Exam 1 - STIs Flashcards
What are the 5 P’s of taking a sexual history?
- Partners
- Practices
- Prevention of pregnancy
- Protection from STIs
- Past hx of STIs
Which special population accounts for half of all new STIs?
Youth (ages 15-24)
What is usually the causative agent of Vulvovaginal Candidiasis?
C. albicans
What are some common symptoms and exam findings consistent with Vulvovaginal Candidiasis?
- Pruritis
- Vulvar soreness/burning/irritation
- Erythema of vulva
- White, thick, curd-like vaginal discharge (adherent to vaginal walls)
How can you diagnose Vulvovaginal Candidiasis?
- Clinical diagnosis
- Wet mount with 10% KOH (budding yeast, hyphae)
When would you obtain a vaginal culture for Vulvovaginal Candidiasis?
Complicated infection
What classifies a Vulvovaginal Candidiasis infection as complicated?
- Severe signs/symptoms
- Recurrent (> 4 years)
- Nonalbicans species
- Pregnancy, poorly controlled DM, immunosupression
What is the treatment for uncomplicated Vulvovaginal Candidiasis?
Oral fluconazole (Diflucan) 150 mg PO x 1
OR
Short course (1-3 days) of topical azole such as Clotrimazole
What is the treatment for an albicans complicated Vulvovaginal Candidiasis?
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
What is the treatment for a non-albicans complicated Vulvovaginal Candidiasis?
Nonfluconazole azole drug
What is the most common cause of vaginal discharge in women of childbearing age?
Bacterial Vaginosis
What is the cause of Bacterial Vaginosis?
Overgrowth of anaerobic bacteria
What is the causative organism of Bacterial Vaginosis?
- Usually polymicrobial
- Often associated with Gardnerella vaginalis
What is the clinical presentation associated with bacterial vaginosis?
- Most often asymptomatic
- Thin, off-white malodorus/”fishy” vaginal discharge
What is the clinical criteria for diagnosis bacterial vaginosis?
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
What is the recommended treatment options for symptomatic Bacterial Vaginosis?
What should you be aware of in regards to patient education with this medication?
Metronidazole (Flagyl) 500 mg PO BID x 7 days
Avoid alcohol while taking Metronidazole
What is the CDC recommendation in regards to testing if a patient is positive for BV?
All women with BV should be offered testing for HIV and other STIs
What is the most common nonviral STI worldwide?
Trichomoniasis
What is the clinical presentation associated with Trichomoniasis?
- 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”)
What is the gold standard diagnostic test for Trichomoniasis?
Nucleic Acid Amplification Test (NAAT)
What is the treatment for Trichomoniasis in a non-pregnant female?
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
What is the treatment for Trichomoniasis in a pregnant female?
- Metronidazole 2 gm x 1
- Metronidazole 500 mg BID x 5-7 days (if N/V)
What is important to note regarding the follow up for Trichomoniasis treatment?
Repeat testing within 3 months following initial treatment to assess for re-infection
What is the CDC recommendation in regards to screening for Trichomoniasis?
Screen in all HIV-infected women annually and at initial prenatal visit
What are some clinical presentations associated with chlamydia and gonorrhea?
- Most are asymptomatic
- Change in vaginal discharge
- Intermenstrual or postcoital bleeding
- Dysuria, urinary frequency
What are some classic exam findings associated with cervicitis/chlamydia/gonorrhea?
- Mucopurulent endocervical discharge
- Cervix-friability, erythema, edema
How is the diagnostic test of choice for chlamydia?
NAAT via vaginal swab
What are some complications of pregnancy associated with chlamydia?
- Increased risk for premature rupture of membranes, preterm delivery
- Transmittable to neonate during delivery (conjunctivitis)
What is the medication treatment for chlamydia?
Treat patient and sex partners
- Azithromycin 1 gm PO x 1
OR
- Doxycycline 100 mg PO BID x 7 days (avoid in pregnancy)
Other than medication, what else is recommended for the treatment of chlamydia and gonorrhea?
- Avoid sex for 7 days after treatment and until resolution of symptoms
- Test for other STIs
- Repeat testing for re-infection at 3 months
Who should be screen for chlamydia and gonorrhea?
Annual screening of all sexually active women aged < 25 years old
How is gonorrhea diagnosed?
NAAT via vaginal swab
What are some complications that can occur from chlamydia and gonorrhea?
- PID, ectopic pregnancy, infertility, chronic pelvic pain
- Disseminated gonococcal infection from gonorrhea specifically
What are some complications of pregnancy associated with gonorrhea?
- Risk of preterm birth, low birth weight, infection (chorioamnionitis)
- Transmittable to neonate during delivery (ophthalmia neonatorum)
What is the medication treatment for gonorrhea?
Treat patient and sex partners
- Ceftriaxone 250 mg IM
PLUS
- Azithromycin 1 gm PO x 1
***same treatment regimen for pregnant women
What is the most commonly reported bacterial infection in the U.S.?
Chlamydia
What is perihepatitis (Fitz-Hugh Curtis Syndrome) and what is it characterized by?
Inflammation of the liver capsule and adjacent peritoneal surfaces
PID with RUQ pain and “violin string” adhesions of the liver
What are some clinical presentations associated with acute symptomatic PID?
- Lower abdominal pain
- Abnormal vaginal discharge, uterine bleeding
- Fever, dyspareunia
- Uterine, adnexal, and/or CMT (Chandelier sign)
What is the outpatient treatment for mild to moderate PID?
- 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
When should you consider hospitalization for PID?
- 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
What is the most common STI in the world?
HPV
Which types of HPV are detected in most cases of Condyloma Acuminata and have low oncogenic potential?
Which have high oncogenic potential?
Low-risk: HPV types 6 and 11
High risk: HPV types 16 and 18
What are some clinical presentation associated with Condyloma Acuminata (Anogenital Warts)?
- Typically asymptomatic, but may be pruritic
- Soft, flesh-colored, smooth, or plaque-like
- Cauliflower-like more common
What is the treatment for Condyloma Acuminata (Anogenital Warts)?
- Cyto-destructive (Podofilox)
- Immune-mediated (Imiquimod, Sinecatechins)
- Surgical
What is the causative organism of most cases of recurrent genital herpes?
HSV-2
What is a primary genital herpes infection?
- 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
Describe a non-primary first episode of genital herpes?
- Acquisition of genital HSV-2 in a patient with pre-existing antibodies to HSV-1
- Symptoms usually milder than primary infection
What is the clinical presentation of a primary genital herpes infection?
- Painful, genital ulcers
- Tender inguinal lymphadenopathy
- Some may be asymptomatic
What is the clinical presentation of a recurrent genital herpes infection?
- Prodromal symptoms such as tingling, burning, or itching before eruption
- Symptoms are less severe than primary infection
What is the preferred diagnostic testing for genital herpes?
Virologic tests:
- Viral culture
- PCR
What does the presence of type-specific HSV-2 antibodies imply?
Anogenital infection
What is the treatment for a first episode of genital herpes?
Valacyclovir, famciclovir, or acyclovir for 7-10 days
What is the episodic treatment for recurrent outbreaks of genital herpes?
Valacyclovir, famciclovir, or acyclovir for 1-5 days
Which diseases require repeat testing within 3 months of treatment?
Chlamydia, gonorrhea, and trichomonas
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)
Vulvovaginal Candidiasis (yeast infection)
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
Bacterial Vaginosis
Based on the following clinical presentation, what is your presumptive diagnosis?
- Purulent, malodorous, frothy, thin vaginal discharge
- Burning, dysuria, dyspareunia
- Postcoital bleeding can occur
Trichomonaisis
Punctate hemorrhages on vagina and cervix (“strawberry cervix”) is associated with what STI?
Trichomonaisis
Lower abdominal pain and CMT (Chandelier Sign) is commonly associated with what disease process?
PID
