E1: STI Part 2

Question 1

What is PID?

Answer 1

An infection of the upper genital tract (ascending infection
-represents a spectrum of infection (any combination of endometriosis, salpingitis, oophoritis, peritonitis, etc

Question 2

What is the etiology of PID/

Answer 2

Majority are N. Gonorrhoeae or C. Trachomatis, or BV associated pathogens
-Mycoplasma is emerging

Question 3

What populations are at risk for PID?

Answer 3

• Women with multiple sex partners
• Age < 25
• Partner with an STI
• Hx of PID or STI
• IUD
• Disruption of normal vaginal flora

Question 4

What is the clinical presentation of PID?

Answer 4

-range from mild, vague pelvic symptoms to tube-ovarian abscess, sepsis, and possibly perihepatitis

Question 5

What is Fitz-Hugh syndrome?

Answer 5

• Perihepatitis, inflammation of the liver capsule and adjacent peritoneal structures
• Characterized by RUQ pain and “violins string” adhesions of the liver

Question 6

Patient presents with lower abdominal pain that occurs after mentees, abnormal vaginal discharge, abnormal bleeding, dyspareunia, and a fever. On PE, patient has abdominal pain in the lower quadrants, and pelvic exam has a positive chandelier sign and purulent endocervical discharge. What is the most likely diagnosis?

Answer 6

PID

Question 7

What is Chandelier sign?

Answer 7

Uterine, adnexal, and/OR CMT

Question 8

What is the outpatient treatment of mild-moderate PID?

Answer 8

Ceftriaxone 250mg IM single dose PLUS doxy 100mg BID x 14 days
With or without metronidazole 500mg PO BID x14 days

Question 9

When should you hospitalize for PID?

Answer 9

• Pregnancy
• lack of response or tolerance to oral medications
• concern for non adherence to therapy
• inability to take oral meds
• severe clinical illness
• complicated PID
• Surgical emergencies

Question 10

What are the possible complications of PID?

Answer 10

• Hydrosalpinx
• infertility
• risk of ectopic pregnancy
• chronic pelvic pain

Question 11

What is the most common STI in the world?

Answer 11

HPV

Question 12

What types of HPV are detected in most cases of condyloma acuminata?

Answer 12

6 and/or 11 (low oncogenes potential

Question 13

What are the types of HPV that have high oncogenic potential?

Answer 13

16 and 18

Question 14

What are the risk factors for HPV?

Answer 14

• Sexual activity
• smoking
• immunosuppresion

Question 15

What is the clinical presentation of Condyloma Acuminata (AKA anogenital wart)?

Answer 15

• Typicall asymptomatic, but may be pruritic
• soft flesh colors smooth or plaque like
• single, multiple, flat, dome shaped, cauliflower, etc

Question 16

How is Condyloma acuminata diagnosed?

Answer 16

• Visualize warts on exam

- biopsy may be considered if dx is uncertain

Question 17

What is the treatment of condyloma acuminata?

Answer 17

• Cyto-destructive (podofilox, trichloracetic acid)
• Immune-mediated (Imiquimod, Sinecatechins)
• Surgical (cryotherapy, laser, electrocautery)

Question 18

How can HPV be prevented?

Answer 18

• HPV vaccine!!
• Condoms used consistently and correctly can lower the changes of acquiring and and transmitting
• Limiting number of sex partners

Question 19

What are most cases of recurrent genital herpes caused by?

Answer 19

HSV2

Question 20

70% of genital herpes transmission occurs during times of ***.

Answer 20

Asymptomatic HSV shedding

Question 21

What is a primary episode of genital herpes?

Answer 21

• Infection in a patient without preexisting antibodies to either HSV1 or HSV2
• longer duration, increased viral shedding, and systemic symptoms
• symptoms may last 2-4 weeks if untreated

Question 22

What is a non-primary first episode of genital herpes?

Answer 22

• Acquisition of genital HSV2 in a patient with preexisting antibodies to HSV1
• symptoms usual milder than primary infection

Question 23

What is the clinical presentation of a primary infection of genital herpes?

Answer 23

• Average incubation period after exposure is 2-12 days
• painful genital ulcers, dysuria, fever, tender inguinal lymphadenopathy, headache
• possible to be asymptomatic

Question 24

What is the clinical presentation of a recurrent infection of genital herpes?

Answer 24

• Prodromal symptoms before the eruption

- symptoms tend to be less severe than primary infection

Question 25

How is genital herpes diagnosed?

Answer 25

• Virologic tests are preferred (viral culture)
• PCR
• Serologic tests (tests for antibodies, may be false negatives in early disease)

Question 26

What does presence of HSV2 antibody imply?

Answer 26

Anogenital infection

Question 27

What does presence of HSV1 antibodies imply?

Answer 27

-consistent with either anogenital or orolabial infections

Question 28

What is the treatment for genital herpes?

Answer 28

-Valacylovir, famciclovir, or acyclovir
-first episode: 7-10 day regimen started within 72 hours
-Recurrent outbreaks: 1-5 day regimens
Suppression: Once a day or BID dosing