EXAM 4 Sexually Transmitted Diseases Flashcards
what are the common bacterial STDs?
gonorrhea, syphillis, chlamydia
what is the common protozoan STD microbe?
trichomonas vaginalis
what are the common arthropod microbes responsible for STDs?
lice and scabies
what are the common viral causes of STDs?
HIV, HPV, and HSV
what are some common syndromes of STDs?
urethritis, cervicitis, genital ulcer, epididymitis, proctitis, vaginitis, pelvic inflammatory disease
which STDs are transmitted sexually?
gonorrhea, chlamydia, and symphilis
people with which symptoms should be screened/tested for STDs?
urethritis/cervicitis, pelvic inflammatory disease, genital ulcers, warts
T or F:
annual testing and licensing is mandatory for persons employed in a sexually oriented business (escorts, dancers, etc)
true
people who are concerned about ___ or ___ should be screened/tested for STDs
exposure to STDs and/or their sexual partner(s)
describe history in the evaluation of patients for STDs
- contact to another person with proven STD
- STD related symptoms
- sex practices
- number of partners, sexual orientation (MSM, male heterosexuals, female heterosexuals, WSW)
- condom use
treatment of STDs is often ___
empiric
describe the examination in the evaluation of patients for STDs
- penis, groin, testicles, perianal area in males
- pelvic exam in women
how is urethritis in men defined?
- visible drip from the penis or
- WBCs seen on a urethral gram stain
- usually accompanied by dysuria
how is cervicitis in women defined?
- vaginal discharge or
- friable cervix on exam
T or F:
asymptomatic infections are uncommon in both sexes
false
they are common
what are the two most common symptoms of STDs?
urethritis (males) and cervicitis (females)
what are the causes of urethritis and cervicitis?
- nongonococcal or nonspecific urethritis
- chlamydia -50%
- mycoplasma genitalium -10-20%
- ureaplasma urealyticum
- herpes simplex viruses
- unknown agents
- gonococcal (neisseria gonorrhea)
in utah, chlamydia cases are found in what major population?
women who are young and live in more urban areas
what is the most common reportable STD in utah?
chlamydia trachomatis
what are the 4 most reportable STDs in utah?
chlamydia, gonorrhea, syphilis, HIV
what is the empiric treatment of nongonococcal urethritis?
- CDC recommended
- azithromycin 1000mg po x1 day
- preferred regimen due to compliance issues
- doxycycline 100mg BID x7 days
- watch for photosensitivity
- azithromycin 1000mg po x1 day
the following is the epidemiology of which bacteria?
association with disease: urethritis, cervicitis, endometritis, and pelvic inflammatory disease
association with adverse reproductive health outcomes unclear
mycoplasma genitalium
what is the treatment for infections caused by mycoplasma genitalium?
- azithromycin 1g is often effective (failure rate 40%)
- doxycycline ineffective, <40%
- moxifloxacin 400mg daily x7 days is an expensive alternative that works
how is gonorrhea diagnosed in males?
- urethral gram stain
- nucleic acid amplification testing of
- urine, urethral swab or discharge, oral swab, rectal swab
how is gonorrhea diagnosed in females?
- nucleic acid amplification testing of
- urine, cervical swab, vaginal swab (including self tests), oral swab, rectal swab
how is gonorrhea treated?
- ceftriaxone 250mg IM
- genital GC, pharyngeal GC
- alternatives
- azithromycin 2000mg po single dose for severe beta lactam allergy
describe the population mostly affected by gonorrhea in utah
men of all sexual orientations who are young and live in more urban counties
what are some issues with the treatment of gonorrhea?
- quinolones are not recommended due to bacterial resistance
- treat all GC-positive patients for nongonococcal urethritis, regardless of nucleic acid amplification testing results
- current NAAT tests do not include mycoplasma or ureaplasma spp.
describe pelvic inflammatory disease
- vaginal discharge +
- clinical criteria (any of 3)
- cervical motion tenderness
- uterine tenderness
- adnexal tenderness
is pelvic inflammatory disease commonly undiagnosed?
- yes
- many cases are missed and go untreated often with serious consequences
- missed cases are often because the physician either doesn’t do a pelvic exam or doesn’t know the criteria for diagnosing PID
how is bacterial vaginosis diagnosed?
- white vaginal discharge
- presence of clue cells
- pH > 4.5
- fishy odor with KOH
what is the treatment of bacterial vaginosis?
- metronidazole po 500mg BID x7 days
- metronidazole gel
- clindamycin cream
the prevalence of trichomonas vaginalis is associated with ___ transmission
HIV
which population should be screened for trichomonas vaginalis?
women in STD clinics and other settings by risk
what is the trichomonas vaginalis screening rationale based on? what are some concerns about screening?
- based on high prevalence, availability of NAAT
- concerns: no evidence that screening and treatment improve health outcomes, and expense
what are the symptoms of genital herpes
- bumps or blisters
- dysuria
- vaginitis
how is genital herpes diagnosed?
- PCR with isotyping as HSV1 or HSV2
- serology - type-specific for HSV1 and HSV2
can you get HSV1 (oral herpes) genital disease?
yes
can you get HSV2 (genital herpes) cold sores?
yes
describe the episodic treatment of genital herpes recurrences
- episodic treatment (treat outbreaks)
- acyclovir 400mg TID x5 days
- acyclovir 800mg BID x5 days
- acyclovir 800mg TID x2 days
- valacyclovir 500mg BID x3 days
- valacyclovir 1000mg daily x5 days
describe the prophylactic treatment of genital herpes recurrences
- prophylactic treatment (prevent recurrences)
- acyclovir 400mg BID works well
- valacyclovir 500-1000mg daily
describe how antivirals reduce transmission of genital herpes
- 1500 heterosexuals monogamous discordant couples
- the infected partner received daily valacyclovir or placebo suppression
- 8 months follow-up
which bacteria causes syphilis?
treponema pallidum
what is the epidemiology of syphilis?
most recent cases are in MSM patients, many of whom are HIV+
describe the diagnosis of syphilis
- unculturable agent
- screening - syphilis IgG ELISA, RPR for staging
in suspected primary syphilis, why is empiric treatment indicated?
serology is positive only in about 50% of cases
what should a physician do if secondary syphilis is suspected?
- confirm with syphilis IgG
- staging with RPR
- *secondary syphilis will have rashes on the palms of the hands and other areas of the skin
are primary and secondary syphilis contagious?
yes
describe the treatment of early syphilis
- primary and secondary disease
- benzathine PCN 2.4M units IM x1
describe the treatment of latent syphlis
- early <1yr - benzathine PCN 2.4M units IM x1
- late or unknown duration - benzathine PCN 2.4M units IM q week x3
- follow up RPR at 6, 12, 24 months
what are genital warts caused by?
human papilloma virus
what are the treatments for genital warts?
- liquid nitrogen
- trichloracetic acid
- podofilox topical
- surgery, cautery
who should be vaccinated against HPV?
girls and boys
quadrivalent vaccine
