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Women's Health > Exam 1 - STIs > Flashcards

Exam 1 - STIs Flashcards

1
Q

What are the 5 P’s of taking a sexual history?

A
  • Partners
  • Practices
  • Prevention of pregnancy
  • Protection from STIs
  • Past hx of STIs
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2
Q

Which special population accounts for half of all new STIs?

A

Youth (ages 15-24)

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3
Q

What is usually the causative agent of Vulvovaginal Candidiasis?

A

C. albicans

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4
Q

What are some common symptoms and exam findings consistent with Vulvovaginal Candidiasis?

A
  • Pruritis
  • Vulvar soreness/burning/irritation
  • Erythema of vulva
  • White, thick, curd-like vaginal discharge (adherent to vaginal walls)
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5
Q

How can you diagnose Vulvovaginal Candidiasis?

A
  • Clinical diagnosis

- Wet mount with 10% KOH (budding yeast, hyphae)

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6
Q

When would you obtain a vaginal culture for Vulvovaginal Candidiasis?

A

Complicated infection

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7
Q

What classifies a Vulvovaginal Candidiasis infection as complicated?

A
  • Severe signs/symptoms
  • Recurrent (> 4 years)
  • Nonalbicans species
  • Pregnancy, poorly controlled DM, immunosupression
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8
Q

What is the treatment for uncomplicated Vulvovaginal Candidiasis?

A

Oral fluconazole (Diflucan) 150 mg PO x 1

OR

Short course (1-3 days) of topical azole such as Clotrimazole

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9
Q

What is the treatment for an albicans complicated Vulvovaginal Candidiasis?

A

Oral fluconazole (Diflucan) 150 mg PO q 72 hours x 2-3 doses

OR

Treat with longer duration (7-14 days) with topical azole such as Clotrimazole

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10
Q

What is the treatment for a non-albicans complicated Vulvovaginal Candidiasis?

A

Nonfluconazole azole drug

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11
Q

What is the most common cause of vaginal discharge in women of childbearing age?

A

Bacterial Vaginosis

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12
Q

What is the cause of Bacterial Vaginosis?

A

Overgrowth of anaerobic bacteria

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13
Q

What is the causative organism of Bacterial Vaginosis?

A
  • Usually polymicrobial

- Often associated with Gardnerella vaginalis

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14
Q

What is the clinical presentation associated with bacterial vaginosis?

A
  • Most often asymptomatic

- Thin, off-white malodorus/”fishy” vaginal discharge

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15
Q

What is the clinical criteria for diagnosis bacterial vaginosis?

A

Amsel’s criteria - presence of at least 3 of the following:

  • Thin, white homogenous discharge
  • Clue cells on saline wet mount
  • Vaginal fluid pH > 4.5
  • (+) whiff test
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16
Q

What is the recommended treatment options for symptomatic Bacterial Vaginosis?

What should you be aware of in regards to patient education with this medication?

A

Metronidazole (Flagyl) 500 mg PO BID x 7 days

Avoid alcohol while taking Metronidazole

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17
Q

What is the CDC recommendation in regards to testing if a patient is positive for BV?

A

All women with BV should be offered testing for HIV and other STIs

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18
Q

What is the most common nonviral STI worldwide?

A

Trichomoniasis

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19
Q

What is the clinical presentation associated with Trichomoniasis?

A
  • Most have minimal or no symptoms
  • Purulent, malodorous, frothy, thin vaginal discharge
  • Burning, dysuria, dyspareunia
  • Postcoital bleeding can occur
  • May see punctate hemorrhages on vagina and cervix (“strawberry cervix”)
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20
Q

What is the gold standard diagnostic test for Trichomoniasis?

A

Nucleic Acid Amplification Test (NAAT)

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21
Q

What is the treatment for Trichomoniasis in a non-pregnant female?

A

Treat both asymptomatic and symptomatic

  • Metronidazole (Flagyl) 2 g x 1
  • Abstain from sex until patient and sex partners are treated
  • Abstain from sex for at least 7 days following treatment and until asymptomatic
  • Test for other STIs including HIV
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22
Q

What is the treatment for Trichomoniasis in a pregnant female?

A
  • Metronidazole 2 gm x 1

- Metronidazole 500 mg BID x 5-7 days (if N/V)

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23
Q

What is important to note regarding the follow up for Trichomoniasis treatment?

A

Repeat testing within 3 months following initial treatment to assess for re-infection

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24
Q

What is the CDC recommendation in regards to screening for Trichomoniasis?

A

Screen in all HIV-infected women annually and at initial prenatal visit

25
Q

What are some clinical presentations associated with chlamydia and gonorrhea?

A
  • Most are asymptomatic
  • Change in vaginal discharge
  • Intermenstrual or postcoital bleeding
  • Dysuria, urinary frequency
26
Q

What are some classic exam findings associated with cervicitis/chlamydia/gonorrhea?

A
  • Mucopurulent endocervical discharge

- Cervix-friability, erythema, edema

27
Q

How is the diagnostic test of choice for chlamydia?

A

NAAT via vaginal swab

28
Q

What are some complications of pregnancy associated with chlamydia?

A
  • Increased risk for premature rupture of membranes, preterm delivery
  • Transmittable to neonate during delivery (conjunctivitis)
29
Q

What is the medication treatment for chlamydia?

A

Treat patient and sex partners
- Azithromycin 1 gm PO x 1
OR
- Doxycycline 100 mg PO BID x 7 days (avoid in pregnancy)

30
Q

Other than medication, what else is recommended for the treatment of chlamydia and gonorrhea?

A
  • Avoid sex for 7 days after treatment and until resolution of symptoms
  • Test for other STIs
  • Repeat testing for re-infection at 3 months
31
Q

Who should be screen for chlamydia and gonorrhea?

A

Annual screening of all sexually active women aged < 25 years old

32
Q

How is gonorrhea diagnosed?

A

NAAT via vaginal swab

33
Q

What are some complications that can occur from chlamydia and gonorrhea?

A
  • PID, ectopic pregnancy, infertility, chronic pelvic pain

- Disseminated gonococcal infection from gonorrhea specifically

34
Q

What are some complications of pregnancy associated with gonorrhea?

A
  • Risk of preterm birth, low birth weight, infection (chorioamnionitis)
  • Transmittable to neonate during delivery (ophthalmia neonatorum)
35
Q

What is the medication treatment for gonorrhea?

A

Treat patient and sex partners
- Ceftriaxone 250 mg IM
PLUS
- Azithromycin 1 gm PO x 1

***same treatment regimen for pregnant women

36
Q

What is the most commonly reported bacterial infection in the U.S.?

A

Chlamydia

37
Q

What is perihepatitis (Fitz-Hugh Curtis Syndrome) and what is it characterized by?

A

Inflammation of the liver capsule and adjacent peritoneal surfaces

PID with RUQ pain and “violin string” adhesions of the liver

38
Q

What are some clinical presentations associated with acute symptomatic PID?

A
  • Lower abdominal pain
  • Abnormal vaginal discharge, uterine bleeding
  • Fever, dyspareunia
  • Uterine, adnexal, and/or CMT (Chandelier sign)
39
Q

What is the outpatient treatment for mild to moderate PID?

A
  • Ceftriaxone 250 mg IM x 1
    PLUS
  • Doxycycline 100 mg BID x 14 days
  • Close follow-up in 48-72 hours

***with or without Metronidazole 500 mg PO BID x 14 days

40
Q

When should you consider hospitalization for PID?

A
  • Pregnancy
  • Lack of response or tolerance to oral meds
  • Concern for nonadherence to therapy
  • Inability to take oral meds due to N/V
  • Severe illness (high fever, n/v, severe pain)
  • Complicated PID with pelvic abscess
41
Q

What is the most common STI in the world?

A

HPV

42
Q

Which types of HPV are detected in most cases of Condyloma Acuminata and have low oncogenic potential?

Which have high oncogenic potential?

A

Low-risk: HPV types 6 and 11

High risk: HPV types 16 and 18

43
Q

What are some clinical presentation associated with Condyloma Acuminata (Anogenital Warts)?

A
  • Typically asymptomatic, but may be pruritic
  • Soft, flesh-colored, smooth, or plaque-like
  • Cauliflower-like more common
44
Q

What is the treatment for Condyloma Acuminata (Anogenital Warts)?

A
  • Cyto-destructive (Podofilox)
  • Immune-mediated (Imiquimod, Sinecatechins)
  • Surgical
45
Q

What is the causative organism of most cases of recurrent genital herpes?

A

HSV-2

46
Q

What is a primary genital herpes infection?

A
  • Infection in patient without pre-existing antibodies to either HSV-1 or HSV-2
  • Longer duration, increased viral shedding and systemic symptoms
  • Symptoms last 2-4 weeks if untreated
47
Q

Describe a non-primary first episode of genital herpes?

A
  • Acquisition of genital HSV-2 in a patient with pre-existing antibodies to HSV-1
  • Symptoms usually milder than primary infection
48
Q

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

A
  • Painful, genital ulcers
  • Tender inguinal lymphadenopathy
  • Some may be asymptomatic
49
Q

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

A
  • Prodromal symptoms such as tingling, burning, or itching before eruption
  • Symptoms are less severe than primary infection
50
Q

What is the preferred diagnostic testing for genital herpes?

A

Virologic tests:

  • Viral culture
  • PCR
51
Q

What does the presence of type-specific HSV-2 antibodies imply?

A

Anogenital infection

52
Q

What is the treatment for a first episode of genital herpes?

A

Valacyclovir, famciclovir, or acyclovir for 7-10 days

53
Q

What is the episodic treatment for recurrent outbreaks of genital herpes?

A

Valacyclovir, famciclovir, or acyclovir for 1-5 days

54
Q

Which diseases require repeat testing within 3 months of treatment?

A

Chlamydia, gonorrhea, and trichomonas

55
Q

Based on the following clinical presentation, what is your presumptive diagnosis?

  • Vaginal pruritis
  • Vulvar soreness/burning/irritation
  • Erythema of vulva
  • White, thick, curd-like vaginal discharge (adherent to vaginal walls)
A

Vulvovaginal Candidiasis (yeast infection)

56
Q

Based on the following clinical presentation, what is your presumptive diagnosis?

  • Most often asymptomatic
  • Thin, off-white malodorus/”fishy” vaginal discharge
  • Presence of Clue cells
A

Bacterial Vaginosis

57
Q

Based on the following clinical presentation, what is your presumptive diagnosis?

  • Purulent, malodorous, frothy, thin vaginal discharge
  • Burning, dysuria, dyspareunia
  • Postcoital bleeding can occur
A

Trichomonaisis

58
Q

Punctate hemorrhages on vagina and cervix (“strawberry cervix”) is associated with what STI?

A

Trichomonaisis

59
Q

Lower abdominal pain and CMT (Chandelier Sign) is commonly associated with what disease process?

A

PID

Women's Health (5 decks)

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