Infections Flashcards
(75 cards)
a 19-year-old sexually active woman who presents to your office with complaints of yellow vaginal discharge and intermittent postcoital vaginal bleeding for 1 week. She otherwise feels well. On examination, there is purulent discharge visible in the endocervical canal. After you collect vaginal fluid for a wet prep and cervical samples for gonorrhea and chlamydia cultures, you note bleeding at the cervical os. On bimanual examination, the patient complains of tenderness on cervical palpation but denies uterine or adnexal tenderness. Wet prep reveals vaginal pH 4; negative whiff; 20 white blood cells (WBCs) per high-power field; and no clue cells, trichomonads, or pseudohyphae.
what is the likely diagnosis
gonorrhea cervicitis
what is the diagnostic test for gonorrhea cervicitis
Nucleic acid amplification test (NAAT) of discharge or urine
what are the recommendations for treatment of gonorrhea
ceftriazone 500 mg IM as a single dose for a person weighting < 300lbs
what is the treatment of chlamydia trachomatis
oral doxycycline (100mg BID) for 7 days
a 21-year-old male complaining of pain during urination and a watery discharge from his penis. Gram stain of the discharge is negative for bacteria but shows many neutrophils. When questioned about his social history, he says that he uses condoms most of the time but occasionally has unprotected sex. The patient responds to treatment with doxycycline.
what is the diagnosis
chlamydia
a sexually active 18-year-old female with a complaint of vague pelvic pain, dysuria, frequency, and urgency. Pelvic examination is remarkable for cervicitis and the presence of cervical motion tenderness. Her urine sample is negative for nitrites, has greater than 5 to 10 WBC/HPF, and 3+ leukocyte esterase but no bacteria.
whats the diagnosis
chlamydia cervicitis
what is the most common STI
Chlaymdia
how does a woman present with chlamydia
urethritis
bartholinitis
cervicitis characterized by dysuria
abnormal vaginal discharge or post-coital bleeding
what is the gold standard diagnostic test for chlamydia
Nucleic acid amplification test (NAAT) = gold standard
a 22-year-old patient presents with a complaint of painful blisters on the vulva and vaginal introitus. She admits to a prodrome of burning, tingling, and pruritus before the appearance of lesions. Upon examination, you note vesicles on an erythematous base.
what is the diagnosis
Herpes simplex cervicitis
what is the gold standard diagnosis for herpes simplex
viral culture
can also do PCR or Tzanck prep scraping
what is the treatment options for herpes simplex
Valacyclovir (1,000mg BID for 7-10 days) > acyclovir due to TID dosing
if a patient has severe or frequent herpes outbreakes - what is the treatment of choice
valacyclovir 500mg once daily for most patients
a 38-year-old male with a history of soft, raised flesh-colored growths on his glans penis, prepuce, and penile shaft. He is sexually active with multiple partners and uses condoms infrequently. An excisional biopsy was carried out.
what is the diagnosis?
Human Papillomavirus (HPV)
what subtypes of HPV accound for >90% of genital warts
subtypes 6 and 11
what is the diagnostic test for HPV
shave or punch bipsy
Koilocytic squamous epithelial cells in clumps on PAP
what is the treament for HPV
spontaneous remission in months to a year is typical of skin warts - can do topical imiquimod or surgery
vaccination (gardasil and Gardisil9)
when is the guardasil vaccine administered
11-12 years should recieve 2 doses; may be initiated at 9 years old
Catch up for all persons 13-26 years regardless of risk factors
a 30-year-old woman complains of a painful sore on her vulva that first resembled a pimple. On examination, you find an ulcer with clearly demarcated borders, gray base, and foul-smelling discharge.
What is this sore called
Chancroid
what is the causative agent of chancroids
haemophilus ducreyi (gram negative rod that is very contagious)
what is the diagnostic test for chancroids
serologic testing for syphilis - PRP/VDRL
Gram stain, culture and biopsy
what is the treatmetn for chancroids
ceftriaxone 250mg IM and 1 dose of azithromycin 1g PO x
what is lymphogranuloma venereum (LVG)
ulcerative disease of genital area
uncommon STI
what are the stages of Lymphogranuloma venereum infection?
- primary stage: development of painless genital ulcers or papulses
- secondary stage: unilateral or bilat tender inguinal and/or femoral lymphadenopathy
- late stage: strictures, fibrosis and fistulae of anogential area
