Infections part 2 Flashcards
What is the most prevalent STI in the US?
HPV
What percent of HPV is cleared by the body’s immune system within 2 yrs with no treatment?
90%
Presentation of HPV
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.
Which strains of HPV cause 70% of cervical CA cases?
16 and 18
Which strains of HPV cause 90% of genital warts cases?
6 and 11
Tx of HPV
Topical (burning creams, acids, etc)
Prevention of HPV
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
Organism of chancroid
Transmission of chancroid
H. ducreyi
Transmitted sexually through direct contact with purulent lesions and by autoinoculation to nonsexual sites
Hx of chancroid
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
PE of chancroid
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
Workup of chancroid
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
Tx of chancroid
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
Organism of lymphogranuloma venereum
Chlamydia trachomatis
First stage of lymphogranuloma venereum
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
MC sites of infection in women in first stage of lymphogranuloma venereum
Posterior vaginal wall
Posterior cervix
Fourchette
Vulva
Second stage of lymphogranuloma venereum
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
Constitutional sx of second stage of lymphogranuloma venereum
Fever
Chills
Myalgias
Malaise
Complications of systemic spread of lymphogranuloma venereum
Arthritis Ocular inflammatory dz Cardiac involvement Pulmonary involvement Asceptic meningitis Hepatitis or perihepatitis
Third stage of lymphogranuloma venereum
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
PE of first stage of lymphogranuloma venereum
Initial lesion is usually a small, painless papule, shallow ulcer, or herpetiform lesion in the genital area
PE of second stage of lymphogranuloma venereum
Painful LNs (usually unilateral) known as buboes Affected nodes often coalesce and form abscesses which can rupture and form sinus tracts
PE of third stage of lymphogranuloma venereum
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
Workup for lymphogranuloma venereum
Dx mainly based on clinical findings with increasing evidence supporting nucleic acid amplification tests
Tx of lymphogranuloma venereum
Doxycycline 100 mg PO BID x 21 days
OR
Erythromycin base 500 mg PO QID x 21 days
