Lecture 13: STIs Flashcards
STI screening:
- Who gets screened for HIV
- Who gets annual chlamydia screening
- What 4 STIs do preg women get screened for
- What 2 STIs do HIV+ women get screened for annually
- how often should MSM be screened
- Who gets screened for HIV - EVERYONE
- Who gets annual chlamydia screening
- ALL sexually active women < 25 - What 4 STIs do preg women get screened for
- Syphillis, HIV, Chlamydia, HBV - What 2 STIs do HIV+ women get screened for annually
- Trichomonas, HPV - how often should MSM be screened
- annually
What are the 5 P’s of risk assessment for STIs?
- Partners
- Practices
- Prevention of preg
- Prevention of STIs
- Past h/o STIs
What is the main cause of sterility and PID in women?
Chlamydia
Female pt comes in w/urethritis w/mild urethral d/c complaining of pruritus, dyspareunia, and hematuria. She also complains of cervicitis (d/c). Dx? Tx of ToC?
Male presentation: Urethritis (dysuria, mild d/c)
Other presentations: pharyngitis, Reactive arthritis
Dx = Chlamydia
Tx = single dose of 1g Azithromycin
Dx ToC for Chlamydia?
NAAT (PCR is best)
3 complications of chlamydia in men? women?
Men
- epidymitis
- prostatitis
- Proctitis
Women
- Endometritis
- Salpingitis
- PID
What 2 the presentations of an infant w/chlamydia
- Conjunctivitis
- PNA
TX IMMEDIATELY for opthalmic G/C
Other option for Txing Chlamydia? Why is it CI in preg?
Doxycycline x 7 days
- CI in preg –> causes teeth problems in baby
What type of organism is Neisseria gonorrhea?
What type of people most often report this dz
gram negative diplococci
most cases reported in gay men (b/c Sxs)
What 3 Sxs of Gonorrhea are common to both men and women?
Part 2: how does d/c differ from Chlamydia?
Note: most cases resolve w/out Tx (less serious than Chalmydia)
- Purulent D/C
- Urethritis
- Dysuria
- Gonorrhea = d/c is more purulent than chlamydia
How does newborn w/gonorrhea present? (where is infection, when does it show up)
conjunctivitis (eye) - purulent exudate w/in 1 wk of delivery
What is the disseminated dz of Gonorrhea called?
3 Other complications of gonorrhea inf?
Arthritis-dermatitis Syndrome
- migratory poly-arthritis
- hemorrhagic papules/pustules
- Ascending inf
- Acute epididymitis
- Septic arthritis
What Dx test for gonorrhea is specific for a genital infxn in men? why wont it work in women?
ToC for gonorrhea is same as chlammydia…what is it?
Other method for detecting G/C = culture… what special culture used for G/C
Gram stain
- women normally have gonorrhea in their vagina
ToC for Dx = NAAT (PCR best)
chocolate agar culture
What 2 drugs used Tx for Gonorrhea? (include dose) – hence what MUST you also Tx for?
IM Ceftriaxone 250 mg single dose
PO Azithromycin 1 g single dose (Tx for chlamydia)
What type of infxn is PID? 2 MC causes together?
ascending infxn
MC caused by mixed combo of G/C
Pt comes in w/pelvic pain, purulent cervical d/c, adenexal tenderness, CMT/Chandelier’s sign and fever > 101F (38.3 C) what is Dx?
Dx = PID
What 2 drugs used to Tx PID outpatient? (sim to G/C)
2 drugs for inpatient?
Who must you also Tx
Outpatient
- IM Ceftriaxone
- PO Doxycycline
Inpatient
- IV Cefotetan
- PO Doxy
Tx PARTNERS
Cause of syphillis/shape?
What is unique about transmission of syphillis
Treponema pallidum - spirochete (corkscrew appearance)
can cross placenta (transplacental transmission)
- Main presentation of primary syphilis?
- Main presentation (general) of secondary syphilis
- Main presentation of tertiary syphilis?
- What is seen in CV sypilis?
- What is seen in late benign syphilis
- primary = chancre
- secondary = rash
- tertiary = neurosyphilis
- CV = endarteritis (cardiac probs)
- Late benign = gummas (granulomatous lesions)
Painless, papule w/ raised borders that ulcerates and erodes
- heals on its own
- cervix, mouth, perinanal area
- a/w regional LAD near the site
What is it?
Chancre
2ndary syphilis:
- When does it occur?
- what type of painless rash is it? what areas are highly suggestive for Dx?
- papules coalesce –> _____
- wart like lesions, gray/white, greasy, highly infectious
- after primary (chancre) –> 2-8 wks after
- Maculopapular rash - highly suggestive if on palms/soles
- Form condyloma lata
Enlargement of epitrochelar nodes is highly suggestive for what dz?
Syphilis
Tertiary/Neurosyphilis:
- in Asx Dz what values seen w/CSF, WBC, protein, glucose and VDRL
- 2 types of Symptomatic Dz
- incr CSF/WBC/protein, decr glucose, + VDRL
2. Endarteritis olbiterans and parenchymatous/degeneritive Dz
Two eye findings a/w parenchymatous/degeneritive Dz?
- Argyll Robertson pupil (pupil constricts w/accomodation but not light)
- Optic atrophy
Tertiary syphillis:
Ataxic gait, foot drop, paresthesia, incontinence, impotence, charcots joints are seen w/what?
Tabes dorsalis = demyelination of dorsal root ganglia
What type of examination is the definitive method for Dx syphilis?
Darkfeld examination
What type of syphilis are serological tests (VDRL and RPR) most reliable for?
secondary syphilis
What are the two non-treponal testing for and what are they?
Which is used for screening and which used for neurosyphilis?
What decr in titer is considered signif
After doing non-treponal testing what type of testing need to confirm results?
- testing for Abs
- RPR
- for screening - VDRL
- for neurosyphilis
4 fold decr in titer = signif
Confirm w/treponemal test
Treponemal Testing
- what are the 3 specific tests?
- FTA-ABS
- TPHA or TP-PA
What two tests MUST be done for neurosyphilis?
Which test when positive indicates CNS involvement? (but also if negative cannot r/o neurosyphilis)
RPR and VDRL tests
Which test when positive indicates CNS involvement
- but also if negative cannot r/o neurosyphilis –> VDRL
Tx for early dz syphilis (< 1 yr)
What is the only option for Tx of Neurosyphillis
Pen G Benzathine
Neurosyphillis –> IV PCN
If you see lice on the eyelashes and pruritus what should you suspect?
Pediculosis pubis (pubic lice)
Name for bluish-gray, irreg shaped macules on lower abd wall, butt, upper thighs seen w/pubic lice (pathonogmonic)
Maculae Ceruleae (taches bleues)
3 tx options for pubic lice
- Permethrin
- Malathion
- Lindane
Permethrin Tx for Pubic Lice
- name for OTC and Rx ?
1. once applied when do you wash off?
2. when must you reapply it?
Permethrin
- OTC = Nix, Rx = Elminite
1. wash off after 10 min
2. reapply 7-14 days later
Malathion Tx for pubic Lice
- how long applied
- when is it indicated
- applied 8-12 hrs
2. indicated if fail permethrin
Lindane
- how long should shampoo be applied then washed off?
- when CI (2)
- 4 min –> wash off
2. CI in preg, breastfeeding
