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Clin med sem 2 > STD > Flashcards

STD Flashcards

1
Q

Herpes Virus- pathophysiology

A

Most common infectious etiology of genital ulceration - 32-50% of adults infected

Often transmitted unknowingly – asymptomatic viral shedding

  • Have the virus w/out any symptoms and still pass it
  • Majority of cases undiagnosed
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2
Q

Herpes Virus- cause

A

HSV1/HSV2

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3
Q

Herpes Virus- S/S & PE

A

Multiple painful vesicles on erythematous base, persist - 7-10 days
- red halo

Primary – fever, bilateral adenopathy
- flu like symptoms
Recurrent – no fever

Prodrome – tingling or burning 18-36 hours prior lesion

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4
Q

Herpes Virus- labs & imaging

A

Serological testing high rate of false negative
Viral studies – TOC
- PCR - CSF
- Culture
Tzank smear – gold standard
- Pos = presence of multinucleated giant cells
- scrape base of wet lesion

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5
Q

Herpes Virus- treatment

A

First episode - 7-10 days

  • Acyclovir – 400mg TID OR
  • Acyclovir – 200mg 5x daily OR
  • Famciclovir 250mg TID OR
  • Valacyclovir 1000mg BID

Episodic therapy –

  • Acyclovir – 400mg BID x 5days
  • Acyclovir 800mg BID x 5 days
  • Acyclovir 800mg TID x 2 days
  • Famciclovir 125mg BID x 5 days
  • Famciclovir 1000mg BID x 1day
  • Valacyclovir 500mg BID x 3days
  • Valacyclovir 1gm PO QD x 5days

Suppression – Daily

  • Acyclovir – 400mg BID
  • Famciclovir – 250mg BID
  • Valacyclovir – 500-1000mg QD
  • > > For those w/ >6outbreaks a year - Reduces frequency by 70-80%

Pregnancy

  • No indicated risk that treatment will hurt fetus
  • Acyclovir – used w/ 1st episode or severe recurrent disease
  • Risk of transmission – 30-50% among women who acquire HSV near delivery
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6
Q

Herpes Virus- prognosis

A

Chronic, lifelong infection

Lesions will spontaneously heal and then reoccur

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7
Q

Herpes Virus- counseling

A
  • Natural hx or infection, recurrence, asymptomatic shedding, transmission risk
  • Use of episodic vs suppressive therapy
  • Abstain from sexual activity when lesions or prodromal symptoms start
  • Inform partners
    Risk of neonatal infection
  • women w/out symptoms can deliver vaginally
  • Ulcer present – c section
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8
Q

Syphilis- pathophysiology

A

Incidence inc - HIV + men and MSM, IV drug usage

  • 71% inc
  • Test for if HIV +
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9
Q

Syphilis- cause

A

Treponema pallidum - spirochete

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10
Q

Syphilis- S/S & PE

A 
Primary:
Incubation - 10-90d
Chancre 
- early - macule/papule -> erodes
- Late - clean based, painless, indurated ulcer w/ smooth firm borders
- unnoticed in 15-30% of pts
- Resolves in 1-5w
- HIGHLY INFECTIOUS
Secondary:
- Hematogenous dissemination of spirochetes
- Usually 2-8w after chancre appears
- Rash - whole body - palms/soles
- Mucous patches 
- condylomata lata - wart like presentation - HIGHLY Infection 
- Constitutional symptoms
- Resolve in 2-10w
Tertiary:
- Gumma - soft, tumor like growth tissues
- CV
- neuro - eye - uveitis, optic neuritis
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11
Q

Syphilis- diagnosis

A

Early latent – reactive testing w/in 1 year of infection
- no symptoms
Late latent – reactive testing >1 year after onset of infection or timing can’t be determined
- No symptoms

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12
Q

Syphilis- labs & imaging

A

Darkfield examination of exudate/tissue – gold standard

Serologic testing:
Nontreponemal – RPR, VDRL
- Reactivity fades over time – can treat them down
Treponemal – fluorescent treponemal ab (FTA-ab)
- Once positive – stays positive -> can’t treat it down

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13
Q

Syphilis- treatment

A

Primary, secondary, early latent:
1st line – Benzathine Penicillin G 2.4mill units IM one dose
Allergy
- Doxy 100mg BID x 14days
- Ceftriaxone 1gm IM/IV QD x 8-10days
- Azithromycin 2gm single dose
Tertiary – Pen G 2.4mill units IM Qweek x 3 weeks – Bicillin LA
Pregnancy
- Screen at 1st prenatal visit – repeat 3rd trimester
- Treat for appropriate stage
- Additional? – benzathine penicillin 2.4mu IM after initial dose for prim, sec, early latent
- U/S 2nd half – eval congenital syphilis
—> Congenital syphilis – 40% die or stillborn
—–> Nerve damage – vision and hearing

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14
Q

Syphilis- prognosis

A

Jarish-Herxheimerr

  • occurs w/in 24hr of treatment
  • acture febrile rxn - HA, myalgia, fever
  • antipyretics
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15
Q

Syphilis- management of sex partners

A

Management of sex partners:

  • Exposure to primary, secondary, early latent w/in 90days – treat presumptively - PenG
  • Exposure to primary, secondary, early latent >90days – treat presumptively if serology not available – Pen G
  • Exposure to latent w/ high nontreponemal titers >1:32 – treat presumptively for early
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16
Q

Chancroid- pathophysiology

A

Declining

Risk for transmitting HIV

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17
Q

Chancroid- cause

A

Hemophilus ducreyi

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18
Q

Chancroid- S/S & PE

A

vesicle, papule, pustule, ulcer
– soft, not indurated, very painful

Classic - painful ulcer w/ tender inguinal adenopathy

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19
Q

Chancroid- diagnosis

A

Diff to diagnose – hard to culture

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20
Q

Chancroid- labs & imaging

A

Culture

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21
Q

Chancroid- treatment

A

Azithromycin 1gm PO
Ceftriaxone 250mg IM single dose
Ciprofloxacin 500mg BID x 3days – contra in Prego
Erythromycin base 500mg TID x 7days

Sex partners
- Exam and treat symptomatic or not if <10 to contact from onset

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22
Q

Chancroid- prognosis

A

Manage

  • Reexam in 3-7days post treatment
  • Time for healing – related to ulcer size
  • Lack of improvement – incorrect diagnosis, coinfection, noncompliance, antimicrobial resistance
  • Lymphadenopathy -> drainage
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23
Q

Lymphogranuloma Venereum- cause

A

Chlamydia trachomatis

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24
Q

Lymphogranuloma Venereum- S/S & PE

A

5–21-day incubation

painless papule, vesicle, ulcer
Tender regional lymphadenopathy – unilateral

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25
Q

Lymphogranuloma Venereum- treatment

A

1st line – Doxy 100mg BID x 21days

2nd – Erythromycin

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26
Q

Granuloma inguinale- pathophysiology

A

Rare in US

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27
Q

Granuloma inguinale0 cause

A

Klebsiella granulomatis

- Calymmatobacterium

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28
Q

Granuloma inguinale- S/S & PE

A

9–50-day incubation
Painless papule -> ulcerations
No regional lymph nodes
Donovanosis

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29
Q

Granuloma inguinale- labs & imaging

A

Culture - donovan bodies

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30
Q

Granuloma inguinale- treatment

A

1st line - Doxy 100mg QD x 3w
Azithromycin 1gm once w x 3w
Cipro 750mg BID x 3w
Trimethoprim-sulfa - 800mg/160mg BID

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31
Q

Gonorrhea- pathophysiology

A

2nd most common reported infection yearly

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32
Q

Gonorrhea- cause

A

Neisseia gonorrhea

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33
Q

Gonorrhea- S/S & PE

A

Urethritis - Male

  • urethral inflammation
  • incubation - 1-14days
  • S/S - dysuria, urethral discharge

Urogenital infection - female

  • Endocervical canal - primary site
  • urethra also - 70-90%
  • Incubation - unclear, 10d?
  • S/S - asymptomatic, vaingal discharge, dysuria, urination, labial pain/swelling, abd pain
  • Bartholin’s abscess - masupilation -> I&D and sew it back up

Skin lesion, arthritis - disseminate gonorrhea

PID

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34
Q

Gonorrhea- labs & imaging

A

NAAT - urine - TOC
Gram stain - Gold
- gram negative diplococi intracellular
Culture

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35
Q

Gonorrhea- treatment

A

Cervix, urethra, rectum, pharynx:
Ceftriaxone 250mg IM single dose + Azithromycin 1g PO single dose

Disseminated Gonococcal

  • 1st line - Ceftriaxone 1gm IM or IV Q 24hr
  • 2nd - Cefotaxime orr Ceftizoxime 1gm IV Q8hr
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36
Q

Gonorrhea- prognosis

A

Resistance

  • penicillin and tetracycline - geographic
  • non to ceftriaxone
  • Fluoroquinolone worldwide
  • Surveillance crucial for therapy
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37
Q

Nongonococcal Urethritis- cause

A 
C. Trachomatis - 20-40%
Genital mycoplasmas - 20-30%
- Ureaplasma urealyticum
- Mycoplasma genitalium 
Trichomonas vaginalis
HSV
Unkown - 50%
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38
Q

Nongonococcal Urethritis- S/S & PE

A

Mild dysuria

Mucoid discharge

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39
Q

Nongonococcal Urethritis- diagnosis

A

Urethral smear - >5PMN
Urine microscopic - >10PMN
Pos Leukocyte esterase

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40
Q

Nongonococcal Urethritis- labs & imaging

A

Urethral smear

Urine

41
Q

Nongonococcal Urethritis- treatment

A

Azithromycin 1gm single dose
OR
Doxy 100mg BID x 7days

42
Q

Chlamydia trachomatis- pathophysiology

A

Most reported STD in US

Screen women <25yo

43
Q

Chlamydia trachomatis- cause

A

Chlamydia trachomatis

44
Q

Chlamydia trachomatis- epidemiology

A

<24yo

45
Q

Chlamydia trachomatis- S/S & PE

A

Asymptomatic

Complications:

  • cervicitis, uretisis, proctiis
  • lymphogranuloma venereum
  • PID - more likely than GC

Cervix - mucopurluant discharge, red base

46
Q

Chlamydia trachomatis- labs & imaging

A 
NAAT - urine
Cervical/urethral swab
Enzyme Immunassay - EIA - Chlamydiazyme 
- 85% sense
- 97% - spec
- high volume screening
- false positives
Nucleic Acid Hybridization - NA probe - Gen-Probe Pace-2
- 75-100% sensitive
- 95% spec
- Detects RNA
- can detect GC and CT

DAN amplification assays - urine

  • PCR - 95% sen
  • LCR - 85% sen
47
Q

Chlamydia trachomatis- treatment

A

Azithromycin 1gm PO single dose
OR
Doxy 100mg BID x 7days

Pregnant

  • Azithromycin 1gm PO OR
  • Amoxicillin 50mmg TID x 7days
48
Q

Chlamydia trachomatis- prognosis

A

Can transmit during delivery
- conjuncitivis, PNA

Screening:

  • sexually active + <25yr - yearly
  • sexually active + >25yr w/ risk - yearly
  • Rescren 3-4m post treatment -> high prevalence of repeat infection
49
Q

Pelvic Inflammatory Disease (PID)- pathophysiology

A

10-20% w/ GC progress to PID
Higher in CT

Inflammatory disorder of upper genital tract

50
Q

Pelvic Inflammatory Disease (PID)- epidemiology

A 
<25
Previous PID
Untreated STI
Multiple sex partners
Douche
IUD
51
Q

Pelvic Inflammatory Disease (PID)- S/S & PE

A

CDC criteria

  • Uterine Adnexal tenderness
  • Cervical motion tenderness

S/S - endocervical discharge, fever, lower abdominal pain, dysuria, pain/bleeding w/ intercourse, irregular vaginal bleeding

Complications

  • infertility - 15-24% w/ 1 episode sec to GC or CT
  • 7x risk of ectopic pregnancy w/ 1 episode
  • Chronic pelvic pain -18%
52
Q

Pelvic Inflammatory Disease (PID)- diagnosis

A

Minimal

  • Uterine/adnexal tenderness OR
  • Cervical motion tenderness

Additional

  • Temp >101F
  • Inc ESR
  • Inc CRP
  • Cervical CT or GC
  • WBC/saline microscopy
  • Cx discharge
53
Q

Pelvic Inflammatory Disease (PID)- labs & imaging

A

Wet prep - white cells
CBC
ESR/CRP
Swabs/urine - GC/CT

Transvaginal US or MRI - thickening or fluid filled tubes

Laparoscopy - diagnostic

All tests can be normal

54
Q

Pelvic Inflammatory Disease (PID)- treatment

A

No data on PO vs IV - should cover anaerobic

Parenteral regimen A

  • Cefotetan 2g IV Q12hr OR
  • Cefoxitin 2g IV Q 6hr And
  • Doxycyline 100mg PO/IV Q12hr

Parrenteral Regimen B
- Clindamycin 900mg IV Q8hr + Gentamicin loading dose IV/IM 2mg/kg -> maintance dose 1.5mg/kg Q8hr

PO Regimen
- Ceftriaxone 250mg IM single dose + Doxycycline 100mg BID x 14days
w/ or w/out -> Metronidazole 500mg BID x 14days

Sex partner

  • Male partners of women w/ PID - examined and treated w/in 60days
  • Treated empirically for CT and GC
55
Q

Pelvic Inflammatory Disease (PID)- prognosis

A

Hospitalization

  • surgica emergencies
  • pregnancy
  • Clinical fialure of PO anitmicrobials
  • Inablity to follow/tolerate PO regimen
  • Severe illness, nausea/vomiting, high fever
  • Tubo-ovarian abscess
56
Q

Epididymitis- pathophysiology

A

Sexually active men - GC or CT

otherwise eColi

57
Q

Epididymitis- S/S & PE

A

Pain, swelling, inflammation of epididymis <6wees
Chronic - >3m
unilateral testicular pain

58
Q

Epididymitis- treatment

A

GC/CT
- Ceftriaxone 250mg IM single dose + Doxy 100mg BID x 10days

Enteric - eColi
- Levofloxacin 500mg PO QD x 10days

59
Q

Bacterial Vaginosis- pathophysiology

A

Not an STD?

Alteration in vaginal flora
- Lactobacillus - decrease

60
Q

Bacterial Vaginosis- cause

A

Gardnerella vaginosis

61
Q

Bacterial Vaginosis- epidemiology

A 
New sex partner
Douching
Dec nl flora
No barrier methods
IUDs
62
Q

Bacterial Vaginosis- S/S & PE

A

Thin gray -white-yellow discharge - fishy odor
- mildly adherent to vaginal wall
Mild vulvar irritation

63
Q

Bacterial Vaginosis- diagnosis

A

Diagnosis - Amsel Criteria - 3 or 4:

  • Abnormal gray discharge
  • pH >4.5
  • whiff test - pos
  • Wet prep - clue cells
64
Q

Bacterial Vaginosis- labs & imaging

A

Wet Prep
- clue cells - epithelial cells eaten away
whiff test

65
Q

Bacterial Vaginosis- treatment

A

Metronidazole - 500mg BID x 7day
Metronidazole gel 0.75% 5g intravainally QD x 5days
Clindamycin cream 5% 5g intravaginally Qhr x 7day

Prego
- Symptomatic - treat due to AE
- don’t use topical
- screen and treat asymp if high risk for preterm delivery - at first prenatal visit 
Metronidazole 500mg PO BID x 7days
Metronidazole 250mg TID x 7days
Clindamycin 300mg BID x 7days

Sex partners
- response to therapy and relapse not related to tx of sex partner

66
Q

Vulvovaginal Candidiasis- pathophysiology

A

Recurrent - >4 symptomatic episodes/year

Don’t usually coexist w/ STD

67
Q

Vulvovaginal Candidiasis- cause

A

Candida albicans - 90%

68
Q

Vulvovaginal Candidiasis- epidemiology

A 
Pregnant
DM
Obese
Immun
Meds - corticosteroids, OCPs, abx
Tight clothing 
Panty liners
69
Q

Vulvovaginal Candidiasis- S/S & PE

A 
Itching
White vaginal discharge - thick, curd like 
Vulvar erythema
Asymptomatic
Burning w/ urination

PE:
Vulva/vaginal tissue bright red
Excoriated external vaginal tissue

70
Q

Vulvovaginal Candidiasis- labs & imaging

A 
Vaginal culture - gold standard 
pH - >4.5
Whiff test - neg, odorless
KOH - spores - spaghetti/meatballs
Wet prep - Hyphae
71
Q

Vulvovaginal Candidiasis- treatment

A

Topical therapy - 7-14day
Fluconazole - 150mg PO x 1 dose

Maintenance
- clotrimazole, ketoconazole, fluconazole, itraconazole

Non-albicans - longer duration of therapy w/ non-azole regimen

Sex partner

  • tx not recommended
  • doesn’t reduce freq of partner
  • Male w/ balanitis - treat

Pregnancy

  • ONLY topical intravaginal regimens recommended
  • 7days

Keep vaginal area dry

72
Q

Trichomonas- pathophysiology

A

2x risk of HIV

Most common non-vaginal STD

Flagellate protozoan - vagina, skene ducts, male/female urethra

Coexists w/ other STDs

73
Q

Trichomonas- cause

A

Trichomonas vaginalis

74
Q

Trichomonas- S/S & PE

A

Vulvar itching, burning, erythema
Thin, ““frothy”” yellow/green discharge - foul smelling
Dysuria
Dyspareunia

Strawberry cervix - petechiae

75
Q

Trichomonas- labs & imaging

A 
Wet prep - gold 
- polymorpho-nuclear cells
- motile flagellates
pH - >5
NAATT - more sensitive and recommended
76
Q

Trichomonas- treatment

A

Metronidazole - 2g PO single dose
Tindiazole - 2g PO single dose

Treatment failure

  • retreat - metronnidazole 500mg BID x 7days
  • Repeat failure - mettronidazole 2mg x 7days
  • metronidazole susceptibility testing via CDC

Sex Partners

  • should be tx
  • avoid intercourse until therapy is completed and both are asymptomatic
77
Q

Trichomonas- prognosis

A

Metro SE - N/V w/ alcohol

78
Q

Trichomonas- prenatal complications

A

preterm birth

79
Q

Human Papillomavirus (HPV)- pathophysiology

A

100 diff strains - 40 infect genital area

Routine pap - early detection

80
Q

Human Papillomavirus (HPV)- cause

A

Type 16 & 18 - high risk - oncogenic

Type 6 &11 - low risk

81
Q

Human Papillomavirus (HPV)- S/S & PE

A

associated w/ cervical cancer - probs other cancer too
- 99% of cervical cancer w/ HPV DNA

Anogenital Warts

  • HPV type 6 or 11
  • Asymptomatic - if large can cause obstructive issues
  • Large - have a risk of causing cancer

Condyloma acuminata

82
Q

Human Papillomavirus (HPV)- diagnosis

A

HPV DNA

83
Q

Human Papillomavirus (HPV)- treatment

A

Removal of symptomatic warts - obstructive issues
Difficult to determine if treatment reduces transmission
No evidence any regimen is superior

Patient applied

  • Podofilox - 0.5% solution or gel
  • Imiquimod - 5% cream
  • Sinecathechins - 15% ointment

Provider administered

  • Cryotherapy
  • Tricholoroacetic or Bichloroacetic acid - 80-90%
  • Surgical removal

Pregnancy - DO NOT use topical

  • imiquimod, podophyllin, podofilox, sinecatechins - DO NOT USE
  • support removal due to proliferation and friability
  • Types 6 & 11 cause resp papillomatosis in infants and children
  • C section?
84
Q

Human Papillomavirus (HPV)- prognosis

A

Vaccines

  • 9-26yo - now approve for 45, don’t do it though
  • Gardisil quadravalent - 6, 11, 16, 18
  • Gardisil 9 valent - 6, 11, 16, 18, 31, 33, 45, 52, 58

Cervical Cancer Screening

  • STD hx inc risk
  • HPV testing for SCUS pap testing
85
Q

Scabies- pathophysiology

A

Parasitic skin infection

86
Q

Scabies- cause

A

Sarcoptes scabiei

87
Q

Scabies- S/S & PE

A

Intense itching
Contagious
Look for tracking

88
Q

Scabies- treatment

A

Permethrin 5% cream - all areas of body
- leave it on overnight and shower off

Ivermectin 200ug/kg PO - repeat in 2w

Persistent Symptoms

  • Rash and pruritis lasts >2w
  • > tx failure, resistance, reinfection, druge aller gy, cross reactivity w/ Houshold mites
  • pay attention to fingernails
  • Treat close contacts empirically
  • Wash - linens, bedding, clothing
89
Q

Scabies- prognosis

A

Norwegain Scabies

  • aggressive infestation in immunodeficient, debilitated or malnourished
  • greater transmissibility
  • Substantial treatment failure w/topical scabicide or oral ivermectin
  • Treat - combo topical scabicie w/ ivermectin OR repeat treatments w/ ivermectin
90
Q

Pediculosis Pubis- pathophysiology

A

In pubic hair

Spread via sexual contact or shared infected bedding/clothes

Eggs laid at base of hair shafter
- hatch in 7-9d

91
Q

Pediculosis Pubis- cause

A

Crab louse - Phthirus pubis
Pruritus
Lice
Nits

92
Q

Pediculosis Pubis- S/S & PE

A

Itching - pubic and anogenital

Pale brown insects or ova seen on hair shafts

93
Q

Pediculosis Pubis- treatment

A

Wash bedding/clothing

Permethrin 1%
Lindance 1% shampoo
Pyrethrins w/ piperonly butoxide

Retreat - if sx persist

Sex partners - tx if w/in last month

94
Q

Molluscum Contagiosum- pathophysiology

A

Benign epithelial

95
Q

Molluscum Contagiosum- cause

A

Poxvirus

96
Q

Molluscum Contagiosum- epidemiology

A

Young children

Adults - sexually transmitted

97
Q

Molluscum Contagiosum- S/S & PE

A 
Pearly dome shaped papules w/ umbilicus
genital
Lower abdomen
Butt
Inner thigh
98
Q

Molluscum Contagiosum- diagnosis

A

Skin scraping or biopsy

-> Microscope - numerous inclusion bodies in cytoplasm

99
Q

Molluscum Contagiosum- treatment

A

Self-limiting
Cryotherapy
Curettage
Topical therapy - imiquimod

Clin med sem 2 (30 decks)

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