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sexual transmitted disease pc 615 test 7 > STD > Flashcards

STD Flashcards

1
Q

Human Papillomavirus (HPV)

A

most common STI
genital warts : 90% type 6 & 11
cervical cancer: 16 & 18

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2
Q

HPV assessment

A

profuse, irritating vaginal discharge, itching, dyspareunia, or postcoital bleeding
“bump” on vagina

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3
Q

Prevention of HPV

A 
Cervarix 
Gardasil  
both protect agains type 16 & 18 
can give as young as 9 y.o 
NOT recommend during pregnancy but yes during lactation 
no routine pregnancy test prior vaccine
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4
Q

management o fHPV

A

Podofilox, imiquimod cream or sinecathechins oinment (patient administered )

Cryotherapy with liquid nitrogen, podophyllin or TCA/BCA or surgical removal ( clinican administered)

alternative : intralesional inerferon
photodynamic therapy or topical cidofovir.

**condoms should be used until both partners are lesion free and for as long as nine months after the appearance of lesions as subclinical HPV may remain infectious.

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5
Q

Genital Herpes

A

recurrent, incurable viral infection characterized by PAINFUL VESICULAR eruption of the skin and mucosa of the genitals.

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6
Q

HSV -1

A

non-sexually transmitted

more common with gingivostomatitis and oral ulcers (fever blisters)

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7
Q

HSV-2

A

sexually transmitted
higher in BLACK
most does not know they have it

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8
Q

HPV assessment

A

viral symptoms: malaise, HA, fever, or myalgia
local symptom: vulvar pain, dysuria, itching, or burning at site of infection and painful genital lesions (vesicles, ulcerated, or crusted areas) that heal spontaneously

inguinal & generalized lymphadenopathy, elevated temp.

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9
Q

diagnostic testing for HPV

A
  • ->polymerase chain reaction (PCR) preferred test in women who have genital ulcers or other mucocutaneous lesions.
  • -> viral culture during primary infection (vesicular stage)
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10
Q

management of HPV

A 
acyclovir 400mg PO TID for 7-10 days
Famciclovir 250mg PO TID for 7-10 days
Valacyclovir 1gm PO BID for 7-10 days 
**recurrent infections--> same meds but for 5 days
**suppressive therapy--> daily
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11
Q

chancroid

A

bacterial infection of genitourinary tract caused by gram negative bacteria known as Haemophilus ducreyi.
uncommon STI

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12
Q

chancroid assessment

A

PAINFUL genital ulcers
regional lymphadenopathy
definite dx is difficulty only identified by culture on special medium that is not used routinely

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13
Q

chancroid management

A

azithromycin single dose
ceftriaxone 250mg IM single dose
ciprofloxacin 500mg BID for 3 days
erythromycin 500mg QID for 7 days
comorbidities (HIV infection) require repeated or longer therapy.
improvement should be seen within 3 days of treatment.
sexual partner within 10 days of onset symptoms should be evaluate

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14
Q

Pediculosis PUbis

A

parasitic infection

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15
Q

Pediculosis PUbis assessment

A

pruritus (caused by lice ingesting saliva, and then depositing digestive juices and feces into the skin.
examine of egg nits in the involved area (hand lens and light can be helpful in identifying them.

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16
Q

management of Pediculosis PUbis

A

permethrin 1% cream rinse or pyrethrins with piperonyl butoxide.
*** applied to affected areas and washed off after 10 minutes
alternative tx if tx failure/drug resistance:
–>malathion lotion
–>oral ivermectin

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17
Q

Trichomoniasis

A

an anaerobic one-celled protozoan with characteristic of FLAGELLAE
commonly live in the vagina & urethra in men
10 times higher in BLACK women
85% asymptomatic, however common experience a characterically YELLOW to GREEN FROTHY MUCOPURULENT COPIOUS, MALODOROUS discharge.
may have InFLAMMATION of vulva vagina, or both
IRRITATION, PRURITUS, DYSURIA, OR DYSPAREUNIA.
***discharge worsen during and after menstruation

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18
Q

Trichomoniasis Assessment

A

STRAWBERRY spots or tiny petechiae on cervix & vaginal walls
severe cases: inflammation
pH is elevated

19
Q

Trichomoniasis diagnosis test

A

WET PREP: visualization of typical one-celled FLAGELLATE trichomonads.
increase WBC
culture is sensitive and highly specific but not routinely performed. this only use when trichomoniasis is suspected but cannot comfirm with microscopic (wet prep)

20
Q

Trichomoniasis management

A

metronidazole (FLAGYL) 2gm PO single dose NO TOPICAL !!!
tinidazole 2gm PO single dose
**not to drink alcohol during abt therapy or will experience abdominal distress, nausea, vomiting, HA. abstinence from alcohol should cont. 24 hours after complete metronidazole tx and 72 hours after tinidazole
sex partner should be treated as well & abstain from sex until treated and asymptomatic.

21
Q

Chlamydia

A

higher in 14-24 y.o, BLACK, multiple partners, and failure to use barrier methods of contraception.
most serious complication –> PID

22
Q

Chlamydia assessment

A

POSTCOIDAL bleeding, MUCOID or PURULENT cervical discharge, urinary frequency, dysuria, lower abdominal pain or dyspareunia.
**BLEEDING result from inflammation and erosion of cervical columnar epithelium **

23
Q

diagnostic testing for chlamydia

A
  • ->urine or swab specimens from endocervix or vagina
  • -> nucleic acid amplification tests (NAATs) PREFERRED technique because they provided the highest sensitivity.
  • -> cell culture
  • ->direct immunofluorescence,
  • ->enzyme immunoassay (EIA)
  • ->nucleic acid hybridization test.
24
Q

management of chlamydia

A

AZITHROMYCIN 1gm single dose

or doxycycline 100mg BID for 7 days

25
Q

what is the TEST OF CURE ?

A

3-4 weeks after treatment
is not necessary unless a woman is pregnant
has persistent symtoms or may have reinfection.
seen in women reinfected by an untreated partner
**abstain from sex until sexual partner treated and wait 7 days after single dose treatment or until completion of 7 day regiment before resuming sexual activity.

26
Q

Gonorrhea

A

aerobic gram-negative diplococcus Neisseria gonorrhoeae
2nd most reported bacteria STI
15-24 y.o (71%)
BLACK women (common)
complications: PID, pelvic abscess or Bartholin’s abscess.

27
Q

what is Disseminated gonococcal infections (DGI) ?

A

untreated gonorrhea (rare)
1st stage: bacteremia with chills fever and skin lesions
2nd stage: acute septic arthritis with effusions : wrists, knees, and ankles.

28
Q

gonorrhea assessment

A

DYSPAREUNIA, change in vaginal discharge, UNILATERAL labial pain and swelling (Bartholin’s gland infection) , or lower abdominal discomfort.
menstrual irregularities with longer painful menses

–>anal intercourse : profuse purulent anal discharge, rectal pain, and blood in the stool. rectal pain itching fullness, pressure, and pain are also common symptoms.

–> viral pharyngitis : red swollen uvula and pustule vesicles on soft palate and tonsils similar to streptococcal infection

29
Q

diagnostic testings for gonorrhea

A

culture
nucleic acid hybridization tests (swabs)
NAATs (urine or swab specimens from endocervix or vagina)

30
Q

management for gonorrhea

A

CEFTRIAXONE IM in single dose
plus +
AZITHROMYCIN 1gm PO singel dose
**all pt should be retested 3 months after tx d/t high rate of reinfection.

31
Q

Pelvic Inflammatory Disease

A

any combination of endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis.
**high risk : ADOLESCENT d/t decrease immunity & increase risk for gonorrhea & chlamydia

32
Q

Pelvic Inflammatory Disease assessment

A 
abdominal, pelvic, and low back PAIN
abnormal vaginal discharge
intermenstrual or postcoital BLEEDING
fever 
N/V 
urinary frequency
33
Q

physical examination of PID

A 
adnexal tenderness
abdominal tenderness
uterine tenderness
tenderness with cervical movement 
pelvic tenderness (bilateral)
34
Q

diagnosis of PID

A

one or more of the following :
**cervical motion tenderness
**uterine tenderness
**adnexal tenderness
one or more additional criteria to enhance the specificity of minimum criteria:
temp >101
abnormal cervical or vaginal mucopurulent discharge
presence of abundant numbers of WBC on saline microscopy of vaginal fluid
elevated erythrocyte sedimentation rate
elevated C-reactive protein level
-documentation of gonorrhea & trachomatis

specific dx:
endometrial biopsy
transvaginal sonography or MRI showing thickened fluid-filled tubs or w/o free pelvic fluid
laparoscopic abnormalities

35
Q

treatment for PID

A

broad spectrum abt, no single regime appears to be superiro to the others.
clinical improvement w/in 72 hours if not should be evaluate

oral :
ceftrizxone IM single dose + Doxycycline 100mg BID for 14 days with or w/o metronidazole BID for 14 days.

36
Q

Syphilis

A

systemic disease caused by Treponema pallidum, motile spirochete
high in Black
30-40 y.o (rather than young adult)
complex infection that can lead to serious systemic disease and even death when untreated.

37
Q

primary syphilis

A

CHANCRE painless papule at the site of inoculation and then erodes to form a nontender, shallow, indurated clean ulcer that is several millimeter to a few centimeter in size
REGIONAL LYMPHADENOPATHY
3-90 days
infectious routes: sexual vertical & chancre

38
Q

secondary syphilis

A

chancre may still present
SKIN LESIONS (papular rash of soles and palms, patchy alopecia, condylomata lata-wartlike lesion)
systemic symptoms: FEVER MALAISE ANOREXIA WT. LOSS, HA, MYALGIAS
lymphadenopathy

39
Q

latent/tertiary syphilis

A 
cardiovascular syphilis (aortitis) 
skin lesions (gumma)
40
Q

diagnostic testing for syphilis

A

dark-field examination & direct fluorescent antibody for T.pallidum (DFA-TP) of lesion exudates or tissue will provide a definitive diagnosis of early syphillis.

VDRL & RPR are screening tests
titer 1:16 =active disease

CSF to confirm neurosyphilis

41
Q

management of syphilis

A

single dose PENICILLIN G is preferred drug for all stages of syphilis ..
3 weeks treatment for latent tertiary or unknown duration syphilis
alternative: doxycycline or tetracycline

42
Q

Hepatitis B

A

bloodborne or body fluids (semen, saliva)
affects primarily the liver. it remains asymptomatic in as many as half of persons with infection.
s/x arthralgia, fatigue, anorexia, N/V, fever, abdominal pain, CLAY COLORED stool, dark urine and JAUNDICE

43
Q

parameters of HEPATITIS B testing

A

HBsAG - hepatitis B surface antigen
(indicates the patient has acute or chronic
HBV infection and can transmit it to
others)
anti-HBs- Hepatitis B surface antibody
(indicates pt. has immunity resulting from
vaccination or previous infections)
anti-HBc- total hepatitis B core antibody
(indicates the patient has previous or
ongoing infection)
IgM anti-HBc- IgM antibody to hepatitis B core
antigen (indicates pts has had an acute
infection within the past 6 months)

44
Q

management hepatitis B

A

Vaccination for all individual
definite exposure to hepatitis B should be given HEPATITIS B IMMUNOGLOBULIN IM single dose asap and preferably w/in 24 hours after exposure.
chronic HBV should be referred to specialist

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