STDs Flashcards
Herpes simplex virus type 1 and 2 (mostly HSV-2) causes….
Genital herpes
Multiple grouped, vesicles (1–3 mm) on an erythematous ground
Possibly concurrent malaise, myalgias, and fever
Reactive painful inguinal lymphadenopathy common
♂: glans and penis shaft
♀: external female genitalia and cervix
Herpes simplex virus type 1 and 2 (mostly HSV-2): best initial test vs up to date
Clinical exam
Best initial test: Tzanck smear (multinucleated giant cells)
UP to date
Cell culture and PCR-based testing are the preferred tests for a patient presenting with active lesions
PCR-based testing has the greatest overall sensitivity and specificity.
Herpes simplex virus type 1 and 2 (mostly HSV-2):
2015 US CDC guidelines recommend any of three oral options for active, episodic, suppressive tx
- Acyclovir: 400 mg three times daily or 200 mg five times daily
- Famciclovir: 250 mg three times daily
- Valacyclovir: 1000 mg twice daily
Haemophilus ducreyi: causes
Chancroid
Single or multiple papules or pustules (10–20 mm) with yellowish-greyish exudate in the center
♂: glans penis, penis shaft, and scrotum
♀: vulva and perineal area
Possibly concurrent painful inguinal lymphadenopathy and abscess formation
Haemophilus ducreyi: treatment
Antibiotic treatment: single dose oral azithromycin or IM ceftriaxone
Examine and treat sexual partner(s).
Trichomonas vaginalis: causes
Trichomonas vaginalis
Vaginitis
Erythematous and papilliform appearance of the cervix (strawberry cervix)
Trichomonas vaginalis: treatment
oral metronidazole or tinidazole for patient and sexual partner(s)
Motile trichomonads on wet mount examination
Chlamydia trachomatis L1–L3
Lymphogranuloma venereum
Primary infection (after approx. one week): small, painless genital ulcers (herpetiform) that heal spontaneously within a few days
Secondary infection (after approx. 3 weeks): painful swelling of the lymph nodes in the inguinal region (buboes) with abscess formation (pus discharge) and systemic symptoms
Chlamydia trachomatis L1–L3: dx
Diagnostics: NAAT using swabs of the anogenital lesions, rectal mucosa, and/or lymph node specimens [23]
Treatment: doxycycline or erythromycin
Chlamydia trachomatis serotypes D–K
Chlamydial genitourinary infections
Men: epididymitis, prostatitis
Women: salpingitis, cervicitis
Both men and women: urethritis, proctitis
Clinical features
(Muco)purulent vaginal discharge and/or intermenstrual/postcoital bleeding
Possible dysuria, pollakiuria, polyuria, dyspareunia
Diagnostics
NAAT: gold standard
PCR detects Chlamydia trachomatis RNA or DNA from vaginal swabs (women) or first-catch urine (men).
Helps differentiate between C. trachomatis and N. gonorrhea
Chlamydia trachomatis serotypes D–K
Treatment
Azithromycin or doxycycline
If gonococcal infection is suspected, combine azithromycin with ceftriaxone.
Pregnant women: azithromycin
Children
Erythromycin for children weighing < 45 kg
Azithromycin for children weighing > 45 kg
Doxycycline may also be used in children > 8 years of age.
Alternatives to azithromycin
Quinolones — The quinolones ofloxacin and levofloxacin are both highly effective against C. trachomatis but require a full week of therapy and are considerably more costly than either doxycycline or azithromycin.
Furthermore, these drugs cannot be used in pregnancy or lactation and should not be administered to adolescents younger than 18 years of age due to concerns regarding bone abnormalities. Other quinolones, including ciprofloxacin, are either less effective or have not been tested against C. trachomatis [3].
For these reasons, ofloxacin and levofloxacin are recognized as alternative therapies in the fluoroquinolone class by the CDC; dose is as follows [3]:
●Ofloxacin 300 mg orally twice daily for seven days
●Levofloxacin 500 mg orally once daily for seven days
