Sexually transmitted disease Flashcards
what is herpes
sexually transmitted disease (STD) caused by the herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2).
How is HS2 virus spread
\HSV-2 infection are spread during genital contact with someone who has a genital HSV-2 infection.
How is HS1 spread?
By receiving oral sex who have HS1
Symptoms of Genital herpes?
s one or more vesicles, or small blisters presents in genitals, rectum or mouth
Herpes- what happen when vesicles break.
painful ulcers occurs
that may take two to four weeks to heal after the initial herpes infection.
Herpes- How bad is the first outbreak as compared to the recurrent outbreak?
. The first outbreak of herpes is often associated with a longer duration of herpetic lesions, increased viral shedding (making HSV transmission more likely) and systemic symptoms including fever, body aches, swollen lymph nodes, or headache.
Recurrent outbreaks of genital herpes are common, and many patients who recognize recurrences have prodromal symptoms, either localized genital pain, or tingling or shooting pains in the legs, hips or buttocks, which occur hours to days before the eruption of herpetic lesions.
HERPES- recurrent outbreak or first outbreak is shorter?
Symptoms of recurrent outbreaks are typically shorter in duration and less severe than the first outbreak of genital herpes.
Herpes and pregnancy? C section or normal delivery?
If herpes symptoms are present a cesarean delivery is recommended to prevent HSV transmission to the infant
Can you give anti viral during third trimester of pregnancy
NO
Name of the diagnostic test for herpes?
HSV nucleic acid amplification tests (NAAT)
Treatment of herpes
There is no cure for herpes.
Antiviral medications can, however, prevent or shorten outbreaks during the period of time the person takes the medication.11
No vaccine
There is currently no commercially available vaccine that is protective against genital herpes infection. Candidate vaccines are in clinical trials.
How antiviral work for herpes?
It reduces the likelihood of transmission to partners
Can a person with herpes who don’t have symptoms transfer it?
Even if a person does not have any symptoms, he or she can still infect sex partners.
Name of medication for herpes?
Daily treatment with valacyclovir decreases the rate of HSV-2 transmission in discordant, heterosexual couples in which the source partner has a history of genital HSV-2 infection
vulvovaginal candiasis causative agent?
candida albicans
How can you diagnose candida?
Saline 10% KOH of vaginal discharge demonstrates budding yeasts, hyphae, or pseudohyphae
Culture shows positive result for a yeast species
Ph less than 4.5
Symptoms of vulvovaginal candiasis?
Typical symptoms of VVC include pruritus, vaginal soreness, dyspareunia, external dysuria, and abnormal vaginal discharge,(thick curdy vaginal discharge)
Do you start treatment for candida who have absent symptoms of candida and have positive culture for candida?
Identifying Candida by culture in the absence of symptoms or signs is not an indication for treatment because approximately 10%–20% of women harbor Candida species and other yeasts in the vagina. T
Treatment of uncomplicated Candida
Short-course topical formulations (i.e., single dose and regimens of 1–3 days) effectively treat uncomplicated VVC.
Treatment with azoles results in relief of symptoms and negative cultures in 80%–90% of patients who complete therapy
Name of the medication for the treatment of Candida?
Clotrimazole 1% cream 5 g intravaginally daily for 7–14 days or Clotrimazole 2% cream 5 g intravaginally daily for 3 days or Miconazole 2% cream 5 g intravaginally daily for 7 days or Miconazole 4% cream 5 g intravaginally daily for 3 days or Miconazole 100 mg vaginal suppository one suppository daily for 7 days or Miconazole 200 mg vaginal suppository one suppository for 3 days or Miconazole 1,200 mg vaginal suppository one suppository for 1 day or Tioconazole 6.5% ointment 5 g intravaginally in a single application Prescription Intravaginal Agents Butoconazole 2% cream (single-dose bioadhesive product) 5 g intravaginally in a single application or Terconazole 0.4% cream 5 g intravaginally daily for 7 days or Terconazole 0.8% cream 5 g intravaginally daily for 3 days or Terconazole 80 mg vaginal suppository one suppository daily for 3 days Oral Agent Fluconazole 150 mg orally in a single do
CANDIDA: Do you need to treat sex partner?
No. Sometimes, it is not sexually transmitted
What are the symtptoms of oral ozoles?
nausea, abdominal pain, and headache
Treatment of complicated Candida?
oral or topical azole therapy.
Initial dose: longer duration of initial therapy is needed. (e.g., 7–14 days of topical therapy or a 100-mg, 150-mg, or 200-mg oral dose of fluconazole every third day for a total of 3 doses [days 1, 4, and 7]) is recommended, to attempt mycologic remission, before initiating a maintenance antifungal regimen.
Maintainance dose: Oral fluconazole (i.e., a 100-mg, 150-mg, or 200-mg dose) weekly for 6 months is the indicated maintenance regimen. If this regimen is not feasible, topical treatments used intermittently can also be considered.
What is the second most commonly reported Bacterial communicable disease?
gonorrhea is the second most commonly reported bacterial communicable disease.
Who needs annual gonorhea examination?
Annual screening for N. gonorrhoeae infection is recommended for all sexually active women aged <25 year
and for older women at increased risk for infection (e.g., those aged ≥25 years who have a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has an STI
Risk factors for getting gonorhea?
Additional risk factors for gonorrhea include inconsistent condom use among persons who are not in mutually monogamous relationships, previous or coexisting STIs, and exchanging sex for money or drugs. substance abuse
What are the microorganism that is transmitted with sexual contact
- Caused by microorganisms transmitted during sexual contact:
- Viruses
- Bacteria
- Protozoa
Ectoparasites (e.g., lice)
what is chancroid?
What are the criteria to diagnose Chanroid?
Inguinal lymphadenitis typically occurs in <50% of cases.
All of the following four criteria are met:
1) the patient has one or more painful genital ulcers;
2) regional lymphadenopathy are typical for chancroid;
3) the patient has no evidence of T. pallidum infection by darkfield examination or NAAT (i.e., ulcer exudate or serous fluid) or by serologic tests for syphilis performed at least 7–14 days after onset of ulcers; and
4) HSV-1 or HSV-2 NAAT or HSV culture performed on the ulcer exudate or fluid are negative
Causative agent for chancroid?
•Haemophilus ducreyi bacterium
Treatment of Chancroid?
Azithromycin and ceftriaxone offer the advantage of single-dose therapy
Special management with Chancroid?
Men who are uncircumcised and persons with HIV infection do not respond well to tretament.
Patients should be tested for HIV at the time chancroid is diagnosed.
If the initial HIV test results were negative, the provider can consider the benefits of offering more frequent testing and HIV PrEP to persons at increased risk for HIV infection
Chlamydial infection
Chlamydia infection causes
PID, ectopic pregnancy, and infertility.
Is chlamydia a annual examination?
Annual screening of C trachomitis for all sexually active women aged <25 years is recommended, as is screening of older women at increased risk for infection (e.g., women aged ≥25 years who have a new sex partner, more than one sex partner, a sex partner with concurrent partners,
Do you need to test men for chlamydia?
Chlamydia screening for men should be considered only when resources permit, prevalence is high, and such screening does not hinder chlamydia screening efforts for women
What is the most sensitive test for C trachomitis?
. NAATs are the most sensitive tests for these specimens and are the recommended test for detecting C. trachomatis infection
What are the other ways, C. Trachomitis be diagnosed, with using NAAT?
For, women, C. trachomatis urogenital infection can be diagnosed by vaginal or cervical swabs or first-void urine. For men, C. trachomatis urethral infection can be diagnosed by testing first-void urine or a urethral swab. N
Recommended regimen for Chlamydia?
Recommended Regimen for Chlamydial Infection
Adolescents and Adults Doxycycline 100 mg orally 2 times/day for 7 days
Alternative Regimens Azithromycin 1 g orally in a single dose or Levofloxacin 500 mg orally once daily for 7 day
Other management for Chlamydia?
To minimize disease transmission to sex partners, persons treated for chlamydia should be instructed to abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a 7-day regimen and resolution of symptoms if present.
To minimize risk for reinfection, patients also should be instructed to abstain from sexual intercourse until all of their sex partners have been treated.
Persons who receive a diagnosis of chlamydia should be tested for HIV, gonorrhea, and syphilis.
MSM who are HIV negative with a rectal chlamydia diagnosis should be offered HIV PrEP.
Follow up Chlamydia?
Men and women who have been treated for chlamydia should be retested approximately 3 months after treatment, regardless of whether they believe their sex partners were treated; scheduling the follow-up visit at the time of treatment is encouraged
If retesting at 3 months is not possible, clinicians should retest whenever persons next seek medical care <12 months after initial treatment
Anogenital wart is caused by?
nononcogenic HPV types 6 or 11
HPV type 6 and 11 is associated with …………………..
HPV types 6 and 11 have been associated with conjunctival, nasal, oral, and laryngeal warts.
Where do you have anogenital warts?
- Anogenital warts occur commonly at certain anatomic sites, including around the vaginal introitus, under the foreskin of the uncircumcised penis, and on the shaft of the circumcised penis.
- Warts can also occur at multiple sites in the anogenital epithelium or within the anogenital tract (e.g., cervix, vagina, urethra, perineum, perianal skin, anus, or scrotum).
- Intra-anal warts are observed predominantly in persons who have had receptive anal intercourse; however, they also can occur among men and women who have not had a history of anal sexual contact
how does anogenital warts appear
They are usually flat, papular, or pedunculated growths on the genital mucosa.
Prevention of Anogenital wart
Use HPV vaccination
How do you diagnose anogenital wart?
- Diagnosis of anogenital warts is usually made by visual inspection but can be confirmed by biopsy, which is indicated if lesions are atypical (e.g., pigmented, indurated, affixed to underlying tissue, bleeding, or ulcerated lesions).
- Biopsy might also be indicated in the following circumstances, particularly if the patient is immunocompromised (including those with HIV infection): the diagnosis is uncertain, the lesions do not respond to standard therapy, or the disease worsens during therapy.
Recommended Regimens for Urethral Meatus Warts/cervical warts and intraanal warts?
Cryotherapy with liquid nitrogen or Surgical removal
Recommended Regimens for Vaginal Warts
Cryotherapy with liquid nitrogen
The use of a cryoprobe in the vagina is not recommended because of the risk for vaginal perforation and fistula formation. or Surgical removal or Trichlorace
Diagnostic consideration of gonorhea?
Culture, NAAT, and POC NAAT, such as GeneXpert (Cepheid), are available for detecting genitourinary infection with N. gonorrhoeae (149); culture requires endocervical (women) or urethral (men) swab specimens. Culture is also available for detecting rectal, oropharyngeal, and conjunctival gonococcal infection.
Recommended Regimen for Uncomplicated Gonococcal Infection of the Cervix, Urethra, or Rectum Among Adults and Adolescents
Ceftriaxone 500 mg* IM in a single dose for persons weighing <150 kg
If chlamydial infection has not been excluded, treat for chlamydia with doxycycline 100 mg orally 2 times/day for 7 days.
* For persons weighing ≥150 kg, 1 g ceftriaxone should be administered.
Recommended Regimen for Uncomplicated Gonococcal Infection of the Pharynx Among Adolescents and Adults
Ceftriaxone 500 mg* IM in a single dose for persons weighing <150 kg
* For persons weighing ≥150 kg, 1 g ceftriaxone should be administered.
Alternative Regimens if Ceftriaxone Is Not Available to treat gonorhea?
Gentamicin 240 mg IM in a single dose plus Azithromycin 2 g orally in a single dose or
Cefixime* 800 mg orally in a single dose * If chlamydial infection has not been excluded, providers should treat fo
Do other sex partner be treated for gonorhea?
To minimize disease transmission, persons treated for gonorrhea should be instructed to abstain from sexual activity for 7 days after treatment and until all sex partners are treated (7 days after receiving treatment and resolution of symptoms, if present)
What are other test should be done who have gonorhea?
All persons who receive a diagnosis of gonorrhea should be tested for other STIs, including chlamydia, syphilis, and HIV. Those persons whose HIV test results are negative should be offered HIV PrEP
Follow up for patient who were treated with uncomplicated gonorhea in the pharynx
Any person with pharyngeal gonorrhea should return 7–14 days after initial treatment for a test of cure by using either culture or NAAT; however, testing at 7 days might result in an increased likelihood of false-positive tests
Follow up for patient who have gonorhea?
Men or women who have been treated for gonorrhea should be retested 3 months after treatment regardless of whether they believe their sex partners were treated; scheduling the follow-up visit at the time of treatment is encouraged.
If retesting at 3 months is not possible, clinicians should retest whenever persons next seek medical care <12 months after initial treatment
What is granuloma inguinale? What causes it?
Granuloma inguinale (donovanosis) is a genital ulcerative disease caused by the intracellular gram-negative bacterium Klebsiella granulomatis (formerly known as Calymmatobacterium granulomatis)
Symptoms of granuloma inguinale?
the disease is characterized as painless, slowly progressive ulcerative lesions on the genitals or perineum without regional lymphadenopathy; subcutaneous granulomas (pseudobuboes) also might occur
How is the lesion in granuloma inguinale
The lesions are highly vascular (i.e., beefy red appearance) and can bleed.
Labrotary work up for granuloma inguinale
K. granulomatis DNA exist, molecular assays might be useful for identifying the causative agent.
-giemasa-stained smear of ulcer
Recommended Regimen for Granuloma Inguinale (Donovanosis
Azithromycin 1 g orally once/week or 500 mg daily for >3 weeks and until all lesions have completely healed
Alternative Regimens for granuloma inguinale
Doxycycline 100 mg orally 2 times/day for at least 3 weeks and until all lesions have completely healed or Erythromycin base 500 mg orally 4 times/day for >3 weeks and until all lesions have completely healed or Trimethoprim-sulfamethoxazole one double-strength (160 mg/800 mg) tablet orally 2 time/day for >3 weeks and until all lesions have completely healed
How Hepatisi A is transferred?
HAV infection is primarily transmitted by the fecal-oral route, by either person-to-person contact or through consumption of contaminated food or water
Labs for Hep A?
serologic testing
hepatitis A vaccination
what are the types of syphilis?
Primary
Secondary
what are the difference between vaginolosis, candiasis, and trichomoniasis
Define molluscum contagiosum lesion appear
small, raised, and usually white, pink, or flesh-colored with a dimple or pit in the center. They often have a pearly appearance. They’re usually smooth and firm. In most people, the lesions range from about the size of a pinhead to as large as a pencil eraser (2 to 5 millimeters in diameter). They may become itchy, sore, red, and/or swollen.
