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Clin med FINAL- sem 2 > STDs > Flashcards

STDs Flashcards

1
Q

Which are fluids?

A

GC
CT
Trich
HIV

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2
Q

Which are skin-skin?

A

HSV
HPV
Syphilis
Chancroid

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3
Q

Preexposure vaccines?

A
  • Hep B- ALL sexually active persons
  • Hep A- MSM
  • HPV- ages 9-26, M & F
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4
Q

What can still get through lambskin condoms due to large pores?

A

HIV

Hep B

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5
Q

MSM screening

A

Annual STD screening:
HIV and syphilis serology
- NAAT for GC/CT- urine or discharges (also in W) - pharyngeal and rectal

HPV- pap smear

HBsAg
Hep C ab

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6
Q

Who should always be tested for HIV?

A

pregnant W

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7
Q

Sores

A
  • Syphilis
  • HSV
  • Lymphogranuloma venereum
  • Chancroid, &
  • Granuloma inguinale
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8
Q

Drips

A
  • Gonorrhea
  • Chlamydia
  • Mycoplasma genitalium
  • Mucopurulent cervicitis
  • Trichomonas vaginitis/ urethritis
  • Candidiasis
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9
Q

Painful vs painless ulcers

A

Painful

  • Chancroid
  • Genital herpes simplex

Painless

  • Syphilis
  • Lymphogranuloma venereum
  • Granuloma inguinale “
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10
Q

Herpes virus (HSV1/HSV2)- HSV1 vs HSV2

A

1-oral- cold sores/blisters

2-genital mucosa

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11
Q

Herpes virus (HSV1/HSV2)- transmission

A

asymptomatic viral shedding

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12
Q

Herpes virus (HSV1/HSV2)- description and duration

A

Multiple painful vesicles on erythematous base- painful ulcer surrounded by red halo
- Persists 7-10 days

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13
Q

Herpes virus (HSV1/HSV2)- primary vs recurrent signs and symptoms

A

Primary lesion:
- Fever and bilateral adenopathy
Recurrent:
- no fever or adenopathy

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14
Q

Herpes virus (HSV1/HSV2)- prodrome

A

tingling or burning 18-36 hours prior lesion

flu like symptoms

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15
Q

Herpes virus (HSV1/HSV2)- labs and diagnosis

A 
Tzank smear (historic test)- lacks sensitivity- GOLD
- (+) if presence of multinucleated giant cells

Serologies- many false + and -

Viral studies

  • Cultures
  • PCR= BEST
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16
Q

Herpes virus (HSV1/HSV2)- treatment 1st episode

A
  • Acyclovir 400mg TID
  • Famciclovir 250mg TID
  • Valacyclovir 1000mg BID

7-10days any agent, within 72hrs is best

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17
Q

Herpes virus (HSV1/HSV2)- treatment episodic

A

same agents

  • Acyclovir 400mg TID
  • Famciclovir 250mg TID
  • Valacyclovir 1000mg BID

For W- happens around menstrual cycle (decreased immunity)- can prescribe episodic if they are regular

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18
Q

Herpes virus (HSV1/HSV2)- treatment suppression

A
  • Acyclovir 400mg BID
  • Famciclovir 250mg BID
  • Valacyclovir 500-1000mg daily
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19
Q

Herpes virus (HSV1/HSV2) treatment in pregnancy

A

acyclovir

  • no increased risk of major birth defects (1st tri)
  • risk of transmission to neonate is 30-50% if acquired HSV near delivery
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20
Q

Hep A vaccine

A

MSM
Illegal drug users
Chronic liver disease
Hep B and C infection

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21
Q

Hep B vaccine

A
  • sex partners
  • MSM
  • illegal drug use
  • household members
  • hemodialysis
  • occupational blood exposure
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22
Q

HIV co-infection with?

A

Hep C= blood borne- no vaccine

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23
Q

Syphilis- incidence increases in…

A

HIV + men
MSM
IV drug usage

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24
Q

Syphilis caused by

A

Treponema pallidum

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25
Q

Syphilis active infection classification

A
  1. Primary (ulcer)
  2. Secondary (skin rash, lymphadenopathy), neurologic (AMS, stroke, meningitis)
  3. Tertiary (cardiac or gummatous lesion)
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26
Q

Syphilis staging

A

Early latent: reactive testing within 1 yr of infection- no symptoms
Late: … greater than 1 yr after onset of infection or timing cannot be determined- no symptoms

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27
Q

Syphilis- chancre description and duration

A
  • Early: macule/ papule- erodes/ulcerates
  • Late: clean based, painless, indurated ulcer w smooth firm borders
  • Resolves in 1-5wks
  • HIGHLY infectious
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28
Q

Syphilis- diagnosis GOLD

A

Darkfield examination of exudates/tissue

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29
Q

Syphilis- labs and imaging

A

Serologic tests
- nontreponemal tests:
RPR, VDRL- reactivity fades over time

  • treponemal tests:
    Fluorescent treponemal ab (FT-AB)
    T pallidum passive particle agglutination (TP-PA)- once +, usually stays +
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30
Q

Syphilis- what should you also test for?

A

Test for HIV in newly diagnosed syphilis

- run close together

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31
Q

Syphilis- treatment for primary, secondary and early latent

A

Benzathine Pen G-

  1. 4 million units IM x 1 dose - into glutes
    - 6-12m follow-up for repeat RPR

Pen allergy
- Doxy or ceftriaxone

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32
Q

Syphilis- treatment for late latent

A

Benzathine Pen G-

2.4 million units IM x 1 dose weekly x 3 weeks

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33
Q

Syphilis- sex partners management

A

treat presumptively

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34
Q

Secondary Syphilis- what is it? when does it appear?

A

Represents hematogenous dissemination of sphirochetes

- 2-8 weeks after chancre appears

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35
Q

Secondary Syphilis- signs and symptoms

A

Rash- whole body includes palms and soles
Mucous patches
Condylomata lata- HIGHLY infectious
Cauliflower lesion in mouth

Resolve in 2-10 wks

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36
Q

Tertiary syphilis- what is it?

A

Gumma (soft tumor like growth of tissues) and cardiovascular syphilis

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37
Q

Tertiary syphilis- treatment

A

Pen G

2.4 million units IM q week x 3 weeks (Bicillin LA)

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38
Q

Neurosyphilis can cause

A

eye disease- uveitis, optic neuritis and AMS

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39
Q

Neurosyphilis- exam

A

CSF

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40
Q

Neurosyphilis treatment

A

Aqueous Pen G 18-24 million units/day for 10-14 days

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41
Q

Jarisch- Herxheimer Rxn

A

Acute febrile rnx w long treatments- not rnx to drug but to death of bacteria- release of toxins
In tertiary syphilis - 24 hr infusion of PCN

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42
Q

Jarisch- Herxheimer Rxn- what is it?

A

Acute febrile rnx w long treatments

-not rnx to drug but to death of bacteria- release of toxins

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43
Q

What reaction do you get with tertiary syphilis?

A

Jarisch- Herxheimer Rxn- 24 hour infusion of PCN

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44
Q

Jarisch- Herxheimer Rxn- signs and symptoms

A

HA
Myalgia
Fever

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45
Q

Jarisch- Herxheimer Rxn- treatment

A

Antipyretics but can be life threatening- can lead to anaphylaxis

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46
Q

Syphilis during pregnancy

A
  • ALL W should be screened for syphilis at 1st prenatal visit
  • Also at 28 wks & before delivery if high risk or high incidence location (Denver)
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47
Q

Syphilis during pregnancy- risk factors

A
  • sex w multiple partners
  • sex in conjunction w drug use or transactional sex
  • late entry to prenatal care or no prenatal care
  • meth or heroin use hx
  • incarceration
  • unstable housing/ homelessness
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48
Q

Syphilis during pregnancy- treatment

A
  • Tx for the appropriate stage of syphilis

- Additional benzathine pen 2.4mu IM after the initial dose for primary, secondary, or early latent syphilis

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49
Q

Congenital syphilis- complications

A

Fetal demise

Nerve damage- vision and hearing

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50
Q

Chancroid is a risk factor for what?

A

HIV transmission

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51
Q

Chancroid is caused by?

A

Haemophilus ducreyi

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52
Q

Chancroid signs and symptoms

A

Painful
Vesicle or papule to pustule or ulcer, soft
Not indurated
Tender inguinal adenopathy

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53
Q

Chancroid- treatment

A

Azithro 1gm PO

Ceftriaxone 250mg IM- single dose

Cipro 500mg BID x 3 days

Erythro base 500mg TID x 7 days

  • no cipro in pregnancy
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54
Q

Who needs a longer course of treatment for chancroid?

A

Uncircumcised men and people w HIV

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55
Q

Lymphogranuloma venereum- caused by

A

Chlamydia trachomatis

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56
Q

Lymphogranuloma venereum- signs and symptoms

A

Painless papule, vesicle or ulcer

Tender regional lymphadenopathy- usually unilateral

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57
Q

Lymphogranuloma venereum in females

A

genital elephantiasis

58
Q

Lymphogranuloma venereum- treatment

A

Doxy 100mg BID x 21 days

Alternative:
Azithro 1g PO once weekly x 3 w
or
Erythro base 500mg 4x/d x 21 days

59
Q

Granuloma inguinale- also called what ?

A

Also called donovanosis- because Donovan bodies are present in swab of ulcer exudate

60
Q

Granuloma inguinale- caused by

A

Klebsiella (Calymmatobacterium) granulomatis

61
Q

Granuloma inguinale- signs and symptoms

A

Painless papule that eventually ulcerates

No regional lymph nodes

62
Q

Granuloma inguinale- treatment

A

Doxy 100mg BID x 3 wks

Azithro 1g once per week x 3 wks

Tri- sulfa 800mg/160mg BID

Minimum tx duration- 3 wks

63
Q

Condyloma acuminatum- cause

A

Genital warts
HPV virus

Name alert- condylomata lata- lesions (grouping) in syphilis

64
Q

Condyloma acuminatum- common in

A

pregnancy

65
Q

Gonorrhea is MC in what population ?

A

MSM

66
Q

Gonorrhea- testing and diagnosis

A

Gram stain- gram (-) diplococci intracellular= GOLD

NAAT= preferred

67
Q

Gonorrhea- Bartholin’s abscess treatment

A

I&D for area to be treated

-small- hot compress & abx

68
Q

Gonorrhea- treatment disseminated infection

A

Ceftriaxone 1gm IM or IV q 24 hrs

69
Q

Gonorrhea- treatment of cervix, urethra, rectum, and pharynx

A

Ceftriaxone 500mg IM single dose (if weight >150kgs- 1g ceftriaxone)

Alternatives:
Gentamicin- 240mg IM x 1 dose + Azythro 2 g PO x 1 dose OR
Cefixime 800mg PO x 1 dose

70
Q

Gonorrhea urethritis- signs and symptoms

A
  • incubation1-14 d - usually 2-5d
  • urethral inflammation
  • Dysuria and urethral discharge
71
Q

Gonorrhea cervicitis- signs and symptoms

A
  • incubation- unlear, sx usually in 10 d
  • majority asymp
  • vaginal discharge (not as much as men)
  • dysuria
  • labial pain/swelling
  • abd pain
72
Q

Gonorrhea cervicitis- complications

A
  • majority asymp so high rate of complications-

PID–> infertility

73
Q

Neisseria gonorrhoeae- resistance to?

A

Antimicrobial resistance
No significant resistance to ceftriaxone
Fluoroquinolone resistance worldwide

74
Q

Nongonococcal urethritis is caused by?

A

C. trachomatis
Genital mycoplasmas- Ureaplasma urealyticum, Mycoplasma genitalium

Occasionally-
Trichomonas vaginalis
HSV

75
Q

Nongonococcal urethritis- signs and symptoms

A

Mild dysuria

Mucoid discharge- not as purulent as gono: clear- watery

76
Q

Nongonococcal urethritis- labs and diagnosis

A

Urethral smear >/= 5 PMNs (usually >15)/ OI field
Urine microscopic >/=10 PMNs/ HPF
Leukocyte esterase +

77
Q

Nongonococcal urethritis- treatment

A

Doxy- 100mg BID x 7 days
OR
Azithro 1gm in a single dose

78
Q

Chlamydia trachomatis- Potential to transmit to newborn during pregnancy- causes what?

A

Potential to transmit to newborn during pregnancy- conjunctivitis, pneumonia

79
Q

Chlamydia trachomatis- responsible for causing:

A
  • Cervicitis
  • Urethritis
  • Proctitis
  • Lymphogranuloma venereum
  • Pelvic inflammatory disease
80
Q

Chlamydia trachomatis- symptoms

A

Most asymptomatic

81
Q

Chlamydia trachomatis- screening

A
  • W =25, sexually active- annually
  • W >25, sexually active, risk factors- annually
  • Rescreen W 3-4m after tx- repeat infection
82
Q

Chlamydia trachomatis- testing

A

Urine (NAAT) or cervical/urethral swabs

Nucleic acid hybridization (NA probe)- ex Gen-probe pace-2
- gono and chlamydia from one swab

83
Q

Chlamydia trachomatis- treatment

A

Doxy 100mg BID x 7d

Azithro 1gm single dose

84
Q

Chlamydia trachomatis- pregnancy

A

Pregnancy

  • Azithro 1g orally
  • Amox 500mg TID x 7days
  • No doxy
85
Q

Pelvic inflammatory disease (PID)- complications

A
  • infertility
  • ectopic pregnancy
  • chronic pelvic pain
86
Q

Pelvic inflammatory disease (PID)- signs and symptoms

A
  • endocervical discharge
  • fever
  • lower abd pain
  • cervical motion tenderness
  • pain or bleeding w intercourse
87
Q

Pelvic inflammatory disease (PID)- diagnosis criteria

A

Minimal:

  • Uterine tenderness
  • Adnexal tenderness (bimanual exam)
  • Cervical motion tenderness

others:
- oral temp >101
- Cervical CT or GC
- WBCs/saline microscopy
- Elevated CRP
- Elevated ESR
- Cx discharge- culture shows gono

88
Q

Pelvic inflammatory disease (PID)- when to hospitalize

A
  • surgical emergencies not excluded
  • pregnancy
  • clinical failure of oral antimicrobials
  • inability to follow or tolerate oral regimen
  • severe illness, N/V, high fever
  • tubo-ovarian abscess
89
Q

Pelvic inflammatory disease (PID)- sex partners

A

treated for sexual contact 60 days preceding pts onset of symptoms
- tx empirically w regimens effective against CT and GC

90
Q

Pelvic inflammatory disease (PID)- parenteral regimen

A

Ceftriaxone 1g IV q 24hrs +
Doxy 100mg PO or IV q 12hrs +
Metro 500mg PO or IV q 12 hrs

91
Q

Pelvic inflammatory disease (PID)- oral regimen

A

Ceftriaxone 250mg IM in a single dose +
Doxy 100mg BID x 14 days +
Metro 500mg BID x 14 days

92
Q

Pelvic inflammatory disease (PID) - what is it?

A

Inflammatory disorder of the upper GT

- caused by gono +/- chlamydia

93
Q

Pelvic inflammatory disease (PID)- risk factors

A 
<25
previous PID
untreated STI
multiple sex partners 
douches 
IUD
94
Q

Epididymitis - cause

A

Sexually active men <35, most likely gono or chlamydia

>35- enteric organisms more likely E.coli

95
Q

Epididymitis- signs and symptoms

A

Pain, swelling and inflammation

Unilateral testicular pain

96
Q

Epididymitis- treatment

A

Scrotal elevation
Ceftriaxone 500mg IM x 1 +
Doxy 100mg BID x 10days (GC/chlamydia)

If enteric organism:
- Levo 500mg PO q day x 10 days

97
Q

Epididymitis- treatment if men insertive anal sex

A

Ceft 500mg IM x 1 dose +

Levo 500mg PO x 10 days

98
Q

Prostatitis- what is it?

A

Acute swelling and inflammation of the prostate gland usually due to infection
Same etiology as epididymitis- gono or chlamydia

99
Q

Prostatitis- signs and symptoms

A 
Dysuria
Pain w erection
Fever
Chills
Low back pain
100
Q

Prostatitis- testing

A

UA/culture

- pre and post prostate exam

101
Q

Prostatitis- treatment

A

Same as epididymitis but longer duration

Ceftriaxone
Doxy

If enteric organism:
- Levo

102
Q

Bacterial vaginosis is most common during what?

A

menses- decreased immunity

103
Q

Bacterial vaginosis is caused by

A

Alteration in vaginal flora- most caused by Gardnerella vaginosis

104
Q

Bacterial vaginosis- risk factors

A
  • new sex partners
  • douching
  • decrease in normal flora
  • absence of barrier methods
  • IUDs- copper
  • partner is uncircumcised male
  • WSW
105
Q

Bacterial vaginosis- diagnosis criteria

A

At least 3 of the following:

  • Homogenous, thin discharge, gray- white
  • Wet prep- clue cells
    • whiff test, fishy odor
  • pH >4.5

NAAT test- higher sensitivity

106
Q

Bacterial vaginosis- treatment

A

Metro 500mg BID x 7days

Metro gel 0.75%, 5g intravaginally once daily x 5 days- caution w alcohol

Clinda cream 5%, 5g intravaginally q hs x 7days

107
Q

Bacterial vaginosis- treatment in pregnancy

A

screen & treat at first prenatal visit

  • Metro 500mg PO BID x 7days
  • Metro 250mg TID x 7days
  • Clinda 300mg BID x 7days
108
Q

Vulvo vaginitis caused by

A

bacterial vaginitis
candidiasis
trichomoniasis

109
Q

Vulvo vaginitis- testing

A

pH
whiff test
KOH microscopy- yeast
saline wet prep

110
Q

Vulvovaginal candidiasis- caused by

A

candida albicans

111
Q

Vulvovaginal candidiasis - classification

A

Uncomplicated:

  • sporadic or infrequent VVC
  • mild to mod VVC
  • likely to be C albicans
  • non immunocompromised

Complicated:

  • recurrent (>/=3 in 1 yr)
  • severe VVC
  • non albicans candida
  • immunocompromised
112
Q

Vulvovaginal candidiasis- signs and symptoms

A 
Pruritis
Vaginal soreness
Dyspareunia
External dysuria
Abnormal vaginal discharge (white, curdy)- "cottage cheese" 
"no odor"
113
Q

Vulvovaginal candidiasis- testing

A

KOH prep or culture- buddying yeast and pseudo hyphae- spaghetti and meatballs

114
Q

Vulvovaginal candidiasis- treatment OTC

A
  • Clotrimazole cream 5g intravaginally
  • Miconazole cream 5g intravaginally or vaginal suppository
  • Tioconazole cream 5g intravaginally
115
Q

Vulvovaginal candidiasis - treatment prescription

A
  • Butoconazole cream 5g intravaginally
  • Terconazole cream 5g intravaginally or suppository

Oral:
- Fluconazole 150mg orally in a single dose

116
Q

Vulvovaginal candidiasis - treatment recurrent

A
  • Initial regimen of 7-14days topical therapy or fluconazole 150 mg (repeat 72 hr)
  • Maintenance regimens: clotrimazole, ketoconazole, fluconazole, itraconazole
  • non albicans: longer duration therapy w non-azole regimen
117
Q

Vulvovaginal candidiasis - treatment sex partners

A
  • not recommended
  • M w balanitis may benefit
  • Doesn’t reduce freq of recurrences in F
118
Q

Vulvovaginal candidiasis - treatment in pregnancy

A

topical, 7 days

119
Q

Trichomonas- associated w

A

risk of HIV
increased risk of PID

coexists with others like gono and chlamydia

120
Q

Trichomonas- signs and symptoms

A

Diffuse malodorous yellow to green discharge- “frothy”

Itchiness and burning

Strawberry cervix- tichomoniasis

In men= asymptomatic

121
Q

Trichomonas- testing

A

Wet prep= GOLD- motile pear-shaped flagellated trichomonas

NAAT = more sensitive

122
Q

Trichomonas- treatment

A

W- Metronidazole 500mg PO x 7d OR

M- Metronidazole 2g orally in a single dose OR

Tinidazole 2g orally in a single dose (W or M)

metro also in pregnancy

123
Q

Trichomonas- treatment if failure or reinfection

A
  • metro 500mg BID x7d
  • if repeat failure- metro or tini 2g PO x7d
  • if repeat consider metro susceptibility testing (CDC)
124
Q

Human Papillomavirus- associated with

A

Cervical cancer and other squamous cell cancers- anal, penile, vulvar, vaginal

125
Q

Human Papillomavirus- high risk and low risk strands for cancer

A

High risk for cancer- 16 & 18, low 6 & 11 (warts)

126
Q

Human Papillomavirus- testing

A

pap smear

127
Q

Human Papillomavirus- treatment

A

Removal of symptomatic warts

- therapy may reduce but not eradicate infectivity

128
Q

Human Papillomavirus vaccines

A
  • ages 9-26, approved till age 45
  • Gardasil quadrivalent- 6, 11, 16, and 18
  • Gardasil 9 valent- 6, 11, 16, 18, 31, 33, 45, 52 & 58”
129
Q

HPV- anogenital warts- strand types

A

6 & 11

130
Q

HPV- anogenital warts- signs and symptoms

A

Asymptomatic
If large- obstructive symptoms
Looks like cauliflower

Condyloma acuminata- high risk for cancer

131
Q

HPV- anogenital warts- patient applied treatment

A

Podofilox 0.5% solution or gel
Imiquimod 5% cream
Sinecatechins 15% ointment

132
Q

HPV- anogenital warts provider administered treatment

A

Cryotherapy
Trichloroacetic or bichloroacetic acid 80-90%
Surgical removal

133
Q

HPV- anogenital warts- what should not be used for treatment in pregnancy

A
  • Imiquimod, podophyllin, podofilox & sinecatechins should not be used
134
Q

Scabies- what is it?

A

Parasitic skin infection by the mite Sarcoptes scabiei

135
Q

Scabies- signs and symptoms

A

intense itching

136
Q

Scabies - treatment

A

Permethrin 5% cream to all areas of body

Ivermectin 200 ug/kg PO- repeat in 2 wks

137
Q

Crusted scabies (Norwegian scabies)- infestation in what populations?

A

immunodeficient, debilitated, or malnourished, organ transplant, hematologic malignancies

138
Q

Crusted scabies (Norwegian scabies) - treatment

A

Failure w topical scabicide or oral ivermectin

Combine or repeat w ivermectin

139
Q

Pediculosis pubis- “crabs”- what is it?

A

Pruritus or lice or nits on pubic hair

140
Q

Pediculosis pubis- “crabs”- treatment

A

Permethrin 1% cream
Pyrethrin w piperonyl butoxide
Both- Applied and washed off after 10 min

If failure- Malathion 0.5% lotion to affected area- washed off 8-12hrs or
Ivermectin 250 ug/kg PO- repeated in 7-14d

Clin med FINAL- sem 2 (5 decks)

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