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Clin Med 3 > STD > Flashcards

STD Flashcards

1
Q

MC to least common vaginitis

A

Bacterial vaginosis
Vulvovaginal candidiasis
Trichomoniasis

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2
Q

Bacteria in Bacterial vaginosis

A

Gardnerella vaginalis

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3
Q

What can bacterial vaginosis lead to?

A

premature rupture of membranes, post-op gynecological infections, premature delivery and low birth weight

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4
Q

Bacteria in candidiasis vaginitis

A

C. albicans

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5
Q

Most prevalent non-viral STI

A

trichomoniasis vaginitis

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6
Q

Trichomoniasis vaginitis can cause what?

A

preterm rupture of membranes and preterm delivery, increased risk of HIV

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7
Q

Patho Bacterial vaginosis

A

Overgrowth of bacteria normally present in vagina with anaerobic bacteria AND decrease of loss of protective lactobacilli

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8
Q

Patho candidiasis

A

Due to overgrowth of C. albicans–> excessive growth of oval budding yeast cells or chains (pseudohyphe)

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9
Q

What is the only protozoan that infects the genital tract?

A

trichomonas vaginalis

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10
Q

RF for bacterial vaginosis

A 
African American
2 or more sex partners in past 6 months
Douching
Lack of condoms
Absence or decrease of lactobacilli
Lack of hydrogen peroxide
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11
Q

RF for candidiasis

A 
Diabetes
Immunosuppression
Antibiotic Use
Prolonged exposure to moist, damp underwear
Non-cotton underwear
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12
Q

RF trichomoniasis

A

Multiple sex partners
Lower socioeconomic status
History of STDs
Lack of condom use

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13
Q

Clinical Bacterial Vaginosis

A

Asx
Malodorous or fishy smell
Pruritic discharge
Thin, milky white and sometimes gray discharge

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14
Q

Clinical candidiasis

A

Pruritic discomfort
Dysuria
Thick cottage cheese like discharge
Dysperunia

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15
Q

Clinical trichomoniasis

A

Asymptomatic
Pruritic discharge that is green, green-yellow, frothy
Strawberry cervix

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16
Q

Vaginal pH and vaginitis

A

<4.5- candidiasis

>4.5- BV or trichomoniasis

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17
Q

Wet prep and vaginitis

A

BV- clue cells (>20%), no/few WBC
Candidiasis- few to many WBC
Trichomoniasis- motile flagellated protozoa, many WBCs

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18
Q

KOH test and vaginitis

A

Candida- pseudohyphae and budding yeast

BV- whiff test (smell like fish)

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19
Q

How to diagnose BV?

A

Amsel Criteria

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20
Q

How to diagnose candidiasis?

A 
Hx/PE
Normal pH
KOH prep
Wet mount
Candida culture is recurrent
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21
Q

How to diagnose Trichomoniasis?

A

Nucleic Acid amplification test (NAAT) via urine or genital swab

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22
Q

Amsel Criteria

A

Need 3 of the follow:

  • pH >4.5
  • Clue cells on wet mount (>20%)
  • Positive amine or “whiff” test
  • Homogenous, non-viscous, milky-white discharge adherent to vaginal walls
23
Q

Tx BV

A

Metronidazole 500mg BID for 7 days
OR
Metronidazole gel 0.75%, one full applicator (5g) intravaginally, once of twice a day for 5 days
OR
Clindamycin cream 2%, one full applicator (5g) intravaginally at bedtime for 7 days

24
Q

Tx Candidiasis

A 
Fluconazole (Diflucan) 150mg x 1
OR
Fluconazole (Diflucan) 150mg, repeat in 72 hours (severe cases)
OR
OTC
25
Q

Tx Trichomoniasis

A

Metronidazole 2gm orally in a single dose
OR
Metronidazole 500mg twice a day for 7 days
OR
Tinidazole 2g orally in a single dose

26
Q

If a pregnant women has candidiasis, can we give her fluconazole?

A

Not in the first trimester, 7 day topical agents recommended

27
Q

Is metronidazole safe in pregnancy?

A

Yes

28
Q

What to advise patients on Metronidazole?

A

May get GI upset and not to drink during or so many days after

29
Q

Patient counseling points for BV

A

Correct and consistent condom use
Avoid douching
Limit number of sex partners
Latex condoms may dissolve in intravaginal cream

30
Q

Patient counseling for Candidiasis

A

Avoid douching
Avoid unnecessary ABX use
Complete the full course of treatment
Latex condoms may dissolve in intravaginal cream

31
Q

Counseling points for Trichomoniasis

A

Correct and consistent condom use
Limit number of sex partners
Avoid sex until patient and partner treated and cured and asx
Any sex partners in last 60 days should be treated
Report to DPH

32
Q

How is gonorrhea transmitted?

A

sexual contact with penia, vagina, mouth or anus of infected person
OR
vertical (perinatally)

33
Q

Bacteria in gonorrhea

A

N. gonorrhoeae (gram negative diplococci)

34
Q

Areas affected by gonorrhea

A 
cervix
uterus
fallopian tubes
urethra
mouth
throat
eyes
anus
35
Q

How is chlamydia transmitted

A

sexual or vertical (perinatal)

36
Q

Incubation period of chlamydia

A

7-21 days

37
Q

Result of perinatal transmission of chlamydia

A

neonatal conjunctivitis

38
Q

MC STD

A

chlamydia

39
Q

Who gets gonorrhea

A

15-24yo sexually active teens, young adults and african americans

40
Q

RF for GC/Chlamydia

A 
Multiple partners
New sex partner last 3 mo
<25yo
Minority ethnicity
Low educational and socioeconomic levels
Substance abuse
Inconsistent use of condoms
History of other STIs
MSM population
41
Q

Complications GC/Chlamydia

A 
PID
Tubo-ovarian abscess
Fitz-Hugh Curtis Syndrome
Epididymitis
Proctitis
Neonatal conjunctivitis
Increases risk of HIV
42
Q

Complication of GC specifically

A

DIC
arthritis
tenosynovitis
dermatitis

43
Q

Complication of Chlamydia specifically

A

reactive arthritis (reiter syndrome)
lymphanogranuloma venereum
neonatal pneumonia

44
Q

Clinical GC/Chlamydia women

A 
dysuria
mucopurulent discharge
cervical motion tenderness
pruritis
tender uterus
PID symptoms
intermenstrual bleeding
red or friable cervix
45
Q

Clinical GC men

A

dysuria
white, yellow or green discharge
+/- penile edema

46
Q

Clinical chlamydia men

A

mucoid or watery urethral discharge

clear discharge may only be seen while milking the penis

47
Q

Clinical pharynx GC

A

sore throat

48
Q

GOLD Diagnosis and screening GC/Chlamydia

A

Nucleic Acid Amplification testing (NAAT)- first catch urine (dirty), vaginal swab, endocervical swab, rectal swab

49
Q

Who to screen for GC/chlamydia

A 
symptoms or partner with STI
high risk behavior (prostitute, no condom use, drug abuse)
new or multiple partners
history or STD
pregnant
HIV infection
MSM (every 6-12 mo)
Military
Men entering jail or juvenile detention
50
Q

Tx Gonorrhea

A

Ceftriaxone 250mg IM + Azithromycin 1g orally (single dose)

OR Doxycycline 100mg orally BID for 7 days

51
Q

Complication of GC/Chlamydia in Men and how to treat

A

Epididymitis (Cepftriaxone 250mg IM + Doxy 100mg BID x 10-21days
Proctitis (Ceftriaxone 250mg IM + Doxy 100mg x 7-21days)

52
Q

Tx Chlamydia

A

Azithromycin 1g orally in a single dose OR Doxycycline 100mg orally BID x 7 days

53
Q

Who gets repeat testing for GC/Chlamydia

A

Pregnant women get NAAT 3 weeks after completion of therapy

54
Q

Follow up instructions for GC/Chlamydia

A

Avoid sex until patient and partners treated and cured (therapy completed AND patient/partners asx)
Sex partners last 60 days should be treated
Report to DPH

Clin Med 3 (2 decks)

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