Clinical aspects of STDs Flashcards
How does HSV enhance the transmission of HIV?
HSV-2 causes genital lesions which are perfect for transmitting HIV.
Inflammatory genital lesions (i.e. vaginitis from trichomatis also contributes)
Is circumcision good?
Yes, it significantly reduces the incident of HSV-2, HPV, syphilis, and trichomonas
What are the infectious causes of urethritis?
Gonorrheal or non-gonorrheal - i.e. Chlamydia, Mycoplasma genitalium
What are the major symptoms of gonorrhea?
Men: Urethritis - urethral discharge, dysuria, epididymitis, and orchitis
Women: Mucopurulent cervicitis - vaginal discharge and dysuria
What eye infection can gonorrhea cause?
Conjunctivitis
What are the spots to get gram stains from when checking for gonorrhea and who are you checking in? What are you looking for?
Symptomatic males - Urethra
Females - Endocervix
Checking for gram negative diplococci within or associated with PMNs
What is used to test the urine males and females with incredibly high sensitivity and specificity for gonorrhea?
LCR - ligase chain reaction, a form of PCR
Nucleic acid amplication tests
What is the first line treatment for gonorrhea?
3rd generation cephalosporin, typically plus azithromycin to treat for chlamydia as well (co-infection likely)
What puts you at increased risk for chlamydia?
Nonwhites, under 20 years old, many and multiple partners, single, with inconsistent condom use
Also: oral contraceptives increase risk
What is typically inflamed in women with chlamydia infection?
Cervix - with open os and swelling which is obvious
Fallopian tubes - loss of cilia can lead to infertility
What is the most commonly used test for NAATS infection?
Nucleic acid amplification tests
What are the treatments for Chlamydia?
1g azithromycin (one dose) or Doxycycline 100 mg BID x7 days.
Amoxicillin if pregnant
What are the two leading causes of PID?
Gonorrhea is #1
Chlamydia is #2
What is genital ulcer disease?
Chancroid caused by hemophilus ducreyi.
Causes unilateral ulcer with painful tender inguinal adenopathy
What marks the secondary syphillis stage?
Multiple mucocutaneous fever, alopecia spots, lymphadenopathy, meningitis, and a rash on palms and soles of feet which is papular or macular
What test is almost always positive in secondary stage of syphilis? What is the positive rate of VDRL test in primary syphillis?
RPR test or VDRL
VDRL: 70% positive rate
What is common in early onset neurosyphilis?
Meningitis
Tabes dorsalis + argyll-robertson pupil is more common in late onset
What is the most common site of cardiovascular syphilis?
Dilation of ascending aorta
What is needed for definitive syphilis diagnosis?
A non-treponemal test and a treponemal test
What is the functional difference between a treponemal and non-treponemal test?
Non-rreponemal tests are quantatitive and will measure disease remission if it’s going away (need a four-fold decrease in titer of VDRL to show a cure) vs
Treponemal tests like FTA-ABS (fluorescent treponemal antibody absorption) just tests for antibody and should be long-lasting even after the infection resolves (shows you had syphilis at some point in your lifetime).
how is the treatment for neurosyphilis different than regular?
Neurosyphilis gets treated x10 days along with IV Ceftriaxone
Primary and secondary just get Benzathine penicillin for 1 or 3 days for primary or secondary
What is the treatment for genital herpes first episode?
Acyclovir 400 mg TID x7-10 days
What two labs are typically elevated in vaginal trichomoniasis?
Vaginal pH and PMNs
What is the treatment for trichomoniasis?
Metronidazole with concurrent treatment of partner
who is cutest person in da wurld
da memo
