STDs

Question 1

List 2 painful and 2 painless ulcerative genital STIs:

Answer 1

Painful
chancroid/HSV

Painless: 
syphillis
lymphogranuloma venerum
granuloma inguinale
HPV

Question 2

What is the causative organism of syphilis?

Answer 2

Treponema pallidum

Question 3

What are characteristics of the 2nd stage of syphillis

Answer 3

2. Secondary Syphilis:
   - Diffuse rash:
   o Macular, starts on trunk, spreads to extremities involving palms and soles.
   o Evolves to become papulosquamous
   o +/- mucous involvement
   - Condylomata lata:
   o Broad based papules with flat moist tops involving anus / perineal region
   - Systemic Sx:
   o Fatigue, fever, malaise, arthralgias,
   o Generalized adenopathy
   - 5-8 weeks after resolution of chancre

Question 4

What are characteristics of the 1st stage of syphillis

Answer 4

1. Primary syphilis
   - Chancre à solitary, painless, raised edges, sharply defined boarders
   - +/- inguinal adenopathy
   - 2-4 weeks post exposure
   Lasts 2-6 weeks, spontaneously resolves

Question 5

What are characteristics of the latent stage of syphillis

Answer 5

• Seroreactivity for syphylis without evidence of disease

Question 6

What are characteristics of the tertiaty stage of syphillis

Answer 6

Tertiary:
- 3-4 years after latent period
- CNS and CVS predominate
- CNS:
o Meningitis
o Peripheral neuropathy (tabes dorsalis)
o Personality change  à dementia
- CVS:
o Thoracic aneurysms à dissection
o AV regurgitation
o MI from vasculitits and thrombosis
- Gummatous:
o Gummas can occur anywhere
Very uncommon today

Question 7

How is the diagnosis of chancroid made?

Answer 7

H. ducreyi is difficult to culture
Clinical diagnosis à Probable diagnosis (all of)
1. One or more painful genital ulcers
2. No evidence of T pallidum by darkfield microscopy or serologic testing
3. Clinical presentation, appearance of genital ulcers, and regional lymphadenopathy are typical for chancroid
4. Test for HSV on ulcer exudates is negative

Question 8

List 5 infections that cause genital discharge:

Answer 8

• Urethritis
• Cervicitis
• Epididymitis
• Proctitis
• Prostatitis
• PID (develops in 40% of untreated women)
• Perihepatitis (Fitz-Hugh-Curtis syndrome)
• UTI like Sx (dysuria, etc)
• Conjunctivitis

Question 9

List treatments for cervicitis or urethritis:

Answer 9

Azithromycin 1g PO

ceftriaxone 250mg IM x 1

Question 10

List major and minor criteria in the diagnosis of PID (according to CDC):

Answer 10

• Major:
  o CMT or uterine or adnexal tenderness in the presence of lower abdominal or pelvic pain
• Additional criteria to support diagnosis:
  o Oral temp>38C
  o Abnormal cervical or vaginal mucopurulent discharge
  o WBCs on wet mount of vaginal secretions
  o Elevated ESR
  o Elevated CRP

Question 11

What is the treatment of PID outpatient and inpatient

Answer 11

Ceftriaxone (250 mg intramuscularly in a single dose) plus doxycycline (100 mg orally twice a day for 14 days)

Inpatient
Cefoxitin (2 g intravenously every 6 hours) or cefotetan (2 g IV every 12 hours) plus doxycycline (100 mg orally every 12 hours).

Question 12

List 6 indications for admission with PID (CDC):

Answer 12

• Surgical emergencies (i.e. appendicitis) cannot be ruled out
• Pregnancy
• Failure of oral antibiotics
• Inability to follow or tolerate outpatient therapy
• Severe illness, nausea and vomiting, or high fever
  Tubo-ovarian abscess