STDs Flashcards
Syphilis - cause
Trepoema pallidum
Syphilis - stage
Stage:
1st = ulcer/chancre ( painless ulcer) at site of infection
2nd = systemic manifestations (hand and feet skin rash, malaise, lymphadenopathy )
Latent= suppresses infection (no symptom)
- Early < 1 yr.
- Late >1 yr.
3rd = within in 1-20yr of infection
- Lesions looks like a benign tumor
- CV: ascending aortic aneurysm, aortic insufficiency, coronary stenosis
Syphilis - manifestation
Neurosyphilis: occur in any stage. Acute syphilitic meningitis with altered mental status.
Endarteritis present as a stroke-like symptoms with seizures
Congenital syphilis:
Infected mother increase risk of baby
Syphilis - diagnosis
Pt history including sexual Physical exam of whole body Darkfield microscopy Nontrponemal test: VDRL,RPR - IgM & IgG - Useful marker of disease severity - 4X change indicated clinical significant - RPR cannot be tested on CSF samples Treponemal test: FTA-ABS, EIA, immunoassays. - Often reactive for life - Not correlate with disease severity - If + run a nontrponemal - If – run another treponemal
Syphilitic Treatment
Pen G IV for all stage
- The only effective therapy for pregnancy
1st, 2nd, early:
- Benzathine Pen G 2.4 MU IM X1; children 5万/kg IM
- Evaluation at 6 & 12 month;
- If retreat needed 3 week is recommended
3rd, Late, unknown:
- 2.4 MU IM weekly X 3
- Children above X 3
- Evaluation 6, 12, 24 month
If Penicillin ALL use Doxycycline 100mg PO BID 14/28 days accordingly
Neurosyphilis:
- Aqueous crystalline Pen G 4 MU IV q4hr or continuous infusion 24 U/day X 10-14 days
- ALL: desensitize Pt
Treat sexual partner:
- 3 month for 1st
- 6 month for 2nd
- 1 yr for early latent
Jarisch- Herxheimer RXN
Abrupt onset fever, headache, myalgia, tachycardia, skin rash, mild hypotension
Syphilis - medication alert
MEDICATION ALERT: There have been errors in treatment of syphilis due to confusion between formulations.
2.4 million Units of Bicillin L-A contains 2.4 million units of benzathine penicillin G as recommended for syphilis. BICILLIN C-R SHOULD NOT BE USED TO TREAT SYPHILIS.
Chlamydia - cause
Chlamydia trachomatis
Chlamydia - presentation
Mostly asymptomatic in both men and women.
Women: Vaginal discharge, dysuria
Men: dysuria, penile discharge, pain/ swelling of testicles
Annual screening of sexually active women 25 and under is recommended
Chlamydia - Diagnosis
- Urine test
- Swans from endocervix or vagina
- Nucleic Acid amplification tests (NAATs)
Testing for other STD is recommended for diagnostic person
- Co-infection w/ gonococcal are common and should be treat simultaneously
Chlamydia - treatment
1st line: - Azithromycin 1g PO X1 - Doxycycline 100mg PO BID X 7 days Alternative - Levoquine 500mg PO daily X 7 days Pregnancy: - Azithromycin 1g X1 - Amoxicillin 500 mg PO TID X 7 days
1st dose of Azithromycin should be directly observed for compliance issue
Pt need to be abstain sexual intercourse for 7 days
EPT
Expedited Partner Therapy
- Treatment for sexual partners
Gonorrhea - causes
Neisseria gonorrhoeae
Gonorrhea - presentation
Most women do not produce recognizable symptoms
Men are symptomatic 90% of the time
- Urethritis, dysuria, epididymitis
- copious purulent/ mucopurulent penile discharge
Screening is only recommended for who are at risk.
Gonorrhea - niagnosis
Diagnosis: - NAATs - Commonly utilized test Men: NAATs Women: vaginal swab
Urethral culture
Testing for other STD is recommended for diagnostic person
Gonorrhea - treatment
Uncomplicated infective:
- Ceftriaxone 250 mg IM + Aziththromycin 1G X 1
- Doxycycline 100mg PO BID X7 days
- If ALL: do Azithro 2G PO X 1
- RX given on directly observation
Disseminated:
- Ceftriaxone 1g IM/IV q24 hr X 1 week or more
- Often presents w/ septic arthritis affecting multiple Joints
Endocarditis:
- Ceftriaxone 1-2g IV BID X 4weeks
Patients should be instructed to abstain from sexual intercourse until therapy is completed and until they and their sex partners no longer have symptoms
it is recommended for patients positive for gonorrhea to be treated for both gonococcal and chlamydial infections concurrently
BV cause
Bacterial vaginosis
G. vaginalis
BV presentation
Women - asymptomatic, vaginal white thin discharge and vaginal fishy odor
clue cells - wet mount
Trichomoniasis - cause
protozoan parasite Trichamonas vaginalis
Trichomoniasis - presentation
malodorous discharge
dyspareunia, burning, dysuria
Thin green-yellow discharge, vulvovsginal erythema
motile trichomonads
BV - treatment
Metronidazole 500mg PO BID X 7 days
metronidazole 0.75% gel, intravaginally daily X 5days
Trchomoniasis - treatment
Metronidazole 2g PO X1
PID (pelvic inflammatory disease ) -causes
N. gonorrhoeae and C. trachomatis
PID diagnosis
Lower abdominal pain is the cardinal symptom in women with PID.
the diagnosis of PID is usually based on clinical findings
at least one of the following criteria is present on pelvic examination: 1) cervical motion tenderness, 2) uterine tenderness, or 3) adnexal tenderness. Additional criteria can support the diagnosis of PID and include: oral temperature >101°F (>38.3°C), abnormal cervical or vaginal mucopurulent discharge, presence of abundant WBC in vaginal fluid, elevated CRP, elevated ESR, or laboratory documentation of cervical infection with N. gonorrhoeae or C. trachomatis
