MIM - STDs Flashcards
One of the biggest problems with STIs…
TOTALLY ASYMPTOMATIC SOMETIMES!!!!
Yet can STILL cause PID in women
3 main PID sequelae –> Infertility, Ectopic, Chronic Pelvic Pain
Biggest sexual practice risk for STI?
Anal Sex
Genital Ulcers Overview
FOUR MAIN DISEASES RESPONSIBLE
Syphilis (#2 cause)
Chancroid (#3)
Granuloma Inguinale
Lymphogranuloma Venereum
HSV is still #1 cause
Syphilis Stages (primary, secondary, latent)
Primary = non/minimally tender chancre, indurated, clean margins; may be regional lymphadenopathyl usually appears 3-6 weeks after sex, BUT WILL DISAPPEAR ON ITS OWN
Secondary Stage –> if primary untreated, may return as secondary; 90% GET CHARACTERISTIC RASHES ON PALMS AND SOLES!!!!!!!!
Not every patient goes through secondary, might have a LATENT STAGE (+ blood test, no clinical signs)
TERTIARY SYPHILIS
NEUROSYPHILIS – presents early with MENINGOVASCULAR SYMPTOMS –> if you see a STROKE in a YOUNG PERSON think Syphilis
Later can cause GENERAL PARESIS of the INSANE (GPI) – dementia, delusions
Late onset is TABES DORSALIS – infection of posterior column, BROAD BASED GAIT
Usually take DECADES TO APPEAR (GPI and TABES)
BUT!!! IF YOU HAVE HIV, IT MAY ONLY TAKE A FEW YEARS*
Besides Neurosyphilis, can have CV SYPHILIS (aneurysms) and GUMMATOUS SYPHILIS (granulomatous lesion in skin, skeletal and muscle tissue) IN THIS STAGE
Serological Tests for Syphilis
NONTREPONEMAL –> Venereal disease research lab (VRDL) or RPR (rapid plasma regain)
These can show FALSE POSITIVES so confirm – titers correlate with stage, HIGHEST TITER SEEN IS THE SECONDARY STAGE
TREPONEMAL – more expensive, used to CONFIRM NON-TREPONEMAL
If positive once, positive forever!!!!
When do we need a LUMBAR PUNCTURE?
If patient is HIV+ and there are INDICATIONS OF HEARING/VISUAL LOSS!!!!!
Need to see if it has gotten to the CNS yet!!
If positive VDRL treat!
If negative but LP shows WBC/Protein, etc –> TREAT for neurosyphilis anyway
Treatment for SYPHILIS?
PENICILLIN!!!!!!!
Primary/Secondary –> 2.4 million units ONE TIME
Latent –> give the same dose, 3x a week for several weeks
Tertiary/Neuro –> 3.4 million units EVERY FOUR HOURS FOR 10-14 DAYS!!!!
Doxy if allergic
When treating what do we need to remember, FOR ALL STI?
TREAT PARTNERS TOO
CHANCROID
Caused by H. Ducreyi
Common in NON-WHITE, UNCIRCUMSCRIBED MEN
Incubates 5-7 d post exposure, presents with PAINFUL PAPULES with erythema, ragged edges, NOT INDURATED
Dx made by CULTURE or by finding painful genital ulcers, regional lymphadenopathy without SYPHILIS
Treat with AZITHRO/CEFTRIAXONE
GRANULOMA INGUINALE
DONOVANOSIS
Endemic to ASIA, OCEANIA, SOUTHERN AFRICA
Painless and progressive ULCERATIVE LESION that is HIGHLY VASCULAR and bloody
DISTINGUISHING FACTOR (bloody)
Dark staining Donovan Bodies
BACTRIM/DOXY
LYMPHOGRANULOMA VENEREUM (LGV)
L1-L3 versions of CHLAMYDIA TRACHOMATIS cause LGV
Africa, SE Asia, South America, Carribean
Heterosexual men get BUBOES WITH GROOVE SIGN (large lymph nodes above and below the INGUINAL LIGAMENT)
PROCTOCOLITIS in women and gay men!!!!!!!
Scarring and rectal stricture
3 Stages
PRIMARY – lesion appears 3-30 days after with a small papule or herpetiform ulcer
SECONDARY – lymphadenopathy and systemic symptoms and/or proctocolitis
TERTIARY –> chronic granulomatous enlargement of the external genitalia with ULCERATION (ELEPHANTIASIS of the GENITALS OCCUR WHEN THERE IS LYMPH OBSTRUCTION)
Tx with Doxy or Erythro
Urethritis/Cervicitis main cause
NEISSERIA GONORRHEA
Different in men and women
Men –> gonoccocall urethritis can incubate for 2-5 days, before appearing as a PURULENT THICK/YELLOW DISCHARGE
Women –> gonococcal cervicitis is ASYMPTOMATIC 90% of the time!!! 10% have yellow discharge
BOTH –> acute proctitis, involvement of pharynx, conjunctive, PID and/or liver as general dissemination is possible
Dx Gonorrhea
Gram stain (look for gm - diplo)
Culture with 3 sets of BLOOD/MUCOSAL/SYNOVIAL fluid
NUCLEIC ACID AMPLIFICATION TEST (NAATS) used for URINE, VAGINAL, PENILE or OCULAR SECRETIONS!
Chlamydia and STDs
HPV most common STD, but CHLAMYDIA CAUSES THE MOST BACTERIAL STDs
A-C cause most common cause of blindness
D-K cause NON-GONOCOCCAL CERVICITIS and PID
L1-L3 cause LGV
Presentation of Cervicitis (non-gonoccocal)
70% of women are ASYMPTOMATIC –> STILL LEADING CAUSE OF PID –> “Silent Salpingitis” - MUST SCREEN FOR CHLAMYDIA –> leading cause of infertility
Men – 40% asymptomatic; epidimytis, prostatitis, proctocolitis possible
BOTH MEN AND WOMEN GET REITER SYNDROME* inflammatory post-infectious autoimmune run
Dx of Cervicitis/Chlamydia?
NAATS!!! Nucleic Acid Amplification Test! NOT for rectal/pharyngeal samples because of common bacteria, but others good
AZITHROMYCIN or DOXYCYCLIN
People taking DOXY tend to feel better and STOP TAKING ANTIBIOTICS!!! So Azithro is better!
Non-gonococcal URETHRITIS
Ureaplasma, mycoplasma, trichomonas vaginalis, herpes (and Chlamydia!)
EPIDIDYMITIS
Causes PAINFUL SCROTAL and TESTICULAR SWELLING
Dysuria, lower urinary tract symptoms (LUTS), Discharge
Sexually active men –> Most likely CHLAMYDIA or NEISSERIA
Older, non-sexually active –> GRAM Negatives (E. Coli, Klebsiella) more likely
PID - Why such a big problem?
1 Cause = CHLAYMIDIA TRACHOMATIS and then NEISSERIA (2/3 from bacterial)
OFTEN ASYMPTOMATIC
Even symptoms suck – SUBTLE discharge, SUBTLE lower abdominal pain
Occurs when microorganisms ascend from the CERVIX to the INNER PELVIC STRUCTURES
Causes ENDOMETRIOSIS, SALPINGITIS, PERITONITIS, TUBOOVARIAN ABSCESS
1/3 are POLYMICROBIAL (anaerobes + gram negatives
Dx based on GENERAL SYMPTOMS (lower abdominal tenderness, cervical motion tenderness, ADNEXAL TENDERNESS seems to be most diagnostic)
Can cause FITZ-HUGH-CURTIS SYNDROME – PeriHEPATITIS –> 10-20%, presents as RUQ PAIN
Treating PID
TREAT ALL POSSIBLE BACTERIAL CAUSES:
Chlamydia
Neisseria
Anaerobes
All at once! Due to LIKELY COINFECTION!!!!!
