Chapter 153: Sexually Transmitted Disease Flashcards
What consists of Reiter’s syndrome
- urethritis
- Conjunctivitis
- rash
when to consider urethral chlamydial infection as differential diagnosis
(+) sterile pyuria
preferred test for diagnosing Clamydia
Nucleic acid amplification testing
*Encourage women to be retested approximately 3 months after treatment because of high incidence of recurrence
Treatment for Chlamydia
single-dose azithromycin 1 gram PO OR doxycycline 100mg 2x/day for 7 days
*Azithromycin is safe for pregnant women
*Amoxicillin is safe alternative in pregnancy
*Refer partners for testing and treatment if there was sexual contact in the last 60 days
*avoid sexual contact until 7 days have elapsed after completion of antibiotic treatment and their symptoms resolved
Second most commonly reported STI
Gonorrhea (caused by Neisseria gonorrhea) - gram-negative diplococcus
Most common presenting symptoms of Gonorrhea in men
- Dysuria
- profuse, purulent penile discharge
Signs and symptoms of disseminated gonococcal infection
- petechial or pustular acral skin lesions on an erythematous base
- asymmetric arthralgias
- tenosynovitis/septic arthritis
- fever/general malaise
gram stain result for gonorrhea
In men, a Gram stain of urethral secretions that demonstrates polymorphonuclear leukocytes with the classic intracellular diplococci confirms the diagnosis
*not recommended as screening tool. absence of this finding is not sufficient to rule out the gonococcal infection
Treatment for Gonorrhea
dual therapy :
1) Ceftriaxone 250mg IM
PLUS
2) Azithromycin 1 gram PO
*Disseminated gonorrhea: higher doses of ceftriaxone - 1 gram IM or IV every 24 hours for 1 to 2 days FOLLOWED BY Cefixime 400mg PO 2x/day for minimum of 1 week
nongonococcal urethritis is usually caused by
Chlamydia trachomatis
Others: Ureaplasma urealyticum, Mycoplasma genitalium, Trichomonas vaginalis, herpes simplex virus, and adenovirus
most sensitive and specific test for Trichomoniasis
Culture
*wet-mount microscopy - poor sensitivity
Treatment for Trichomonas infection
Metronidazole, 2 grams PO in a single dose or 500 milligrams PO twice daily for 7 days
Patients must avoid alcohol when taking metronidazole because of what reaction?
disulfiram-like reaction
Drug of choice for treating pregnant patients with Trichomonas
Metronidazole 2g single dose
*some avoid oral treatment in first trimester
Causative agent for Syphilis
Treponema pallidum
Stage of infection in syphilis characterized by absence of clinical manifestations but positive serologic testing
Latent syphilis
Stage of infection in syphilis: painless chancre with indurated borders on the penis which resolves spontaneously
Primary syphilis
Stage of infection in syphilis: characterized by rash and lymphadenopathy; non specific symptoms; resolves spontaneously
Secondary syphilis
Stage of infection in syphilis: involvement of the nervous and cardiovascular systems, with widespread granulomatous lesions (gummata)
Tertiary syphilis
TRUE OR FALSE: Diagnostic test for T. pallidum is culture
FALSE: T. pallidum cannot be cultured in the laboratory, and there is no single optimal test
*Direct visualization of the organism using darkfield microscopy is diagnostic however, failure to visualize the organism does not exclude syphilis
*VDRL and rapid plasma reagin tests -screening tests and also, once diagnosis is made, to assess disease activity and response to treatment
non specific antibodies released as a result of Trichomonas infection
Cardiolipin
*for secondary syphilis, nontreponemal antibody tests are nearly 100% sensitive with high specificity
TRUE OR FALSE: Patients who develop disease and have a reactive result on a specific treponemal antibody test will have a reactive test result for life regardless of disease activity or treatment
TRUE
treatment for Syphilis
Primary and secondary: Penicillin G benzathine 2.4 million units IM in a single dose
*Doxycycline 2x/day for 2 weeks if allergic to penicillin
Tertiary: Penicillin G benzathine 2.4 million units IM weekly for 3 weeks
*follow all patients for repeat serologic testing at 6 and 12 months
TRUE OR FALSE: Pregnant women should be treated with parenteral penicillin G; if allergic, medication should be discontinued and proceed with alternative medication
FALSE: Pregnant women should be treated with parenteral penicillin G; if allergic, they should be desensitized and then given this medication
characterized by an acute febrile reaction associated with headache and myalgias seen in treatment of early syphilis within the first 24 hours after treatment of Syphilis
Jarisch-Herxheimer reaction
TRUE or FALSE: Treatment for HSV is curative
Treatment shortens the duration of outbreaks but is not curative.
Antiviral medications decrease the time until all lesions are crusted and healed, decrease pain and constitutional symptoms, and decrease the period of viral shedding by several days
Treatment for first clinical episode genital herpes
Treat the first clinical episode of genital herpes
- Acyclovir, 400 milligrams PO three times daily × 7–10 d
- OR Acyclovir, 200 milligrams PO five times daily × 7–10 d
- Valacyclovir, 1 gram PO two times daily × 7–10d
- Famciclovir, 250 milligrams PO three times daily × 7–10 d
treatment for HSV proctitis or oral infections
use higher doses: (acyclovir, 400 milligrams five times a day for 7 to 10 days)
- for hospitalized patients: acyclovir, 5 to 10 milligrams/kg IV every 8 hours, for at least 2 days before transitioning to oral therapy
Treatment for episodic recurrent infection
- Acyclovir, 400 milligrams orally twice a day for 5 days
- OR Valacyclovir 500-1000 milligrams orally once a day (500 milligrams may not be as effective as 1000)
- OR Famciclovir 250 milligrams orally twice a day
disease characterized by painful genital ulcers and lymphadenitis that is caused by the pleomorphic gram-negative bacillus Haemophilus ducreyi
Chancroid
treatment for Chancroid
- Azithromycin 1 gram PO single dose OR (Pregnant)
- Ceftriaxone 250 mg single dose Or (pregnant)
- Ciprofloxacin 500 mg IM for 3 days OR
- Erythromycin base 500mg PO 3x/day for 7 days
*Azithromycin and Ceftriaxone used in patients without HIV, ciprofloxacin as alternative
causative agent for Lymphogranuloma venerum
Chlamydia trachomatis (L1, L2, L3)
groove sign (Scarring of inguinal masses that may cause linear depressions parallel to the inguinal ligament) is seen in what disease
Lymphogranuloma venerum
TRUE or FALSE: Diagnosis of Lymphogranuloma venerum is based on clinical suspicion, epidemiologic data, and exclusion of other causes
TRUE
treatment for Lymphogranuloma venerum
Doxycycline, 100 milligrams PO two times daily × 21 d
- Alternative erythromycin base
causative agent for Granuloma inguinale (donovanosis)
Klebsiella granulomatis
Painless, beefy red, bleeding ulcers
Granuloma inguinale (donovanosis)
Treatment of choice for Granuloma inguinale (donovanosis)
Azithromycin 1 gram PO weekly or 500 mg PO daily for at least 3 weeks and until all lesions have healed
alt: Doxycycline, ciprofloxacin, erythromycin base, and trimethoprim-sulfamethoxazole
CI in pregnancy: Doxycycline, ciprofloxacin, and sulfonamides are contraindicated in pregnancy
oncogenic, high-risk sub types of HPV
HPV types 16 and 18 - cervical, vulvar, penile, anal, and oropharyngeal cancers
non oncogenic subtypes of HPV
types 6 and 11 - cause genital warts
TURE or FALSE: Diagnosis for HPV is culture
FALSE: clinical
most common method of transmission of HIV worldwide
Sex with an infected partner (male-to-male sexual contact accounts for 78% of new infections)
pearly, umbilicated papules, which may be scattered or in clusters
Molluscum contagiosum
