Sexual Health Flashcards
Ectopic Pregnancy
Implantation of fertilized ovum in tissue other than endometrium
Most commonly occurs in the fallopian tube -96%
Life-threatening complication is tubal rupture
Causes: Ectopic Pregnancy
-PID, STIs, Endometriosis,
-Prior tubal or uterine surgery
-Use of IUD,
-Ovulation inducing drugs (infertility treatment)
-Prior ectopic pregnancy,
-Cigarette smoking
Subjective Findings of Ectopic Pregnancy
6-8 weeks following LNMP
Normal pregnancy s/s plus
*Classic symptoms:
Abdominal pain
Amenorrhea
Vaginal bleeding
*50% of women are asymptomatic prior to tubal rupture
Fait, vertigo, dizziness
Shoulder strap pain
Ectopic Pregnancy on US
Positive Morrison’s pouch/splenorenal/pelvic view on bedside US exam
Ectopic Pregnancy: Treatment
-Surgical: Salpingostomy vs. Salpingectomy
-Medication: Methotrexate therapy
Pelvic Inflammatory Disease
-Acute infection/inflammation of upper genital tract structures in women
-Causes: Normal vaginal flora, trauma, surgery (N. gonorrhoeae and Chlamydia)
PID Early Subjective Findings
-Lower abdominal pain is cardinal presenting symptoms (pain is usually bilateral)
-Pain that worsens with intercourse or with jarring movement
-Onset of pain during or shortly after menses
-Menstrual cramping
-Malaise
Late Findings
-Severe pain
-Temperature
-Profuse foul and purulent vaginal discharge
PID exam
-Chandelier’s Disease: uterine and cervical motion tenderness; marked tenderness of cervix, uterus, and adnexa
-Diffuse tenderness
-Friable cervix
-Rebound tenderness
-Purulent cervical discharge/bleeding
PID Diagnoses
-Uterine/adnexal tenderness
-Cervical motion tenderness
PID Treatment Inpatient
-Ceftriaxone 1 g Q24 h IV OR
-2nd generation cephalosporin (cefotetan, cefoxitin)
Cefotetan 2 gms IV every 12 or Cefoxitin 2 gms IV every 6 hrs.
-Plus doxycycline IV
100mg every 12 hours
-Plus Metronidazole 500mg IV q 8 hrs.
-Convert to oral after at least 24-48 hours of significant clinical improvement – treat for 14 days
PID Treatment Outpatient
-Outpatient tx
-One IM dose of 500 mg ceftriaxone
-Plus doxycycline 100mg BID po for 14 days
-Plus metronidazole 500mg BID for 14 days
-Close follow up at 72 hours
-All women who receive a diagnosis of PID should be tested for gonorrhea, chlamydia, HIV, and syphilis
Chlamydia Trachmoatis
-Most common bacterial cause of STIs
-Majority of those affected are asymptomatic
-Complications include:
Women: PID, infertility, pelvic absecesses, ectopic pregnancy, endometritis
Men: epidiymitis, Retier’s synd,
Newborn: conjunctivitis, pneumonia
Chlyamydia Subjective/PE findings
-Women
Asymptomatic, spotting, bleeding, abdominal pain, dysuria, dyspareunia, cervical discharge
-Men
Asymptomatic, dysuria, cloudy discharge, unilateral testicular pain/swelling
Chlymadia Dx
-Nucleic acid amplification testing (NAAT) is test of choice
-Vaginal swabs for women and urine for men
Chlymadia Tx
-First line
Doxycycline 1000mg po BID x 7 days
Pregnancy-erythromycin or amoxicillin
Alternative-azithromycin 1 gm or Levofloxacin 500 mg daily for 7 days.
Gonorrhea
-Gram negative Neisseria gonorrhea
-Incubation period 3-7 days average
-M2F transmission is 80-90%
-Complications: PID, infertility, ectopic pregnancy, epididymitis, Most common cause of infected septic joint
Gonorrhea Subjective/PE Findigns
-Women
Often asymptomatic, mucopurulent discharge, labial swelling, pain, abdominal discomfort, pharyngitis
-Men
Usually asymptomatic, dysuria, yellow-greenish, profuse discharge, pharyngitis, epididymitis, lower abdominal pain
Gonorrhea Dx
Gram stain and culture on Thayer-Martin medium
Nucleic acid methods
Gonorrhea Tx/Management
-Ceftriaxone 500mg IM once <150 kg
>150 kg Ceftriaxone 1 gm IM
-Doxycycline/Azithromycin for treatment of concurrent chlamydia
Syphilis
-Caused by Treponema pallidum
-Can present in different phases: Primary, Secondary, Latent, Tertiary (Late)
Diagnostics of Syphilis
-VDRL – non-specific
-RPR – non-specific
**FTA-ABS – specific (identifies antibodies against the spirochete)
Treatment of Syphilis: Early Late
-Early Late: PCN G 2.4 million units IM x 1; or Doxycycline 100mg po BID x 14d
-Late, Cardiovascular, Gumma: PCN G 2.4mil units IM weekly for 3 weeks; Doxycycline 100 mg oral twice daily for four weeks
Tx of Syphilis: Tertiary
-Tertiary Syphilis with normal CSF Examination:Benzathine penicillin G7.2 million units total, administered as 3 dosesof 2.4 million units IM each at 1-week intervals
-PCN G 3 to 4 million units IV every four hours or 24 million units continuous IV infusion for 10 to 14 days OR
-PCN G procaine 2.4 million units IM daily PLUS probenecid 500 mg four times daily oral, both for 10 to 14 days OR
-Ceftriaxone 2 g IV once daily for 10 to 14 days (23% failure rate)
Mycoplasma Genitalium
-Men
Causes 15-25% of non gonococcal urethritis and up to 40% of recurrent NGU.
-Women
Causes cervicitis, PID, preterm labor, spontaneous abortion and infertility (2 fold increase).
Often asymptomatic
Mycoplasma Genitalium Tx
-Macrolide resistance extremely high
-2-stage treatment recommended
-If Macrolide sensitive: Doxy 100 mg PO BID x7 days, followed by Azithro 1 g PO x1, 500 mg PO qd x 3 days (2.5gtotal)
-Macrolide resistant: Doxy 100 mg po BID x7 days, followed by moxifloxacin 400 mg qd x7 days
condylomata acuminata(Genital Warts)
-Caused by human papilloma virus (HPV)-HPV types 6 and 11
-Most common viral STI in the United States
-More common in women and MSM
-Complications: increase anogenital cancers, HPV types 16 & 18 cause 70% of cervical cancers
condylomata acuminata(Genital Warts) Treatment
-Patient applied: Imiquimod, Podophyllotoxin, Sinecatechins
-Clinician applied: Cryotherapy, electrosurgery, trichloracetic acid, laser therapy, surgical excision
-Women-similar tx’s however depends on where the lesions are located-
condylomata acuminata(Genital Warts) Prevention
*Quadrivalent vaccine (Gardasil) includes HPV types 6, 11, 16, and 18,
Bivalent vaccine (Cervarix) includes HPV types 16 and 18
*Recommended in boys and girls from 9-12 years and for men who have sex with men up to 26 years of age.
Vaginitis
-Characterized by vaginal discharge, vulvular itching, vaginal odor
-Bacterial vaginosis
-Vulvovaginal candidiasis
-Trichomoniasis
Bacterial Vaginosis
-Change in normal (lactobacillus) vaginal flora
-PH changes from normal of 4.0 to alkaline
-Causative agents: gardnerella, bacteroide species, mycoplasma hominis, among others (anerobes)
-Risk factors
Sexual activity
High fat diets
Smoking
Douching
BV Consequences and Dx
-Pregnant women at risk for preterm delivery
-Increase risk of HIV, STI and precancerous cervical lesions
-Diagnosis
Amsels Criteria (3 out of 4) – gray white thin discharge, vaginal PH >4.5, positive whiff test, clue cells on wet prep.
BV Tx
-Metronidazole 500mg BID 7 days (vaginal gel)
Caution in first trimester of pregnancy
-Tinidazole 2 gms QD for 2 days
-Clindamycin 300 BID for 7 days (vaginal troche or cream)
Vulvovaginal Candidiasis
-Discharge – white, thick and clumpy “cottage cheese” appearance
-Erythema and inflammation of vaginal vault
Dx of Candidiasis
-10% KOH wet prep shows psuedohypha or budding yeast
-Tx: Fluconazole 150mg tablet once
-Over the counter intravaginal agents (azoles) per packaging
Trichomonas
-Protozoan infection caused by trichomonas vaginalis
-Most common non viral STI transmitted world wide
Trichomonas Symptoms
-Symptoms
Frothy gray, green, yellow malodorous discharge
Cervical petechiae – Strawberry cervix
Men – usually asymptomatic or sx of urethritis
Trichomonas Dx & Tx
-Wet prep-Motile trichomonade, Nucleic acid amplification test (more sensitive)
-Metronidazole 2gms po x 1 or 500mg po BID x 7 days (pregnant patients)
-Tinidazole 2 gms po x 1
Herpes Simplex Virus (HSV) -symptoms
-Severe and painful genital vesicular lesions
-Dysuria
-Localized
-lymphadenopathy
-Fever
-Headache
HSV-1-Around mouth-Kanker sores
HSV-2-genital warts
HSV Tx-primary infection
Acyclovir 400 mg TID
Famciclovir 250 mg TID
Valacyclovir 1000 mg BID
Treat for 7-10 days
HSV Tx-Episodic
Acyclovir 800 mg TID for 2 days
Famciclovir 1000 mg BID for 1 day
Valacyclovir 500 mg BID for 3 days
