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Clin Med III > STDs > Flashcards

STDs Flashcards

1
Q

vaginitis

A
  • general term for vaginal infection, inflammation or change in vaginal flora
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2
Q

sx of vaginitis

A
  • discharge- change in volume, color
  • pruritis
  • odor
  • dyspareunia
  • dysuria
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3
Q

normal vaginal flora

A
  • mainly lactobacilli
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4
Q

normal vaginal pH in premenopausal women

A
  • 4.0 - 4.5
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5
Q

normal vaginal pH in premenarche or postmenopasual

A
  • 4.7
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6
Q

normal vaginal discharge

A
  • d/c is normal
  • is an issue when it causes sx like itching, pain, odor
  • normally clear or whiteish
  • odorless
  • more during mid cycle and pregnancy
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7
Q

things that can impact vaginal discharge

A
  • estrogen- progesterone contraceptives
  • diet
  • sexual activity
  • medications
  • stress
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8
Q

bacterial vaginosis

A
  • shift in vaginal flora: decreased lactobacilli and more diverse bacteria
  • increased production of amines by new bacteria
  • rise in pH > 4.5
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9
Q

what is the most common cause of discharge in younger women

A
  • bacterial vaginosis
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10
Q

major bacterial responsible for BV

A
  • gardnerella vaginalis*
  • prevotella spp
  • prophyromonas spp
  • bacteroides spp
  • produce amines
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11
Q

risk factors for BV

A
  • sexual activity
  • STD
  • AA
  • smoking
  • hygiene use i.e. douching
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12
Q

clinical manifestations of BV

A
  • asymptomatic
  • discharge*- thin, off white
  • fishy odor*
  • more noticeable after intercourse or during menses
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13
Q

dx of BV

A
  • thin gray- white d/c
  • pH > 4.5
  • pos whiff test- drop of KOH on discharge -> fishy odor
  • clue cells
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14
Q

treatment for BV

A
  • flagyl* PO or intravaginally
  • clindamycin or tinidazole
  • vaginal boric acid suppository X 30 d (recurrent)
  • flagyl gel intra vag 2X a week X 4-6 mo (recurrent)
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15
Q

candidiasis

A
  • common cause of vaginal itching and discharge
  • due to inflammation of candida spp
  • present in normal flora of 25% of women
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16
Q

types of candida that cause yeast infections

A
  • candida albicans- majority of cases
  • candida glabrata- milder sx
  • NOT assoc with reduction in lactobacilli
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17
Q

risk factors for candidiasis

A
  • diabetes
  • abx
  • increased estrogen levels
  • immunosuppression
  • diaphragms, sponges, IUDs
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18
Q

clinical manifestations of candidiasis

A
  • vulvar pruritis**
  • burning, soreness, irritation
  • dysuria
  • dyspareunia
  • erythema, vulvar excoriation
  • discharge is white, thick, adherent
  • normal cervix
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19
Q

diagnosis of candidiasis

A
  • microscopy of vaginal d/c
  • pH usu 4-4.5
  • KOH on discharge -> hyphae and budding
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20
Q

management of simple uncomplicated candidiasis

A
  • fluconazole (diflucan)
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21
Q

management of complicated candidiasis

A
  • fluconazole 2-3 doses 72 hours apart

- 7-14 days topical cream

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22
Q

management of candidiasis in pregnancy

A
  • no PO options

- clomitrazole, miconazole intravag X 7 days

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23
Q

trichomonas

A
  • due to protozoa trichomonas vaginalis
  • most common non-viral STD world wide
  • may be asymptomatic
  • usu self limited in men
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24
Q

trichomonas sx in women

A
  • varied sx
  • prurulent, malodorous thin d/c
  • burning, pruritis
  • dysuria
  • frequency
  • lower abd pain, dyspareunia
  • 70-85% are asymptomatic but will eventually dev sx
  • erythema of vulva and vaginal mucosa
  • strawberry cervix*
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25
Q

trichomonas sx in men

A
  • 75% asymptomatic
  • spont resolution within 10 d but can persist for months
  • mucopurulent urethral d/c
  • dysuria, burning
  • mild pruritis
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26
Q

diagnosis of trichomonas

A
  • microscopy shows jerky/ spinning protozoa
  • pH > 4.5
  • NAAT- gold std
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27
Q

management of trichomonas

A
  • flagyl or tinidazole 2g single dose
  • treat partners
  • abstain from sex X 7 days
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28
Q

gonorrhea

A
  • 2nd most commonly reported communicable disease/ STI
  • cervicitis in women
  • urethritis in men
  • extragintal infections- pharynx and rectum
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29
Q

risk factors for gonorrhea

A
  • recent new sex partner, multiple partners
  • unmarried
  • young age
  • minority
  • low education
  • low SES
  • substance abuse
  • hx of gonorrhea, HIV
30
Q

clinical manifestations of gonorrhea in women

A
  • cervicitis*
  • urethritis- more in men
  • 70% asymptomatic
  • pruritis
  • mucopurulent d/c
  • pain is atypical unless PID
31
Q

clinical manifestations of gonorrhea in men

A
  • urethritis
  • mucupurulent d/c
  • dysuria
  • epdidymitis will dev if not treated
  • majority of men are symptomatic
32
Q

diagnosis of gonorrhea

A
  • genital swab in females
  • urine cx in men
  • NAAT- quicker but does not test susceptibility
33
Q

treatment for gnorrhea

A
  • ceftrixone PLUS azithromycin
34
Q

chlamydia

A
  • most commonly reported bacterial infx in U.S.
  • causes cervicitis and urethritis
  • mostly asymptomatic
  • 2X more common in women
35
Q

risk factors for chlamydia

A
  • age < 25
  • new partner or more than 1 partner in last mo
  • hx of prev chlamydia or STIs
  • inconsistent condom use
  • ethnic groups
  • special pops
36
Q

screening for chlamydia

A
  • sexually active women 25 and under annually
  • over 25 based on risk
  • pregnant women
  • MSM- annually
  • men entering jail
  • military
  • new partner
37
Q

clinical manifestations for chlamydia in women

A
  • cervix affected
  • majority asymptomatic
  • nonspecific sx
  • change in vaginal d/c
  • cervical bleeding
  • frequency, dysuria
  • UA pos, Cx neg
38
Q

clinical manifestations for chlamydia in men

A
  • urethritis
  • mucoid or watery d/c
  • dysuria
39
Q

diagnosis of chlamydia

A
  • vaginal swabs in women
  • urine for men
  • NAAT
40
Q

treatment of chlamydia

A
  • azithromycin

- doxy

41
Q

pelvic inflammatory disease

A
  • acute infection of upper genital tract in women
  • uterus
  • ovaries
  • fallopian tube
  • endometrium
  • intiated by sexually transmitted agent
42
Q

what disease causes more severe PID

A
  • gonorrhea
43
Q

risk factors for PID

A
  • multiple sex partners
  • younger age
  • partners with STI or prev hx of STI
  • prev hx of PID
  • AA and black caribbean
44
Q

clinical manifestations of PID

A
  • usu acute onset
  • sx vary from mild vague pelvic sx to tubo-ovarian abscess
  • rarley fatal intra-abd sepsis
  • liver inflammation- perihepatitis
  • lower abd or pelvic pain, worsens with intercourse
  • onset of pain during or shortly after menses
45
Q

dx of PID

A
  • pelvic organ tenderness
  • CT if uncertain dx or complications
  • US
  • presumptive dx is enough to warrant empiric tx due to reprod sequelae
  • temp > 101
  • abnormal d/c
  • WBC on microscopy
  • documentation of GC/ chlamydia infection
46
Q

what causes syphilis

A
  • treponema pallidium

- spirochete

47
Q

how is syphilis transmitted

A
  • direct contact with infectious lesion

- crosses placenta -> fetal infection

48
Q

stages of syphilis

A
  • early- occurs weeks to months after infection
  • early subdivided into primary, secondary, or early latent
  • late- untreated pts that go onto dev complications
  • late subdivided into tertiary or late latent
49
Q

clinical manifestations of early syphilis

A
  • chancre- painless ulcer

- bilateral LAD

50
Q

secondary sx of early syphilis

A
  • fever, HA
  • LAD
  • malaise, anorexia, weight loss
  • sore throat
  • rash*- maculopapular on soles of feet and trunk
51
Q

clinical manifestations of late syphilis

A
  • CV syphilis- esp aortitis
  • gummatous syphilis- nodular lesions
  • CNS paresthesias- tabes dorsalis
52
Q

tertiary syphilis

A
  • late who are sympomatic with CV or gummatous disease
53
Q

latent syphilis

A
  • asymptomatic but still infected

- not considered infectious

54
Q

who to test for syphilis

A
  • painless genital ulcer
  • rash on palms and soles
  • neuro sx without alternative etiology
  • partner with early syphilis
  • MSM
  • HIV infected
  • high risk sexual behavior
  • incarceration
  • sex workers
55
Q

what are the tests for syphilis

A
  • nontreponemal
  • treponemal
  • both are serum tests
56
Q

non-treponemal test

A
  • initial screening for syphilis in asymptomatic pts
  • non-specific, measures antibodies
  • reported as titer
  • can be used to monitor tx
  • RPR, VRDL, TRUST
57
Q

treponemal test

A
  • used as confirmatory test when non-treponemal is positive
  • reported as reactive or nonreactive
  • usu remain positive for life
  • FTA-ABS, TP-EIA
58
Q

treatment of syphilis

A
  • early= pen G IM X 1
  • late= pen G IM X once weekly X 3 weeks
  • prednisone X 3 days if CV syphilis
59
Q

treatment for neurosyphilis

A
  • pen G IV q 4 hours 10-14 days or as cont infusion
  • cefriaxone
  • doxy
60
Q

HPV cutaneous types

A
  • types 1 and 2

- assoc with plantar and common hand warts

61
Q

HPV mucosal types

A
  • types 6, 11, 16, or 18

- assoc with genital warts, precancerous or cancerous lesions

62
Q

risk factors for HPV

A
  • sexual activity
  • increased number of partners
  • vaginal and anal intercourse
  • MSM higher risk for anal infection
  • heterosexual men higher risk oropharyngeal infection
63
Q

vaccines for HPV in kids 11-12

A
  • 2 shouts 6-12 mo apart
64
Q

vaccines for HPV in kids over 14

A
  • 3 shots over 6 mo
65
Q

diagnosis of HPV

A
  • pap smear to look for abnormal/ cancerous cells
  • HPV test to look for virus
  • women < 21 no testing
  • women 21-29 PAP q 3 years
  • women 30-65 and HPV cotesting q5 years
66
Q

clinical manifestations of HPV

A
  • most asyptomatic
  • abnorm pap or pos HPV test may be first sign
  • vulvar/ vaginal warts
  • itchy and painful
  • most strains that cause cervical cancer dont cause warts
67
Q

management of HPV

A
  • no tx for virus

- monitor with PAP smears

68
Q

diagnosis of herpes

A
  • active lesions can be unroofed and sent for viral cx and PCR
  • serologic testing not commonly done
  • screening not recommended
69
Q

who needs chronic suppressive therapy for herpes

A
  • 6+ episodes per year
70
Q

who needs episodic therapy for herpes

A
  • 5 or less episodes per year

Clin Med III (26 decks)

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