Infections part 2

Question 1

What is the most prevalent STI in the US?

Answer 1

HPV

Question 2

What percent of HPV is cleared by the body’s immune system within 2 yrs with no treatment?

Answer 2

90%

Question 3

Presentation of HPV

Answer 3

May present as genital warts. Varied in appearance and may get worse or may clear without tx. Do not turn into CA
Some strains cause cervical CA. Women can have no sx.

Question 4

Which strains of HPV cause 70% of cervical CA cases?

Answer 4

16 and 18

Question 5

Which strains of HPV cause 90% of genital warts cases?

Answer 5

6 and 11

Question 6

Tx of HPV

Answer 6

Topical (burning creams, acids, etc)

Question 7

Prevention of HPV

Answer 7

Gardasil- recommended for boys and men age 9-21 (MSM til 26) and girls 11 and 12 and women 13-26 who have not yet been vaccinated or did not receive all three doses

Question 8

Organism of chancroid

Transmission of chancroid

Answer 8

H. ducreyi

Transmitted sexually through direct contact with purulent lesions and by autoinoculation to nonsexual sites

Question 9

Hx of chancroid

Answer 9

Extremely painful suppurative ulcers that may be single or multiple
Papule to pustule to ulcer progression
Women are commonly asymptomatic
Chief symptom may be dysuria or dyspareunia
Painful LAD with subsequent ulceration, usually unilateral, develops in about 50% of pts within 1-2 wks

Question 10

PE of chancroid

Answer 10

Soft chancre that begins as erythematous tender papules that become pustular and later erode to form an extremely painful and deep ulcer with soft ragged margins
MC found on fourchette, labia, vestibule, clitoris, cervix, and anus
Could have vaginal or rectal d/c
LAD

Question 11

Workup of chancroid

Answer 11

Role of PCR is promising and may supercede culture on special media
Pts should also be tested for other common STIs and HIV
Needle aspiration and/or I & D for buboes that are fluctuant and tender

Question 12

Tx of chancroid

Answer 12

Azithromycin 1 g PO as a single dose
OR
Ceftriaxone 250 mg IM as single dose
OR
Erythromycin base 500 mg PO TID x 7 days
OR
Ciprofloxacin 500 mg PO BID x 3 days

Question 13

Organism of lymphogranuloma venereum

Answer 13

Chlamydia trachomatis

Question 14

First stage of lymphogranuloma venereum

Answer 14

Occurs 3-30 days after inoculation
Begins as a small, painless papule or pustule that may erode to form a small, asymptomatic herpetiform ulcer that usually heals rapidly without scarring

Question 15

MC sites of infection in women in first stage of lymphogranuloma venereum

Answer 15

Posterior vaginal wall
Posterior cervix
Fourchette
Vulva

Question 16

Second stage of lymphogranuloma venereum

Answer 16

Begins 2-6 weeks after the primary
Painful regional LAD (usually in inguinal and/or femoral LNs)
Coalesce to form buboes, which may rupture
Females more typically do not have inguinal LAD and instead have involvement of the deep iliac or perirectal nodes- may only present with nonspecific back and/or abdominal pain
Not usually dx-ed in this stage because of lack of inguinal LAD

Question 17

Constitutional sx of second stage of lymphogranuloma venereum

Answer 17

Fever
Chills
Myalgias
Malaise

Question 18

Complications of systemic spread of lymphogranuloma venereum

Answer 18

Arthritis
Ocular inflammatory dz
Cardiac involvement
Pulmonary involvement
Asceptic meningitis
Hepatitis or perihepatitis

Question 19

Third stage of lymphogranuloma venereum

Answer 19

More common in women secondary to lack of sx during first two stages
Rectal involvement more common in women who practice anal-receptive intercourse
Characterized by proctocolitis
Characterized by:
-Bloody purulent discharge
-Rectal pain
-Tenesmus

Question 20

PE of first stage of lymphogranuloma venereum

Answer 20

Initial lesion is usually a small, painless papule, shallow ulcer, or herpetiform lesion in the genital area

Question 21

PE of second stage of lymphogranuloma venereum

Answer 21

Painful LNs (usually unilateral) known as buboes
Affected nodes often coalesce and form abscesses which can rupture and form sinus tracts

Question 22

PE of third stage of lymphogranuloma venereum

Answer 22

Pts initially develop proctocolitis
Perirectal fistulas
Ulcers
Abscesses
Strictures
Rectal stenosis
Hyperplasia of intestinal and perirectal lymphatics may form lymphorrhoids
Enlargement, thickening, and fibrosis of the labia
Chronic lymphatic obstruction may lead to elephantiasis of the genitals

Question 23

Workup for lymphogranuloma venereum

Answer 23

Dx mainly based on clinical findings with increasing evidence supporting nucleic acid amplification tests

Question 24

Tx of lymphogranuloma venereum

Answer 24

Doxycycline 100 mg PO BID x 21 days
OR
Erythromycin base 500 mg PO QID x 21 days