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Clin Med - Repro > Lecture 13 - STI > Flashcards

Lecture 13 - STI Flashcards

1
Q

Who gets tested for chlamydia?

A

annual for sexually active women <25

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2
Q

What STIs do we test in a pregnant pt?

A

syphilis
HIV
Chlamydia
HBV

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3
Q

What STIs are tested annually in HIV+ women?

A

trichomonus

HPV

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4
Q

Which STIs do we report to the health department?

A 
Chalmydia
Gonorrhea
Neonatal herpes
Syphilis
Chancroid
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5
Q

When do people get the HPV vaccine?

A

ages 9-14: 2 doses 6-12 months apart

ages 15-26: 3 doses 0,1,6 months apart

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6
Q

What are the 5Ps of risk assessment for STIs?

A 
partners
practices
prevention of pregnancy 
prevention of STIs
past hx of STIs
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7
Q

Chlamydia tachomatis

A

obligate intercellular bacterial parasite

less transmissible than GC

transmitted by sexual contact and perinatally

many men and most women are asymptomatic

high incidence of co-infection with N/gonorrhea

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8
Q

What is the clinical manifestations of Chlamydia?

A

incubation 7-14 days

Men:
urethritis - dysuria, mild urethral discharge (less purulent than GC)
complications: epididymitis, prostatitis, procitis, can cause strictures, abscessess

Women:
cervicitis - mild discharge, urethritis - dysuria, mild urethral discharge
complications: endometritis, salpingitis, PID
pharyngitis
reactive arthritis
in infants: conjunctivitis, PNA (prophylaxis treatment at birth)

Lymphogranuloma venereum
endemic in africa, SE asia, caribbean
primary lesion: asymptomatic papule or ulcer, heals rapidly, occurs 3-30 days post infection
secondary: days to weeks - adenopathy

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9
Q

Lymphogranuloma venereum

A

seen, but rare, with chlamydia
endemic in africa, SE asia, caribbean
primary lesion: asymptomatic papule or ulcer, heals rapidly, occurs 3-30 days post infection
secondary: days to weeks - adenopathy

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10
Q

How do you dx chlamydia?

A

NAAT - nucleic acid amplification tests

DFA - direct fluorescent antibody

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11
Q

What is the treatment for chlamydia?

A

azithromycin 1g single dose treatment

doxycycline 100mg twice daily for 7 days (not in pregnancy –remember doxy effects teeth of children)

for LGV treat for at least 3 weeks

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12
Q

Neisseria gonorrheae

A

gram negative intracellular diplococci

more cases reported in men

transmitted perinatal and sexual contact

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13
Q

What is the clinical manifestation of neisseria gonorrheae?

A

incubation 2-10 days

men: purulent discharge, dysuria, urethritis, or may be asymptomatic
women: vaginal discharge, dysuria, cervicitis, 90% may be asymptomatic

anorectal gonorrhea: proctitis, purulent discharge
pharyngeal disease
conjunctivitis in the newborn: purulent exudate within a week of delivery
co-infection with chlamydia 10-15% of pts

in most cases sxs resolves without tx

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14
Q

Complications of gonorrhea

A

10-20% ascending infection: PID, endometritis, salpingitis, tubo-ovarian abscess
acute epididymitis
disseminated disease “arthritis dermatitis syndrome”

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15
Q

How do you dx gonorrhea?

A

NAAT

gram said: specific for genital infections in male

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16
Q

What is the treatment of gonorrhea?

A

Ceftriaxone 250mg IM + 1g Azithromycin PO

alternative:
cefixime 400mg PO + 1gm Azithromycin PO

risk of resistance coming

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17
Q

PID risk factors

A 
cigarette smoking
high frequency of intercourse
multiple partners
new sexual partner within 1 months of sxs onset 
recent hx of douching 
IUD
young age at first intercourse
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18
Q

What is the clinical manifestation of PID?

A 
fever >101
pelvic pain 
cervical motion tenderness (chandelere sign)
adnexal tenderness
cervical discharge
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19
Q

How do you dx PID?

A

clinical presentation
WBC >20,000
ESR >15

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20
Q

What is the gold standard to detect chlamydia or GC?

A

PCR

sample can be done with a first-catch urine or a cervical swab

other options:
gram stain cultured on chocolate agar

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21
Q

What is the treatment for PID?

A

cerftriaxone 250mg IM once + doxycycline 100mg PO twice daily for 14 days +/- metronidazole 500mg twice daily x 14 days

sexual partners should be treated

inpt treatment:
Cefotetan 2g iV q 12 hours + doxycycline 100mg PO twice daily x 14 days

22
Q

Does syphilis hurt?

A

no

painLESS

23
Q

Epididymitis

A

scrotal pain
Prehn’s sign

urine NAAT for GC, chlamydia

tx: according to risk + symptomatic

24
Q

Prostatitis

A

ascending infection from urethra
reflux of infected urine
urethral instrumentation, foley catheters, surgery

sxs:
high fever, chills, perineal and back pain, UIT sxs

25
Q

What are the sxs of acute prostatitis?

A

high fever, chills, perineal and back pain, UIT sxs

26
Q

Acute vs chronic prostatitis?

A

acute: high fever, chills, perineal and back pain, UIT sxs

chronic:
asymptomatic to perineal discomfort, low back pain, dysuria

Microbio differs:
actue - N. gonorrheae, E. coli
chronic - E. coli, enterococci, chlamydia, ureaplasma

27
Q

How do you dx prostatitis?

A

+/- urine culture, blood culture, CBC

28
Q

How do you tx prostatitis?

A

Quinolone: ciprofloxacin 500mg q 12 hours x 4-6 weeks
alternative levofloxacin or norfloxcain
or Bactrim DS

29
Q

Chancriod

A

Haemophilus ducreyi

incubation 1 day - weeks
generally confined to the genitalia
initially begins as a tender papule with surrounding erythema
forms PAINFUL ulcer

30
Q

How do you dx chancroid?

A

clinical
culture, gram satin
“school of fish”

31
Q

What is the treatment for chancroid?

A

azithromycin 1g PO once
or
ceftriaxone 250mg IM once
or
ciprofloxacin 500mg PO twice daily for 3 days
or
erythromycin base 500mg 3 times daily x 7 days

32
Q

Granuloma inguinale

A

klebsiella granulomatis
rare in US
painLESS ulceration of genital lesions withOUT regional lymphadenopathy

dx: Donovan bodies on tissue biopsy
tx: Azithromycin 1g weekly once per week for 3 weeks

33
Q

Syphilis

A

treponema pallidum

highly infectious: transmitted by sexual contact, transplacentally, transfusion, needle stick, most infectious early in disease
majority of cases are 15-30 yo
higher rates in MSM

34
Q

What is the clinical manifestation of primary syphilis?

A

incubation periods 3-90 days
Chancre forms at site of inoculation: initially painless papule, erodes with raised borders
heals within 3-6 weeks
can be multiple, atypical, or absent
can be present on the cervix, mouth, perianal area
accompanied by adenopathy

35
Q

What is the clinical manifestation of secondary syphilis?

A

begins 2-8 weeks after appearance of chancre
disseminated disease
maculopapular rash can involve any surface of the body, presence on PALMS and SOLES is HIGHLY suggestive
papule can coalesce to form gray-white highly infectious plaques called CONDYLOMATA LATA

36
Q

Latent syphilis

A

no clinical manifestation, but positive serology (usually)

37
Q

Tertiary syphilis clinical manifestation

A

progressive inflammatory disease, can affect any organ
neurosyphilis
CV syphilis
late benign syphilis

Neurosyphilis 
Parenchymatous disease 
Syphilitic otitis
Cranial nerve palsies
Gummas
38
Q

Neurosyphilis

A

NOT DONE HERE

39
Q

How do you dx syphilis?

A

darkfield examination is dx method

serological tests: nonspecific, non-treponemal reaginic tests: VDRL and RPR
-false negatives in primary, most reliable for secondary syphilis, false positive can occur (pregnancy, SLE, and HIV)
become positive 3-6 weeks after inoculation

non-treponemal tests:
-RPR is used primarily for screening; VDRL primarily for CSF (neurosyphilis)

treponemal tests:
FTA-ABS
TPHA (+ on CSF for neurosyphilis)

40
Q

What is the treatment of syphilis?

A

early disease (less than 1 year) - PCN G benzathine 2.4 MU, IM

neurosyphilis IV PCN = only option

alternative to PCN: doxycycline, ceftriaxone

41
Q

Primary vs reactive HSV

A

primary:
often asymptomatic
painful clusters of vesicles
systemic sxs

reactive:
often asymptomatic
prodrome then vesicles at same site

42
Q

What is the treatment for herpes?

A

Primary/suppressive (6+/year)/recurrent
acyclovir
famcyclovir
valacyclovir

43
Q

HPV

A

human papilloma virus
cancers of the cervix, vulva, vagina, penis, anus

transfer skin to skin

2/3 of sexual contacts develop disease
respiratory papillamatosis in children
infection often asymptomatic

44
Q

Which HPV is associated with malignancies?

A

6, 11 = warts

16, 18, 31, 33, 35 – cancer (and flat warts)

45
Q

What is the clinical manifestation of HPV?

A

flesh to gray colored papules either sessile or pedunculated, they may merge into plaques

in men, usually on the penile shaft, urethra may be involved

in women, usually posterior introitus, labia
flat condylomas on cervix, vagina
perianal warts

46
Q

How do you dx HPV?

A

clinical (warts)
application of acetic acid solution
HPV DNA detection

47
Q

How do you treat HPV?

A

no treatment is curative and relapses are common

48
Q

Prevention of HPV?

A

Gardasil

49
Q

Pubic Lice Clinical Presentation

A

not done here

50
Q

What is the treatment for pubic lice?

A

not done here

51
Q

Scabies presentation

A

not done here

52
Q

Scabies treatment

A

not done here

Clin Med - Repro (18 decks)

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