Schoenwald - STIs Flashcards
1
Q
5 p’s of the STI medical interview
A
partners
practices
protection from std’s
past hx std’s
pregnancy intention
2
Q
3 pre exposure vaccines
A
hep B
hep A
HPV
3
Q
who should get the hep B preexposure vaccine
A
all sexually active patients
4
Q
who should get the hep A vaccine
A
MSM
5
Q
who should get the HPV vaccine
A
9-26 yo male and female
6
Q
male condoms are most effective in preventing
A
mucosal surface contact infxns
7
Q
what are mucosal surface contact infxns (4)
A
GC
CT
trichomonas
HIV
8
Q
what are skin-skin contact infxns
A
HSV
HPV
syphilis
chancroid
9
Q
con of non latex condoms
A
higher breakage/slippage rate
lambskin: larger pores → infxn
10
Q
are female condoms an effective barrier to viruses
A
yes
11
Q
are spermicides effective in preventing STIs
A
no
12
Q
what is N-9
A
vaginal spermicide
13
Q
t/f: N-9 can be used as a microbicide or lubricant during anal sex
A
f!
14
Q
annual STI screenings for at risk MSM (7)
A
HIV
syphilis
GC
CT
HPV
HBsAG
Hep C Ab
15
Q
preferred screening test for GC/CT
A
NAAT
16
Q
HPV test for MSM
A
anal pap smear
17
Q
screening tests for WSW (5)
A
HPV
HIV
GC
CT
trichomonas and BV
18
Q
what is PrEP
A
pre exposure prophylaxis for HIV
19
Q
what is opt out HIV testing
A
notify pt that HIV test will be performed unless they decline
20
Q
all __ women should be tested for HIV
A
pregnant
21
Q
what is expedited partner therapy
A
treating partner of STI pt
22
Q
what 3 STIs does expedited partner therapy make you think of
A
syphilis
GC
CT
23
Q
t/f: in CO, expedited partner therapy is sanctioned
A
T!
also recommended by CDC and CDPHE
24
Q
what are STIs of concern
A
trick question!
they all are
just needed to toss a softball in here :)
25
STIs involving ulcers
**syphilis**
**genital herpes**
also (uncommon):
lymphogranuloma venereum
chancroid
granuloma inguinale
26
mc cause of ulcers in young women in the US
HSV
syphilis
27
5 sources of non infectious ulcers
carcinoma
trauma
psoriasis
fixed drug eruption
yeast
28
STI ulcers are often classified into
painful vs painless
29
painful STI ulcers (2)
chancroid
genital herpes simplex
30
2 STI strains of HSV
HSV 1 and 2
31
painless STI ulcers (3)
syphilis
lymphogranuloma venereum
granuloma inguinale
32
6 STIs w. drip/discharge
**gonorrhea**
**chlamydia**
**nongonococcal urethritis/mucopurulent cervicitis**
**trichomonas vaginitis/urethritis**
**vulvovaginal candidiasis**
**HPV 16 and 18**
*also cervical ca*
33
what do you think when you see: **multiple painful vesicles on erythematous base lasting 7-10 days**
HSV
34
mc infectious etiology of genital ulcerations
hsv 1 and 2
35
mc cause of genital herpes/recurrent herpes
hsv 2
36
prodrome of HSV involves
tingling/burning 18-36 hr prior to lesions
37
primary (first presentation) of HSV lesions are associated w.
fever
bilateral LAD
38
recurrent HSV does not involve
fever
LAD
39
in terms of detecting HSV, the majority of infxns are \_\_
undiagnosed
40
in women, HSV symptoms often occur
during menstrual cycle
41
what is wrong w. serologic HSV testing
high rate of false positives
42
\_\_ is the gs dx testing for HSV
but it lacks \_\_
Tzank smear
sensitivity
43
preferred testing for HSV
culture and PCR
44
positive findings of Tzanc smear
presence of multinucleated giant cells
45
tx for first clinical episode of HSV
**acyclovir 400 mg tid**
OR
famciclovir 250 mg tid
OR
valacyclovir 1000 mg bid
**7-10 days for all agents**
46
pharm for HSV is most effective w.in __ hr of lesions
72
47
tx for episodic HSV
acyclovir
famciclovir
valacyclovir
*don't need to know dosing for this one*
48
tx for daily suppression of HSV
acyclovir 400 mg bid
famciclovir 250 mg bid
valacyclovir 500-1,000 mg qd
49
t/f: suppression tx for HSV reduces frequency of recurrence by 70-80%
t!
50
tx for first episode of HSV in pregnant pt
acyclovir
51
there is a high rate of transmission of HSV to neonate if HSV is transmitted to MOC
near delivery
52
t/f: pregnant pt can deliver vaginally if asymptomatic
t!
53
painless papule that ulcerates
chancre → syphilis
54
incidence of syphilis is high and increasing in what 3 pt populations
HIV
MSM
IVDU
55
what pathogen causes syphilis
treponema pallidum
56
active syphilis infxn is classified into (3)
primary
secondary
tertiary
57
primary presentation of syphilis
chancre/ulcer
58
describe early chancre
macule/papule → erodes
59
describe late chancre
clean based
painless
indurated
smooth, firm borders
60
t/f: syphilis chancre is generally asymptomatic
F! it is HIGHLY infectious
61
syphilis chancre usually resolves in
1-5 weeks
62
secondary presentation of syphilis (6)
whole body skin rash (including palms/soles)
LAD
mucous patches
condylomata lata
constitutional sx
neuro sx
63
flesh colored/hypopigmented macerated papules or plaques
condylomata lata
genitals/anus
64
which sx of secondary syphilis is highly contagious
condylomata lata
65
secondary syphilis usually resolves w.in
2-10 weeks
66
3 neuro sx associated w. secondary syphilis
AMS
stroke
meningitis
67
tertiary presentation of syphilis
gummatous lesions
cardiovascular syphilis
68
soft, tumor like growth of tissues
gumma
69
staging of syphilis
early latent
late latent
70
define early latent syphilis
reactive testing w.in 1 year of infxn
no sx
71
define late latent syphilis
reactive testing \> 1 year after onset of infxn
OR
timing can not be determined
no sx
72
gs dx test for syphilis
darkfield examination of exudate/tissue
73
2 types of serologic tests for syphilis
nontreponemal
treponemal
74
nontreponemal serologic tests for syphilis
RPR (rapid plasma reagin)
VDRL (veneral dz research lab test)
75
2 treponemal serologic tests for syphilis
fluorescent trepenemal ab **(FTA-AB)**
T-pallidum passive particle agglutination **(TP-PA)**
76
reactivity of non treponemal tests \_\_,
treponemal tests \_\_
fades over time
stay positive
77
for serologic testing for syphilis you need to do both \_\_
and __ tests
treponemal
nontreponemal
78
dx test for neurosyphilis
CSF
79
3 complications of neurosyphilis
eye dz
uveitis
optic neuritis
80
maternal rf for syphilis
multiple partners
drug use
transactional sex
late entry to prenatal care
no prenatal care
meth/heroin
incarceration
unstable housing/homeless
81
tx for primary, secondary, and early latent syphilis
**benzathine pen g 2.4 million doses IM x 1 dose**
6-12 mo f.u for repeat RPR tx
82
tx for primary, secondary, and early latent syphilis for pt w. PCN allergy
**doxycycline 100 mg bid x 14 days**
OR
ceftriaxone
83
tx for late latent syphilis
benzathine pen g 2.4 million units IM 1 dose weekly x 3 weeks
84
tx for tertiary syphilis
pen g 2.4 million units IM q week x 3 weeks (bicillin LA)
85
acute febrile rxn w. HA and myalgia that occurs w.in 24 hr of initiation of tx for **neurosyphilis**
jarisch-herxheimer rxn
86
jarisch-herxheimer rxn is associated w. __ syphilis
neurosyphilis
87
jarisch-herxheimer rxn is usually controlled w. \_\_
but can be life threatening
antipyretics
88
do you typically treat sex partner of syphilis positive pt
yes!
89
syphilis screening for pregnant pt
1st prenatal visit
AND
at 28 weeks before delivery if high risk
90
congenital syphilis is associated w. (4)
fetal demise
cleft palates
mental retardation
nerve damage → vision/hearing
91
t/f: congenital syphilis is rarely seen
f! → 291% increase from 2015-2019
92
what test should you order for newly diagnosed syphilis pt and vice versa
HIV
93
what do you think when you see: **painful ulcer + tender inguinal adenopathy**
chancroid
94
chancre is \_\_
and a chancroid is \_\_
painless
painful
*really, we couldn't think of a different name for one of these??*
95
what pathogen causes chancroid
haemophilus ducreyi
96
chancroids are difficult to test and must be cultured w.in \_\_
1 hour
97
culture for chancroid have \_\_% sensitivity
80
98
tx for chancroid
**azithromycin 1 gm orally**
OR
ceftriaxone
OR
cipro
99
2 other tx considerations for chancroid
re-exam 3-7 days after tx
LAD may need drainage
100
2 factors that reduce effectiveness of tx for chancroid
uncircumcised
HIV
101
what determines healing time for chancroid
size of the ulcer
102
tx for partner of pt w. chancroid
treat partner even if asymptomatic if contact was 10 or fewer days prior to onset
103
chancroids are a rf for __ transmission
HIV
104
2 other tx considerations for chancroid
re-exam 3-7 days after tx
LAD may need drainage
105
what abx for chancroid is contraindicated in pregnancy
cipro
106
what STI do you think of when you see lymphogranuloma venereum
chlamydia trachomatis
107
painless papule, vesicle or ulcer PLUS tender regional, unilateral LAD
lymphogranuloma venereum
108
what do you think when you see genital elephantiasis
chronic lymphogranuloma venereum in females
109
tx for lymphogranuloma venereum
**doxycycline 100 mg bid x 21 days**
OR
azithromycin 1 gm po q week x 3 weeks
110
painless papule that ulcerates, NO lymph node involvement
granuloma inguinale
111
granuloma inguinale is same-same
donovanosis
112
what pathogen is associated w. granuloma inguinale
klebsiella (calymmatobacterium) granulomatis
113
dx for granuloma inguinale (donovanosis)
wound exudate culture
114
what do you think when you see: donovan bodies (WBC inclusions)
wound exudate findings of granuloma inguinale/donovanosis
115
tx for granuloma inguinale (donovanosis)
**doxycycline 100 mg twice weekly x 3 weeks**
OR
azithromycin 1 gm once weekly x 3 weeks
116
minimum tx duration for granuloma inguinale
3 weeks
117
what are condyloma acuminatum
genital warts
118
what STI do you think of when you see condyloma acuminatum
HPV
119
t/f: h&p exam for genital ulcers is super accurate
f!
120
evaluation of genital ulcers:
syphilis: \_\_
HSV: \_\_
chancroid: \_\_
syphilis: serologic
HSV: culture/antigen
chancroid: haemophilus ducreyi culture
121
what other test may be useful in evaluation of genital ulcers
biopsy
122
moving on to STIs that cause “drips”/ discharge
gonorrhea
nongonococcal urethritis → chlamydia, mycoplasma genitalium
mucopurulent cervicitis
trichomonas vaginitis and urethritis
candidiasis
123
2nd mc reported STI yearly
gonorrhea
124
in males, gonorrhea is associated w. (2)
urethritis
dysuria
125
main presentation of gonorrhea in females
asymptomatic
126
if gonorrhea is symptomatic in females, what are the symptoms
vaginal discharte
dysuria
labial pain/swelling
abd pain
127
gs test for gonorrhea
gram stain → gram negative diplococci intracellular
128
preferred testing for gonorrhea
NAAT
129
what do you think when you see bartholian's abscess
gonorrhea
130
primary site of gonorrhea
**endocervical canal → gonorrhea cervicitis**
*also urethra*
131
sign of disseminated gonorrhea
skin lesions
132
tx for gonorrhea for pt's \< 150 lb
ceftriaxone 500 mg IM single dose
*alternate: gentamicin*
133
tx for gonorrhea for pt's \> 150 lb
ceftriaxone 1 gm
134
tx for disseminated gonorrhea
ceftriaxone 1 gm IM or IV q 24 hr x 7 days
135
mc pathogen associated w. nongonococcal urethritis
**c. trachomatis**
*also genital mycoplasmas*
136
2 sx associated w. nongonococcal urethritis
mild dysuria
mucoid d.c
137
gonorrhea has developed resistance to \_\_
and \_\_
penicillins
tetracyclines
138
dx for nongonococcal urethritis (3)
urethral smear
urine microscopic
139
diagnosis on urethral smear for nongonococcal urethritis is __ or more PMNs,
but PMNs are usually \> or higher
5
15
140
2 findings of microscopic eval of nongonococcal urethritis
PMNs 10 or higher
leukocyte esterase (+)
141
tx for nongonococcal urethritis
**doxycycline 100 mg bid x 7 days**
OR
azithromycin 1 gm in a single dose
142
mc reported STI in the US
chlamydia trachomatis
143
mc presentation of chlamydia
asymptomatic
144
sx of chlamydia if symptomatic (5)
cervicitis
urethritis
proctitis
lymphgranuloma venereum
PID
145
2 sx associated w. neonate chlamydia
conjunctivitis
PNA
146
dx for chlamydia (2)
urine NAAT
cervical/urethral swabs (NA probe)
147
what do you think when you see Gen-Probe Pace-2
dx test for chlamydia
148
tx for chlamydia
doxycycline 100 mg bid x 7 days
149
tx for chlamydia in pregnant pt
azithromycin 1 gm single dose
150
women \< __ yo should be screened for chlamydia
25
151
what women \> 25 yo should be screened for chlamydia
sexually active
risk factors
152
10-20% of women w. __ develop PID
gonorrhea
153
minimal dx criteria for PID
uterine adnexal tenderness
cervical motion tenderness
154
other diagnostic criteria for PID
oral temp \> 101
elevated ESR/CRP
cervical CT or GC
WBC/saline microscopy
cervical d.c
155
sx of PID
endocervical d.c
fever
lower abd pai
156
3 complications of PID
infertility
ectopic pregnancy
chronic pelvic pain
157
indications for hospitalization for PID (5)
pregnancy
failure of oral abx or antimicrobials
inability to follow oral regimen
severe illnes → n/v, high fever
tubo-ovarian abscess
158
inpatient tx for PID
ceftriaxone 1 gm IV q 24 hr
PLUS
doxycycline 100 mg po or IV q 12 hr
PLUS
metronidazole 500 mg po OR IV q 12 hr
159
oral (outpatient) tx for PID
ceftriaxone 250 mg IM in a single dose
PLUS
doxycycline 100 mg bid x 14 days
PLUS
metronidazole 500 mg bid x 14 days
160
tx for male sexual partner of PID pt
empiric abx w.in 60 days of onset of sz
161
epididymitis is chronic if it lasts \>
3 months
162
mc cause of epididymitis in sexually active men \< 35 yo (2)
gonorrhea
chlamydia
163
mc cause of epididymitis in men \> 35 yo
enteric organisms →
e.coli
164
cardinal sx of epididymitis
unilateral testicular pain
165
tx for epididymitis
ceftriaxone 500 mg IM x 1
PLUS
doxycycline 100 mg bid x 10 days
166
tx for epididymitis in men who practice insertive anal sex
ceftriaxone 500 mg IM x 1 dose
PLUS
levofloxacin 500 mg po x 10 days
167
tx for epididymitis if enteric organism is involved
levofloxacin 500 mg po q day x 10 days
168
prostatitis has the same etiology as
epididymitis
*2/2 to infxn*
169
is prostatitis part of the STI tx guidelines
no!
170
4 sx of prostatitis
dysuria
pain w. erection
f/v
low back pain
171
dx for prostatitis
UA culture
pre/post prostate exam
172
tx for prostatitis
same as epididymitis:
ceftriaxone PLUS doxy
but longer duration
173
mc cause of vaginal d.c worldwide
BV
174
what pt population is rarely affected by BV
not sexually active
175
what bacteria makes up 95% of vaginal flora
lactobacillus
176
known rf for bv (7)
new sex partner
douching
decrease in normal flora
absence of barrier methods
copper IUD
uncircumcised partner
WSE
177
BV is mc caused by
gardnerella vaginosis
178
\_\_ criteria is used for BV dx
amsel
179
amsel criteria
**at least 3 of the following:**
homogeneous, thin white d.c
wet prep → clue cells
positive whiff test → fishy odor
pH \> 4.5
180
\_\_ tests have higher sensitivity than amsel criteria
NAAT
181
why do we need to tx BV
risks for:
fetal complications
PID
postsurgical infxn
cervical ca
mucopurulent cervicitis
HIV/other STIs
182
tx for BV
metronidazole 500 mg bid x 7 days
OR
metronidazole gel 0.75%, 5 g intravaginally x 5 days
OR
clindamycin cream
183
should pregnant women be treated for BV
yes!
184
tx for BV in pregnant pt
metronidazole 500 mg po bid x 7 days
*same as for non pregnant*
185
is it recommended to tx partner of pt w. BV
no!
186
only infxn so far w. no rec to tx partner
BV
187
vulvovaginal candidiasis is mc caused by
candida albicans
188
d.c associated w. vulvovaginal candidiasis
white
curdy
189
what do you think when you see: pruritis, vaginal soreness, dyspareunia, external dysuria, and white curdy d.c
vulvovaginal candidiasis (VVC)
190
dx for vulvovaginal candidiasis
clinical
KOH
culture
191
is PCR testing used for vulvovaginal candidiasis
no! → not FDA approved
192
4 indications of uncomplicated VVC
sporadic/infrequent
mild-moderate sx
c albicans
nonimmune compromised
193
4 indications of complicated VVC
recurrent
severe sx
non c albicans
DM/immunocompromised
194
recurrent VVC is defined as
3 or more episodes \< 1 year
195
what agents can be used to tx VVC
- azoles
* this will be my sacrificial lamb if she expects us to memorize all of these*
196
what dx test is useful to confirm dx and identify unusual species (non c. albicans) for recurrent VVC
vaginal culture
197
initial tx for recurrent VVC:
maintenance tx for VVC:
initial: topical azole OR fluconazole 150 mg x 7-14 days
maintenance: -zoles
198
tx for non-albicans (complicated)
longer duration of non -azole agent
199
are there recommendations to tx partner of VVC pt
no!
200
what VVC tx is recommended in pregnancy
only topical intravaginal x 7 days
201
what do you think when you see, diffuse, malodorous yellow to green d.c
trichomonas vaginalis
202
\_\_ infxn is associated w. 1.5 x risk of HIV
and increased risk for PID
trichomonas vaginalis
203
\_\_ is the gs dx for trichomonas vaginalis,
but __ is more sensitive
wet prep
NAAT
204
what do you think when you see strawberry cervix
trichomoniasis
205
tx for trichomoniasis
women:
men:
women: metronidazole 500 po bid x days
men: metronidazole 2 gm orally in a single dose
206
recs for partner of trichomoniasis pt
partner should be treated
no sexy time until tx is done
207
oncogenic strains of hpv
16
18
208
nononcogenic hpv strains
6
11
209
nononcogenic hpv (6, 11) are associated w.
warts
*condyloma acuminata*
210
HPV infxn is detected in 99% of __ cancers
and is also causally associated w.
cervical
other anogenital ca (anal, penile, vulvar, vaginal)
211
lab markers for HPV
trick question dummy!
there are none
*jk, we aren't dummies*
212
3 possible tx for HPV/warts
podofilox 0.5% solution or gel
OR
imiquimod 5% cream
OR
sinecatechins 15% ointment
213
what strains of hpv cause respiratory papillomavirus in infants.children
6
11
214
what agents are contraindicated for hpv in pregnancy
imiquimod
pdophylllin
podoflox
sinecatechins
215
HPV vaccine is recommended for m and f aged \_\_,
and is FDA approved up to age \_\_
9-26
45
216
t/f: both gardasil quadravalent and gardasil 9 cover HPV 16 and 18
T!
217
what do you think when you see: intense itching, contagious, mite
scabies
218
what parasite is associated w. scabies
sarcoptes scabiei
219
tx for scabies
permethrin 5% cream to all areas of the body
OR
ivermectin 200 ug/kg po → repeat in 2 weeks
220
what is persistent scabies
rash and pruritis \> 2 weeks
221
in persistent scabies, you should check the __ of the pt,
tx close contacts \_\_,
and instruct the pt to \_\_
fingernails
empirically
wash all linens, bedding, clothing
222
crusted scabies is same-same
norweigan scabies
223
what pt pop is usually affected by crusted scabies
immunodeficient
debilitated
malnourished
organ transplant
hematologic malignancies
224
t/f: crusted scabies is more contagious than regular scabies
T!
225
tx for crusted scabies
combo:
topical scabicide PLUS ivermectin
OR
repeated tx w. ivermectin
226
pruritis or lice/nits on pubic hair
pediculosis pubis
227
tx for pediculosis pubis
permethrin 1%
pyrethrin w. piperonyl butoxide
applied to affected are and washed off after 10 min
228
tx for partner of pt w. pediculosis pubis
tx sex partners w.in the last month
229
vaccine preventable STDs
hep A
hep B
HPV
230
high risk population for hep A
MSM
IVDU
chronic liver dz
hep B/C infxn
231
high risk pops for hep B
hx of STI
multiple sex partners
MSM
IVDU
household member/sex contact of Hep B person
hemodialysis
occupational exposure
232
what 2 HPV vaccines are available
quadrivalent
Gardasil 9
233
what are the oncogenic/wart associated strains of HPV
6
11
234
mc bloodborne infxn
hep C
235
is hep C commonly sexually transmitted
no
236
hep C pt is commonly co-infected w.
HIV
237
is a hep C vaccine available
no!
238
what STIs are associated w. assault/abuse
GC
CT
trichomonas
candida/BV
HIV
HBV
syphilis
239
recommended empiric tx regimen for adolescent and adult female sexual assault survivors
ceftriaxone 500 mg IM single dose
PLUS
doxycycline 100 mg po bid x 7 days
metronidazole 500 mg po bid x 7 days
240
recommended empiric regimen for adolescent and adult male sexual assault survivors
ceftriaxone 500 mg IM in a single dose
PLUS
doxycycline 100 mg po bid x 7 days
*same as for female minus metronidazole*
241
tx for post HIV exposure prophylaxis
HIV PEP
case by case basis
referral to specialty care
242
HIV PEP is only recommended w.in \< __ hours of substantial exposure risk
\< 72 hr
243
is HIV PEP recommended for negligible exposure risk
no!
