STD Flashcards
Vaginitis – Non STD Related
Monilia–fungal
Bacterial Vaginosis–bacterial
Normal vagina
Acidic environment PH 3.8 – 4.2
Maintained by Lactic Acid produced by lactobacilli
In the healthy vagina there is homeostatic co-existence of
anaerobes and aerobes with non-exfoliated epithelial cells.
Affected by products, practices, nutrition (ie excessive sugar intake/diabetes, douching, bubble bath, sprays, scented products, fancy condoms/toys)
Vulvovaginal Candidiasis
Candida – fungal resident flora, overgrowth creates infectious process
Albicans – most common genus
Over 50 different types of candida – most responsive to “azole” therapy
Glabrata & Rugosa types are becoming more resistant to current therapies
Vulvovaginal Candidiasis
symptoms
Symptoms: severe pruritis, curdy vaginal discharge, vaginal soreness, dysuria, white or erythemic skin
Vulvovaginal Candidiasis
treatment
External – antifungal creams (clotrimazole, nystatin)
Internal – antifungal suppositories, creams (miconazole, terconazole)
Systemic – antifungal oral pills (fluconazole)
BACTERIAL VAGINOS
Infection occurs when “good” bacteria go bad
One term used to describe a polymicrobial ascending infection caused by one or more organisms Gardnerella Mobiluncus Coccobacilli Mycoplasma hominis
involve organisms transmitted sexually and/or may be confined to anaerobic organisms
BACTERIAL VAGINOS
Causes
Douching
Sexual activity
Recent antibiotic use
Hormonal changes
Essentially anything that disrupts the balance of normal resident flora (lactobacilli)
Bacterial Vaginosis
Subjective
Gray/white homogeneous milky white discharge
fishy odor typically worse following sex
Bacterial Vaginosis
Objective
homogeneous, thin, white discharge that smoothly coats the vaginal walls;
• presence of clue cells on microscopic examination;
• pH of vaginal fluid >4.5; or
• a fishy odor of vaginal discharge before or after addition of 10% KOH (i.e., the whiff test)
Bacterial VaginosisTreatment
Recommended Regimens
Metronidazole 500 mg orally twice a day for 7 days*
OR
Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, once a day for 5 days
OR
Clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days**
*Consuming alcohol should be avoided during treatment and for 24 hours thereafter.
**Clindamycin cream is oil-based and might weaken latex condoms and diaphragms for 5 days after use)
Bacterial VaginosisTreatment
Alternative Regimens
Tinidazole 2 g orally once daily for 2 days
OR
Tinidazole1 g orally once daily for 5 days
OR
Clindamycin 300 mg orally twice daily for 7 days
OR
Clindamycin ovules 100 mg intravaginally once at bedtime for 3 days
OR
Clindesse 1 1 applicatorfull intravaginally x 1 dose
Sexually Transmitted Infections
Parasitic
Pediculosis pubis (crab lice) Trichomoniasis
Sexually Transmitted
Infections
Bacterial
Chlamydia
Gonorrhea
Syphilis - spirochete (bacterium)
Sexually Transmitted
Infections
Viral
Herpes simplex virus—Types I and II
Human papillomavirus (HPV)
Human Immunodeficiency virus (HIV)
Hepatitis Types B, C
Trichomonas Vaginalis
Subjective
Men: usually asymptomatic
Women: bad smelling, yellow/green
frothy discharge, irritation and excoriation of genital area strawberry cervix, can also present with dysuria as the only subjective symptom
Trichomonas Vaginalis
Objective
Wet mount of vaginal discharge shows protozoan is alive and moving. It has a tail or flagella for propulsion. + Whiff when KOH is added to wet prep. Cervix is erythemic with a “strawberry” appearing cervix .
Trichomoniasis treatment
Recommended Regimens
Metronidazole 2 g orally in a single dose
OR
Tinidazole 2 g orally in a single dose
Alternative Regimen
Metronidazole 500 mg orally twice a day for 7 days*
Important to treat partner to prevent re-infection
Patient Education
Important to treat partner to prevent re-infection
Review safe sex practices
Patients should be advised to avoid consuming alcohol during treatment with metronidazole or tinidazole.
Abstinence from alcohol use should continue for 24 hours after completion of metronidazole or 72 hours
after completion of tinidazole
Pediculosis Pubis
Pubic Lice…”crabs”
Parasite
- Louse eggs seen on hair shafts – hatch in 7-9 days causes severe itching
- Transmitted by sexual contact, contaminated
bedding,etc
Pediculosis Pubis
Treatment
Treatment:
Kwell, RID, Permethrin, Lindane
Treat partner(s) and household contacts, clean fomites
CHLAMYDIA
Caused by: bacterium chlamydia trachomatis
Most rapidly increasing STD especially in young adults
Leading cause of infertility
1 episode …12% infertility
2 episodes…30% infertility
3 episodes…50% infertility
Estimated than 1 million people in US have it now
Becoming known as the “silent epidemic”
Commonly concurrent with Gonorrhea (Treat both)
In 70% – 80 % of cases patients are asymptomatic.
SCREENING GUIDELINES
for chlamydia infections
USING THESE SCREENING GUIDELINES, 90% OF ALL CHLAMYDIA INFECTIONS WOULD BE DETECTED
24 years of age or younger
Intercourse with a new partner
Suspicious cervical discharge
Cervical bleeding cause by swabbing / post-coital bleeding
No contraception usage or non-barrier methods
Chlamydia
Subjective
Often asymptomatic Increased thick yellow vaginal discharge Post-coital bleeding Abnormal vaginal bleeding / inter-menstrual bleeding Urinary s/s (dysuria, frequency)
Chlamydia
Objective
Irritated appearing cervix with “contact” bleeding
Painful bimanual exam
Chlamydial cervicitis in a female patient characterized by mucopurulent cervical discharge, erythema, and inflammation .
