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Womens Health > STD > Flashcards

STD Flashcards

1
Q

High risk populations for STD

A

youth (15-24)
Racial/ethnic minorities (black, Hispanic)
MSM (72% syphilis in 2011, high HIV coinfect)

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2
Q

What is Vulvovaginal Candidiasis (VVC) and what causes it

A

Common “yeast infection” not STD (at least 75% women have 1 episode)

Cause: Candida albicans 90%
(can be caused by other candida sp. or yeasts - candida glabrata, candida tropicalis etc)

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3
Q

What are the presenting sx associated with VVC?

A

vulvar pruritis, external dysuria, burning, dyspareunia, swelling, redness, excoriation

Thick curd like vaginal dc
Normal vaginal pH (<4.5)

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4
Q

What are risk factors associated with VVC

A

taking antibiotics (PCN, Augmentin), immunocompromised pt (on steroid, DM, HIV+)

*warm, moist environment

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5
Q

How do you dx VVC?

A

Clinically

Testing:

  • Wet prep (saline & 19% KOH); micro budding yeast and hyphae (spaghetti and meatballs)
  • candida culture usually not needed
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6
Q

How do you treat uncomplicated VVC?

A

short course (1-3d) topical/vaginal azole such as Clotrimazole (OTC)

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7
Q

What is considered a complicated yeast/VVC infection? How do you treat complicated VVC?

A

Recurrent (>4 episodes in 1 yr), Sever, non-albicans VVC, uncontrolled DM, immunocomprom

  • treat longer (7-14d) with topical/vaginal azole [Clotrimazole] or oral fluconazole (Diflucan)
  • if non albicans, avoid fluconazole
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8
Q

If pt has non-albicans VVC, how should they be treated

A 
considered complicated VVC
Avoid oral fluconazole
treat longer (7-14d) topical/vaginal azole
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9
Q

In VVC, does the male partner need to be treated

A

NO

unless he has balanitis (inflammation of skin covering glans penis)

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10
Q

How should you treat a pregnant pt with VVC

A

do not give oral Fluconazole, treat pregnant with Topical treatment (Clotrimazole)

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11
Q

If a pt has recurrent or difficult to treat yeast infections, what should you be suspicious of and test for

A

DM, HIV

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12
Q

What is BV (bacterial Vaginosis) and what is the cause

A

BV due to disruption of usual “healthy” vaginal microflora (lactobacillus sp), not an STD

  • allows overgrowth of bacteria
  • cause is usually polymicrobial, often assoc with Gardnerella vaginalis and Mobiluncus sp (gram variable anaerobes)
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13
Q

What sx are associated with BV

A

vaginal irritation
thin white or gray dc
strong fishy odor

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14
Q

what are risk factors for developing BV? can you get BV if not sexually active

A

new or multiple sex partners (but not an STD)
Vaginal douching
*yes, can affect women that are not sexually active

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15
Q

How do you dx BV?

A

Need at least 3/4 Amsel’s criteria

  1. thin, white homogenous dc
  2. Clue cells on microscopy
  3. Vaginal fluid pH >4.5 (alkaline)
  4. fishy odor when adding KOH solution (+whiff)
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16
Q

what is the best lab test for dx BV?

A

GRAM STAIN is best lab test to dx BV

  • shows anaerobes known to cause BV and lack of lactobacilli
  • Gram stain is gold standard but not generally used clinically
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17
Q

How do you treat BV? do you treat everyone

A

treat all pt with sx, Male partner doesn’t need tx

  1. Metro (flagyl) po x 7d
    * no alcohol while on metro, disulfuram rxn
  2. Metro gel intravaginally for 5d
  3. Clindamycin po or intravaginally
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18
Q

How do you treat pregnant pt with BV?

A

Use oral med (Metro po x7d) in order to maker sure treating entire vaginal tract

*opposite of VVC, where you use topical clotrimazole and don’t use oral fluconazole

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19
Q

What are some complications of BV?

A

Increases risk of acquiring/transmitting HIV
Increases risk fo acquiring herpes, GC, CT
Association with PID (not direct cause)

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20
Q

What is Trichomoniasis, what causes it, and how frequent?

A

Trich is most common non-viral STD
cause: Trichomonas vaginalis (single celled protozoan parasite)

  • common
  • sx 1-4 wk post exposure (usually vaginal sx), men usually asymp
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21
Q

Though men are usually asymp in Trich, if have sx, what are they and how often do they occur?

A

Sx in <10% cases

*sx of urethritis: clear or mucupurulent urethral dc and/or dysuria

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22
Q

How do pt normally present with Trichomoniasis

A

*Increased vaginal pH >4.5 (like BV)
*vaginal irritation, malodorous/fishy, frothy, yello-green discharge
*petechiae on cervix or vagina
STRAWBERRY CERVIX

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23
Q

How would you diagnose a pt with Trichomoniasis

A
  1. largely on wet mount (do quickly), see motile flagellated organisms
  2. Swab (vaginal, cervical) then culture but may take up to 7 d
  3. Other: NAAT to detect genetic material: (faster, more sensitive), preferred for males
  4. May identify on PAP smear
    * testing difficult on males, know 5-20% of men with NGU have trich
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24
Q

How do you treat Trichomoniasis

A

Treat every: pt & partner with METRO (FLAGYL) po

  • no sex for pt and partner till tx complete
  • consider treating for CT and GC
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25
Q

What are complications of Trichomoniasis

A

increases risk fo acquiring and transmitting HIV

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26
Q

What should pregnant pt with Trichomoniasis be aware of

A

Trich increases risk of PROM, preterm delivery, LBW yet tx is not shown to reduce risks

  • treat pt with sx
  • no breastfeeding will on Metro (flagyl)
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27
Q

What is CT and what causes it

A

Chlamydia (CT) is the most common bacterial STI in the US, peaks in late teens early 20s

Cause: Chlamydia trachomatis (G- bacterium)

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28
Q

Who should be screened for CT and what do CT pt commonly have

A
  • women <25 screen for chlamydia yearly
  • screen older women with risk factors, all preg pt
  • routine screening for Males not recommended
  • Pt frequently co-infected with gonorrhea
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29
Q

What sx do pt with CT normally have

A
  • often Asymp (50% M, 80% women asymp)
  • sx 1-3 wk post exposure
  • women: cervical dc, vaginal bleeding, low abdominal, Fever/chill, adnexal/uterine tenderness
  • Men: irritated urethra/urethritis, penile dc, dysuria
  • can cause oral and rectal infections
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30
Q

Chlamydia and gonorrhea are more _____ where as BV, Trich and VV are more ________

A

CT and GC = cervicitis

BV, VV, Trich = vaginitis

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31
Q

Chlamydia: what are Women sx

A

asymp in 80%

vaginal bleeding, cervical dc, low abdominal pain, fever chills, adnexal/uterine/cervical tenderness

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32
Q

Chlamydia: what are Male sx

A

Penile dc, urethritis, dysuria

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33
Q

How do you dx Chlamydia?

A

a) Swab: cervical, vaginal or male urethral - NAAT
b) Urine: NAAT
c) Pharynx or rectal swab: NAAT, check with lab
* sensitivity a bit better with swab; plus can test for Trich, GC at same time

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34
Q

How do you treat Chlamydia

A

Treat everyone: pt/partner (if possible test partner)
*in AZ can treat partner without testing

Doxy po x 7d OR
Azithromycin (Zithromax) po x1dose

No sex during tx (or 7 d post Zithromax)

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35
Q

What are some notes about treating pt with Chlamydia (treated with doxy x 7d or Azithromycin x 1d)? Pregnancy recommendation?

A

Consider treating for gonorrhea too
no sex during tx or 7d after Zithromax tx
Retest in 3-4 month

*Preg = do Doxy bc Preg cat D
TREAT PREG WITH ZITHROMAX
*retest 3 wk after preg pt tx

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36
Q

What are some complications of Chlamydia

A

Increases risk of acquiring and transmitting HIV

  • left untreated, can cause PID and assoc complications
  • in M: can cause epididymitis
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37
Q

What should a pregnant pt with CT be aware of

A
  • May lead to preterm delivery
  • transmittable to neonate during delivery:
  • conjunctivitis (ophthalmia neonatorum) &
  • pneumonia
  • can cause other respiratory tract infections
  • ocular specimens should be tested for GC, CT

NO DOXY FOR PREG, only zithromax

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38
Q

What causes GC, when do pt get sx and who should you screen

A

cause: Neisseria gonorrhea (G- diplococci bac)
* screen pt at risk (USPSTF)
- risk: GC, other STD, new/mult partners
* pt often co-infected with chlamydia

sx 1-14 d post exposure

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39
Q

What sx does a pt with GC have

A

similar to CT but more severe
*more mucupurulent dc, abdominal pain, etc
WOMEN: vaginal dc, low abdominal pain, fever, cervical motion tenderness
MEN: urethritis, white yellow or green penile dc, dysuria

(can cause oral and rectal infections)

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40
Q

How do you dx pt with GC

A

Swab or urine (like Chlamydia)

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41
Q

How do you treat GC

A

tx all (pt/partner)

Ceftriaxone (Rocephin) IM injection PLUS azithromycin or doxycycline (to cover CT)

  • no sex during tx
  • retest 3-4 mth
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42
Q

What are complications of GC

A

increase risk getting/giving HIV
If untreated can cause PID and associated complications (males can cause epididymitis)

*can cause conjunctivitis, meningitis, endocarditis, disseminated disease

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43
Q

what should a pregnant pt be aware of if they have GC

A

Transmittable to neonate during delivery

  • neonate: sometimes causes ophthalmia neonatorum (can perforate globe, cause blindness)
  • -> ,most states require ophthalmia neonatorum prophylaxis: top erythromycin applied both eyes
  • in newborns with sx, ocular specimens should be tested for GC and CT (culture before initiating tx)
  • rarely can cause sepsis, arthritis, meningitis
44
Q

What is NGU? sx? dx? tx?

A 
Non gonococcal Urethritis
Cause: CT, mycoplasma genitalium, other
sx: urethritis
dx: test for GC, CT
Tx: dependent on testing, empiric for CT (azithromycin or doxycycline)
*follow up for persistent sx
45
Q

What is PID

A

pelvic inflam dz: gen term referring to spectrum of inflammatory dx of upper genital tract
–> endometritis, salpingitis, tubo-ovarian abscess

46
Q

What causes PID

A

most commonly sexually transmitted organisms (CT, GC)

*other: anaerobes, H flu, CMV

47
Q

What is the freq and pathophysiology of PID

A

750,000 infections/yr
10-15% become infertile

Patho: ascending infection from vagina or cerix to upper genital tract

48
Q

What are the sx of PID: acute vs chronic infection (cause of chronic PID?)

A

May be subtle/mild

acute: vag dc, low ab pain, chandelier sign (cervical motion tenderness), uterine/adnexal tenderness, dyspareunia, fever >101

Chronic: occurs due to insuff tx, vague sx

49
Q

Risk factors for PID

A

<25, African Am, early onset sexual activity, multiple partners, douching, IUD w/in 3 wk, *prior hx PID

50
Q

PID diagnosis and testing

A

dx largely clinical; other impt testing
*hCG test
*GC, CT
*check WBC on saline microscopy of vaginal fluid
*CBC, ESR, CRP
*US (r/o ectopic preg, thickening in areas of inflammation, tubo-ovarian abscess)
laparoscopy (visualization, can take specimens)

51
Q

How do you treat PID

A 
treat like  GC/Chlamydia
*treat empirically:
*Outpt:
ceftriaxone IM injection &
doxy x14d or Zithromax & 
w or w/o Metro x14 d
  • inpt: IV regiment
  • follow up in 48 hr
52
Q

When should you hospitalize for PID

A

*if surgical emergency cannot be ruled out (ectopic preg, appendicitis, ovarian torsion)

  • Pt is preg
  • pt not responding to oral abx within 8-72 hr
  • pt has tubo-ovarian abscess
  • pt very ill (high fever, N/V, looks sick)
53
Q

Complications of PID

A

a) infertility
b) ruptured tubo-ovarian abscess (surg emerg)
c) Chronic pelvic pain
d) increased risk ectopic pregnancy
e) Fitz-hugh curtis syndrome (perihepatitis characterized by RUQ pain and adhesions)

54
Q

Genital Herpes: cause, background?

A

cause: HSV type 1 or 2
* common
* HSV 2 usu causes genital lesions
* most infected have minimal or no sx
* commonly acquired from asymptomatic partner

55
Q

What are the 4 designations of Genital Herpes

A
  1. Primary
  2. Non-primary 1st episode
  3. Recurrent
  4. Asymptomatic viral shedding
56
Q

What is the pathophysiology of Genital Herpes

A
  • spread through contact w/ lesions, mucosal surfaces, genital secretions or oral secretions
  • viral shedding can occur when lesions not present
  • virus remains latent in nerve root ganglion
  • virus may be reactivated by change in immune status (stress, menses, infection
57
Q

what are the presenting sx of genital herpes

A

prodrome of burning, tingling and/or pruritis followed by outbreak of painful vesicles on erythematous base
*initial/primary outbreak tends to be most severe

dew drops on rose petal, shallow, potentially coalescing ulcers
*can make it difficult to dx

58
Q

How do you dx herpes

A

clinically

  • direct viral culture from swab (preferred but can get false neg, requires active lesion)
  • serology/blood: some tests can detect HSV1 &2 specific antibodies
  • limitations: antibodies usually do not appear until 3-4 wks post exposure, lesions may appear in 2-14 days; + test not definitive for genital herpes
59
Q

How do you treat genital herpes

A

acyclovir. .. “cyclovirs”
- for initial outbreak: 7-10 d
- recurrent outbreak: 1-5d
- for suppresion: daily dose, discus dc annually, REDUCES not eliminates risk of transmission to partner

60
Q

Things to consider for pt preg with genital herpes

A

Can be vertically transmitted to infant before, during or after delivery (during delivery most common)
*C section reduces risk

Risk:
if mom with primary infection: 50% risk
if mom with recurrent HSV: risk 1% (mom’s antibodies are protective)

61
Q

What perfecnt of infants with neonatal HSV are born to mothers with no known hx of genital HSV

A

MOST! 70-95%

62
Q

What types of Neonatal HSV are possible

A

3 syndromes:

1) localized skin, eye, mouth (SEM) dz
2) CNS dz (encephalitis) *long term morbidity common ie mental retardation
3) Disseminated disease (Organ invovlement) *mortality common (80%)

63
Q

How can you help prevent neonatal HSV

A

Offer women with active recurrent genital herpes suppressive viral therapy (acyclovir) at or after 36 wk gestation (may reduce need for C section)

*perform C section if active genital lesions or prodromal sx (ie vuvlvar burning) at time of delivery

64
Q

What counseling should you provide women

A

during 3rd trimester….

Pregnant women w/o known genital herpes
- avoid intercourse w/ partner or suspected of having genital herpes

Preg women w/o known orolabial herpes
- avoid receptive oral sex w/ partners known or suspected of having orolabial herpes

65
Q

Cause and history of HPV

A

human papillomavirus (>40types)

  • can infect genital area (vulva, vagina, penis, anus)
  • can also infect mouth, throat)
  • MOST COMMON STD
  • nearly all sexually active men and women will get at least one type of HPV at some point in their lives (most clear w/in 2 year)
66
Q

Sx of HPV

A

*most never have sx

  • visible genital warts (condyloma acuminata)
  • soft, flesh color, single/mult flat cauliflower like
  • precancerous, cancerous changes (anywhere)
  • persistent HPV main cause of cervical cancer
67
Q

How do you dx HPV

A
  1. visualize warts: vinegar, biopsy if uncertain
  2. Abnormal pap: (anal Pap not recommended)
    * no test for men*
68
Q

How do you treat HPV

A

No cure, just tx for dz HPV causes

  • destroy warts:
    a) liquid nitrogen, TCA
    b) rx: podofilox ointment, topical imiquimod (aldara)
69
Q

What are complications of HPV

A

~15 types lead to cervical CA

*types 16,18 account for 70% of cervical CA

70
Q

How do you prevent HPV

A

Vaccine (FDA licensed 2006), series of 3 inj

1) Cervarix (bivalent), for girls only: types 16,18 cervical CA protection
2) Gardasil (quad) boys and girls: 16, 18, 6, 11 protects against cervical, vulvar, vaginal, anal CA and warts

71
Q

What are the CDC recommendations for the HPV vaccine

A

Recommended for girls and boys

  • 11-12 (can start as early as 9)
  • 13-26 girls who have not completed series
  • 12-21 who have not completed series

*best to start before becoming sexually active

72
Q

What are things to be aware of if pregnant and have HPV

A

rarely can be transmitted to neonate during delivery

*rarely causes warts in baby’s throat

73
Q

What is the cause of syphilis and pathophysiology of transmission?

A

Cause: Treponema pallidum

  • highest rates Men 20-29
  • direct contact with infected lesion (genitals, anus, lips, mouth) –> bacteria enter skin –> 10-90 d create painless chancre
74
Q

What is syphilis known as and describe the infectious process?

A 
"great imitator"
Has four potential phases:
1. Primary
2. Secondary
3. Latent 
4. Late/tertiary
75
Q

What does the primary phase of syphilis involve?

A

Painless chancre appears at location where syphilis entered, lasts 4-6 wk

76
Q

What does the syphilis chancre appear like

A

punched out appearance, rolled edges, painless

77
Q

What does the secondary phase of syphilis involve?

A

multiple manifestations

a) RASH very common: usually non pruiritic, characteristically on palms and soles of feet, not contagious
b) CONDYLOMA LATA: moist, heaped, wart like papules usually in intertriginous areas, highly contagious
c) MUCOUS PATCHES: painless flat patches involving oral cavity, pharynx, genitals (not painful, pt may be unaware); in 6-30% secondary syphilis, highly infectious

78
Q

How does secondary syphilis present itself?

A

besides rash, condyloma lata, mucous patches:

  • pt may also experience systemic sx such as malaise, LAD
  • secondary syphilis usually lasts 2-6 wks then enters latent phase
79
Q

Aspects of Latent syphilis?

A

Asymptomatic, syphilis no longer sexually transmittable, may persist for years

80
Q

How may lat syphilis present?

A

may appear 10-20 YEARS after infection acquired, develops in 15% of those untreated
*causes neurologic deficits (blindness, dementia) & damage to internal organs

*neurosyphilis can occur w/in any stage of syphilis

81
Q

How do you dx syphilis?

A
  • Bacteria from chancre under DARKFIELD MICRO
  • Serology: RPR or VDRL
  • titer indicates dz activity, may be low if false+ (eg low titer is 1:4)
  • confirm RPR with antibody test FTA-ABS
82
Q

what does RPR stand for? VDRL?

A

*these are initial serology tests to dx syphilis
RPR: rapid plasma reagin
VDRL: venereal dz research lab test

83
Q

False positives on RPR and VDRL test for syphilis may be due to

A

autoimmune dz, illness, possibly pregnancy

84
Q

If you suspect neurosyphilis (late stage), what should you do

A

must do LP (lumbar puncture) & VDRL on spinal fluid to confim

*refer to neurologist

85
Q

How/who should you treat syphilis

A 
Treat everyone (pt/partner) with:
* Benzathine PCN G 2.4 mu IM x 1
  • additional doses required if syphilis present >1yr
  • get pt hx, contact county health dept for advice
86
Q

If pt with syphilis is allergic to PCN (syphilis tx is Benzathine PCN G 2.4 mu IMx1), then what do you do

A

treat with Oral DOXYCYCLINE

*however always treat HIV pt & preg pt with PCN

87
Q

Who should you always treat with PCN for syphilis

A

HIV and preg Patient

88
Q

How do you confirm treatment success for syphilis pt

A

check RPR titer (3, 6, 12, 24 mth)

4 fold decrease = adequate response

89
Q

What are some complciations of syphilis

A

chancre ^ risk getting/giving HIV

*late syphilis risk

90
Q

What is congenital syphilis

A

untreated syphilis during preg, esp early syphilis can lead to stillbirth, neonatal death or disorders

Disorders: deaf, neuro impairment, bone deform

91
Q

How do you prevent congenital syphilis

A

Screen preg women at 1st prenatal visit

  • If risk high, screen and obtain sexual hx again at 28 wk and at delivery
  • if preg pt is PCN allergic, consider desensitization with oral PCN
  • monitor serology closely to confirm successful tx
92
Q

What is chancroid, what causes it and how does it present?

A

STD caused y H. ducreyi

  • sporadic US outbreaks
  • Presents: painful tender genital ulcer, fould smelling contagious dx, inguinal adenitis (buboes)
93
Q

How do you dx chancroid

A

r/o syphilis

if chancroid suspected, contact county health dept

94
Q

What is lymphogranuloma venereum (LGV)

A

LGV is STD caused by Chlamydia trachomatis, rare in US but most commonly in MSM population usually

95
Q

How does lymphogranuloma venereum present

A

systemically
Unilateral inguinal bubo
self limited genital ulcer or papule at site of innoculation
anal dx and rectal bleeding

96
Q

how do you dx lymphogranuloma venereum (LGV)

A

r/o syphilis

If LGV suspected, contact Country Health Dept

97
Q

What is Pediculosis Pubis, how do you dx it and how do you tx it?

A

STD (pubic lice) caused by parasite pthirus pubis
“crab louse”

dx: clinical presentation
tx: premethrin 1% cream rinse

98
Q

If you are in doubt of STD dx, what should you do

A

contact county health dept

99
Q

Genital lesion.. ddx?

A

syphilis, LGV, chancroid, HPV, Herpes

100
Q

For a pregnant women, what should you do at first visit

A

screen for HIV, syphilis, Hep B, GC, CT

  • Hep C for those at risk
  • take hx to assess for HSV
101
Q

How should you approach adolescents and STDs?

A

realize STDs are highest in adolescents

  • minors may consent to STD service in ALL 50 states (some regard HIV tx separately0
  • routine screening for GC/chlamydia women <25
  • discuss HIV screening (CDC rec for 13-64 yr)
  • discuss/offer HPV vaccine
102
Q

How should you address MSM population and STDs

A

realize MSM may be at higher risk, take good hx

  • screen HIV and syphilis annually
  • offer HepA&B vaccines
103
Q

How should you address WSW and STD

A

do not assume low risk

104
Q

what should you do if young children have STD?

A

prompt involvement of CPS

105
Q

General considerations STD screening?

A

screen pt age 13-64 for HIV
- screen those with risk factors annually
- opt out testint
all pt with STD should be screened for HIV (test for HIV with each new STD)

*report communicable STDs

Womens Health (3 decks)

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