IM - long acting depo - spirochetalcidal level for several weeks

Question 32

traditional syphilis screening sequence

Answer 32

RPR > TP-PA

Question 33

reverse syphilis screening sequence

Answer 33

EIA or CIA > qualitative RPR > if negative TP-PA

Question 34

guidelines for prevention of congenital syphilis

Answer 34

screening -first prenatal visit, 28 weeks, delivery -take action on positives treatment with penicillin -accept no substitutes; do desensitization for allergies education

Question 35

STD from most to least prevalent

Answer 35

``` HPV HSV2 trichomoniasis chlamydia HIV HBV gonorrhea syphilis ```

Question 36

characterize genital herpes

Answer 36

due primarily to HSV2, but genital HSV1 increasing herpesvirus family (dsDNA, enveloped) latency and reactivation

Question 37

genital ulcers in herpes

Answer 37

multiple small painful serous

Question 38

chanroid genital ulcers

Answer 38

``` multiple large painful dirty presents with lymphadenopathy ```

Question 39

noninfectious genital ulcers

Answer 39

lichen planus Behcet syndrome Crohn's disease

Question 40

treatment for first episode of genital herpes

Answer 40

acyclovir 400 mg PO 3 times a day acyclovir 200 mg PO 5 times a day valacyclovir 1 g BID -all for 7-10 days