Sexually Transmitted Infections Flashcards
Describe normal vaginal discharge.
Clear-white, odorless, and of high viscosity
What is the dominant bacteria present in the vagina?
Lactobacilli
What is the normal vagina pH range?
3.8-4.2 (acidic environment- to help inhibit overgrowth of bacteria)
What are the 3 most common types of vaginitis?
(1) bacterial vaginosis (2) vulvovaginal candidiasis (3) trichomoniasis
What is the major bacteria detected in bacterial vaginosis?
Gardnerella vaginalis
What is candidiasis vaginitis most commonly caused by?
C. albicans
What is the most prevalent nonviral STI?
Trichomoniasis vaginitis
What are the 2 aspects of bacterial vaginosis microbiology?
(1) overgrowth of bacteria species normally present in vagina w/anaerobic bacteria
(2) dec or loss of protective lactobacilli
What is produced by some lactobacilli that helps maintain a low pH to inhibit bacteria overgrowth?
H2O2
What is the only protozoan that affects the genital tract?
Trichomonas vaginalis
What are 6 risk factors for bacterial vaginosis?
(1) African American
(2) 2+ sex partners in previous 6 months/new sex partner
(3) douching-b/c gets rid of good bacteria
(4) lack of condom use
(5) absence of or dec in lactobacilli
(6) lack of H2O2 producing lactobacilli
What are 5 risk factors for candidiasis?
(1) diabetes
(2) immunosuppression
(3) abx use
(4) prolonged exposure to moist, damp underwear
(5) non-cotton underwear
What are 4 risk factors for trichomoniasis?
(1) multiple sex partners
(2) lower socioeconomic status
(3) hx of STDs
(4) lack of condom use
What is an important question to ask pts regarding pain and urination and why?
Does it hurt WHILE you pee or AFTER you pee? → open lesions= while peeing, dysuria from UTIs= after peeing
What are 4 si/sx of bacterial vaginosis?
(1) asymptomatic
(2) malodorous or fishy smell
(3) pruritic discharge
(4) thin, milky white sometimes grey discharge
What are 3 si/sx of candidiasis?
(1) pruritic discomfort
(2) dysuria
(3) thick cottage cheese like discharge
What are 3 si/sx of trichomoniasis?
(1) asymptomatic ~70%
(2) pruritic discharge sometimes green, yellow-green, and frothy
(3) strawberry cervix
What are 3 diagnostic aides for vaginitis?
(1) vaginal pH
(2) wet prep (NaCl)
(3) KOH test
What are pH findings consistent with candidiasis? With BV and trichomoniasis?
Candidiasis: <4.5
BV and trich: >4.5
What are findings on wet prep indicative of bacterial vaginosis?
Clue cells, no/few WBCs
What are findings on wet prep indicative of candidiasis?
Few-many WBCs
What are findings on wet prep indicative of trichomoniasis?
Motile flagellated protozoa, many WBCs
What are findings on KOH test indicative of candida?
Pseudohyphae and budding yeast
What do you do w/KOH test to help dx bacterial vaginosis?
Whiff test
What do you do w/KOH test to help dx trichomoniasis?
Whiff test
List the 6 key identifiers to dx bacterial vaginosis. (hint: recap of previous questions)
1) Sx: odor, discharge, itch
2) Discharge: homogenous, adherent, thin, milky white; malodorous “fishy” smell
3) Clinical findings: odor, white or gray discharge
4) pH: >4.5
5) Whiff test: positive
6) NaCl wet mount: clue cells, no/few WBCs
List the 7 key identifiers to dx candidiasis. (hint: recap of previous questions)
1) Sx: itch, discomfort, dysuria, thick discharge
2) Discharge: thick clumpy white “cottage cheese”
3) Clinical findings: inflammation and erythema
4) pH: < 4.5
5) Whiff test: negative
6) NaCl wet mount: few to many WBCs
7) KOH wet mount: pseudohyphae (or spores if non-albicans species)
List the 6 key identifiers to dx trichomoniasis. (hint: recap of previous questions)
1) Sx: itch, discharge, ~70% asymptomatic
2) Discharge: frothy, gray or yellow-green; malodorous
3) Clinical findings: cervical petechiae, “strawberry cervix”
4) pH: > 4.5
5) Whiff test: usually positive
6) NaCl wet mount: motile flagellated protozoa, many WBCs
What is the preferred way to dx trichomoniasis?
Nucleic acid amplification test (NAAT)
How is candidiasis typically diagnosed?
History and PE (clinically)– also: normal pH, KOH prep, wet mount, +/- culture if all else is negative
How is bacterial vaginosis typically diagnosed?
Amsel criteria– also: DNA probe based test for G. vaginalis, vaginal sialidase activity test, +/- gram stain (research only typically)
What are the four components of the Amsel criteria, and at least how many must be present to dx BV?
Amsel criteria-must have at least 3 of the 4:
1) Vaginal pH > 4.5
2) Presence of >20% per HPF of “clue cells” on wet mount examination
3) (+) amine or “whiff” test- fishy smell
4) Homogeneous, non-viscous, milky-white discharge adherent to the vaginal walls
What are 3 tx options for bacterial vaginosis?
(1) metronidazole 500 mg BID x 7 days- usual tx
(2) metronidazole gel 0.75% one full applicator intravaginally 1-2x/day for 5 days
(3) clindamycin cream 2% one full applicator (5g) intravaginally at bedtime for 7 days
What is the tx of candidiasis? In severe cases? If pt is pregnant?
Fluconazole 150 mg x 1
Severe: fluconazole 150 mg repeated in 72 hrs
Pregnancy: OTC, 7 day topical txs (fluconazole is C/I in first trimester)
What are 3 tx options for trichomoniasis?
(1) metronidazole 2gm orally in a single dose
(2) metronidazole 500 mg BID x 7 days
(3) tinidazole 2 gm orally in a single dose
What are 2 counseling points for metronidazole?
(1) metronidazole is safe in pregnancy
(2) do not drink alcohol while taking or after taking
What are 2 tx options for pts with multiple recurrences of BV?
(1) twice weekly metronidazole gel for 4-6 months
(2) oral nitroimidazole followed by intravaginal boric acid suppressive metronidazole gel
What are 3 risk reduction counseling points for BV?
(1) correct and consistent condom use
(2) avoid douching
(3) limit number of sex partners
What are 2 tx instruction counseling points for BV?
(1) avoid alcohol if taking metronidazole
(2) latex condoms may dissolve intravaginal creams
What are 3 risk reduction counseling points for candidiasis?
(1) avoid douching
(2) avoid unnecessary abx use
(3) complete course of tx
What is a tx instruction counseling point for candidiasis?
Latex condoms may dissolve intravaginal creams
What are 2 risk reduction counseling points for trichomoniasis?
(1) correct and consistent condom use
(2) limit number of sex partners
What are 4 tx instruction counseling points for trichomoniasis?
(1) avoid alcohol if taking metronidazole
(2) avoid sex until pt and partners tx and cured and asymptomatic
(3) any sex partners in last 60 days should be treated
(4) report to local DPH
What type of organism is gonorrhea?
Gram (-) diplococci
What is the typical incubation period of chlamydia and why is it so easily transmissible?
7-21 days–significant asymptomatic reservoir
What sx does vertical transmission of chlamydia result in in babies?
Neonatal conjunctivitis