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Woman's Health > Sexually Transmitted Infections > Flashcards

Sexually Transmitted Infections Flashcards

1
Q

1 cause of vaginal discharge

A

bacterial vaginosis

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2
Q

Bacterial Vaginosis Pathophysiology

A

not fully understood:
vaginal dysbiosis - overgrowth of gardnerella, haemophilus and other anaerobic bacteria
??Altered vaginal pH

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3
Q

Risk factors for BV

A

multiple male/female partners, new partner, not using condoms, douching, menses, copper IUD, >1 partner

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4
Q

BV Presentation

A

most patients are asymptomatic
some pts come reporting more vaginal discharge - may be more grayish and usually has odor
milky with a fish odor after addition of KOH prep or unprotected intercourse
non irritating - no vaginal irritation

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5
Q

Bacterial Vaginosis Amsel’s Criteria

A

requires 3 out of 4
homogenous vaginal d/c
fishy (amine) odor w/ KOH prep (+whiff test)
Clue cells on microscopy
Vaginal pH > 4.5

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6
Q

BV treatment

A

First line - metronidazole PO 7 days
metronidazole intravaginal gel
clindamycin intravaginal gel

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7
Q

What should you warn pts about when being treated for BV

A

metronidazole may cause n/v with ETOH
should refrain from intercourse or use condoms regularly during treatment
clindamycin preps may weaken condoms or diaphragms

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8
Q

Risk of untreated BV

A

because of the friability of the epithelium:
increased risk for STIs including HIV
increased risk of pre-term delivery
risk of candidiasis infection after treatment

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9
Q

Gonorrhea is a common co-infection with

A

Chlamydia

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10
Q

Gonorrhea increases risk for

A

HIV infection

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11
Q

Gonorrhea presentation

A

often asymptomatic
wide range of presenting sx - dysuria, purulent d/c (white, green, yellow)
increased vaginal discharge
friable cervix
vaginal bleeding
scrotal pain (epididymitis)
possible extra-genital infections (conjunctivitis, arthritis, disseminated)

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12
Q

Gonorrhea diagnosis

A

Nucleic acid amplification test (NAAT) - urine or swab

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13
Q

Treatment of Gonorrhea

A

Ceftriaxone IM single dose plus azithromycin or doxycycline (azithro/doxy for likely co-infection with Chlamydia)
no intercourse for 7 days
Treat partners
re-test at 3 months after treatment

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14
Q

Gonorrhea complications

A

PID –> intertility, abscess, chronic pain, ectopic preg
Epididymitis –> infertility
Mom-to-baby transmission –> blindness, joint infection, sepsis

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15
Q

Chlamydia is an infection of

A

chlamydia trachomatis - intracellular gram negative bacterium

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16
Q

Chlamydia presentation

A

primarily asymptomatic
presentation similar to gonorrhea - dysuria, pyuria, increased urinary frequency, mucopurulent d/c, mucoid, watery d/c, friable cervix, vaginal bleeding, scrotal pain, scrotal tenderness, edema

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17
Q

Chlamydia dx

A

Nucleic acid amplification test (NAAT) - urine or swab

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18
Q

Chlamydia treatment

A

doxycycline for 7 days
consider addition of ceftriaxone IM single dose to cover gonorrhea
no intercourse for 7 days
treat partners
re-test at 3 months after treatment

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19
Q

Trichomonas Vaginitis is the most prevalent

A

non-bacterial STI (flagellate protozoan)

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20
Q

Trich risk factors

A

Incarceration
2 plus partners in one year
less than HS education
poverty
BV
douching

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21
Q

Trich can be prevented with

A

condom use

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22
Q

Trich presentation

A

many pts asymptomatic
females –> frothy yellow greenish vaginal discharge, +/- vaginal irritation, +/- burning with urination, pH > 5.0, strawberry cervix - small red dots on cervix, punctate hemorrhages
males –> urethritis, epididymitis, prostatitis

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23
Q

Trich dx

A

microscopy/ wet mount (POC) - must do immediately after sampling, will have increased number of PMNs and motile flagellates
nucleic acid type testing
culture - most sensitive and specific –> do if wet mount is inconclusive but high suspicion

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24
Q

Trich treatment

A

first line- metronidazole
females - 7 days
males - one day
tinidazole is alternative
NO GELS - don’t reach therapeutic concentrations
non-reportable disease
treat partners
no intercourse until treatment completed and infection cleared

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25
Q

Candidiasis aka vulvovaginal candidiasis primary cause is

A

candida albicans

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26
Q

Candidiasis aka vulvovaginal candidiasis risk factors

A

DM
obesity
HIV+
preg
antibiotic use
steroid use
OCP use
debilitation
moist vaginal environment

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27
Q

Candidiasis can be _____ or ______

A

uncomplicated or complicated

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28
Q

Candidiasis presentation

A

usually people report vaginal pain, itching, burning, vaginal d/c thick, curdy, cheesy

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29
Q

Candidiasis dx

A

presence of budding yeast and hyphae on KOH wet mount
if negative or complicated –> Culture (gold standard)
vaginal pH < 4.5
Some patients - empirically treat

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30
Q

Candidiasis treatment

A

OTCs - clotrimazole cream, miconazole cream, miconazole suppository
RX - Butoconazole cream, terconazole cream/ supp, PO fluconazole x one day
if complicated - longer regimen and/or add 3 doses of PO fluconazole (immunocompromised pts)

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31
Q

Syphilis is caused by

A

Treponema pallidum (spirochete)
can cause infection of virtually any tissue/organ

32
Q

Syphilis has 3 categories

A

primary syphilis
secondary syphilis
tertiary syphilis

33
Q

Primary syphilis presentation

A

single painless ulcer (chancre)
Nontender, nonpurulent, indurated
3-4 weeks after infection

34
Q

Secondary Syphilis presentation

A

Skin rash, mucocutaneous lesions, lymphadenopathy

35
Q

Both primary and secondary lesions are

A

self limiting and infectious

36
Q

Syphilis dx

A

early syphilis - dark microscopy or molecular testing - ID spirochetes on dark microscopy of lesional tissue or exudates

37
Q

pts dx with syphilis should also be tested for

A

HIV

38
Q

Syphilis screening

A

MSM every 6-12 months
high risk every 3 months
preg women - first prenatal visit, 3rd trimester, at delivery
anyone treated for another STI

39
Q

Syphilis treatment

A

parenteral penicillin G first line for all stages
doxycycline second line
no intercourse 7-10 days
reportable disease
ID and treat contacts within the last 3 months

40
Q

Jarisch-Herxheimer reaction is when

A

you treat Syphilis and there is a lysis of spirochetes which releases endotoxin
starts within hours of treatment

41
Q

Chancroid is a (what kind of infection)

A

rare STI

42
Q

Presentation of Chancroid

A

Ulcerations - painful, soft, irregular borders, friable, necrotic base with yellow gray exudates
+/- fever malaise
+/- unilateral lymphadenopathy

43
Q

Clinical dx of a chancroid if all of the following

A

painful genital ulcer
SSx consistent with chancroid
no evidence of syphilis on darkfield microscopy or serology

44
Q

Gold standard for dx of chancroid is

A

lesion culture (requires special medium)

45
Q

Treatment of chancroid

A

azithromycin 1g PO x 1
Ceftriaxone 250mg IM x 1

46
Q

Herpes Simplex:
Type 1 =
Type 2 =

A

primarily oral ulcers
primarily genital ulcers

47
Q

Both Herpes simplex virus infect _______ cells

A

epithelial cells

48
Q

How does HSV spread?

A

Infection via viral particles in body fluids or direct contact with open lesions - individual must be shedding virus can not be latent

49
Q

HSV can be primary or secondary

A

Primary = initial outbreak
Secondary = recurrence
virus lays dormant in sensory nerves - reactivated - recurrent mucocutaneous lesions

50
Q

Presentation HSV

A

+/- tingling prodrome
macular or papular lesion -> vesicles on an erythematous base -> ulcerations
ulcerations are shallow and severely painful
tender lymphadenopathy
edema, burning, itching, dysuria, vaginal or urethral discharge

51
Q

HSV lesions are ____ over ~ ____

A

self limiting over ~3 weeks

52
Q

Dx of HSV

A

can be clinical if vesicles are present
swab lesions for HSV PCR
HSV serology (antibodies)
HSV serum PCR
Tzanck smear - multinucleated giant cells

53
Q

Treatment of HSV

A

lifelong infection
acyclovir or valacyclovir (oral, IV, topical)
no intercourse while active lesions

54
Q

Genital Warts AKA condyloma acuminata are related to what types of HPV

A

6 or 11 (90%)

55
Q

What has decreased the incidence of HPV

A

HPV vaccine
Gardasil 9
(prevention but not treatment of genital warts)

56
Q

Presentation of genital warts

A

many infections are asymptomatic
characterized by flat papular or pedunculated lesions near introitus, under foreskin or penile shaft
+/- pain, puritis

57
Q

Genital warts dx

A

primarily clinical dx
definitive dx - bx of lesion

58
Q

Genital Warts treatment

A

likely doesn’t resolve HPV infection - no gold standard treatment shared decision making
recommended:
Cryotherapy
surgical removal
TCA or BCA (caustic agents)

59
Q

When removing genital warts it is important for the provider to wera

A

mask and eye covering because you need to protect your own mucus membranes

60
Q

PID is

A

inflammation of the upper genital tract - uterus, fallopian tubes, ovaries

61
Q

PID is usually secondary to

A

an ascending infection from the lower genital tract - m/c related to gonorrhea/chlamydia

62
Q

Why is an IUD a risk factor for PID

A

strings hang out which leaves the cervix open allowing for bacteria to get in easily

63
Q

PID presentation

A

abnormal or lower pelvic pain
vaginal d/c
dyspareunia
AUB

64
Q

On cervical exam for PID what are you going to find

A

cervical d/c
cervical motion tenderness (chandelier sign)
uterine tenderness
adnexal tenderness
+/- pelvic masses

65
Q

Clinical Dx of PID if it has these 3 things

A

reliable dx if 3 clinical criteria present:
cervical motion tenderness
uterine tenderness
adnexal tenderness

66
Q

Symptoms that might also present with a dx of PID

A

temp > 101
mucopurulent cervical discharge
cervical friability
increased WBCs on wet mount
elevated ESR/CRP
Documented GC infection

67
Q

What test are we always checking on every patient with a uterus of reproductive age?

A

bHCG

68
Q

“best” lab test for PID

A

WBCs on wet mount

69
Q

what do you do for a definitive dx of PID

A

laparoscopic endometrial bx - will show scaring

70
Q

Presumptive treatment of PID treatment requirements

A

presumptive treatment if sexually active F at risk for STI
+ pelvic or lower abdominal pain
3 clinical criteria are met
no other cause is more likely

71
Q

treatment of PID

A

ceftriaxone IM or IV
doxycycline PO or IV
metronidazole PO or IV
treat for 14 days
treat partners
no intercourse till resolved
re-test 3 months after treatment

72
Q

Indications for admission

A

need to r/o other surgical emergency
presence of tubo-ovarian abscess
patient is pregnant
severe infection (+ n/v, temp > 101)
patient cant tolerate PO treatment
No response to PO treatment

73
Q

How long should it take for pts with PID to improve after initiation of treatment

A

within 72 hours - if not reconsider dx, bx? or step up to IV abx

74
Q

Complications of PID

A

tubo-ovarian abscess
pelvic abscess
ectopic pregnancy (due to scarring of fallopians)
infertility
chronic pelvic pain
scaring –> adhesions

75
Q

Acute Pelvic pain =

A

< 3 months duration

76
Q

Chronic pelvic pain =

A

persistent, noncyclic pain perceived to be in structures related to the pelvis and lasting more than six months
often no etiology identified

Woman's Health (13 decks)

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