STDs AHHH! Flashcards
___-___ y/o account for 50% of all new STD infections
15-24 y/o
What is the most common STD? 2nd most common? 3rd most common?
Most common: HPV
then HSV-2, then Trich
Disruption of ___ and ____ make the transmission of HIV much easier
epithelial and mucosal barriers
What factors facilitate HIV transmission?
- Increase the # of HIV target cells in the genital tract
- Increase expression of HIV co-receptors
- Induce secretion of cytokines (increase HIV shedding)
- HIV alters natural hx of some STIs
Where are people most likely to seek care for a STD?
Are men or women more likely to seek care?
PCP
Women
What STDs commonly present as sores?
Syphillis
Herpes (HSV1 or 2)
*uncommon in the USA–> Lymphogranuloma venereum, Chancroid, Granuloma inguinale
What STD commonly present w/ discharge?
Gonorrhea Chlamydia Trichomonas vaginitis / urethritis Candidiasis (not an STD) Bacterial vaginosis (sexually associated, but not sexually transmitted!)
Other major concerns: genital HPV and caCAncer
Just as birds of a feather, flock together…. so do ____
STDs
What is the DDx of painful genital ulcers
Genital herpes simplex
Chancroid
What is the DDx of PAINLESS genital ulcers?
Syphilis
Lymphogranuloma venereum (caused by chlamydia) Granuloma inguinale (a sexually transmitted version of Klebsiella)
What is the incubation phase for syphilis?
10-90 days (averge 3 weeks)
A ___ is a painless, indurated ulcer w/ a clean base and smooth, firm border
What STD if this associated w/?
Chancre
Syphilis
A chancre goes unnoticed in __-__ % of pts and resolves in ___-___ wks
Unnoticed in 15-30% of pts
Resolves in 1-5 weeks
T/F: A chancre makes syphilis very infectious
True
____ is the hematogenous dissemination of spirochetes that usually occurs 2-8 weeks after a chancre appears. S/s resolve in 2-10 weeks.
secondary syphilis
What are common findings w/ secondary syphilis? (x4)
Rash - whole body (includes palms/soles)
Mucous patches
Condylomata lata - HIGHLY INFECTIOUS
Constitutional sxs
What can you use to dx syphilis?
Darkfield
Serology
What is the recommended tx for syphilis?
Benzathine PCN G (Bicillin), 2.4 million units IM x 1
Transmission of HSV is through direct contact usually during (symptomatic/asymptomatic) shedding
asymptomatic
Shedding during the prodrome is common!
The primary infection of HSV is commonly (symptomatic/asymptomatic)
Asymptomatic (mainly people dont know they have it)
How do you dx HSV?
PCR
Cx
Serology (Type-specific; Western blot)
How do you tx HSV?
Acyclovir
Valacyclovir
Famciclovir
What is the dosing for acyclovir?
***MUST KNOW
400 mg PO q8hr for 7-10 days
or 200 mg PO q4hr while awake (5 times daily) for 10 days
Tx is (longer/shorter) for primary infection and (longer/shorter) for recurrent infection
Longer
Shorter
When may you consider chronic HSV suppression tx?
After 1 yr of infection (more likely to have recurrences at this time)
If the pt is having 4+ recurrences/year
_____ is an effective tx against STIs. When treating gonorrhea, ureaplasma urealyticum and chlamydia, take a dose of 1000mg (two 500mg tablets).
When treating Mycoplasma genitalium, primary syphilis, and nonspecific urethritis, the dose should be increased to ____ mg
Zithromax
2000 mg
What are the S/S of Gonorrhea in males?
“Drippy, Hurty PP”
Dysuria and urethral discharge (5% asymptomatic)
What are the S/S of Gonorrhea in Women?
Majority are asymptomatic
may have…
- vaginal discharge
- dysuria, urination
- labial pain/swelling
- abdominal pain
where is the primary site for urogenital infection in women with gonorrhea?
Endocervical canal
***70-90% also colonize urethra
what is the incubation phase for gonorrhea in men?
1-14 days
women maybe 10 days
what is the etiology (bacteria) for Nongonococcal Urethritis
Unknown in ~50% cases
20-40% C. trachomatis
20-30% genital mycoplasmas (Mycoplasma genitalium, Ureaplasma urealyticum)
What are s/s of Nongonococcal Urethritis
Mild dysuria
mucoid discharge
What is the clinical Manifestations for chlamydia
Mostly asymptomatic (50% of men, 75% in women)
cervicitis urethritis proctitis lymphogranuloma venereum PID
how can you dx Chlamydia
NAAT
can gram stain
how can you tx Gonorrhea?
Cefitriaxone 250 mg IM x 1
+
Azithromycin 1gm PO x 1 Or OR
Doxycycline 100mg PO BID x 7d
what complications are caused during delivery for infected women with chlamydia and transmits it to newborn
Conjunctivitis
PNA
Chlamydia is an ____ ____ bacteria that infects columnar epithelial cells and survive by ____ and results in the death of the cell
obligatory intracellular bacteria
replication
How do you tx Chlamydia/NGU
**Know doses
Azithromycin 1gm po x 1 Or
Doxycycline 100mg po BID x 7d
Alternative: Erythromycin base 500mg po QID x 7d Or Erythromycin EES 800mg po QID x 7d Or Levofloxacin 500mg po qd x 7d Or Ofloxacin 300mg po BID x 7d
___ is a Sexually transmitted parasite
Trichomonas Vaginalis
Trichomonas Vaginalis has an estimated prevalence os
___% in the general female population
Prevalence (increases/decreases) with age
Highest rates in __ (populaiton)
3.1%
increases
AA
How do you dx trich?
wet mount (fastest)
or OSOM test (trich rapid test)
How do you treat Trich?
**know doses
Metronidazole 2gm PO x 1 dose Or
Tinidazole 2gm PO x 1 dose
Alternative:
Metronidazole 500mg PO BID x 7d
