Clinical aspects of STDs

Question 1

How does HSV enhance the transmission of HIV?

Answer 1

HSV-2 causes genital lesions which are perfect for transmitting HIV.

Inflammatory genital lesions (i.e. vaginitis from trichomatis also contributes)

Question 2

Is circumcision good?

Answer 2

Yes, it significantly reduces the incident of HSV-2, HPV, syphilis, and trichomonas

Question 3

What are the infectious causes of urethritis?

Answer 3

Gonorrheal or non-gonorrheal - i.e. Chlamydia, Mycoplasma genitalium

Question 4

What are the major symptoms of gonorrhea?

Answer 4

Men: Urethritis - urethral discharge, dysuria, epididymitis, and orchitis

Women: Mucopurulent cervicitis - vaginal discharge and dysuria

Question 5

What eye infection can gonorrhea cause?

Answer 5

Conjunctivitis

Question 6

What are the spots to get gram stains from when checking for gonorrhea and who are you checking in? What are you looking for?

Answer 6

Symptomatic males - Urethra

Females - Endocervix

Checking for gram negative diplococci within or associated with PMNs

Question 7

What is used to test the urine males and females with incredibly high sensitivity and specificity for gonorrhea?

Answer 7

LCR - ligase chain reaction, a form of PCR

Nucleic acid amplication tests

Question 8

What is the first line treatment for gonorrhea?

Answer 8

3rd generation cephalosporin, typically plus azithromycin to treat for chlamydia as well (co-infection likely)

Question 9

What puts you at increased risk for chlamydia?

Answer 9

Nonwhites, under 20 years old, many and multiple partners, single, with inconsistent condom use

Also: oral contraceptives increase risk

Question 10

What is typically inflamed in women with chlamydia infection?

Answer 10

Cervix - with open os and swelling which is obvious

Fallopian tubes - loss of cilia can lead to infertility

Question 11

What is the most commonly used test for NAATS infection?

Answer 11

Nucleic acid amplification tests

Question 12

What are the treatments for Chlamydia?

Answer 12

1g azithromycin (one dose) or Doxycycline 100 mg BID x7 days.

Amoxicillin if pregnant

Question 13

What are the two leading causes of PID?

Answer 13

Gonorrhea is #1

Chlamydia is #2

Question 14

What is genital ulcer disease?

Answer 14

Chancroid caused by hemophilus ducreyi.

Causes unilateral ulcer with painful tender inguinal adenopathy

Question 15

What marks the secondary syphillis stage?

Answer 15

Multiple mucocutaneous fever, alopecia spots, lymphadenopathy, meningitis, and a rash on palms and soles of feet which is papular or macular

Question 16

What test is almost always positive in secondary stage of syphilis? What is the positive rate of VDRL test in primary syphillis?

Answer 16

RPR test or VDRL

VDRL: 70% positive rate

Question 17

What is common in early onset neurosyphilis?

Answer 17

Meningitis

Tabes dorsalis + argyll-robertson pupil is more common in late onset

Question 18

What is the most common site of cardiovascular syphilis?

Answer 18

Dilation of ascending aorta

Question 19

What is needed for definitive syphilis diagnosis?

Answer 19

A non-treponemal test and a treponemal test

Question 20

What is the functional difference between a treponemal and non-treponemal test?

Answer 20

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).

Question 21

how is the treatment for neurosyphilis different than regular?

Answer 21

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

Question 22

What is the treatment for genital herpes first episode?

Answer 22

Acyclovir 400 mg TID x7-10 days

Question 23

What two labs are typically elevated in vaginal trichomoniasis?

Answer 23

Vaginal pH and PMNs

Question 24

What is the treatment for trichomoniasis?

Answer 24

Metronidazole with concurrent treatment of partner

Question 25

who is cutest person in da wurld

Answer 25

da memo