STDs

Question 1

Age group which accounts for half of all new STD infections

Answer 1

15-24 yr olds

Question 2

“Sores”

Answer 2

Syphilis
Genital Herpes (HSV 1 or 2)

Question 3

“Drips” / discharges

Answer 3

Gonorrhea
Chlamydia 
Trichomonas
Candidiasis 
BV

Question 4

Painful sores

Answer 4

Herpes

Chancroid

Question 5

PainLESS sores

Answer 5

SYPHYILIS

Lymphogranuloma via CHLAMYDIA

Granulima inguinale (from Klebsiella)

Question 6

Incubation for primary syphilis

Answer 6

10-90 days (average 3 weeks)

Question 7

Primary syphilis chancre

Answer 7

Painless
macule/papule&raquo_space; erodes
“clean base, smooth firm borders”

Resolves in 1-5 weeks

HIGHLY INFECTIOUS

Question 8

Tx syphilis

Answer 8

Long acting benzathine penicillin G IM, 2.4 million units x1

Question 9

Secondary syphilis

Answer 9

2-8 weeks after primary chancre appears

Whole body rash - PALMS AND SOLES
Condylomata lata - genitourinary area
Red patches in mucus membranes

Resolves 2-10 weeks

Question 10

HSV Tx

Answer 10

Valacyclovir
Acyclovir
Famciclovir

Initial: 200mg PO q4hrs x 10 days
OR 400 mg PO q8hr for 7-10 days

Chronic Recurrence Suppression: 400 mg PO q12hr for up to 12 months; alternatively, 200 mg 3-5 times daily

Question 11

Tx gonorrhea, ureaplasma urealyticum and chlamydia

Answer 11

Zithromax 1000mg

Question 12

Tx Mycoplasma genitalium, primary syphilis, and nonspecific urethritis

Answer 12

Zithromax 2000mg

Question 13

“yellow penile discharge and mild dysuria.
He has no testicular pain, frequency, rash, or visible lesions”

Tx?

Answer 13

Zithromax 1g (1000mg)

Question 14

Gonorrhea urethritis - male

Answer 14

Incubation 1-14 days

Dysuria and urethral discharge (5% asymptommatic)

Question 15

Urogenital gonorrhea - female

Answer 15

Endocervical canal is the primary site
70-90% also colonize urethra

Incubation: unclear; sx usually occur in about l0 d

Sx: majority of women are ASYMPTOMATIC;
may have vaginal discharge, dysuria, urination, labial pain/swelling, ABDOMINAL PAIN

Question 16

Nongonococcal Urethritis

Answer 16

20-40% Chlamydia (c. trachomytis)
20-30% genital mycoplasmas (Mycoplasma genitalium, Ureaplasma urealyticum)

Occasionally it’s Trichomonas vaginalis, HSV

Unknown in ~50% cases

Question 17

Nongonoccocal Urethritis Sx

Answer 17

Mild dysuria, mucoid discharge

Question 18

Nongonoccocal Urethritis Dx

Answer 18

Urethral smear with ≥ 5 PMNs/Oil Immersion field

Urine microscopic ≥ 10 PMNs/HPF

Leukocyte esterase (+)

Question 19

Chlamydia trachomitis, Sx

Answer 19

• Mostly asymptomatic (50% of men, 75% in women)

- cervicitis, urethritis, proctitis, lymphogranuloma venereum, and pelvic inflammatory disease

Question 20

Chlamydia trachomitis, complications

Answer 20

Potential for infected women to transmit to newborn during delivery

Conjunctivitis, pneumonia

Question 21

Will gram stain show chlamydia?

Answer 21

NO - bc it’s intracellular

will show gonorrhea

Question 22

Gonorrhea tx guidelines

Answer 22

Ceftriaxone 250mg IM x1

PLUS
Azithromycin 1g PO x1
Doxycycline 100mg PO x7d

Question 23

Chlamydia / NGU tx guidelines, 1st line

Answer 23

Azithromycin 1gm po x 1

Or
Doxycycline 100mg po BID x 7d

Question 24

Chlamydia / NGU tx guidelines, 2nd line

Answer 24

Erythromycin base

OR
Erythromycin EES

OR
Levofloxacin

OR
Ofloxacin

Question 25

Fastest dx for trichomonas

Answer 25

Wet mount, vag swap w saline

OSOM ok too (rapid test)

Question 26

Trichomoas tx guidelines 1st line

Answer 26

Metronidazole 2gm PO x 1 dose

Or
Tinidazole 2gm PO x 1 dose

Question 27

Trichomonas tx guidelines, alternative, for HIV pos women

Answer 27

Alternative, for HIV positive women:

Metronidazole 500mg PO BID x 7d*