E1: STI Part1 Flashcards
What are the “5 P’s” of taking a sexual history?
- Partners
- Practices
- Prevention of pregnancy
- Protection from STIs
- Past hx of STIs
What are the high risk populations for STIs?
- Youth (ages 15day-24)
- Men who have sex with men
- Pregnant women
- HIV infected patients
- Individuals entering correctional facilities
What are the 3 types of vaginitis?
- vulvovaginal candidiasis
- bacterial vaginosis
- trichomoniasis
What is vaginitis?
A general term for disorders of the vagina caused by infection, inflammation, or changes in the normal vaginal flora
What are the symptoms of vaginitis?
Vaginal discharge, odor, and pruritis
Is vulvovaginal Candiss is an STI?
No, it is a yeast infection
What is the causative organism of Vulvovaginal candidiasis?
C. Albicans
Patient presents with vaginal soreness and pruritis, as well as dysuria and abnormal vaginal discharge. On pelvic exam, you see erythema and edema of the vulva and a thick, white, curd like discharge that is adherent to the vaginal wall. What is the most likely diagnosis?
Vulvovaginal candidiasis
What are the risk factors for developing Vulvovaginal candidiasis?
- DM
- Abx use
- increased estrogen levels
- immunosuppressed
How is Vulvovaginal candidiasis diagnosed?
- Clinically
- Wet mount shows budding yeast, hyphae, or pseudohyphae
What is considered uncomplicated vulvovaginal candidiasis?
- mild to moderate symptoms
- infrequent occurrence
- caused by C. Albicans
- Pt is a healthy, immunocompetent, non pregnant women
What is considered a complicated case of vulvovaginal candidiasis?
- Severe symptoms
- recurrent ( >4 times per year)
- Caused by a nonalbicans species
- Pt is pregnant, has DM, immunosuppresion, debilitation
What is the treatment for uncomplicated vulvovaginal candidiasis?
-Oral fluconazole (Diflucan) 150mg PO x1
OR
Short course (1-3 days) of topical azole
What is the treatment of complicated vulvovaginal candidiasis?
-Oral Fluconazole 150mg PO Q 72 hours x 2-3 doses
OR
-longer duration (7-14 days) of topical azole
-if nonalbicans, use nonfluconazole drug as first line
-maintenance tax for recurrent vulvovaginal candidiasis
How is vulvovaginal candidiasis treated in pregnant women?
-Use topical treatments, Clotrimazole or miconazole x7 days
What is the most common cause of vaginal discharge in women of childbearing age?
Bacterial vaginosis
What causes bacterial vaginosis?
- usually polymicrobial and associated with Gardnerella vaginalis
- replacement of “healthy” vaginal flora with overgrowth of anaerobic bacteria
What is the clinical presentation of bacterial vaginosis?
- Many are asymptomatic
- May have vaginal discharge/odor
- PE with thin, off white discharge with a “fishy odor”
What are the risk factors of bacterial vaginosis?
- Sexual activity
- presence of other STIs
- Race
- lack of condom use
- douching
- smoking
What is Amsels criteria used to diagnose? What are the criteria?
-Used to diagnose bacterial vaginosis Criteria is that there must be at least 3 of the following: -thin white homogenous discharge -Clue cells on saline wet mount -Vaginal fluid pH >4.5 -+ Whiff test
Who should be treated for bacterial vaginosis?
- Patient with symptoms
- pregnant women
- routine treatment of sexual partners is not recommended
What are the treatment options of bacterial vaginosis?
- Metronidazole 500mg BID x7 days
- Metronidazole gel 0.75% intravaginally QD x5days
- Clindamycin cream 2% intravaginally QHS x7 days
What is the CDC recommendation for all women with BV?
They should all be offered testing for HIV and other STIs
What is the most common nonviral STI worldwide?
Trichonmoniasis
Coexistence with Trich and what other organism is common?
BV pathogens
What is the clinical presentation of trichomoniasis?
- Asymptomatic
- vaginal discharge, vulvar irritation, purulent malodorous frothy thin discharge
What should you be suspicious of if you see a “strawberry cervix” on pelvic exam?
Trichomoniasis
How is trichomoniasis diagnosed?
- Wet mount shows motile organisms
- Nucleic acid amplification test (GOLD STANDARD)
- Culture
- Rapid antigen and DNA probes
What can trichomoniasis cause if it goes untreated?
- urethritis/cystitis
- PID
- cervical neoplasia
- infertility
- increased risk of acquiring and transmitting HIV
- pregnancy complications
What is the treatment for trichomoniasis?
- Treat asymptomatic, symptomatic, and sexual partners
- Metronidazole (or tinidazole) 2g single dose
How is trichomoniasis treated in pregnancy?
-Metronidazole
OR
Metronidazole 500mg BID x 5-57 days
After treating someone for trichomoniasis, what kind of follow up should they have?
-Repeat testing within 3 months following initial treatment because reinfection rates of up to 17% have been reported
What is the CDC recommendation regarding Trichomoniasis?
-Screen for trich in all HIV infected women
What is the most commonly reported bacteria infection in the US?
Chlamydia
Patients with Chlamydia are often co infected with what?
Gonorrhea
Patient presents with symptoms of abnormal changes in her vaginal discharge and intermenstrual bleeding. Patient also has dysuria and increased urinary frequency. On Pelvic exam, you see mucupurulent endocervical discharge as well as cervix friability, erythema, and edema. What is the most likely diagnosis?
Chlamydia or Gonorrhea
How is chlamydia diagnosed?
-NAAT is test of choice, vaginal swab is preferred over endocervical swab or urine
How is Chlamydia treated?
-Treat patient and sex partners
-azithromycin 1gm PO single dose
OR
Doxy 100mg PO BID x 7 days
What is the treatment of Chlamydia in pregnancy?
- Treat with Azithromycin (avoid doxy)
- test of cure is recommended
Who should be screened for Gonorrhea and Chlamydia?
- Annual screening of all sexually active women aged <25
- older women with risk factors such as new or multiple sex partners, partner recently treated, inconsistent condom use, etc
How is gonorrhea diagnosed?
- NAAT (vaginal swab preferred)
- Culture
How is gonorrhea treated?
- Treat patient and sex partners
- Ceftriaxone 250mg IM PLUS azithromycin 1gm PO single dose
**same for pregnancy, but order test of cure
