Shapiro > Genital Infxns Flashcards
which gender is likely to have fewer sx & seek care later & have more complications?
women
what dzs are characterized by urethritis & cervicitis?
gonococcal infxn
chlamydial infxn
nongonococcal urethritis
what dzs are characterized by vaginal discharge?
bacterial vaginosis
trichomoniasis
vulvovaginal candidiasis
what dzs are characterized by ulcerations?
chancroid & syphillis
genital herpes infxn (HSV 2 & 1)
granuloma inguinale
what are the 4 categories of infxn of the genitals & urinary tract?
- dz char by urethritis & cervicitis
- dz char by vaginal discharge
- dz char by ulcerations
- other genitourinary infxns
what are the 2 “other” genitourinary infxns?
PID
genital warts
T/F: an individual can have more than one cause of urethritis
TRUE
what 4 bugs are responsible for non-gonococcal urethritis?
- chlamydia trachomatis
- ureaplasma urealyticum
- mycoplasma genitalium
- trichomonas vaginalis
what sex does gonococcal urethritis affect?
both sexes
how is gonococcal urethritis transmitted?
sexual contact or during birth
what is the incubation pd of gonococcal infxn?
2-5 days
what are the general sx of gonococcal infxn?
intense burning
fever
malaise
what characterizes urethritis in MALES?
clear, mucopurulent, or purulent discharge
what characterizes GONOCOCCAL urethritis in MALES?
purulent discharge
what % of males have a mild or asymptomatic presentation of urethritis?
15%
what % of females w/ gonococcal urethritis may be asymptomatic?
50%
what is the primary site of infxn of gonococcal urethritis in females?
endocervical canal
what are the sx of urethritis in females?
scant mucopurulent cervical discharge
vaginal pruritis
dysuria
what are the complications of gonococcal urethritis in both sexes?
- disseminated gonococcal infxn
- acute arthritis-dermatitis syndrome
- gonococcal arthritis
- endocarditis (unc)
- meningitis (rare)
if you have a male pt & you suspect urethritis, what 2 things should you test for?
gonorrhea & chlamydia
how should you begin your diagnostic approach w/ males w/ urethral discharge?
purulent vs. mucopurulent
how sensitive is gram stain of urethral secretions for gonoccocal infxn in symptomatic men?
> 90%
can you use gram stain for cervix?
NOPE
what other 2 things besides gram stain can you use to dx gonococcal infxn?
PCR
culture (less common)
why is treatment of gonorrhea complicated?
anti-microbial resistance
how do you treat gonorrhea?
ceftriaxone (N. gonorrhoeae)
+ azithro or doxy (C. trachomatis)
what should you tell your pt to do if you are treating that pt for urethritis?
don’t have sex until you complete your treatment regimen
what other tests should you do for your pt if you treat them for gonorrhea?
other STDs incl syphilis & HIV
what 3 local infxns can c. trachomatis cause in men?
conjunctivitis
urethritis
prostatitis
what 4 local infxns can c. trachomatis cause in women?
conjunctivitis
urethritis
cervicitis
proctitis
what 4 local infxns can c. trachomatis cause in infants?
conjunctivitis
pneumonitis
pharyngitis
rhinitis
what tissue does C. trachomatis preferentially infect?
squamo-columnar epithelium
how many serological variants of c. trachomatis are there, & what is that based on?
18
based on monoclonal ab assay
what is the incubation period for c. trachomatis?
1-3 wks
what are the sx of c. trachomatis?
low grade urethritis
mod mucoid or mucopurulent urethral discharge
variable dysuria
how is ureaplasma urealyticum transmitted?
sexual contact
what does ureaplasma urealyticum cause in males?
urethritis
proctitis
whta does ureaplasma urealyticum cause in females?
cervicitis
vaginitis
mycoplasma genitalium accounts for (?%) of sexually transmitted urethritis
30%
if you have c. trachomatis-NEG urethritis, what is it probably d/t?
mycoplasma genitalium
what bug is common in recurrent urethritis?
mycoplasma genitalium
what things cause VIRAL urethritis?
adenovirus & HSV
what is cervicitis & what causes it?
inflammation of the cervix
d/t gonorrhea & chlamydia
what are the 2 types of cervicitis?
acute
chronic
how do you treat cervicitis?
w/ abx after you ID the underlying cause of infxn
what are the 2 major dx signs of acute cervicitis?
- purulent & mucopurulent endocervical exudate
2. sustained cervical bleeding induced w/ gentle swabbing
what do most women complain of if they have acute cervicitis?
abn vaginal discharge & intermenstrual vaginal bleeding
can be asymptomatic
how do you dx acute mucopurulent cervicitis?
gross evidence of purulent material from an inflamed cervix w/ 10+ PMN leukocytes per micro field
what are the 3 main sx of CHRONIC cervicitis?
- leukorrhea
- ext genital sx: bleeding, itching, irritation, pain
- cervical polyps
what is a cervical polyp?
small, smooth, red, fingerlike growth in the passage extending from the uterus
what are the sx of vaginitis?
vaginal discharge &/or vulvar itching & irritation & vaginal odor
why is it hard to differentiate btwn vaginitis & cervicitis?
they both can have vaginal discharge
how can you determine the cause of vaginal sx?
pH & micro examination of discharge
what is bacterial vaginosis?
normal balance of bacteria in vagina is disrupted & replaced by an outgrowth of certain bacteria
what are the sx of bacterial vaginosis?
discharge odor pain itching burning
what are the 2 ways you can dx bacterial vaginosis?
- gram stain
2. clinical criteria (YOU NEED 3)
what are the clinical criteria for bacterial vaginosis?
YOU NEED 3 OF THESE:
- homogeneous thin white discharge that smoothly coats vaginal wall
- clue cells
- pH >4.5 of vaginal fluid
- fishy odor of vaginal discharge before or after add’n of 10% KOH
what is the whiff test?
fishy odor of vaginal discharge before or after add’n of 10% KOH
is the prevalence of bacterial vaginosis higher or lower in women w/ no sexual exposure?
LOWER
what group has higher prevalence of bacterial vaginosis?
women w/ new or multiple sex partners
what is one of the main causes of bacterial vaginosis?
gardnerella vaginalis
dec or absence of THIS species causes inc vaginal pH
lactobacillus
why is there malodor w/ bacterial vaginosis?
overgrowth of anaerobes > inc enzymes > inc breakdown of vaginal peptides into amines > malodor
can you make a dx of bacterial vaginosis based on pt hx only?
nope
what are 3 ways you can dx bacterial vaginosis OTHER THAN HX?
- wet mount eval
- vaginal secretion culture
- DNA probe
what are clue cells?
vaginal epithelial cells w/ indistinct borders d/t lots of adherent bacteria
what is the clue cell threshold for dx of bacterial vaginosis?
more than 20% of cells must be clue cells
what allows you to see clue cells?
wet mount
what causes trichomoniasis?
trichomonas vaginalis > flagellated protozoan parasite w/ multiple strains
what are the sx of trichomoniasis?
vulvar irritation
AND
diffuse malodorous yellow-green vaginal discharge
(or asymptomatic)
what is trichomoniasis like in males?
colonizes male urethra
mostly asymptomatic but can cause NGU (non-gon urethritis)
what is the discharge like in trichomoniasis?
profuse
frothy
foul smelling
yellow-green
what do the external genitalia look like in trichomoniasis?
patchy redness on the labia & vagina
what happens if urine touches inflamed tissues in trichomoniasis?
painful dysuria
how do you culture & ID trichomonads?
rapid assay or Pap
what vaginal pH is indicative of trichomoniasis?
pH >5
what species most commonly causes vulvovaginal candidiasis?
C albicans causes 80-90%
what other 2 species are capable of causing vulvovaginal candidiasis?
c. glabrata
c. tropicalis
what % of women have asymptomatic colonization w/ C. albicans?
10-20%
what are sx of vulvovaginal candidiasis?
pruritis
dysuria
thick curdy discharge
T/F: vulvovaginal candidiasis is an STI
FALSE
what is the BEST way to dx vulvovaginal candidiasis?
KOH wet mount
specificity of 97%
whom should receive vaginal cultures of vulvovaginal candidiasis?
in pts w/ persistent or recurrent sx
what defines “recurrent infxn”?
4 or more infxns in 1 year
what routes of treatment are best for vulvovaginal candidiasis?
oral or topical
equal efficacy
what are the diffs in physical exam findings btwn bacterial vaginosis, candidiasis, & trichomoniasis?
BV: thin, whitish gray discharge
C: curdy discharge
T: yellow, frothy discharge
what causes chancroid?
haemophilus ducreyi
what causes syphilis?
treponema pallidum
what causes genital HSV infxn?
HSV2 & HSV1
what causes granuloma inguinale?
klebsiella granulomatis
T/F: chancroid is common in the US
FALSE
what is the course of chancroid?
papule > erosion > painful ulcer
why do all these clinicians love osler
i don’t fucking know
what are the stages of syphilis?
primary secondary latent tertiary or congenital
T/F: latent syphilis is asymptomatic
TRUE
what are the sx of primary syphilis?
chancre
LAD
what are the sx of latent syphilis?
rash fever malaise LAD mucus lesions condyloma lata alopecia meningitis HA
what are the 2 systemic manifestations of tertiary syphilis?
CVS
neuro
what is a gumma?
monocytic infiltrate w/ tissue destruction of any organ
how do you get syphilis?
sex or vertical spread
what happens if you don’t treat syphilis?
may become chronic
when is syphilis most contagious to sex partners?
primary & secondary stages
why did syphilis decline rapidly in the 1940s?
penicillin & public health
when did syphilis have an all-time low in the US?
2000
what population is an important risk pop for syphilis?
men who have sex with men (MSM)
what type of syphilis increased in incidence btwn 1986-1990?
primary & secondary
which sex has more syphilis?
males
what race is most affected by syphilis?
blacks (then hispanics)
what does treponema pallidum look like?
corkscrew
motile, microaerophilic
can you culture treponema pallidum in vitro?
nope
can you view treponema via normal light micro?
nope
darkfield or electron photomicrograph
how does treponema penetrate?
enters via skin & mucous membranes thru abrasions during sexual contact
OR
transmitted transplacenta
how does treponema disseminate?
circulatory system (incl lymph) > invades CNS
when does treponema invade the CNS?
any stage of syphilis
where do you get a chancre?
at the site of inoculation
what is the progression of a chancre?
macule > papule > ulcer
how do you describe a chancre?
indurated w/ a clean base
T/F: chancres are painful
FALSE
painLESS
how long does it take for a chancre to heal?
3-6 wks
T/F: you can only have one chancre at a time
FALSE
multiples can occur
what kind of LAD do you get w/ primary syphilis?
regional, rubbery, painless, bilateral
what happens if you do a serological test for syphilis if it’s early primary?
may not be +
what stage of syphilis has chancres?
primary
T/F: chancres are highly infectious
TRUE
T/F: you can get a primary syphilitic chancre on your TONGUE
true
gross
when do you get a secondary lesion?
several weeks after the primary chancre appears
how long will you have a secondary lesion?
weeks to months maybe
T/F: primary & secondary stages of syphilis might overlap
TRUE
what type of lesion is the most common in secondary syphilis?
mucocutaneous
what stage has the highest serologic titer for syphilis?
secondary
this is poorly worded but you get the buzzwords
what TYPE of rash do you get w/ secondary syphilis?
papulosquamous rash
or
papulo-pustular
WHERE do you get a rash w/ secondary syphilis?
body rash
palmar/plantar
what stage of syphilis has nickel & dime lesions?
secondary
what is happening in latent syphilis?
host is suppressing infxn
no lesions are clinically apparent
when does latent syphilis occur?
btwn primary & secondary OR btwn secondary relapses OR after secondary
what is the ONLY evidence of latent syphilis?
positive serological test
what are the 2 categories of latent syphilis?
early latent
late latent
what are the time parameters for early & late latent syphilis?
early <1yr
late 1+ yr
what happens when t. pallidum invades the CNS?
neurosyphilis!
what stage of syphilis is assoc w/ neurosyphilis?
any!
when do you get early neurosyphilis?
a few months to years after infxn
what are the clinical manifestations of early neurosyphilis?
acute syphilitic meningitis
meningovascular syphilis
ocular involvement
when do you get neurologic involvement?
decades after infection
rarely seen
what are the clinical manifestations of neurologic involvement of syphilis?
general paresis
tabes dorsalis
ocular involvement
what stain can you use to see spirochetes in neural tissue?
silver
what is tabes dorsalis?
syphilitic invasion of the DORSAL COLUMNS of the spinal cord
what % of untreated syphilis pts progress to the tertiary stage w/i 1-20yrs?
30%
why is tertiary syphilis rare?
abx!
what are the 2 manifestations of tertiary syphilis?
gummatous lesions
CVS syphilis
T/F: gumma can ulcerate
TRUE
yucko
how do you get congenital syphilis?
t. pallidum is transmitted from a pregnant woman to her fetus
what can congenital syphilis cause (while the baby is still in utero)?
- stillbirth
- neonatal death
- infant deafness, neuro impairment, bone deformities
when can transmission of syphilis from mom to baby occur (what stage of syphilis)?
any stage!
risk is HIGHEST during primary & secondary!
in what stage of pregnancy can syphilis be transferred to the fetus?
any
T/F: all congenital syphilis cases are severe
FALSE
only the severe cases are apparent at birth, but there is a wide spectrum of severity
what type of congenital syphilitic lesions are msot common?
early
infants <2 yo
usu inflammatory
what do late congenital syphilitic lesions do?
kids >2yo
immunologic & destructive
what are the oral manifestations of congenital syphilis?
- mucus patches
- Hutchinson’s teeth
- palate perforation
what are Hutchinson’s teeth?
small, widely spaced incisors w/ notches on the biting surface
what are the 3 main aspects of syphilis dx?
clinical hx
physical exam
lab dx
what 4 things do you need to ask about when you assess a clinical hx for syphilis?
- hx of syphilis
- known contact to an early case of syphilis
- typical sx in past 12 mos
- most recent sero test for syphilis
what areas should you pay particular attn to when doing your physical exam for syphilis? (7 areas)
- oral cavity
- lymph nodes
- torso skin
- palms & soles
- genitalia & perianal area
- neuro
- abdomen
what serological tests allow a presumptive dx of syphilis?
nontreponemal or treponemal
how do you ID t. pallidum in lesion exudate or tissue?
darkfield micro
or
other tests (?)
what are the 2 advantages of darkfield micro?
- definitive immediate dx
2. rapid results
what are you looking for on darkfield micro?
t. pallidum morphology & motility
what are the 5 disadvantages of darkfield micro?
- special equipment & microscopist
- confusion w/ other spirochetes
- must be done immediately
- not for oral lesions
- false-negs
which type of sero test for syphilis is qualitative AND quantitative?
nontreponemal
treponemal is ONLY quaLitative
can you use only 1 sero test to dx syphilis?
nope
that’s insufficient
what does the nontreponemal sero test measure?
ab against cardiolipin-lecithin-cholesterol ag
is nontreponemal sero test specific for t. pallidum?
nope
what do titers of the nontreponemal sero test correlate w/?
disease activity
how are results of the nontreponemal sero test reported?
quantitatively
what does “serofast” mean?
syphilitic pts may be reactive for life on a nontreponemal sero test
what are the nontreponemal sero tests?
VDRL & RPR
what are the 5 advantages of a nontreponemal sero test?
- fast & cheap
- easy to do
- quantitative
- used for following response to therapy
- can be used to evaluate reinfection
what are the 3 disadvantages of nontreponeaml sero test?
- can be insensitive in certain stages
- false posi
- prozone effect can cause false neg (rare)
what does a treponemal sero test measure?
ab against t. pallidum ag
can you use titers of a treponemal sero test to assess treatment response?
NO
only nontreponemal!
what are the treponemal tests?
TP-PA
FTA-ABS
EIA
what stage will ALWAYS be detected by ALL the sero tests for syphilis?
secondary
what sero test is best for primary syphilis?
EIA
what sero test is best for latent syphilis?
FTA-ABS or EIA
what sero test is best for tertiary syphilis?
FTA-ABS
i’m skipping slide 93 bc fuck that
p much
what are the 4 criteria for early latent syphilis?
if w/i the year preceding the eval…
- documented seroconversion or 4x inc in cp w/ a serological titer
- sx of primary or secondary syphilis
- contact w/ an infectious case of syphilis
- only possible exposure occurred w/i the last year
how should you manage latent syphilis of unk duration?
as if they have late latent syphilis
what do public health laws require about syphilis?
you MUST report ALL cases to the state/local health dept
what are the criteria for CSF exam in syphilis pts?
- neuro or ophthalmic signs/sx
- evidence of tertiary syphilis (gumma)
- treatment failure
- HIV infxn w/ CD4 1:32
what test is considered diagnostic of neurosyphilis?
reactive VDRL-CSF
can you use VDRL-CSF alone to dx neurosyphilis?
nope
what 3 factors does dx of neurosyphilis depend on?
- reactive sero test
- abn CSF cell count or protein
- reactive VDRL-CSF w/ or w/o clinical manifestations
what happens to CSF leukocytes in pts w/ neurosyphilis?
usu elevated (>5 WBCs/mm^3)
what is the specificity & sensitivity of VDRL-CSF?
highly specific
insensitive
what does syphilis commonly coexist w/?
HIV
T/F: you can use conventional therapy on pts infected w/ both syphilis & HIV
TRUE
what is the therapy for primary, secondary, & early latent syphilis?
benzathine penicillin G 2.4 million units IM, 1 dose
Bicillin L-A
what do you give your pt w/ primary, secondary, or early latent syphilis if they are allergic to penicillin?
doxy 100 mg oral 2x/day for 14 days
OR
tetracycline 500 mg oral 4x/day for 14 days
what is the therapy for late latent syphilis?
benzathine penicillin G 7.2 million units total
admin as 3 doses of 2.4 million units IM at 1 wk intervals
what is the therapy for late latent syphilis if the pt is allergic to penicillin?
doxy 100 mg oral 2x/day for 28 days
OR
tetra 500mg oral 4x/day for 28 days
what is the therapy for tertiary syphilis?
SAME AS LATE LATENT!
same things if penicillin allergic too!
how do you treat neurosyphilis?
aqueous crystalline penicillin G 18-24 million units/day
admin as 3-4 million units IV q4 hours or continuous infusion for 10-14 days IV
what is the alternative regimen for neurosyphilis if you can ensure compliance?
procaine penicillin 2.4 million units IM 1x/day
+
probenecid 500 mg oral 4x/day
BOTH for 10-14 days
how do you treat syphilis in pregnancy?
treat w/ penicillin according to stage of infxn
do NOT use erythro
what do you do w/ a pregnant pt w/ syphilis if they have a reactive skin test to penicillin?
desensitize them in the hospital & treat them w/ penicillin
the fuck is a Jarisch-Herxheimer rxn???
self-limited rxn to antitreponemal therapy
what are the sx of a Jarisch-Herxheimer rxn?
fever malaise N/V chills exacerbation of secondary rash
when does a Jarisch-Herxheimer rxn occur?
w/i 24 hours after therapy
is a Jarisch-Herxheimer rxn the same thing as an allergic rxn to penicillin?
nope
when is a Jarisch-Herxheimer rxn most common?
after treatment w/ penicillin & treatment of early syphilis
what can manage but not prevent a Jarisch-Herxheimer rxn?
antipyretics
what can happen if a pregnant pt gets a Jarisch-Herxheimer rxn?
it can precipitate early labor, so call your OB if probs develop
what do you give HIV pts w/ primary, secondary, or early late syphilis?
single IM dose of 2.4 MU benzathine penicillin (conventional therapy)
what do you give your pt w/ HIV & syphilis if they are allergic to penicillin & compliance can’t be ensured?
desensitize them & treat them w/ penicillin
all pts who have syphilis should be tested for (__?__)
HIV infxn
when should you reexamine a pt w/ primary or secondary syphilis?
6 & 12 mos
what should you cp follow-up titers to?
max or baseline nontreponemal titer obtained on day of treatment
when should you reexamine a pt w/ latent syphilis?
6, 12, & 24 mos
when should you reexamine an HIV pt w/ syphilis?
primary or secondary: 3, 6, 9, 12, 24 mos
latent: 6, 12, 18, 24
when should you repeat CSF exam in pts w/ neurosyphilis?
6 mo intervals until normal
what are the 3 indications of probably treatment failure or reinfection?
- persistent/recurrent clinical signs/sx
- sustained 4x inc in titer
- titer fails to show a 4x decrease w/i 6-12 mos
what should you do for sex partners of pts w/ syphilis in any stage? (2 things)
- draw syphilis serology
2. perform physical exam
what should you do for sex partners of pts w/ primary, secondary, or early latent syphilis?
treat presumptively as for early syphilis at the time of exam, unless…
- nontreponemal test result is neg
- last sex contact w/ pt is >90 days prior to exam
what are the 2 screening recommendations for syphilis?
- screen pregnant women at least at 1st prenatal visit
2. screen other pops based on local prevalence & pt’s risk behaviors
how often should you test pregnant pts in high prevalence communities or pts at risk?
2x during 3rd trimester
at 28 wks
at delivery
in add’n to early routine screening
T/F: any woman who delivers a stillborn infant after 20 wks gestation should be tested for syphilis
TRUE
what is the most common cause of genital ulceration worldwide?
genital herpes
why are there increases in relative prevalence of genital herpes in dvlping countries?
HIV infxn & assoc immunosuppression
what kind of migration does HSV have?
retrograde migration along sensory nerves
where does HSV infect?
mucocutaneous
where is HSV latent?
dorsal root or trigeminal ganglia
where are most HSV1 infxns?
orolabial
only 20% are genital
where are most HSV2 infxns?
almost always genital
how long is the incubation period of genital herpes?
short
what are the sx of genital herpes primary infxn?
erythema blisters ulcerations first episode is severe multiple painful vesicles shallow ulcers
how long do the ulcers of primary genital herpes infxn take to heal?
2-3 weeks
upon recurrence of genital herpes, are the lesions more or less severe?
LESS
what % of ppl w/ primary HSV genital infxn have recurrences?
80%
what can increase reactivation of genital herpes?
HIV infxn or immunosuppression
how long does primary HSV2 infxn last?
3 weeks
t/f: LAD & systemic sx are common w/ HSV2 infxn
true
why is HA common w/ primary HSV2 infxn?
viral meningitis can occur in primary genital infxns
what are the biggest diffs btwn primary & recurrent genital herpes?
recurrent lasts 5-10 days
recurrent has fewer lesions
recurrent generally does NOT have LAD or systemic sx or mucosal invovlement
what is responsible for most transmission of herpes?
viral shedding
what are the mean # of outbreaks in the 1st year after initial genital HSV infxn for men & women?
men: 5.2 outbreaks/yr
women: 4 outbreaks/yr
T/F: the rate of recurrence of HSV outbreaks increases over time
FALSE
it declines
outbreak recurrence rates are lower in HSV1 or HSV2 genital infxn?
genital HSV1 infxn
pts infected w/ HSV2 shed virus subclinically, when?
more in the 1st yr after infxn
how do you distinguish HSV1 from HSV2?
real time PCR
how do you do a type specific serology for HSV?
ELISA & western blot
is a microscopy Tzanck smear good for diagnosing HSV?
no, it’s only ~50% sensitive
what test can you do on the day you collect a sample of HSV?
direct immunofluorescence
how long does it take to get a posi result if you do tissue culture followed by immunofluorescent staining?
one to several days
how do you treat primary & recurrent genital herpes infxns?
antiviral agents
Acyclovir
Valaciclovir
Famciclovir
what happened to HSV2 isolates in 1980?
resistance to acyclovir assoc w/ long term therapy, esp in HIV pts, d/t THYMIDINE KINASE gene mutations
what does thymidine kinase do?
catalyzes conversion of THM to THMP w/ conversion of ATP to ADP
what is granuloma inguinale?
genital ulcerative dz d/t Klebsiella granulomatis
where is granuloma inguinale endemic?
tropical & subtropical developing countries
how does granuloma inguinale spread?
sexual contact (vaginal or anal)
what are the sx of granuloma inguinale?
painless, slowly progressive ulcerative lesions on genitals & perineum that bleed on contact w/o LAD
how long after contact w/ bacterium will you see sx of granuloma inguinale?
1-12 weeks
what is the grossest possible description you can think of for granuloma inguinale?
small BEEFY red bumps on genitals
what is granuloma inguinale difficult to differentiate from?
chancroid
what 2 things can you do to dx granuloma inguinale?
culture of tissue samples (difficult)
OR
scrapings or biopsy of lesion
how do you treat granuloma inguinale?
abx
what is pelvic inflammatory dz (PID)?
spectrum of inflammatory disorders in the upper female genital tract
what % of women w/ gonorrheal or chlamydial infxn develop PID?
10-20%
to what does PID usu refer?
ascending infxn from cervix/vagina
what are the sx of PID?
low fever
abd pain (uni or bilat)
uterine tenderness on pelvic exam
what is a sequela of PID?
infertility (sometimes)
what should you test endocervical discharge for?
G & C
how do you treat PID?
broad-spectrum abx (oral if mild, IV if hospitalized)
rest for 1-3 days until sx resolve
DON’T HAVE SEX
what is the most commonly acquired STD?
genital warts
what happens if you treat HPV-related genital warts?
reduces infectivity but doesn’t eliminate it
what types of HPV cause general warts?
6 & 11
what types of HPV cause cervical warts?
16 & 18
what are the 3 screening modalities you can use for HPV?
Pap smear
cytology
HPV-based DNA testing
what population should be screened for HPV-related cervical lesions?
sexually active women
who should receive cervical cytology screening on an annual basis?
women under 30 yo
how often should you repeat HPV DNA & cervical cyt testing in women who are high risk HPV DNA +?
6-12 months
what are the sx of genital warts?
pruritis
burning
vaginal bleeding
post-coital bleeding
what do HPV genital warts look like?
maybe pigmented
fixed to underlying tissues
T/F: genital warts frequently recur
TRUE
what is the recommended age for the HPV vax?
11-12 yo
how many shots are in the HPV series & when should you get them?
3 vax series
1st, then 2nd 1-2 mos later, then 3rd 6 mos later
why does the HPV vax target types 6, 11, 16, & 18?
primary capsid proteins
what is the structure of HPV?
nonenveloped double stranded DNA virus
what is the cervical transformation zone?
area of immature metaplasia btwn the original & current squamocolumnar jxn
where do ~99% of HPV-related genital cancers arise?
w/i the transformation zone of the cervix
what HPV types are responsible for >90% of anogenital warts?
6 & 11
what age groups have the peak prevalence of anogenital warts?
women 20-24 yo
men 25-29 yo
what % of the sexually active US adult population has clinically apparent anogenital warts?
only ~1%
what % of anogenital warts spontaneously remit?
up to 40%
how do you treat genital warts?
topical or surgical therapy
what is a pt-applied therapy for HPV?
imiquimod
what are 2 provider-applied therapies for HPV?
podophyllin resin
TCA
what is the mechanism for imiquimod?
cell-mediated immune response modifier
induces interferon pdtion
how does podophyllin resin work?
cytotoxic & antimitotic
how does TCA work?
protein coagulation of wart tissues
what types of surgical therapy are there for HPV?
cryotherapy
excision
how do you choose a therapy for HPV?
number, size, & site of lesions
individuals w/ STDs are 2-5x more likely to dvlp what?
HIV
if exposed to virus thru sexual contact
individuals w/ STI & HIV are more likely to transmit what?
HIV
what increases your susceptibility to HIV?
genital ulcers that break the genital tract lining (like syphilis, herpes, chancroid)
how do pts w/ STDs & HIV have increased infectiousness?
more likely to shed HIV in genital secretions if they are infected w/ other STDs
what is lymphogranuloma venereum?
an STI d/t diff serotype of C. trachomatis
how does lymphogranuloma venereum start?
small painless sore (on penis, vag, or rectum) > pain for ~30 days > swollen painful lymph nodes in groin
can you get anal bleeding w/ lymphogranuloma venereum?
yes, 2-6 weeks after infxn
what are sx of lymphogranuloma venereum infxn?
diarrhea
abd pain
where is lymphogranuloma venereum most common?
tropics & subtropics
how do you dx lymphogranuloma venereum?
oozing, abn connection in rectal area
swollen LN in groin
swelling of vulva or labia in women
what abx can you use for lymphogranuloma venereum?
tetracycline
doxy
erythro
