Lecture 9- STDs Flashcards
What STDs can you use expedited partner therapy for?
gonorrhea
chlamydia
What are the 2 immunizations to consider w/ STDs
Gardasil
Hep B
Who should be screened annually for STDs?
Sexually active women under 25 (book) 26 in CDC
older women with multiple sexual partners or a new partner
What is the most frequently reported infectious disease in the US?
Chlamydia trachomatis
What STD usually has less symptoms- chlamydia or gonorrhea?
gonorrhea
Is gonorrhea a reportable disease?
Yes, reportable disease in all states and sexual partners of infected individuals must be tested and treated
What are some screening diagnostics for discharge?
culture
microscopy
NAATs
EIA (immuno-assay)
What is NAATs?
nuclear acid amplification testing (can be rapid screens)
Name the condition: Recently on antibiotics, itchy white, curdy discharge, see hyphae and buds on microscope. Will have normal pH.
Candidasis albicans
What do you use to treat candidiasis albicans first line?
OTC intravaginal butoconazole (Femstat)
(any that end in “ole”)
use at bed time 3-5 nights
Name the condition: discharge, odor that is worse after intercourse. Thin homogenous, white, adherent discharge w/ fishy odor, positive whiff test. pH >4.5. On microscope there is clue cells
Bacterial vaginosis
How do you treat bacterial vaginosis?
Metronidazole (flagyl) 500 mg po BIDx 7
What are some precautions to take with metronidazole (flagyl) (treatment for BV, t. vaginalis) ?
Take with food
May have mild headache
No alcohol while taking it
May have a metallic taste
Name the condition: discharge, foul odor, dysuria, dyspareunia, vulvar itching and burning. Yellow-green discharge, frothy, “strawberry cervix” Will see protozoan on microscope.
Trich (T. vaginalis)
How do you treat t. vaginalis?
Metronidazole (flagyl) 2 grams po single dose
What is the progression with chlamydia trachomatis?
PID, ectopic, infertility
What does the cervix with chlamydia look like?
mucoprurulent cervicitis, friable cervix (bleed when touched)
What diagnostics do you do for chlamydia?
culture or liquid based cytology
urine based test (NAAT)
How do you treat chlamydia?
Azithromycin 1 gm po single dose
do partners needs to be treated with chlamydia?
yes
When do you do a test of cure with chlamydia?
Pregnant
Re-infection suspected
When should you do a test of cure?
Give at least 4 weeks after treatment
How far back do you have to treat partners of people who had chlamydia?
60 days
What is the sequelae with gonorrheae?
PID, ectopic, infertility
How do you treat gonorrhoeae?
Ceftriaxone (Rocephine) 250 mg IM single dose plus azithromycin (zithromax) 1 g PO (covers co-existant chlamydia)
Where can gonorrhoeae present?
Cervix
Rectum
Pharynx
Eye
What can cause PID?
N. gonorrhea, C. trachomatis, vaginal anaerobes
What is necessary for a diagnosis of PID?
Uterine, cervical or adnexal tenderness plus at least one of the following: T >101 F Mucopurulent discharge WBCs in vaginal fluid elevated sed rate elevated c-reactive protein documented GC or chlamydia
How do you treat PID in the non vomiting, non spetic or pregnant, non surgical abdomen.
Ceftriaxone 250 mg IM plus azithromycin 1 g Po single dose or doxycycline 100 mg BID x 7 days
For inpatient treatment of PID (those who fail to response w/in 24-72 hours outpatient Rx, TOA, can’t do outpatient Rx) how do you treat it?
IV cephalosporin plus doxycycline
What is caused by the pox virus. Presents as umbilicated papules.
Molluscum
how do you treat molluscum?
Cryotherapy
Laser
Topicals
What is caused by human itch mite, rash ad burrows in belt area, intertriginous spaces.
scabies
How do you treat scabies?
Permethrin 5% (adult, egg)
Bedding, clothing and towels use hot water and hot dry cycle
How do you treat pubic lice?
Permethrin 5% (adult, egg) bedding, clothing, and towels use hot water dry cycle
What is the most common STD in the US?
HPV
What are the high risk types of HPV?
16, 18
How does HPV appear on a PE?
visible condyloma (flat, smooth, pedunculated): genitalia, anus, mouth
How do you treat visible condyloma?
Liquid nitrogen/ cryotherapy
Patient applied imiquimod (Aldara) 5% cream
Sinecatechins 15% ointment (Veregen)
Podofilox
What is used for prevention of HPV?
Gardasil (quadrivalent)
Cervarix (bilvalent)
Where does HSV 1 occur?
Oral cold sores, fewer recurrences
where does HSV 2 occur?
Genital area, recurrent but less severe
With the first episode of HSV 2 what can happen?
Constitutional episode
pelvic adenopathy
lesions
What is a prodrome?
Presents with HSV, feel tingling, symptoms on a outbreak coming on
What are diagnostics for herpes?
Culture and PCR
type specific: HSV G1 and G2 (glycoprotein)
What can you use to treat the 1st episode of herpes?
Ancyclovir (Zovirax) 400 mg TID 2-10 days
To suppressive herpes what do you give?
Suppressive: Acyclovir 400 mg BID
For an episode of herpes what can you give?
Acyclovir 400 mg TID x 5 days
For discordant couples for herpes what do you give to treat?
Valacyclovir 500 mg qd (only to partner that is symptomatic)
What organism causes syphilis?
Treponema pallidum (spirochete organism)
What is the average time it takes for clinical signs for syphilis to occur?
3 weeks
What is the sign of the primary stage of syphilis?
Chancre (10-60 days post infection)
painless, punched out ulcer gone in 3-6 weeks, regional adenopathy.
When does secondary syphilis occur?
4-8 weeks after chancre, resolves spontaneously
What are some symptoms of secondary syphillis?
Rash will also include palms and soles
fever, HA, malaise, sore throat
Rah is contagious
What happens in the latent phase of syphilis?
No clinical S and S
What happens in tertiary syphilis?
Have gumma= nodular, granulomatous lesions
can be external or internal
What do you use to diagnose syphilis?
RPR (rapid plasma reagin) & FTA-ABS (fluorescent treponemal antibody absorption)
If FTA is positive then def syphilis
VDRL & HA-TP
Serum/CSF/ Tissue : dark field (microscopy)
How do you treat syphilis?
Benzathine PCN G (Bicillin LA) 2.4 mu IM
Single dose for primary, secondary and early latent
Weekly X 3 weeks for late latent or unknown
How often do you monitor people with syphilis?
Monitor 6, 12, 24 months
What is considered treatment failure w/ syphilis?
Failure to decrease titer by 2 dilutions
How do you know if someone has been re-infected w/ syphilis?
4 fold increase in titer
What is the Jarisch - Herxheimer rxn?
HA, fever w/in 24 hours of injection
Due to die off of spirochete in blood
What are 2 other conditions to consider in the ddx for syphilis?
Lymphogranuloma venerum (LGV) Donovanosis
What condition has a break down of the lymph notes (bubos)?
Lymphogranuloma venerum (LGV)
How do you treat lymphogranuloma venerum and donovanosis?
doxycycline 100 mg BID x 21 days
What is a disorder often found in Australia, India, Africa with Painless, slow growing ulcerative lesions w/out LAD
Donovanosis
What presents with painful genital ulcer w/ tender, suppurative inguinal LAD. Prevelant in Africa, Caribbean?
Chancroid
How do you treat chancroid?
Azithromycin single 1 g dose
What are symptoms of HIV?
Fever, pharyngitis, lymphadenopathy (inguinal, axillary) rash, arthralgias, myalgias, HA
What are diagnostics for HIV/ AIDS?
Rapid screening confirmed with Western Blot
If the WB blot is positive what other information do you want to get?
Viral lode, CD4 count, CBC< CMP, other STDs, hep, TB, CXR
What is quantitative? RPR (rapid plasma reagin) or FTA-ABS (fluorescent treponemal antibody absorption)
RPR
What is the name for lesions associated with genital warts caused by HPV?
Condyloma acuminata
What is the name for white lesions associated w/ secondary syphillis?
Condylomata lata
