Sexually Transmitted Infections Flashcards

Question

Diagnosis of syphillis require how many tests? Why?

Answer 1

At least 2 tests Treponemal and Nontreponemal Results in false negative results during primary syphilis Results in false positive results in those without syphilis

Answer 2

Detect antibodies that are not specifically directed against the T. pallidum bacterium _ Venereal Disease Research Laboratory (VDRL) _ Rapid Plasma Reagin (RPR)

Answer 3

Detect antibodies that specifically target T. pallidum bacterium _ Fluorescent treponemal antibody absorbed (FTA-ABS) test _ T. Pallidum passive particle agglutination (TP-PA) assay _ Various enzyme immunoassays (EIAs)

Answer 4

Inexpensive, easily performed Positive results indicate any stage of syphilis Useful for screening, progression of disease, recovery after therapy, reinfection Antibodies in adequately treated patient disappear after about 3 years Results can vary in HIV positive patients Chronic false-positive results are commonly associated with heroin addiction, aging, chronic infection, autoimmune disease, malignant disease

Answer 5

Highly specific for syphilis – unlikely to have a false positive Once infected, antibodies remain in blood for life Positive screening must be followed by nontreponemal test to differentiate between an active infections vs one that occurred in the past and has been treated

Answer 6

look in ppt or add pic later

Answer 7

Benzathine penicillin G 2.4 million units IM in a single dose ``` For PCN allergy: Doxycycline 100mg PO BID x 14 days OR Tetracycline 500mg PO 4x daily x 14 days OR Ceftriaxone 1g IM or IV daily x 10-14 days ```

Answer 8

Benzathine penicillin G 2.4 mil units IM once a week for 3 successive weeks (7.2 mil units total) For PCN allergy: Doxycycline 100mg PO BID for 28 days OR Tetracycline 500mg PO 4x daily x 28 days

Answer 9

Aqueous crystalline penicillin G 18-24 mil units IV (3-4 mil units every 4 hours or by continuous infusion) for 10-14 day For PCN allergy Ceftriaxone 2g daily either IM or IV for 10-14 days

Answer 10

Clinical and quantitative nontreponemal tests at 6 and 12 months for primary and secondary At 6, 12, and 24 months for early latent Retreatment as needed with weekly injections of benzathine penicillin 2.4 mil units IM for 3 weeks

Answer 11

Clinical and quantitative nontreponemal tests at 6, 12, and 24 months Retreatment with neurosyphillis

Answer 12

CSF examination every 6 months until the cell count is normal; if it has not decreased at 6 months or is not normal by 2 years, retreatment should be considered Retreatment as initial

Answer 13

Self-limited reaction to anti-treponemal therapy Headache, fever, myalgia, malaise, nausea/vomiting Occurs within 24 hours after therapy Not an allergic reaction to penicillin May pre-treat with APAP or ibuprofen to prevent reaction More frequent after treatment of early syphilis Pregnant women should be informed of this possible reaction – may induce early labor

Answer 14

Patients with syphilis who demonstrate any of the following criteria should have a CSF evaluation promptly: _ Neurologic or ophthalmic signs or symptoms _ Evidence of active tertiary syphilis (e.g. aortitis, gumma, and iritis) _ Treatment failure _ HIV infection with late latent syphilis or syphilis of unknown duration

Answer 15

Can cross the placenta at any time during pregnancy The greatest risk of fetal infection occurs during primary and secondary syphilis in mother Complications include fetal demise, premature delivery, and deformities All women screened during first pregnancy visit

Answer 16

No unprotected sex until lesion is healed or 5-7 days after treatment (whichever is longer)

Answer 17

in ppt, mostly treat presumptively

Answer 18

Spirochete

Answer 19

Chlamydia trachomatis An intracellular parasite that shares properties of both a virus and bacteria – maintains its cellular identity throughout development Like viruses, chlamydiae require cellular material from host cells for replication Although the cells lack a cell wall, its major outer membrane is similar to gram-negative bacteria

Answer 20

Neisseria gonorrhea is gram-negative diplococcus

Answer 21

Infection from inanimate objects and bath or toilet articles is possible – can survive on moist surface for 45 minutes Coinfection with other STIs is common Approximately 20% of men with gonococcal urethritis also have trichomoniasis

Answer 22

Trichomonas vaginalis is flagellated, motile protozoan that attaches to vaginal or urethral mucosa An inflammatory response is initiated that manifests as a discharge containing large amounts of PMNs

Answer 23

``` More common for females to have symptoms than males. Painful urination Frequent urination Discharge – may be yellow or green Typically smells Painful urination Pain during sex “Strawberry” cervix ```

Answer 24

Metronidazole 2g PO in a single dose

Answer 25

Increase in GI complaints (e.g. anorexia, nausea, vomiting, and diarrhea) associated with 2g dose of either metronidazole or tinidazole Patients intolerant to GI ADRs usually tolerate the alternate metronidazole multidose regimen Alcohol should be avoided for 24 hours after completion of metronidazole and 72 hours after completion of tinidazole

Answer 26

No sexual activity until 1 week after treatment is completed!

Answer 27

High rate of reinfection for all sexually active women diagnosed need to be retested within 3 months following initial treatment regardless of whether they believe their sex partners were treated or not Data insufficient to suggest retesting men

Answer 28

Treat with metronidazole 500mg PO BID x 7 days for patient and partner

Answer 29

Most common cause of genital ulceration Presence of genital herpes is associated with an increased risk of contracting HIV after exposure

Answer 30

Oral herpes Most common cause of genital ulceration More than 50 million Americans have genital herpes, and is increasing by at least 776,000 cases each year Presence of genital herpes is associated with an increased risk of contracting HIV after exposure

Answer 31

Genital herpes Lives in nerve cells in the lower back Recurs in genital or anal areas Spread through unprotected oral, anal, vaginal sex

Answer 32

``` Infection occurs in 5 stages: _ Primary mucocutaneous infection _ Infection of the ganglia _ Establishment of latency _ Reactivation _ Recurrent infection ``` Latency appears to be lifelong Interrupted by reactivation of the viral infection Unclear what factors are important in maintaining latency but appear to be affected by: Immune responses Emotional stressors Physical stressors

Answer 33

Tissue culture, serologic test, PCR

Answer 34

Detect HSV DNA, and can differentiate HSV-1 and 2 More sensitive than culture, diagnostic test of choice for suspected CNS infection (i.e. HSV encephalitis and HSV meningitis) Not widely used to diagnose genital ulcers Highly sensitive in detecting asymptomatic viral shedding

Answer 35

Most achievable goals in the management of genital herpes are Relieve symptoms and shorten the clinical course Prevent complications and recurrences Decrease disease transmission

Answer 36

Valacyclovir 1g PO BID for 7-10 days

Answer 37

Valacyclovir 1g PO once daily for 5 days

Answer 38

Valacyclovir 1g PO once daily

Answer 39

CDC recommends discontinuing at 1 year Some clinicians will continue indefinitely or use “drug holidays” Not clear if decreases transmission to partners, although markedly decreases asymptomatic viral shedding

Answer 40

Not effective for treatment or prophylaxis. | DO NOT USE

Answer 41

Risk for spread of disease – viral shedding | No sexual activity during active outbreak

Answer 42

Anogenital warts are usually asymptomatic as well, but depending on size and anatomic location, they can be painful or pruritic ``` _ Condylomata, acuminata (Cauliflower-like appearance, skin-colored, pink, or hyperpigmented) _Smooth papules (dome-shape, skin-colored) _ Flat papules (Macular or slightly raised, skin-colored, smooth surface, most commonly found on internal structures (cervix) but can be on external genitalia) _Keratotic wart (Thick horny layer, can resemble common warts or seborrheic keratosis) ```

Answer 43

Pap smear Depends on the degree of abnormal cells Colposcopy may be completed – small sample of tissue taken from cervix and examined under microscope Cervical cell biopsy may be completed

Answer 44

Pap smear Depends on the degree of abnormal cells Colposcopy may be completed – small sample of tissue taken from cervix and examined under microscope Cervical cell biopsy may be completed

Answer 45

Eliminate symptoms, and removal of wart(s)

Answer 46

``` Podofilox 0.5% solution or gel (Condylox) OR Imiquimod 3.75% or 5% cream (Aldara) OR Sinecatechins 15% ointment (Veregen) ```

Answer 47

Apply to visible warts BID x 3 days, followed by 4 days of no therapy Cycle may be repeated as needed up to 4 cycles *May cause mild to moderate pain or local irritation *Contraindicated in pregnancy

Answer 48

Apply to visible warts QHS 3x/week up to 16 weeks Treatment area should be washed with soap and water 6-10 hours after application *May cause local inflammatory reactions, redness, irritation, induration, ulceration/erosions, and hypopigmentation *Limited information in pregnancy, but animal data suggest low risk

Answer 49

Apply 0.5cm strand to each wart TID, up to 16 weeks Must avoid sexual contact while ointment is on the skin *May cause erythema, pruritus/ burning, pain, ulceration, edema, induration, and vesicular rash *Avoid use in pregnant patients and patients with HIV or genital herpes

Answer 50

Cryotherapy with liquid nitrogen or cryoprobe OR Trichloroacetic acid (TCA) or Bichloroacetic acid (BCA) 80-90% solution OR Surgical remove More info in ppt

Answer 51

Age 21-29: Pap smear every 3 years – HPV testing only if patient has an abnormal Pap smear Age 30-65: Pap smear and HPV testing every 5 years – optional Pap smear only every 3 years Age 65: If they have had any pre-cancers found, they need to continue screening every 3-5 years until it has been 20 years since the pre-cancer was found. If their screens have been normal, they may stop screening for cervical cancer.

Answer 52

Gardasil 9

Answer 53

BV is a clinical syndrome resulting from replacement of the normal Lactobacillus sp. in the vagina with high concentrations of anaerobic bacteria Cause of microbial alteration is not fully understood Most prevalent cause of vaginal discharge or malodor

Answer 54

``` Having multiple male or female partners New sex partners Douching Lack of condom use Lack of vaginal lactobacilli ``` *women who have never been sexually active are rarely affected

Answer 55

Thin, white vaginal discharge Malodorous – usually fishy smell present Most women are asymptomatic

Answer 56

Diagnosis requires 3 of the following signs or symptoms: _ Homogeneous, thin, white discharge that smoothly coats the vaginal walls _ Presence of clue cells on microscopic examination _ pH of vaginal fluid > 4.5 _ A fishy odor of vaginal discharge before or after addition of 10% KOH (i.e. the whiff test)

Answer 57

Relieve vaginal symptoms and signs of infection Reduce risk of acquiring STIs

Answer 58

Metronidazole 500mg orally BID for 7 days OR Metronidazole gel 0.75% one applicator (5g) intravaginally, once daily for 5 days More info in ppt

Answer 59

Should be advised to refrain from sexual activity or use condoms, consistently and correctly during the treatment regimen Avoid douching – can increase risk for relapse No data support the use of douching for treatment or relief of symptoms No data available supporting the use of lactobacillus formulations or probiotics as adjunctive therapy or replacement therapy All women with BV diagnosis should be tested for HIV and other STIs

Answer 60

Follow-up unnecessary if symptoms resolve Since BV recurrence is common, women should be advised to return for evaluation if symptoms recur Can reuse the previous tx or choose an alternate

Answer 61

For women with multiple recurrences after completion of a recommended regimen Metronidazole 0.75% gel 2x/week for 4-6 months shown to reduce recurrences; benefit is not persistent once suppressive therapy is stopped

Answer 62

Presumptive Treatment _ Ceftriaxone 250mg IM x 1 _ Metronidazole 2g PO x 1 _ Azithromycin 1g PO x 1 ``` Emergency contraception may be offered Hep B vaccine HPV vaccine HIV test Anti-emetics ```

Answer 63

Prevent method Talk w her BF so he can be treated Need to treat partner (> or