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General ID 2019 > IDBR STI > Flashcards

IDBR STI Flashcards

1
Q

which ulcers are painful?

A

HSV, CHancroid

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2
Q

which ulcers are painless?

A

syphillis, LGV (but lymphadenopathy painful), Granuloma Inguinale (Donovanosis)

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3
Q

Describe the Key words of syphillis?

A

Single, painless, ulcer or chancre at innoculation site with heaped up borders and clean base; painless bilateral lymphadenopathy

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4
Q

Describe the Key words of HSV?

A

multiple, painful, vesicular or ulcerative lesions with erythematous base

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5
Q

Key words of chancroid?

A

painful, indurated, ragged genital ulcer, suppurative inguinal adenopathy, kissing lesions on thigh

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6
Q

Key words of granuloma inguinale?

A

painless, progressive, destructive serpiginous ulcerative lesions without regional lymphadenopathy, beef red with white border and highly vasuclar.

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7
Q

key words of LGV?

A

short lived painless genital ulcer with painful suppurative inguinal lymphadenopathy, groove sign

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8
Q

where should you never collect specimens for darkfield microscopy?

A

specimens from mouth/stool b/c lots of non-treponemal false positives

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9
Q

what alternative agent can you use to treat syphillis in a pencillin-allergic pregnant women?

A

NONE! in non-pregnant, can use doxycycline

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10
Q

what is the incubation time for early syphillis? when does it resolve?

A

3 weeks incubation time, resolves in 3-6 weeks independent of treatment

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11
Q

define secondary syphillis?

A

disseminated syphillis with symptoms

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12
Q

Describe the rash associated with secondary syphilis/

A

evanescent copper colored macular (dry) rash followed by a red papular eruption involving the palms and soles

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13
Q

Describe the LFT findings in secondary syphillis?

A

mildly elevated AST/ALT with high alk phos

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14
Q

Describe the features of latent syphilis?

A

Early<1 year, late>1 year and asymptomatic

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15
Q

what are the basic findings of secondary syphilis?

A

rash, condyloma lata, mucosal gray plaques/ulcers, patchy alopecia, Glomerulonephritis

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16
Q

TIming and features of tertiary syphilis?

A

1-10 years after infection with either gummas, aortitis, coronary arteritis, tabes dorsalis, paresis

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17
Q

what are the two broad types of late neurosyphillis?

A

> 0 years + meningovascular or parencymatous

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18
Q

what are the meningovascular symptoms of neurosyphilis?

A

endoarteritis or small blood vessels in CNS: (ex- MCA strokes/seizures)

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19
Q

what are the parenchymatous symptoms of neurosyphilis?

A

due to actual destruction of nerve cells. Tabes Dorsalis (shooting pain, cranial nerve) and general paresis (dementia, psychosis, slurring speech, argyll robertson pupil)

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20
Q

how does symptomatic early neurosyphillis typically present?

A

within the 1st year of infection in HIV+ with meningitis

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21
Q

what forms of syphilis can occur at any stage?

A

neurosyphilis, Eyes, ears

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22
Q

which forms of syphilis is CSF examination normal?

A

In otic syphilis - 90% CSF normal. In ocular syphilis, 30% of CSF exam is normal

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23
Q

how does syphilis affect the eyes?

A

uveitis and neuroretinitis

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24
Q

how does syphilis affect the ars?

A

sensorineural hearing loss with vestibular complaints

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25
Q

what are the nontreponemal tests?

A

RPR or serum VRDL

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26
Q

what are the treponemal tests?

A

MHA-TP, TPPA, FTA-Abs

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27
Q

what can give you a false positive nontreponemal test?

A

old age, pregnancy, AI disease (APS), viral infections

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28
Q

what can give you falsely negative nontreponemal test?

A

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.

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29
Q

what can give you a false positive treponemal test?

A

endemic treponemal infections like syphillis (yaws, pinta, bejel) or lyme disease

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30
Q

+EIA/-RPR/-FTA Abs

A

false positive

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31
Q

+EIA/-RPR/+FTA abs

A

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

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32
Q

what test can be used to diagnose neurosyphilis?

A

50% of NS have negative CSF VDRL - specific but insensitive. 30% of late neurosyphilis can ahve negative serum non-treponemal test but have pleiocytosis

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33
Q

treatment of neurosyphilis?

A

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

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34
Q

Treatment of early stages syphilis?

A

primary, secondary, early latent - 2.4MU of long-acting benzathine penicilin or doxycycline 100mg PO BID x 14 days

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35
Q

treatment of late latent/unknown duration syphilis?

A

2.4MU of long acting benzathine penicillin IM x 3 over 2 weeks or doxycycline 100mg PO BID x 4 weeks.

36
Q

when do you screen for syphilis in pregnancy?

A

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

37
Q

how would you diagnose HSV in a patient with genital ulcer?

A

PCR (90% sensitive), antigen detection (70% sensitive), Culture (30-80% sensitive), Tzanc smear (40%)

38
Q

how would you diagnose HSV in an asymptomatic paitent?

A

glycoprotein G based type specific assays

39
Q

What does a gG1 and gG2 mean?

A

in an asymptomatic patient, if gG1 positive - oral or genital herpes. If gG2 positive, genital herpes.

40
Q

when do you suspect LGV L1-L3 in the US?

A

MSM/proctitis.

41
Q

what are mimics of crohns disease in GUD?

A

early syphilis/LGV can look same as crohns disease on anoscopy

42
Q

Treatment of LGV?

A

doxycycline 100mg PO BID x 3 weeks or azithromycin 1g PO qweek x 3 weeks

43
Q

how do you diagnose chancroid?

A

culture which is 80% sensitive

44
Q

how do you treat chancroid?

A

Azithromycin 1g PO or ceftriaxone 250mg IM x 1. Remember to treat all partners in preceding 60 days

45
Q

who is at risk for chancroid?

A

sex workeres, HIV, endemic in parts of southern US

46
Q

what areas are endemic to donovanosis?

A

same as granuloma inguinale. common in SE asia, brazil, southern africa. Used to be australia

47
Q

Treatment of granuloma inguinale?

A

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

48
Q

How would you diagnose donovanosis?

A

tissue biopsy demonstrating donovan bodies using wright giemsa stain

49
Q

How would you diagnose LGV?

A

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

50
Q

when does Jarisch-herxheimer reaction occur?

A

between 1-6 hours, usually 3 hours after abx

51
Q

do you need to treat sexual partners of syphilis?

A

Yes! all partners within 3 months

52
Q

what STI organisms cause urethritis/cervicitis/vaginitis?

A

neisseria gonorrhea, chalmydia trachomatis, mycoplasma genitalium, trichomonas vaginalis, bacterial vaginosis

53
Q

what is the treatment duration of chlamydia generally?

A

L1-L3 serotypes - 3 weeks. D-K (US) - 1 week

54
Q

what are the most common symptoms of c.trachomatis D-K in men?

A

epididymitis, reactive arthritis. but most of the time asymptomatic!

55
Q

What are the most common symptoms in C.Trachomatis D-K in women?

A

PID, reactive arthritis, asymptomatic!

56
Q

How would you diagnosis chlamydia?

A

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.

57
Q

Treatment and dose for C.Trachomatis D-K? F/u?

A

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.

58
Q

Treatment and dose for C.Trachomatis L1-L3? F/u?

A

Doxycycline 100mg PO BID x 3 weeks (preferred) or azithromycin 1g POq week x 3 weeks

59
Q

symptoms of disseminated gonococcal infection?

A

petichial/pustular acral skin lesionsv(<12),asymetrical arthrlagia, tenosynovitis, or monoarticular septic arthritis

60
Q

Treatment of DGI?

A

cetriaxone 250mg IM/IV plus single dose 1g azithromycin

61
Q

Ddx of DGI?

A

RMSF, dengue, staph endocarditis, Reiters, meningococcemia

62
Q

who do you screen for gonorrhea?

A

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

63
Q

when do you need to do a test of cure for gonorrhea?

A

if a second line agent is used like cefexime + azithromycin, gent + azithromycin, gemifloxacin + azithromycin.

64
Q

ddx of non-gonococcal urethritis?

A

Mycoplasma genitalium (30%), chlamydia trachomatis (25%), trichomonas vaginalis, ureaplasma urealyticum, HSV.

65
Q

Tx of non-gonococcal urethritis?

A

Azithromycin 1g PO x 1 or doxycycline 100mg PO BID x 7 days

66
Q

If person fails to respond to NGU tx, what are the 4 possibilities?

A

(1) reinfection (2) M.Genitalium did not responde to tx (3) T.Vaginalis (needed metro), (4) HSV

67
Q

What is the tx of M.genitalium?

A

Azithromycin 1g PO x 1 or doxycycline 100mg PO BID x 7 days. If above fails, moxifloxacin 400mg PO x 10-14 days

68
Q

Tx of trichomonas vaginalis?

A

metronidazole 2g PO x 1 or tinidazole 2g PO x 1, or metronidazole 500mg PO bid x 7 days. No topical options

69
Q

things to remember for T.Vaginalis tx in HIV?

A

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

70
Q

what is the tx for BV?

A

metronidazole 500mg PO BID x 7 days or clindamycin 300mg PO TID x 7 days or topical metronidazole gel or clindamycin cream

71
Q

how would you diagnose BV?

A

amsel clinical criteria of discharge, pH>4.5, clue cells, amine odor with KOH (whiff test)

72
Q

how would you diagnose PID?

A

dx criteria of only one of the following: cervical motion tenderness, uterine tenderness, adnexal tenderness

73
Q

Treatment of PID?

A

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

74
Q

when should you hospitalize patients with PID?

A

if patients on PO regiments do not improve within 3 days

75
Q

should you treat sex partners?

A

yes in preceding 60 days

76
Q

what is the causative organisms for Epidimyitis?

A

young men - chlamydia trachomatis, N.gonorrohoae. Older men - E.Coli

77
Q

Treatment of epididmytiis?

A

ceftriaxone 250mg IM x1 + Doxycycline 100mg PO BID x 10 days

78
Q

what is the treatment of proctitis?

A

ceftraixone 250mg IM x 1 + Doxycycline 100mg PO BID x 7 days

79
Q

key words for molluscum contagiosum?

A

pox virus, 1-5mm painless papules with centrla umbilication with intracyctoplasmic inclusions (molluscum bodies)

80
Q

treatment of pediculosis pubis?

A

permethrin cream and treat sex partners within previous 30 days.

81
Q

what happens if you have first line treatment failure for pediculosis pedis?

A

if permethrin 1% cream or pyrethrins fail, can use ivermectin or malathion 0.5% lotion

82
Q

treatment of sarcoptes scabei?

A

permethrin 1% cream or ivermectin 200mcg/kg PO day 1 and day 14.

83
Q

what are the general symptoms of scabies?

A

severe pruritisu especially at night or after bathing. rash and pruritis can persist up to 2 weeks after successful therapy.

84
Q

treatment of norweigan scabies?

A

same as crusted scabies but occurs in HIV. No pruritis or burrows. Tx with ivermectin 250 mcg/kg on days 1, 15 and 29.

85
Q

side effect of lindane?

A

seizures and aplastic anemia

86
Q

Tx f mollucuscum contagiosum?

A

curettage, cryotherapy or topical cidofovir

General ID 2019 (19 decks)

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