Infectious Diseases (STIs and UTIs) Flashcards
How do you differentiate urethritis from cystitis?
Cystitis does not give urethral discharge
What is the best initial test for urethritis?
Urethral swab for gram stain
What is suspected in the presence of intracellular gram-negative diplococci? What is the next step?
Neisseria gonorrhoeae; initiate treatment
What is the most accurate test for urethritis? (3 options)
Urethral culture, DNA probe, or nucleic acid amplification test (NAAT)
What are other common causes of urethritis besides N. gonorrhoeae and Chlamydia trachomatis? (2)
Mycoplasma genitalium and Ureaplasma
How do you treat urethritis when the organism is unknown?
Use a combination of one drug for gonorrhea and one for chlamydia
How does cervicitis present?
Cervical discharge and an inflamed “strawberry” cervix
How is cervicitis diagnosed?
Self-administered swab for nucleic acid amplification
How is cervicitis treated?
Single dose of ceftriaxone and azithromycin
How does PID present? (5)
Lower abdominal tenderness Lower abdominal pain Fever Cervical motion tenderness Leukocytosis
When symptoms of PID are present, what is most appropriate next step in management?
Exclude pregnancy
What is the most accurate test for PID?
laparoscopy
How is PID treated inpatient vs. outpatient?
Inpatient: Cefoxitin or cefotetan combined with doxycycline
Outpatient: Ceftriaxone and doxycycline
How is PID treated inpatient vs. outpatient in patients with anaphylaxis to penicillin?
Inpatient: Clindamycin, gentamicin, and doxycycline
Outpatient: Levofloxacin and metronidazole
Genital ulcers that are painful are most likely…
Genital ulcers that are painless are most likely…
Painful: Chancroid
Painless: Syphilis
Genital ulcers with tender lymph nodes and suppurating are most likely…
Genital ulcers that are painful and have vesicles prior to the ulcer are most likely…
Tender lymph nodes: Lymphogranuloma venerum
Vesicles prior to the ulcer: Herpes symplex
What are the diagnostic tests for Syphilis?
Dark field microscopy
VDRL or RPR
FTA or MHA-TP
What are the diagnostic tests for Chancroid (Haemophilus ducreyi)?
Stain and culture on specialized media
What are the diagnostic tests for Lymphogranuloma venerum?
Complement fixation titers in blood
Nucleic acid amplification testing on swab
What are the diagnostic tests for herpes simplex?
Tzanck prep is the best initial test
Viral culture is the most accurate test
How do you treat syphilis?
Single dose of intramuscular benzathine penicillin (Doxy if patient is penicillin allergic)
How do you treat chancroid?
Azithromycin (single dose)
How do you treat Lymphogranuloma venereum?
Doxycycline
How do you treat herpes simplex? (3 choices)
Oral acyclovir, valacyclovir, or famciclovir (Foscarnet for acyclovir-resistant herpes)
How does primary syphilis present?
Painless genital ulcer with heaped-up indurated edges
Painless adenopathy
How does secondary syphilis present?
Rash on palms and soles
Alopecia areata
Mucous patches
Condylomata lata
How does tertiary syphilis present?
Neurosyphilis: Meningovascular, Tabes dorsalis, General Paresis, Argyll Robertson pupils
Aortitis: regurgitation, aneurysm
Gummas: Skin and bone lesions
What does Argyll Robertson pupil mean?
Reacts to accommodation but not light
