STDs Flashcards
AIDS is defined as an absolute CD4 count of
less than 200
s/s of AIDS
oral candidiasis, fever, weight loss, diarrhea, SOB
infection that causes the most deaths in patients with HIV
Pneumocystis jirovecii
An acute and brief illness that occurs in those within a few weeks after initial exposure to HIV
acute retroviral syndrome
s/s of acute retroviral syndrome
mimic mono (fatigue, fever, lymphadenopathy)
diagnosis tests for acute retroviral syndrome
HIV will be negative; if strongly suspected then order HIV PCR
s/s of disseminated gonococcal disease
petchial/pustular lesions on hands and soles; one swollen, red, tender joint; pharyngitis with green purulent exudate
recommended screening for gonorrhea chlamydia
screen annually in all sexually active females aged 25 and younger
repeat testing in 3 months is needed for this infection d/t high rate of recurrence
gonorrhea
cervical ectropion
immature cervix that has red bumps out of the cervical os (columnar cells).
Why young girls are at higher risk of STDs
their cervix hasn’t matured yet; columnar cells are easier to infect than squamous (mature cells)
Difference between cervical ectropion and cervicitis
ectropion has clear mucus, cervicitis has purulent mucus.
risk factors for chlamydia
age younger than 25
complication of chlamydia in males
Reiter’s syndrome
most sensitive test for gonorrhea and chlamydia
NAAT- can be collected from urine, cervix, urethra, oral, or rectal site.
GenProbe for gonorrhea and chlamydia
used to swab only the cervix or urethra
treatment for chlamydia
azithromycin 1 g PO x1 or doxycycline 100 mg PO bid x 7 days
side effects of doxycyline
GI upset, can cause tooth staining, photosensitivity
treatment for sexual partners of those with chlamydia
azithromycin 1 g PO x 1
treatment for pregnant women with chlamydia
azithromycin 1 g PO x 1 or amoxicillin 500 mg PO tid x 7 days
trx for PID
ceftriaxone 250 mg IM x 1 + doxycycline 100 mg PO bid with or without metronidazole bid x 14 days
difference between chlamydia and gonorrhea
gonorrhea can become systemic or disseminated if left untreated
Neisseria gonorrhoeae is a
gram negative bacterium
Chlamydia trachomatis is a
atypical bacteria
s/s of gonorrhea in female
green purulent vaginal discharge; cervix has purulent drainage
s/s of gonorrhea in male
purulent penile discharge and dysuria
Bartholin gland abscess
can be caused by gonorrhea
trx for gonorrhea
ceftriaxone 250 mg IM x1 + azithromycin 1 gm PO x 1 or doxycycline 100 mg BID x 7 days.
test of cure for gonorrhea/chlamydia
not needed
education about trx for gonorrhea/chlamydia
trx partners within 60 days, avoid sex until therapy completed.
If gonorrhea/chlamydia infection becomes complicated with PID, epididymitis, prostatitis, then trx
for 14 days
risk factors for PID
age less than 24, hx of PID, multiple partners
Fitz-Hugh-Curtis syndrome
chlamydia/gonorrhea infection of liver capsule; c/o RUQ pain with normal LFTs
Jarisch-Herxheimer reaction
acute febrile reaction that occurs during first 24 hours after trx of syphilis; resolves on own.
If gonorrhea positive, then
always co-treat for chlamydia, even if chlamydia is negative.
If chlamydia positive, then
you don’t have to co-treat with gonorrhea.
HSV1 is more
oral herpes
HSV2 is more
genital herpes
who to screen for syphilis
HIV infection, gay men, genital ulcer, previous STD, IV drug use
syphilis is caused by
treponema pallidum (spirochete)
s/s of primary syphilis
painless chancre
s/s of secondary syphilis
condyloma lata, maculopapular rash on palms and soles that is not pruritic.
s/s of tertiary syphilis
neuro, cardiac, and gummatous
screening test for syphilis
RPR or VDRL (nontreponemal test)
diagnostic test for syphilis
confirmed with treponemal test (FTA-ABS)
trx for primary syphilis
benzathine PCN G 2.4 million units IM x1
f/u for trx of syphilis
recheck RPR and VDRL at 6 and 12 months; look for a 4 fold decrease in titers
condyloma lata is seen in ____; condyloma acuminata is seen in ______
syphilis (later phyllis!); genital warts
risk factors of HIV
gay men, received blood from 1975-1985, hx of drug use
diagnosis of HIV
screening with ELISA, confirmed with Western Blot
ability of a test to identify or rule out a person WITH a disease
sensitivity (sensitive people have the disease)
ability of a test to identify or rule out a person WITHOUT the disease
specificity
The ELISA and Western blot only detect ____; if both are positive then this needs a ____ ordered
IgG antibodies; PCR/RNA
window period of HIV
6 weeks to 6 months may show false negative Elisa/Western blot
prophylaxis for opportunistic infections from HIV
Bactrim DS one tab daily
live viruses that can be given to HIV people if their CD4 is greater than 200
MMR and varicella
HIV education
avoid handling cat litter or eat uncooked meat; avoid birds; use gloves when gardening
antibiotic prophylaxis for pneumocystis jerovecii pneumonia (PCP) is started when
CD4 less than 200
if HIV patient is allergic to sulfa, then second line trx for PCP is
dapsone 100 mg daily
the safest HIV drug to use during pregnancy
zidovudine (AZT); ideally start during 2nd trimester
condylmata acuminata is caused by
HPV 6 and 11
age a person is eligible for HPV vaccine
9-26
acetowhitening is
white colored skin on cervical surface after acetic acid is applied; used to help detect areas to biopsy during colposcopy
cervical cancer is caused by
HPV 16 and 18
trx for genital warts
podofilox 0.5% gel/cream; Imiquimod 5% cream; cryotherapy
diagnostic for herpes simplex virus
RPR assay HSV 1 and HSV 2
s/s of herpes simplex virus
may have prodrome phase (itching, burning), sudden onset of small vesicles on erythematous base
trx for herpes simplex virus
acyclovir 400 mg 5x/day x 7-10 days or Valtrex tid x 7-10 days
trx for flare ups of herpes simplex
acyclovir or valacyclovir x 5 days; best to start one day of lesion onset.
instructions on how to use Imiquimod (Aldara) gel for herpes warts
apply 3x/week at bedtime for up to 16 weeks. Do not cover with dressing. Leave on for 6-10 hours
