STDs Flashcards
Graham negative diplococci; Bacterial STD
Gonorrhea
What STDs are reportable ?
Gonorrhea, chlamydia, syphilis
Thick White yellow purulent creamy discharge
Gonorrhea
Irregular /painful menses, frequent, urgent, painful urination, rectal pain, sore throat, fever, malaise, chills, bartholin gland abscess
Scrotal/growing pain/enlarged prostate in men
Gonorrhea signs and symptoms
Both males and females are often asymptomatic
Diagnostic for gonorrhea
NAATS most sensitive and specific
Vaginal swab for women
First part void for men
Graham negative diplococci and white blood cells; cervical culture using thater-or Martin or transgrow media
Treatment for gonorrhea
Rocephin and a child < 8 years or <45 kg
500 mg IM x1 dose treat & doxycycline 100 mg PO b.i.d. daily X7 days covering chlamydia
Or azithromycin 1g po x1dose
Pregnancy:
Azithromycin PO single dose
Or erythromycin 50 mg/KG/day x4 daily doses x14 days
What causes urethritis in men And cervicitis and women; Leading cause of infertility and females
Gonorrhea
Parasitic STD; intracellular obligate
Chlamydia
Dysuria, intermenstrual spotting, postcoital bleeding, lower abd pain, Reto tenesmus, testicular pain, Penile or vagina discharge
Signs and symptoms of chlamydia
Thick cloudy to yellow watery discharge
Chlamydia
Can be transmitted perinatal, sexual, cause conjunctivitis, and pneumonia
Chlamydia
Diagnostic studies for chlamydia
NAAT most sensitive/specific
Culture, DNA probes, and NAATs acceptable in adolescents
Urine testing method of choice for detection
Treatment for chlamydia
1 Azithromycin (Zithromax) 1 g PO x1 dose
Or doxycycline hundred milligrams PO bid X7 days
Do not give doxycycline in pregnancy; Give erythromycin for amoxicillin (retest 3 week)
Follow up for chlamydia
3 months after treatment
STD caused by treponema Pallidum
Spirochete
Syphilis
This disease has an increased risk and man-to-man sex & HIV coinfection
Syphilis
All + cases should also have HIV testing
Primary stage of syphilis
Painless canker/lesion with erythematous base
Can be found on genital, lip/tongue
Regional lymph enlargement
Secondary stage of syphilis
Fever, malaise, sore throat, skin rash (polymorphic maculopapular) *palms/soles, hair loss
Latent syphilis
70% of people remain asymptomatic for the rest their life
No lesions
Early = less than one year Late = greater than one year
Tertiary syphilis
Neurosyphilis, cardiac syphilis
S/S: reoccur @ years of initial untreated infections
When is VDLR/RPR done & what does it test for?
All pregnancies and at delivery to test for syphilis
Treatment for syphilis
Benzanthine penicillin G
For penicillin allergic patients:
Doxycycline 100 mg PO BID x14 day
Or erythromycin/tetracycline
Neurosyphilis Crystaline PEN G
Increase pH and decrease lactobacilli
Bacterial vaginosis
Most prevalent vaginal infection and women of reproductive age not a STD/STI
Increase milky discharge, puritis, malodorous profuse fishy discharge / or thin white gray discharge after sexual intercourse
Maybe asymptomatic
Bacterial vaginosis signs and symptoms
Treatment for a bacterial vaginosis
Metronidazole 500mg PO
Clindamycin PO
Or Intravaginal
HSV
Chronic, lifelong viral infection of the herpes genital Simplex virus
Painful rash, blisters and ulcers, burning and irritation 24 hours prior to outbreak; dysuria; Fever, Malaise, tender swollen lymph nodes
White to yellow discharge,
Vesicles erythematous base that ulcerates
S/S of HSV
Diagnostics for HSV
Viral culture definitive
Tzanck stain
PCR, serologic test can show increased HSV antibodies
Management and treatment for HSV
Antiviral chemotherapy counseling Sitz bath First clinical episode: Acyclovir 200 mg PO 5X/day x7 to 10 days OR 400 mg TID X7 - 10 days
Recurrent a cycle of ear 400 to 800 mg for 5 days
Initiate treatment within six days of onset
What is a transmission for HIV
Maternal infant perinatal transmission, breast-feeding, sexual intercourse, blood
If mom is positive with HIV can she breast-feed?
No
Sign and symptoms of HIV infant
Low birth weight, failing ratio of head circumference to height/weight, recurrent infections, decreased activity, developmental delay, hepatosplenomegaly, generalized lymphadenopathy
Diagnostics for screening infants of HIV
Polymerase chain reaction PCR testing is used
Screen diagnostic for older children for HIV
Enzyme linked amino‘s orbit essay ELISA screening is used sensitivity 99.9%; Followed by Western blot to confirm
Flagellated protozoan
Trichomonas
Profuse vaginal discharge, serratus, irritation with burning on urination, frothy greenish or yellow, fishy discharge, strawberry cervix (read with petechiae) bleeds easily
History for trichomonas
Diagnostic for trichomonas
NAAT, gen/probe, culture no longer preferred method
What mount shows trichomonads
Treatment for trichomonas
Metronidazole 2 g single-dose
Alcohol consumption should be avoided 24 hours after medication
No sex during treatment ; treat sexual partner
When should I patient be followed up for trichomonas?
3 months after treatment
Painful water rash, cauliflower like 4 to 6 weeks after sex
HPV
No treatment will eradicate this disease
Symptomatic viral reproductive tract infection caused by condylomata acuminata
General warts caused by HPV through sexual transmission
Prepubescent children should be screamed for sexual abuse
Epithelial warts or firm bumps that are cauliflower in nature found on anus/genitals
Burning/pain/itching/bleeding
symptoms for genital warts
Diagnostics for genital warts
Clinical inspection
Colonoscopy on cervical/vinegar to Blanch
Pap smear/biopsies
Treatment for Genital warts
No Way to eradicate this disease; can have spontaneous resolution within three months reoccurrences are common
Refer to GYN
When is the first Pap smear and subsequent ones?
First Pap smear at 21 years subsequent every three years if normal
Male condom
Mechanical barrier preventing semen from entering vagina/most effective barrier method
Latex recommended prevents STDs
Polyurethane is latex free for latex sensitive
Natural skin/lamb skin not recommended
Failure rate 3-18%; breaks 1 to 2%
Female condom
Worn by women
Available over the counter
Inserted up to eight hours before intercourse
21% failure rate
Topical creams, jellies, phones, suppositories, and films from her vent pregnancy; used alone or with condoms
Vaginal spermicides
Failure rate 6%
Not effective in preventing cervical gonorrhea, chlamydia, HIV
Do not use an anal intercourse can cause cell damage
Increased UTIs
Female barrier thinly text done with flexible ring in spermicide applied for vaginal insertion prior to intercourse
Diaphragm
Failure rate in adolescents 10 to 25%
Requires pelvic exam for proper fitting
Can you cause UTI, vaginitis
Transdermal contraceptive patch
Ethinylestradiol/norelgestromin
Where one patch for one week, repeat with a new patch weekly for two more weeks patch must be correctly applied and rotated
Do not use for clotting disorder, impaired liver, abnormal vaginal bleeding, pregnancy, estrogen dependent carcinoma
Depo shot
IM Q3 months
0.25% failure rate
Contra indicated an active thrombophlebitis, undiagnosed vaginal bleeding, breast malignancy, liver disease
Side effects: spotting, weight gain, bloating, headaches, mood changes, increase risk of bone density
One rod implanted in subcutaneous tissue of upper inner arm; long-acting reversible contraception (LARC)
Nexplanon
Effective for three years
Vaginal spotting and bleeding or not predictable
Radiopaque
Long-acting reversible contraceptive, safe effective Placed by provider implant
IUD
Copper T380A Increases uterine and tubal fluids impair sperm function; last 10 years; failure rate 0.8% percent
LNG-IUS marina—-releases levonorgestrel 20 MCG/day; taking cervical mucus, inhibit sperm, suppresses endometrium
Last up to five years ; failure rate 0.2%
When should emergency contraception be used
Within 72 hours of unprotected intercourse
How does emergency contraception work
Does not terminate existing pregnancy
Plan B is progesterone only two tabs; plan B one step is a one pill, purchase at any age
Meclizine can be given to Combat symptoms of nausea/vomiting; given first before dose of OCP method to reduce nausea
Pregnancy test after three weeks
Symptoms of pregnancy
Irregular menses/amenorrhea, nausea vomiting, urinary frequency, breast tenderness, headache, dizziness, abdominal cramps
