S13C144 - STI

Question 1

What test to also do with any STI test?

Answer 1

• preg test

- affects tx options

Question 2

Chlamydia

Answer 2

-most common STI
-Sx: urethritis, d/c, dysuria, bleeding b/w menses
-70% women asymptomatic
-reiter syndrome: urethritis, conjunctivitis, rash
-tx: azithro 1g PO x1 OR doxy 100mg BID x7d
or erythromycin 500mg PO QID x7d
or levofloxacin 500mg PO OD x7d
-pregnant: azithro (do TOC 4w later) or amoxicillin
-no sex x7d after completion of Abx, re-test 3mo later for re-infection
-should also treat for gonorrhea

Question 3

Gonorrhea

Answer 3

• gm- diplococcus
• often asymptomatic and coexists with chlamydia
• mucopurulent cervicitis, dysuria, penile d/c, epididymitis, prostatitis
• Dx: swab or urine NAAT
• tx: cefixime 400mf PO x1 OR CTX 125mg IM x1
• or cefoxitin 2g IM plus probenecid 1g PO x1
• or cefotaxime 500mg IM x1
• penicillin allergy: spectinomycin IM2g
• PLUS tx for chlamydia

-NB can manifest on the skin as petechial acral skin lesions on an erythematous base (disseminated gonorrhea)

Question 4

Trichomoniasis

Answer 4

-protozoan
-trichomoniasis can be asymptomatic or watery d/c, burning, pruritus, frequency, dyspareunia, abdo pain
-Dx: culture
-Tx: flagyl 2g PO x1 or 500mg PO BID x7d
treat sexual partners
no sex until 7d after finished Abx
-if asymptomatic in pregnancy don’t treat, flagyl is safe

Question 5

BV

Answer 5

-flagyl 500mg PO BID x7d or vaginal gel 0.75% OD x5d or clinda cream 2% PV qhs x7d

Question 6

Syphilis

Answer 6

• treponema pallidum (spirochete)
• causes syphilis, yaws and pinta
• primary syphilis: painless chancre, 21d incubatn, lesion appears at 3-6w then resolves
• secondary: 3-6w after primary stage, rash (red papular), lymphadenopathy, sore throat, malaise, fever, h/a
• tertiary: 3-20y after infection, nervous and cardiovascular system, gummata, miningitis, tabes dorsalis

-Tx: PCN G 2.4m units IM x1
or Doxy x14d
latent/tertiary: IM weekly x3 doses

Question 7

HSV

Answer 7

-Tx: acyclovir 400mg PO BID x5d

or valacyclovir 500mg PO OD x5d

Question 8

Chancroid

Answer 8

-multiple painful irregular purulent ulcers 1-2cm wide, lymphadenitis
-haemophilus ducreyi, gm- bacillus
-incubation 4-10d
-Tx: azithromycin 1g PO x1
or CTX 250mg IM x1
or ciprofloxacin 500mg PO BID x3d

Question 9

Lymphogranuloma venereum

Answer 9

-small shallow ulcers
-starts with painless ulcer, lasts 3d then goes away, 1-3w later get unilateral inguinal lymphadenopathy, purplish hue to the skin
-can get LGV proctitis, systemic symptoms
-Tx: doxy x3w, if pregnant give erythro
drain buboes

Question 10

Granuloma inguinale (donovanosis)

Answer 10

• klebsiella granulomatis, gm- intracellular
• long incubation (up to 6m), SC nodules appear, painless ulcers, beefy red, bleed easily
• dx: donovan bodies on tissue biopsy
• doxy 100mg BID x3w or longer until lesions healed

Question 11

Syphilis: Dx

Answer 11

-primary: can do scrapings of the chancre and use darkfield microscopy, however if microscopy negative pt will still require serology testing in 2-4w
do VDRL/RPR but know they need to be repeated in 2-4w
-secondary: VDRL and RPR are 100% sensitive for secondary syphilis

Question 12

TSS

Answer 12

• hemodynamic instability, erythroderma, hyperemic mm, pharyngitis, diarrhea, fever, desquamation, renal failure from tubular necrosis
• most caused by staph aureus
• RF: menses, cutaneous lesions, recent Sg, postpartum, IUD URTI
• Abx: keflex 2g IV q6h, vanco if MRSA

Question 13

TSS: strep

Answer 13

• GAS
• usually have a soft tissue infectio present, necrotizing fasciitis or mysoitis
• Sx: POOP, sudden ans evere onset, myalgias, erythema, flu-like illness
• Tx: pcn G 24m units/d divided, or clinda or linezolid or CTX plus clinda
• debridement