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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
Candidiasis aka vulvovaginal candidiasis primary cause is
candida albicans
26
Candidiasis aka vulvovaginal candidiasis risk factors
DM obesity HIV+ preg antibiotic use steroid use OCP use debilitation moist vaginal environment
27
Candidiasis can be _____ or ______
uncomplicated or complicated
28
Candidiasis presentation
usually people report vaginal pain, itching, burning, vaginal d/c thick, curdy, cheesy
29
Candidiasis dx
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
30
Candidiasis treatment
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)
31
Syphilis is caused by
Treponema pallidum (spirochete) can cause infection of virtually any tissue/organ
32
Syphilis has 3 categories
primary syphilis secondary syphilis tertiary syphilis
33
Primary syphilis presentation
single painless ulcer (chancre) Nontender, nonpurulent, indurated 3-4 weeks after infection
34
Secondary Syphilis presentation
Skin rash, mucocutaneous lesions, lymphadenopathy
35
Both primary and secondary lesions are
self limiting and infectious
36
Syphilis dx
early syphilis - dark microscopy or molecular testing - ID spirochetes on dark microscopy of lesional tissue or exudates
37
pts dx with syphilis should also be tested for
HIV
38
Syphilis screening
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
Syphilis treatment
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
Jarisch-Herxheimer reaction is when
you treat Syphilis and there is a lysis of spirochetes which releases endotoxin starts within hours of treatment
41
Chancroid is a (what kind of infection)
rare STI
42
Presentation of Chancroid
Ulcerations - painful, soft, irregular borders, friable, necrotic base with yellow gray exudates +/- fever malaise +/- unilateral lymphadenopathy
43
Clinical dx of a chancroid if all of the following
painful genital ulcer SSx consistent with chancroid no evidence of syphilis on darkfield microscopy or serology
44
Gold standard for dx of chancroid is
lesion culture (requires special medium)
45
Treatment of chancroid
azithromycin 1g PO x 1 Ceftriaxone 250mg IM x 1
46
Herpes Simplex: Type 1 = Type 2 =
primarily oral ulcers primarily genital ulcers
47
Both Herpes simplex virus infect _______ cells
epithelial cells
48
How does HSV spread?
Infection via viral particles in body fluids or direct contact with open lesions - individual must be shedding virus can not be latent
49
HSV can be primary or secondary
Primary = initial outbreak Secondary = recurrence virus lays dormant in sensory nerves - reactivated - recurrent mucocutaneous lesions
50
Presentation HSV
+/- 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
HSV lesions are ____ over ~ ____
self limiting over ~3 weeks
52
Dx of HSV
can be clinical if vesicles are present swab lesions for HSV PCR HSV serology (antibodies) HSV serum PCR Tzanck smear - multinucleated giant cells
53
Treatment of HSV
lifelong infection acyclovir or valacyclovir (oral, IV, topical) no intercourse while active lesions
54
Genital Warts AKA condyloma acuminata are related to what types of HPV
6 or 11 (90%)
55
What has decreased the incidence of HPV
HPV vaccine Gardasil 9 (prevention but not treatment of genital warts)
56
Presentation of genital warts
many infections are asymptomatic characterized by flat papular or pedunculated lesions near introitus, under foreskin or penile shaft +/- pain, puritis
57
Genital warts dx
primarily clinical dx definitive dx - bx of lesion
58
Genital Warts treatment
likely doesn't resolve HPV infection - no gold standard treatment shared decision making recommended: Cryotherapy surgical removal TCA or BCA (caustic agents)
59
When removing genital warts it is important for the provider to wera
mask and eye covering because you need to protect your own mucus membranes
60
PID is
inflammation of the upper genital tract - uterus, fallopian tubes, ovaries
61
PID is usually secondary to
an ascending infection from the lower genital tract - m/c related to gonorrhea/chlamydia
62
Why is an IUD a risk factor for PID
strings hang out which leaves the cervix open allowing for bacteria to get in easily
63
PID presentation
abnormal or lower pelvic pain vaginal d/c dyspareunia AUB
64
On cervical exam for PID what are you going to find
cervical d/c cervical motion tenderness (chandelier sign) uterine tenderness adnexal tenderness +/- pelvic masses
65
Clinical Dx of PID if it has these 3 things
reliable dx if 3 clinical criteria present: cervical motion tenderness uterine tenderness adnexal tenderness
66
Symptoms that might also present with a dx of PID
temp > 101 mucopurulent cervical discharge cervical friability increased WBCs on wet mount elevated ESR/CRP Documented GC infection
67
What test are we always checking on every patient with a uterus of reproductive age?
bHCG
68
"best" lab test for PID
WBCs on wet mount
69
what do you do for a definitive dx of PID
laparoscopic endometrial bx - will show scaring
70
Presumptive treatment of PID treatment requirements
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
treatment of PID
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
Indications for admission
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
How long should it take for pts with PID to improve after initiation of treatment
within 72 hours - if not reconsider dx, bx? or step up to IV abx
74
Complications of PID
tubo-ovarian abscess pelvic abscess ectopic pregnancy (due to scarring of fallopians) infertility chronic pelvic pain scaring --> adhesions
75
Acute Pelvic pain =
< 3 months duration
76
Chronic pelvic pain =
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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