IDBR STI Flashcards
which ulcers are painful?
HSV, CHancroid
which ulcers are painless?
syphillis, LGV (but lymphadenopathy painful), Granuloma Inguinale (Donovanosis)
Describe the Key words of syphillis?
Single, painless, ulcer or chancre at innoculation site with heaped up borders and clean base; painless bilateral lymphadenopathy
Describe the Key words of HSV?
multiple, painful, vesicular or ulcerative lesions with erythematous base
Key words of chancroid?
painful, indurated, ragged genital ulcer, suppurative inguinal adenopathy, kissing lesions on thigh
Key words of granuloma inguinale?
painless, progressive, destructive serpiginous ulcerative lesions without regional lymphadenopathy, beef red with white border and highly vasuclar.
key words of LGV?
short lived painless genital ulcer with painful suppurative inguinal lymphadenopathy, groove sign
where should you never collect specimens for darkfield microscopy?
specimens from mouth/stool b/c lots of non-treponemal false positives
what alternative agent can you use to treat syphillis in a pencillin-allergic pregnant women?
NONE! in non-pregnant, can use doxycycline
what is the incubation time for early syphillis? when does it resolve?
3 weeks incubation time, resolves in 3-6 weeks independent of treatment
define secondary syphillis?
disseminated syphillis with symptoms
Describe the rash associated with secondary syphilis/
evanescent copper colored macular (dry) rash followed by a red papular eruption involving the palms and soles
Describe the LFT findings in secondary syphillis?
mildly elevated AST/ALT with high alk phos
Describe the features of latent syphilis?
Early<1 year, late>1 year and asymptomatic
what are the basic findings of secondary syphilis?
rash, condyloma lata, mucosal gray plaques/ulcers, patchy alopecia, Glomerulonephritis
TIming and features of tertiary syphilis?
1-10 years after infection with either gummas, aortitis, coronary arteritis, tabes dorsalis, paresis
what are the two broad types of late neurosyphillis?
> 0 years + meningovascular or parencymatous
what are the meningovascular symptoms of neurosyphilis?
endoarteritis or small blood vessels in CNS: (ex- MCA strokes/seizures)
what are the parenchymatous symptoms of neurosyphilis?
due to actual destruction of nerve cells. Tabes Dorsalis (shooting pain, cranial nerve) and general paresis (dementia, psychosis, slurring speech, argyll robertson pupil)
how does symptomatic early neurosyphillis typically present?
within the 1st year of infection in HIV+ with meningitis
what forms of syphilis can occur at any stage?
neurosyphilis, Eyes, ears
which forms of syphilis is CSF examination normal?
In otic syphilis - 90% CSF normal. In ocular syphilis, 30% of CSF exam is normal
how does syphilis affect the eyes?
uveitis and neuroretinitis
how does syphilis affect the ars?
sensorineural hearing loss with vestibular complaints
what are the nontreponemal tests?
RPR or serum VRDL
what are the treponemal tests?
MHA-TP, TPPA, FTA-Abs
what can give you a false positive nontreponemal test?
old age, pregnancy, AI disease (APS), viral infections
what can give you falsely negative nontreponemal test?
prozone effect or hook effect where effectivness of antibodies to form immune complexes stop increasing with greater concentrations and then decreases with extremly high concentrations.
what can give you a false positive treponemal test?
endemic treponemal infections like syphillis (yaws, pinta, bejel) or lyme disease
+EIA/-RPR/-FTA Abs
false positive
+EIA/-RPR/+FTA abs
syphilis in the past and adequately treated; syphilis in the past and not adequately treated, prozone of secondary syphilis, early syphilis and the EIA became positive before RPR
what test can be used to diagnose neurosyphilis?
50% of NS have negative CSF VDRL - specific but insensitive. 30% of late neurosyphilis can ahve negative serum non-treponemal test but have pleiocytosis
treatment of neurosyphilis?
aqueous penicllin 18-24MU IV x 10-14 days. Procaine penicllin 2.4MU IMqd + probeneicd QID x 10-14 days; ceftriaxone 1-2g IV/IM x 10-14 days
Treatment of early stages syphilis?
primary, secondary, early latent - 2.4MU of long-acting benzathine penicilin or doxycycline 100mg PO BID x 14 days
treatment of late latent/unknown duration syphilis?
2.4MU of long acting benzathine penicillin IM x 3 over 2 weeks or doxycycline 100mg PO BID x 4 weeks.
when do you screen for syphilis in pregnancy?
1st prenatal visit, high risk/high prevalence areas at 28-32 weeks/and at delivery, women who deliver a stillborn infant after 20 weeks gestation
how would you diagnose HSV in a patient with genital ulcer?
PCR (90% sensitive), antigen detection (70% sensitive), Culture (30-80% sensitive), Tzanc smear (40%)
how would you diagnose HSV in an asymptomatic paitent?
glycoprotein G based type specific assays
What does a gG1 and gG2 mean?
in an asymptomatic patient, if gG1 positive - oral or genital herpes. If gG2 positive, genital herpes.
when do you suspect LGV L1-L3 in the US?
MSM/proctitis.
what are mimics of crohns disease in GUD?
early syphilis/LGV can look same as crohns disease on anoscopy
Treatment of LGV?
doxycycline 100mg PO BID x 3 weeks or azithromycin 1g PO qweek x 3 weeks
how do you diagnose chancroid?
culture which is 80% sensitive
how do you treat chancroid?
Azithromycin 1g PO or ceftriaxone 250mg IM x 1. Remember to treat all partners in preceding 60 days
who is at risk for chancroid?
sex workeres, HIV, endemic in parts of southern US
what areas are endemic to donovanosis?
same as granuloma inguinale. common in SE asia, brazil, southern africa. Used to be australia
Treatment of granuloma inguinale?
doxycycline 100mg PO BId x 3 weeks (or until resolution) or azithromycin 1g PO qweek x 3. Can also use bactrim and cipro +/- aminoglycosides if slow to improve
How would you diagnose donovanosis?
tissue biopsy demonstrating donovan bodies using wright giemsa stain
How would you diagnose LGV?
NAAT to tell you LGV but then need multiplex PCR for serotypes. 4 fold rise of IgM/IgG diagnostic of active infection or single IgM>1:64 or single IgG>1:256
when does Jarisch-herxheimer reaction occur?
between 1-6 hours, usually 3 hours after abx
do you need to treat sexual partners of syphilis?
Yes! all partners within 3 months
what STI organisms cause urethritis/cervicitis/vaginitis?
neisseria gonorrhea, chalmydia trachomatis, mycoplasma genitalium, trichomonas vaginalis, bacterial vaginosis
what is the treatment duration of chlamydia generally?
L1-L3 serotypes - 3 weeks. D-K (US) - 1 week
what are the most common symptoms of c.trachomatis D-K in men?
epididymitis, reactive arthritis. but most of the time asymptomatic!
What are the most common symptoms in C.Trachomatis D-K in women?
PID, reactive arthritis, asymptomatic!
How would you diagnosis chlamydia?
NAAT (gold standard). In men - urine; women - vaginal swab. If doing culture, men is urethral swab and women endocervical swab. CDC not FDA still recommends rectal and pharyngeal swabs. Remember 95% of rectal/pharyngeal + are asymptomatic.
Treatment and dose for C.Trachomatis D-K? F/u?
azithromycin 1g PO x1 or doxycycline 100mg PO BID x 7 days. Test of cure 3-4 weeks later not routinely recommended. Screen all women treated for infection 3 months later.
Treatment and dose for C.Trachomatis L1-L3? F/u?
Doxycycline 100mg PO BID x 3 weeks (preferred) or azithromycin 1g POq week x 3 weeks
symptoms of disseminated gonococcal infection?
petichial/pustular acral skin lesionsv(<12),asymetrical arthrlagia, tenosynovitis, or monoarticular septic arthritis
Treatment of DGI?
cetriaxone 250mg IM/IV plus single dose 1g azithromycin
Ddx of DGI?
RMSF, dengue, staph endocarditis, Reiters, meningococcemia
who do you screen for gonorrhea?
HIV, MSM, h/of of STIs, sexually active women<25, sexually active in high endemic areas, women<35 and men<30 in correctional facilities at intake
when do you need to do a test of cure for gonorrhea?
if a second line agent is used like cefexime + azithromycin, gent + azithromycin, gemifloxacin + azithromycin.
ddx of non-gonococcal urethritis?
Mycoplasma genitalium (30%), chlamydia trachomatis (25%), trichomonas vaginalis, ureaplasma urealyticum, HSV.
Tx of non-gonococcal urethritis?
Azithromycin 1g PO x 1 or doxycycline 100mg PO BID x 7 days
If person fails to respond to NGU tx, what are the 4 possibilities?
(1) reinfection (2) M.Genitalium did not responde to tx (3) T.Vaginalis (needed metro), (4) HSV
What is the tx of M.genitalium?
Azithromycin 1g PO x 1 or doxycycline 100mg PO BID x 7 days. If above fails, moxifloxacin 400mg PO x 10-14 days
Tx of trichomonas vaginalis?
metronidazole 2g PO x 1 or tinidazole 2g PO x 1, or metronidazole 500mg PO bid x 7 days. No topical options
things to remember for T.Vaginalis tx in HIV?
all women need to be screened anually and need to treat with metronidazole 500mg PO bid x 7 days as first line. Partners to be treated from the past 60 days
what is the tx for BV?
metronidazole 500mg PO BID x 7 days or clindamycin 300mg PO TID x 7 days or topical metronidazole gel or clindamycin cream
how would you diagnose BV?
amsel clinical criteria of discharge, pH>4.5, clue cells, amine odor with KOH (whiff test)
how would you diagnose PID?
dx criteria of only one of the following: cervical motion tenderness, uterine tenderness, adnexal tenderness
Treatment of PID?
ceftriaxone 250mg IM x 1 + Doxycycline 100mg PO BIDx 14 days with or without metronidazole 500mg PO BID x 14 days. Other is Cefotetan 2g IV q 12 hours or cefoxitin 2g IV q6 hours + Doxycycline 100mg IV/PO x 12 hours
when should you hospitalize patients with PID?
if patients on PO regiments do not improve within 3 days
should you treat sex partners?
yes in preceding 60 days
what is the causative organisms for Epidimyitis?
young men - chlamydia trachomatis, N.gonorrohoae. Older men - E.Coli
Treatment of epididmytiis?
ceftriaxone 250mg IM x1 + Doxycycline 100mg PO BID x 10 days
what is the treatment of proctitis?
ceftraixone 250mg IM x 1 + Doxycycline 100mg PO BID x 7 days
key words for molluscum contagiosum?
pox virus, 1-5mm painless papules with centrla umbilication with intracyctoplasmic inclusions (molluscum bodies)
treatment of pediculosis pubis?
permethrin cream and treat sex partners within previous 30 days.
what happens if you have first line treatment failure for pediculosis pedis?
if permethrin 1% cream or pyrethrins fail, can use ivermectin or malathion 0.5% lotion
treatment of sarcoptes scabei?
permethrin 1% cream or ivermectin 200mcg/kg PO day 1 and day 14.
what are the general symptoms of scabies?
severe pruritisu especially at night or after bathing. rash and pruritis can persist up to 2 weeks after successful therapy.
treatment of norweigan scabies?
same as crusted scabies but occurs in HIV. No pruritis or burrows. Tx with ivermectin 250 mcg/kg on days 1, 15 and 29.
side effect of lindane?
seizures and aplastic anemia
Tx f mollucuscum contagiosum?
curettage, cryotherapy or topical cidofovir
