STDs Flashcards
what are the 5 Ps of sexual health (helpful for gathering a sexual history)
Partners, practices, prevention of pregnancy, protection from STIs, past history of STIs
what is the organism for gonnorrhea, where are cultures taken from?
Neisseria gonorrhoeae: gram negative bacteria
cultures: GU- urine sample, oropharynx, conjunctiva, rectum
complications if gonorrhea untreated
women: pelvic inflammatory disease, fallopian tube damage, infertility or risk of ectopic pregnancy
men: epididymitis- infertility (rare)
what are s/s of gonorrhea- female vs male
female: dysuria, mucopurulent vaginal discharge, lower abd pain, fever, dysmenorrhea, n/v
male: dysuria, frequency, white/ yellow penile discharge, testicular pain
what is the lab test for gonorrhea?
Urine sample: NAAT nucleic acid amplification test
POC Cepheid test
culture- Thayer-Martin media- rectal, oropharyngeal, conjunctival infection, and endocervical or urethral
what is gonorrhea treatment?
ceftriaxone 500 mg IM x 1 dose < 150kg, 1gm if >150kg
if chlamydial infection not rule out: doxycycline 100mg PO BID x 7 days
alternatives: gentamycin, azithromycin or cefixime
what is organism of syphillis
treponema pallidum
what are the 4 stages of syphilis
- painless chancre- within 3 weeks of exposure, regional lymphadenopathy
- flu like symptoms, generalized lymphadenopathy, generalized maculopapular rash- palms and soles
- latent phase: seropositive but asymptomatic
- tertiary: leukoplakia, cardiac insufficiency: aortic regurg. aortitis, aneurysms, infiltrative tumors of skin, bones, liver, CNS involvement: meningitis, hemiparesis, hemiplegia
syphilis screening test
Screening: VDRL: Venereal Disease Research Laboratory or rapid plasma reagin: non-treponemal antibody tests
Diagnosis: Treponemal test (confirmation) TP- particle agglutination assay (TP-PA)
FTA-ABS- fluorescent treponemal antibody absorption
ICA: chemiluminescence imunoassays
syphilis treatment
benzathine penicillin IM single dose (early syphilis)
IM weekly x3 doses for latent infection, indeterminate length or tertiary stage
severe conditions of syphilis: CNS, eye or ear involvement: treatment
neurosyphilis, ocular or otosyphilis: aqueous crystalline penicillin IV q 4hours, continuous infusion 10-14 days, or procaine PCN IM once daily plus probenecid 500 mg PO QID for 10-14 days
if PCN allergy, what is syphilis tx?
Early: doxycycline 100 mg PO BID x 14 days or tetracycline
Latent: doxy or tetracycline x 28 days
what is organism for chlamydia?
parasitic infection- intracellular obligate- looks like gram neg bacteria
chlamydia trachomatis
what are s/s of chlamydia by sex, and what are complications?
female: vaginal discharge, pelvic pain, postcoital bleeding, spotting, dysuria, PID, infertility, ectopic pregnancy
male: penile discharge- thick and cloudy, dysuria, testicular pain, rectal tenesmus, epididymitis, prostatitis
chlamydia testing
NAAT: bacterial DNA or RNA
women- vaginal or cervical swabs optimal
men: first void urine or urethra swab
chlamydia treatment
doxycycline: 100 BID x 7 days
alternative: azithromycin 1gm PO x 1 dose or levofloxacin 500 mg PO daily x 1 week
vulvovaginitis
inflammation of vulva and vagina: bacteria, protozoa or fungi infection
common: trichomoniasis (chlamydia)- malodorous, yellow/green discharge, pruritus, petichiae (strawberry patches) on cervix, candidiasis (non-sexual transmission) thick white curd like discharge, erythema, pruritus
bacterial vaginosis: watery, gray, fish smelling discharge
how to diagnosis vulvovaginitis
microscopic wet prep; NAAT or vaginal culture
treatment for trichomoniasis and bacterial vaginosis
metronidazole 500 PO BID x 7 days
alternative: tinidazole orally for 2 days
clindamycin
candidiasis regimen
clotrimazole cream intravaginally 7-14 days or miconazole cream intravaginally
oral: fluconazole 150 mg PO x1 (not recommended in 1st trimester of pregnancy- this has been retracted recently, now considered safe)
genital chancroid organism, coinfections
hemophilus ducreyi (gram neg bacillus)
cofactor for HIV transmission, 10% also infected with syphilis and HSV
Men; superficial painful ulcer- may be necrotic or erosive
women: asymptomatic
diagnose based on morphology of chancroid (sensitivity < 80%)
treatment of chancroid
azithromycin, ceftriaxone (rocephin), ciprofloxacin
gram negative coverage
Herpes organism, treatment
herpes simplex virus, recurrent infection, no cure
type 1: lips, face, mucosa
type 2: genitalia
triggers for HSV flare
stress, lack of sleep, sunlight exposure, cold weather exposure, female hormone changes
HSV- 2 s/s
headache, fever, aches, malaise, joint pain
what is a herpetic whitlow
can be both type 1 and type 2 HSV
small blisters form on fingertip- painful- develop after contact with contagious sore
diagnosis: NAAT, culture
Tx: no treatment needed- usually clears in 2-3 weeks, or antiviral meds can be given: acyclovir, famiciclovir, valacyclovir: can shorten duration of ulcer
