Genital Tract Infections

Question 1

What are the 2 most common viral STIs?

Answer 1

1. HPV

2. HSV

Question 2

What are the symptoms of Urethritis in men?

Answer 2

1. Dysuria

2. Discharge from the penis

Question 3

What are symptoms of Urethritis/cervicitis in women?

Answer 3

1. Vaginal discharge
2. Abnormal vaginal bleeding or spotting
3. Dyspareunia
4. Dysuria
5. Could be asymptomatic

Question 4

Which pathogens can cause Urethritis/cervicitis?

Answer 4

1. Chlamydia

2. Gonorrhea

Question 5

What comprises a relevant Hx for genital tract infections?

Answer 5

1. New partners?
2. Multiple partners?
3. High-risk partners?
4. Type of exposure: men, women, both?
5. Anal, vaginal, oral?
6. Frequency of condom use
7. Past STIs

Question 6

What methods are available for the Dx of STIs?

Answer 6

1. Clinical
2. Microscopy (Gram stain)
3. Culture
4. Ag detection
5. NAAT
6. Serology

Question 7

Dx method for Gonorrhea and Chlamydia

Answer 7

1. NAAT - can be done on urine

2. Can also do Gram stain and culture

Question 8

Tx for Gonorrhea

Answer 8

1. Increasing resistance

2. Cefixime or IM Ceftriaxone + azithromycin

Question 9

Tx for Chlamydia

Answer 9

1. Doxycycline or azithromycin

Question 10

What else is involved in the Tx of STIs besides drugs?

Answer 10

1. Reportable infection?
2. Partner notification
3. Counselling
4. Test for other STIs
5. Check vaccination status for Hep B and HPV

Question 11

<p>

| What is PID?</p>

Answer 11

<p>

| PID = Pelvic Inflammatory Disease Infection of the female upper genital tract (endometrium, Fallopian tubes)</p>

Question 12

What causes PUD?

Answer 12

1. Polymicrobial infection (STI + endogenous flora)

Question 13

What are the S/S’s of PUD?

Answer 13

1. Abdominal pain
2. Fever
3. Lower abdominal tenderness
4. Cervical motion tenderness
5. Adnexal tenderness

Question 14

What is the Tx for PUD?

Answer 14

Antibiotics to cover STI + endogenous flora

Question 15

What complications arise from scarring due to PUD?

Answer 15

1. Infertility
2. Ectopic pregnancy
3. Chronic pelvic pain

Question 16

What elements are involved in the Dx of PUD?

Answer 16

1. Clinical
2. Test for Gonorrhea/Chlamydia
3. Imaging
4. Possible OR

Question 17

What are characteristics of Genital Ulcer Disease (GUD)?

Answer 17

1. Ulcers, erosive, vesicular

2. Lymphadenopathy

Question 18

What causes GUD?

Answer 18

1. HERPES SIMPLEX VIRUS (HSV-1 or HSV-2)

2. Syphilis - less common (Treponema pallidum)

Question 19

Presentation of primary HSV infection (genitals)

Answer 19

1. May be asymptomatic
2. Painful vesiculo-ulcerative lesions
3. Fever
4. Tender lymphadenopathy

Question 20

What is an atypical presentation of primary HSV infection (genital)?

Answer 20

1. Urethritis/cervicitis

2. Aseptic meningitis

Question 21

Where does HSV go during latency (genital)?

Answer 21

Sacral sensory ganglion

Question 22

What are some characteristics of recurrent genital HSV infections?

Answer 22

1. Prodromal symptoms (burning, itching, tingling)
2. Not as bad as primary episode
3. Become less frequent and less severe over time

Question 23

How do you Dx HSV?

Answer 23

1. Viral swab for HSV PCR

Question 24

What is the Tx for HSV infection?

Answer 24

1. Valacyclovir
2. Famiciclovir
3. Acyclovir

Question 25

What is characteristic of primary syphilis?

Answer 25

Painless chancres

Question 26

How do you Dx Syphilis?

Answer 26

1. Serology (RPR or VDRL) | 2. Can take fluid from chancre for staining or PCR

Question 27

What is the Tx for Syphilis?

Answer 27

IM benzathine penicillin

Question 28

What are 3 causes of vaginal discharge?

Answer 28

1. Bacterial vaginosis 2. Vulvovaginal candidiasis 3. Trichomonas

Question 29

Bacterial vaginosis is the most common cause of vaginal discharge, what is it a result of?

Answer 29

Overgrowth of genital tract organisms

Question 30

What is Trichomonas?

Answer 30

1. Vaginal discharge caused by the protozoan Trichomonas vaginalis 2. This is an STI

Question 31

What diagnostics can be done for vaginal discharge?

Answer 31

1. Vaginal swab 2. Gram stain 3. ELISA for trichomonas Ag

Question 32

Tx for Vulvovaginal candidiasis

Answer 32

1. OTC antifungal cream 2. Fluconazole PO 3. Eliminate risk factors (i.e. antibiotics)

Question 33

Tx for Trichomonas

Answer 33

1. Tx pt and partners with Metronidazole

Question 34

When and how should you Tx Bacterial Vaginosis?

Answer 34

1. Tx if symptomatic and/or pregnant 2. Use Metronidazole or Clindamycin (PO or topical) 3. Don't Tx partners

Question 35

What causes Prostatitis?

Answer 35

1. Gram -ve bacilli (i.e. E. coli) | 2. Not usually an STI

Question 36

How to Dx Prostatitis

Answer 36

1. Clinical - Hx and tender/mushy prostate on exam 2. Urine microscopy (WBCs) 3. Urine culture 4. Blood culture

Question 37

Tx for Prostatitis

Answer 37

1. Antibiotics that cover Gram -ve bacilli (cipro, TMP-SMX) | 2. Tx for 4-6 weeks

Question 38

Clinical presentation of Prostatitis

Answer 38

1. Fever 2. Chills 3. Dysuria 4. Pelvic pain

Question 39

What should you screen all pregnant women for?

Answer 39

1. HIV 2. Hep B 3. Chlamydia 4. Gonorrhea 5. Syphilis

Question 40

What 2 things does HPV cause?

Answer 40

1. Warts | 2. Cancer

Question 41

What HPV strains cause anogenital warts (AKA Condyloma acuminata)?

Answer 41

HPV 6 and 11

Question 42

Which HPV strains cause cervical cancer?

Answer 42

HPV 16 and 18

Question 43

What are the 2 HPV vaccine available?

Answer 43

1. Gardasil - (quadravalent) against 6, 11, 16, and 18 | 2. Cervarix - (bivalent) against 16, 18

Question 44

How can you Dx HPV?

Answer 44

1. Pap tests | 2. HPV DNA

Question 45

What is the Tx for HPV?

Answer 45

1. Ablation for warts/pre-cancer | 2. Test for other STIs

Question 46

What are the 2 most common bacterial STIs?

Answer 46

1. Chlamydia | 2. Gonorrhea