STDs Flashcards
In men, what is the best initial test for dx of urethritis?
Urethral swab for gram stain and WBC, look for intracellular gram negative diplococci for N.gonorrhea
What is the most accurate test for urethritis
Urine for nucleic acid (NAAT) detects gonorrhea and chlamydia
Organisms causing urethritis?
N.gonorrhea
Chlamydia
Mycoplasma genitalium
Ureaplasma
Best initial test for dx of urethritis in women?
Self administered vaginal swab
What is tx for urethritis?
One drug for gonorrhea and one for chlamydia
Gonorrhea: cefixime (resistant to quinolones) or ceftriaxone
Chlamydia: azithromycin or doxy
Cervicitis px
Cervical discharge, strawberry cervix
Cervicitis tx
Ceftriaxone or cefixime and azithromycin or doxy
Cervicitis dx
Self administered cervical swab for NAAT
PID is caused by which bugs?
Gonorrhea, chlamydia
PID presentation
Lower abdominal tenderness, fever, cervical motion tenderness (found on bimanual exam), leukocytosis
Most specific tests for PID
Culture, DNA probe or nucleic acid amplification (NAAT)
Clarify need for treating the partner
How to determine resistance of organisms causing PID?
Culture
When to use laparoscopy in PID and why?
It is the most accurate test, use only if the dx is unclear, sx persist despite tx or there is recurring episodes for unclear reasons
It is very rarely done
PID tx?
Inpatient: cefoxitin or cefotetan combined with doxy
Outpatient: ceftriaxone and doxy (possibly with metronidazole)
Patient has PID but anaphylaxis to penicillin, what is the tx?
Levofloxacin and metronidazole in outpatient
Clindamycin and gentamycin in inpatient
In ulcerative genital disease, how to make a ddx with px and hx?
Painless ulcer : syphillis
Painful ulcer : chancroid (hemophilus ducreyi)
Tender and supurrating lymph nodes : lymphogranuloma venereum
Painful ulcer with prior vesicules : herpes simplex
Best initial test for syphillis?
Dark field microscopy (best in primary) if positive, no further testing is necessary!, VDRL or PCR (75% sensitive only), FTA or MHA-TP (for confirmation only)
Dx test for chancroid?
Stain and culture (special media): pleomorphic gram neg coccobacillus
Dx test for lyphogranuloma venerum?
Complement fixation titers serology, nucleic amplification testing on swab
Dx for herpes simplex?
Tzank prep (best initial test): multinucleated giant cells Viral culture : most accurate test
Tx for syphillis?
One dose IM benzathine penicillin
Tx for syphillis if the patient is allergic to penicillin?
Doxy
Tx for chancroid?
Single dose of azithromycin
Tx for lymphogranuloma venerium
Doxy
Tx for herpes simplex
Acyclovir, valacyclovir, famciclovir
How to detect aciclovir resistant herpes?
Viral sensitivity testing
What is the tx for aciclovir resistant herpes?
Foscarnet
Woman comes to the clinic with multiple painful genital vesicles, what is the next best step?
Go straight to tx (not tzank prep), gove acyclovir orally
Primary syphillis sx
Painless genital ulcer, can become painful is secondarily infected, painless adenopathy, chancres will heal spontaneously but use penicillin to prevent secondary/tertiary
Secondary syphillis sx and presentation
Rash on palms and soles
Alopecia areata
Mucous patches
Condylomata lata
Tertiary syphilis presentation
Neurosyphilis: meningovascular (stroke at a young age); tabes dorsalis (loss of position and vibratory sense, incontinence, cranial nerve), general paresis (memory and personality changes), argyll robertson pupil,
Gummas (skin and bone lesions)
Aortitis (aortic regurgitation, aortic aneurysm)
What could cause a false positive VDRL/RPR?
Infection, older age, injection drug use, AIDS, malaria, antiphospholipid syndrome and endocarditis
Titers for VDRL or RPR are reliable at?
Rarely false positive at?
Reliable at >1:8 (lower is often false positive)
Rarely false positive at >1:32
Treatment of primary and secondary syphilis
Single dose IM injection of penicillin, oral doxy if allergic
Tx of tertiary syphilis?
IV penicillin, desensitization if allergic
What is the Jarish-herxheimer reaction?
Fever, headache, myalgiad after treatment
Give aspirin and antipyretics, it is benign and will pass
When to desensitize patients that have syphilis?
In neurosyph if penicillin allergic or pregnancy only
How to diagnose genital warts (condylomata acuminata)
Visual appearance (no biopsy, serology or stains)
How to treat genital warts?
Remove it by cryotherapy, surgery if large, laser, podophyllin or trichloroacetic acid
imiquimod (apply locally): immunostimulant
How does pediculosis presents
Itchy little “black dots” , visible on hair baring areas (axilla, pubis)
How to treat crabs?
Permethrin
How do scabies present?
Visible burrows in web spaces (between fingers and toes), around nipples, near genitals
How to dx scabies?
Scrape and magnify
Tx for scabies?
Permethrin
If widespread scabies: oral ivermectin
Severe disease needs repeat dosing
What are the common sx between cystitis and urethritis and how to differentiate them based on symptomatology?
Dysuria, frequency and burning are common sx
Cystitis does NOT have discharge
