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Women's health > STDs and a couple of add-ons > Flashcards

STDs and a couple of add-ons Flashcards

1
Q

High risk pops (STDs, chlamydia, syphilis)

A

youth

chlamydia: black>Hispanic>white
syphilis: MSM account for 72% cases 2011, high rate of HIV coinfection

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2
Q

Vulvovaginal Candidiasis causative organism(s)

A

NOT AN STD
(U) Candida albicans
can be caused by other Candida sp. or yeasts (Candida glabrata, Candida tropicalis or Torulopsis glabrata)

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3
Q

Vulvovaginal Candidasis epidemiology

A

COMMON!
at least 75% of women experience 1 episonde
40-45% experience>1 episode

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4
Q

Vulvovaginal Candidiases Clinical Presentation

A

-Vulvar pruritis, external dysuria, burning, dyspareunia, swelling, redness, excoriation
-thick, curd-like vaginal discharge
NORMAL VAGINAL pH (<4.5)

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5
Q

Vulvovaginal Candidiasis: Risk Factors

A

taking antibiotics
immunocompromise (eg. HIV, DM, steroids)
body w/warm, most environment

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6
Q

Vulvovaginal Candidiases: Dx

A
  1. clinical presentation
  2. Testing:
    a. wet prep (saline & 10% KOH) w/microscope visualization of budding yeast & hyphae
    b. Candida culture
    - spaghetti & meatballs
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7
Q

Vulvovaginal Candidiasis: UNCOMPLICATED tx

A 
Uncomplicated:
short course (103 days) of topical (vaginal) azole e.g. clotrimazole (OTC)
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8
Q

Vulvovaginal Candidaisis: COMPLICATED definition and tx

A

def: Recurrent (> or =4 episodes in 1 yr), severe, non-albicans, patient has uncontrolled DM or immune compromise
-tx w/longer duration (7-14 d) topical azole or oral fluconazole (Diflucan)
IF NON-ALBICANS, AVOID FLUCONAZOLE-pick a different azole

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9
Q

Vulvovaginal Candidiasis: tx of male partner

A

male partner DOESN’T NEED TX

UNLESS HE HAS BALANTIS (inflammation of the skin covering the glans of the penis)

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10
Q

Vulvovaginal candidiasis: pregnant patients tx

A

ONLY use TOPICAL txs in pregnant pts

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11
Q

What do you do if a patient has recurrent or difficult to tx yeast infections?

A

evaluate for DM, HIV

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12
Q

Bacterial Vaginosis: an STD?

A

NOT an STD

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13
Q

Vulvovaginal Candidiasis: an STD?

A

NOT an STD

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14
Q

Bacterial Vaginosis causative organism/background

A 
results from disruption of usual, "healthy" vaginal microflora (Lactobacillus sp)-allows overgrowth of bacturea
cause is (U) polymicrobial, often a/w Gardnerella vaginalis & Mobiluncus sp (gram variable anaerobes)
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15
Q

Bacterial Vaginosis: Clinical Presentation

A

vaginal irritation, thin white or gray discharge w/strong fishy odor

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16
Q

Bacterial Vaginosis: Risk factors

A

(although NOT an STD),

  • New or multiple sex partners
  • douche
  • can affect women that are NOT sexually active
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17
Q

Bacterial vaginosis diagnosis (clinical criteria)

A

Clinical criteria (Amsel’s criteria) at least 3 of 4 present

  1. Thin white homogenous discharge
  2. Clue cells on microscopy
  3. Vaginal fluid pH>4.5
  4. Release of fishy odor when adding KOH solution (+whiff test)
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18
Q

Bacterial vaginosis: lab test

A

best LAB test is Gram stain-shows anaerobes known to cause BV & lack of Lactobacilli
-Gold Standard but NOT generally used clinically

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19
Q

Bacterial Vaginosis: tx

A

treat ALL PATIENTS WITH SXS
Metronidazole (Flagyl) orally for 7 days
-avoid EtOH while taking metronidazole
Metronidazole gel intravaginally for 5 dyas
Clindamycin orally or intravaginally
PREGO PTs: USE ORAL MEDS [just incase they have an infection higher up & to avoid premature birth]

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20
Q

Bacterial Vaginosis: male partner tx

A

male partner DOES NOT need tx

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21
Q

Bacterial Vaginosis: complications

A
  • increases risk of acquiring & transmitting HIV
  • increases risk of acquiring herpes, gonorrhea (GC) & chlamydia
  • a/w PID (but BV is not believed to he a causative factor)
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22
Q

Trichomoniasis: causative organism & description

A

Trichomonas vaginalis: single celled protozoan parasite

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23
Q

Trichomoniasis: how common is this?

A

common (most common NON-VIRAL)

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24
Q

Trichomoniasis: sxs appear when

A

1-4 weeks after exposure

men (U) ASYMPTOMATIC: sxs<10% of cases [male sx: clear or mucopururent urethral dc &/or dysuria]

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25
Q

Trichomoniasis clinical presentation

A
  1. INCREASED VAGINAL pH (>4.5)
  2. vaginal irritation & malodorous, frothy, yellow-green discharge
  3. may see petechiae on cervix or vagina (“strawberry cervix”)
    [although these are the classical sxs, they occur only in some cases]
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26
Q

Trichomoniasis: dx

A

-visualize motile organisms on wet mount
-swab (vaginal, cervical, some tests appropriate for male urethra)
-culture (may take up to 7 days)
other technologies: eg NAAT
-pap test may identify trich
-testing is difficult in males (a little “trick”:5-20% of men w/non-gonococcal urethritis (NGU) have trich

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27
Q

Nucleic Acid Amplification test (NAAT)

A
  • biochemical technique used to detect the genetic material of an infecting organism
  • faster than culture
  • very sensitive (also preferred in males)
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28
Q

Trichomoniasis: tx

A
  • treat everybody (pt & sex partners)
  • Metronidazole (Flagyl) orally
  • pt&partners should abstain from sex until tx is complete (high recurrence rate)
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29
Q

Trichomoniasis complications

A

increases risk of acquiring & transmitting HIV

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30
Q

Trichomoniasis: pregnancy considerations

A

trich increases risk of premature rupture of membranes, preterm delivery, low birth wt BUT TX NOT SHOW TO REDUCE RISKS

  • tx recommended for pts with symptoms
  • lactating women should withhold breastfeeding while taking metronidazole
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31
Q

Bacterial Vaginosis: microscopic appearahce

A

increased WBCs
decreased lactobacilli
many CLUE CELLS

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32
Q

Candidiasis: microscopic appearance

A

hyphae and buds

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33
Q

Trichomoniasis: microscopic appearance

A

normal epithelial cells
increased WBCs
trichomonads

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34
Q

Normal vaginal microscopic appearance

A

normal squamous epithelial cells

numerous lactobacilli

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35
Q

Bacterial Vaginosis common sxs

A
  • discharge

- odor that gets works after intercourse, may be asymptomatic

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36
Q

Candidiasis: common sxs

A
  • itching
  • burning
  • irritation
  • thick, white discharge
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37
Q

Trichomoniasis: common sxs

A
  • frothy d/c
  • bad odor
  • dysuria
  • dyspareunia
  • vulvar itching & brining
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38
Q

Normal vagina: amount of d/c, appearance of d/c

A

small amount of d/c

d/c is white, clear, flocculent

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39
Q

Bacterial vaginosis: amt of d/c and appearance of d/c

A

amt: often increased
appearance: thin, homogenous, gray-green, white, adherent

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40
Q

Candidiasis: amount of d/c & appearance of d/c

A

amt: sometimes increased
appearance: white, curdy, “cottage cheese-like”

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41
Q

Trichomoniasis: amount of d/c & appearance of d/c

A

Amt: increased
appearance: gray-green, frothy, adherent

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42
Q

Normal vaginal pH

A

3.8-4.2

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43
Q

Bacterial vaginosis vaginal pH

A

> 4.f

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44
Q

Candidiasis vaginal pH

A

normal (3.8-4.2)

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45
Q

Trichomoniasis vaginal pH

A

> 4.5

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46
Q

KOH “whiff test” (amine odor) present in?

A 
Bacterial vaginosis (fishy)
possibly present in Trichomonaisis (fishy)
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47
Q

Chlamydia: causative organism & gram stain

A

Chlamydia trachomatis

GRAM NEGATIVE BACTERIUM

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48
Q

Chlamydia epidemiology

A

most common BACTERIAL STI in the US

peaks in late teens, early 20s

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49
Q

Chlamydia: screening recommendations

A
  • women < or =25 should be screened for chlamydia every year (screen older women w/risk factors)
  • only screen higher risk males (correctional facilities, etc.)
  • screen ALL PREGNANT PATIENTS
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50
Q

Patients infected with chlamydia are frequently co-infected with what

A

gonorrhea

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51
Q

Chlamydia presentation (in women, in men)

A

often asymptomatic, sxs 1-3 weeks after exposure

WOMEN: cervical d/c, vaginal bleeding, low abdominal pain, fever/chills, adnexal tenderness [adnexal=pain from ovary & fallopian tube]

MEN: irritated urethra(urethritis), penile d/c, dysuria

can cause oral & rectal infections

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52
Q

Chlamydia dx

A

Swab: cervical, vaginal or male urethral; various technologies (eg NAAT-gen most sensitive)
Urine: NAAT
Pharynx or rectal swab: NAAT, check w/lab to determine if there is a specific swab for the pharynx or rectal swab you need to use

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53
Q

Chlamydia tx: who do you treat

A

treat everybody [test(if possible) & tx pt & partners]

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54
Q

Chlamydia tx

A

tx everybody
Doxycycline orally x7d
OR
Azithromycin (Zithromax) single dose
no sex during tx
consider tx for gonorrhea too (assume coinfection)
retest in 3-4 months
pregnant pts: avoid doxycycline, pregnancy cat D
perform test-of-cure 3 weeks after therapy completion

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55
Q

Chlamydia complications

A

increases risk of acquiring & transmitting HIV
if left untx, can cause PID and associated complications
in males, can cause epididymitis

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56
Q

Chlamydia: pregnancy considerations

A
  • may lead to preterm delivery
  • may transmit to neonate during delivery
  • a leading cause of CONJUNCTIVITIS(ophthalmia neonatorum) & PNEUMONIA in newborns
  • can cause other respiratory tract infections
  • AVOID DOXYCYCLINE IN PREGNANCY
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57
Q

Gonorrhea: causative organism & morph/gram

A

Neisseria gonorrhea-gram NEGATIVE DIPLOCOCCI bacterium

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58
Q

Gonorrhea background: when to symptoms occur, who do you screen

A

symptoms may occur 1-14 days after exposure
screen pts at risk
-pts often co-infected with chlamydia

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59
Q

Gonorrhea clinical presentation (women[W,4]and males[M,3], both [B,])

A

(like Chlamydia but more severe)
W: vaginal d/c, low abdominal pain, fever, cervical motion tenderness
M: irritated urethra (urethritis), white-yellowish-or green penile d/c, dysuria
B: can cause oral & rectal infections

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60
Q

Gonorrhea lab dx

A

swab or urine (like chlamydia)
Swab: cervical, vaginal or male urethral; various technologies (eg NAAT-gen most sensitive)
Urine: NAAT
Pharynx or rectal swab: NAAT, check w/lab to determine if there is a specific swab for the pharynx or rectal swab you need to use

61
Q

Gonorrhea tx: who to treat

A

treat everybody

62
Q

Gonorrhea tx

A

Ceftriaxone (Rocephin) IM (injection)
PLUS azithromycin or doxycycline (this regimen convers chlamydia too)
no sex during tx
retest in 3-4 months

63
Q

Gonorrhea complications

A

-increase risk of acquiring & transmitting HIV
-if left untx, can cause PID & assoc. complications (in males, can cause epididymitis)
CAN CAUSE CONJUNCTIVITIS, MENINGITIS, ENDOCARDITIS & DISSEMINATED DZ
(U) need to hospitalize in disseminated dz

64
Q

Gonorrhea: pregnancy considerations

A

transmittable to neonate during delivery
neonatal infections:
-can result in perforation of the globe & blindness
-most states require conjunctivitis (ophthalmia neonatorum) prophylaxis for all newborns
-topical erythromycin applied to both eyes asap after delivery
IN NEWBORNS W/SXS, ocular specimens should be tested for gonorrhea & chlamydia->always do cultures before initiating tx
-rarely can cause sepsis, arthritis, meningitis

65
Q

Nongonococcal Urethritis (NGU): causative organism

A

urethritis caused be any pathogen other than gonorrhea

eg. Chlamydia trachomatis (most common), Mycoplasma genitalium, others

66
Q

Nongonococcal Urethritis clinical presentation

A

urethritis

67
Q

Nongonococcal Urethritis dx

A

test for gonorrhea & chlamydia

68
Q

Nongonococcal Urethritis (NGU) tx

A
  • dependent on testing
  • empiric tx w/azithromycin or doxycycline (like for chlamydia)
  • follow-up for persistent sxs
69
Q

Pelvic Inflammatory Disease: What is it?

A

general term, refers to SPECTRUM OF INFLAMMATORY disorders of the UPPER GENITAL TRACT
-endometritis, salpingitis, tubo-ovarian abscess

70
Q

Pelvic Inflammatory Disease includes which conditions

A

endometritis, salpingitis, tubo-ovarian abscess

71
Q

Pelvic Inflammatory Disease:causative organisms

A
  • sexually transmitted organisms most common (U) chlamydia &/or gonorrhea
  • other pathogens (eg. anaerobes, Haemophilus influenza, CMV)
72
Q

PID pathophysiology

A

ascending infection from vagina or cervix to upper genital tract

73
Q

PID clinical presentation: acute (6)

A 
many have subtle or mild sxs
ACUTE: vaginal discharge
lower abdominal pain
cervical motion tenderness (chandelier sign)
uterine or adnexal tenderness
dyspareunia
fever (>101*F)
74
Q

PID clinical presentation: chronic

A

occurs due to insufficient tx

vague symptoms

75
Q

PID risk factors

A 
age<25
African American race
early onset of sexual activity
multiple sex partners
douche
IUD (only within 3 weeks of insertion)
prior history of PID
76
Q

PID diagnosis & other impt testing

A

serum quantitative HCG (pregnancy test)
test for GC & chlamydia
-check WBCs on saline microscopy of vaginal fluid
-CBC, ESR, CRP
-ULTRASOUND: r/o ectopic pregnancy, thickening noted in areas of inflammation, tubo-ovarian abscess
-LAPAROSCOPY: visualization, can take specimens

77
Q

PID tx

A

test for GC/Chlamydia, other pathogens before intiating tx
-tx empirically (presumptively)-begin prior to receiving tests results
-selection of Abs dependent on clinical scenario
OUTPATIENT REGIMEN eg.:
Ceftriaxone (Rocephin) IM injection (covers Gonorrhea)
Doxycyclinex14 days (covers Chlamydia)
Metronidazolex14days (covers trich, BV, ?maybe candidiasis?)
***FOLLOW UP WITHIN 48 HOURS

78
Q

PID hospitalize if

A

(inpatient=IV tx)

  • surgical emergencies can’t be r/o (ectopic preg, appendicitis, ovarian torsion)
  • patient is pregnant
  • patient is not responding to oral antibiotics (win 48-72 hours)
  • patient has tubo-ovarian abscess
  • pt is very ill, eg: high fever (>202.2*F), N/V, looks sick
79
Q

PID complications

A
  • infertility
  • ruptured tubo-ovarian abscess (surgical emergency)-life threatening
  • chronic pelvic pain
  • increased risk of ectopic pregnancy
  • Fitz-Hugh-Curtis syndrome (perihepatitis characterized by RUQ pain & adhesions)
80
Q

Genital Herpes: causative organism

A

Herpes simplex virus type 1 or type 2

81
Q

Genital Herpes prevalence

A

common

at least 50 million ppl in the US with HSV-2 genital herpes

82
Q

HSV-2 usually cases what

A

genital lesions

83
Q

Genital Herpes symptoms of most infected people

A

most infected have minimal or no symptoms

84
Q

Genital Herpes is commonly acquired from….

A

an ASYMPTOMATIC partner

85
Q

4 designations of genital herpes

A
  • primary
  • non-primary 1st episode
  • recurrent
  • asymptomatic viral shedding
86
Q

Genital herpes pathophysiology

A
  • spread through contact with lesions, mucosal surfaces, genital secretions or oral secretions
  • viral shedding can occur when NO lesions present
  • virus remains latent in nerve root ganglion
  • virus may be reactivated by a change in immune status (eg. status, menses, infection)
87
Q

Genital Herpes clinical presentation

A
  • prodrome of burning, tingling and/or pruritis followed by outbreak of painful vesicles on erythematous base
  • initial (primary) outbreak tends to be the most severe
88
Q

Genital Herpes diagnosis

A

-clinical
-direct viral culture (swab): preferred method (but can get false negatives, REQUIRES ACTIVE lesion)
-Serology (blood test): some tests can detect HSV-1& HSV-2 specific Abs
limitations or serology: Abs don’t (U) appear until 3-4 weeks after exposure (lesions may appear in 2-4d), a positive test is NOT definitive for GENITAL herpes

89
Q

Genital Herpes tx (drugs and length, initial outbreak, recurrent outbreak & suppression)

A

Acyclovir (Zovirax), Valacyclovir (Valtrex) or Famciclovir (Famvir)
[must reduce the dose of cyclovir meds in pts w/renal insufficiency]
Tx length
initial outbreak: 7-10d
recurrent outbreak: 1-5d
suppression: daily dose, discuss discontinuation annually, REDUCES risk of transmission to partner but DOES NOT ELIMINATE RISK

90
Q

Genital Herpes length of tx for initial outbreak

A

7-10 days

91
Q

Genital Herpes length of tx for recurrent outbreak

A

1-5 days

92
Q

Genital herpes tx for suppression

A

daily dose
discuss d/c annually
reduces risk of transmission to partner but does not eliminate it

93
Q

Genital herpes tx meds

A

cyclovir’s=antivirals
Acyclovir (Zovirax),
Valacyclovir (Valtrex) or
Famciclovir (Famvir)

94
Q

Genital herpes pregnancy considerations

A

can be vertically transmitted to infant before, during or after delivery

  • transmission during vaginal delivery is most common (C section reduces risk of transmission, risk of transmission during vaginal delivery-mom w/primary HSV-risk is 50%, mom w/recurrent HSV, risk is 1% [mom’s Abs are protective]
  • most (70-95%) infants with neonatal HSV are born to moms w/no known history of genital HSV
95
Q

Neonatal HSV, 3 possible syndromes

A 
localized skin, eye, mouth (SEM) dz
CNS dz (eg. encephalitis): long-term morbidity common (eg. mental retardation)
disseminated dz (organ involvement): mortality common
96
Q

Prevention of neonatal HSV

A
  • offer women w/active recurrent genital herpes suppressive viral therapy (acyclovir) at or beyond 46 weeks gestation (may reduce need for C-section)
  • perform C-section delivery in women w/active genital lesions or prodromal symptoms (eg. vulvar pain or burning) at time of delivery
97
Q

Genital Herpes: Pregnancy considerations (w/out known herpes & without known orolabial herpes)

A
  • pregnant women WITHOUT KNOWN GENITAL HERPES: during 3rd trimester, avoid intercourse w/partners known or suspected of having genital herpes
  • pregnant women WITHOUT KNOWN OROLABIAL HERPES: during 3rd trimester, avoid intercourse with partners known or suspected of having orolabial herpes
98
Q

Human Papillomavirus: causative organism

A

HPV>40 types sexually transmitted

99
Q

What is the most common STD?

A

HPV

nearly all sexually-active men & women will get at least one type of HPV at some point in their lives

100
Q

HPV can infect which areas

A

genital area, incl. skin of vulva, lining of vaginal, penis, anus
can also infect mouth, throat

101
Q

HPV clinical presentation

A

*most never have symptoms
-visible genital warts (CONDYLOMA ACUMINATA)
soft, flesh-colored, single or multiple, flat, cauliflower-like
-precancerous/cancerous changes (anywhere infected), persistent HPV is main cause of cervical cancer

102
Q

What is the main cause of cervical cancer?

A

persistent HPV

103
Q

HPV diagnosis

A

visualize warts, -vinegar solution may help identification (warts may turn white), biopsy may be considered if dx uncertain

  • abnormal pap (anal pap not CDC recommended), can test for HPV DNA during Pap
  • no test for men
104
Q

HPV treatment

A

no cure-tx is for the diseases caused by HPV

destruction of warts via:
liquid nitrogen or trichloroacetic (TCA)
or prescriptions: (podofilox ointment, topical imiquimod)

tx the precancerous/cancerous changes (eg. cervical dysplasia)

105
Q

HPV complications (and which types have high prevalence)

A

~15 types lead to cervical cancer

types 16 & 18 account for 70% of cervical cancer

106
Q

Prevention of HPV-vaccines & descriptions

A

FDA licensed in 2006
Ceravarix (bivalent)-approved for girls, protects against cervical cancer (HPV types 16 & 18)
Gardasil (quadrivalent) approved for girls & boys-protects against types 16,18,6,11
protects against cervical, vulvar, vaginal, anal cancers & against warts
SERIES OF 3 INJECTIONS (like Hep B)

107
Q

Ceravix description

A

bivalent, approved for girls

protects against cervical cancer (HPV types 16 & 18)

108
Q

Gardasil description

A

quadrivalent, approved for girls & boys
protects against types 16, 18,6, 11
protects against cervical, vulvar, vaginal, anal cancers & against wards

109
Q

HPV vaccine: single injection or series

A

series of 3 injections (like Hep B)

110
Q

HPV vaccine CDC recommendations

A

CDC recommended for girls and boys
-Girls&boys 11-12 yrs (can start as early as 9)
-Girls 13-26 yrs who have not completed series
-Boys 13-21 who have not completed series
ideally begin before sexual activity

111
Q

HPV pregnancy considerations

A

rarely-can be transmitted to neonate during delivery

very rarely causes warts in baby’s throat

112
Q

Syphilis causative organism

A

bacterium Treponema pallidum

113
Q

Syphilis epidemiology

A

in 2011, 46,000 new cases in US

rates highest amongst men 20-29 yo

114
Q

Syphilis pathophysiology

A

transmitted through direct contact with infected lesion (usu. genitals, anus, lips, mouth)
bacteria enter the skin & in 10-90 days create a PAINLESS chancre

115
Q

What is the “great imitator”

A

syphilis

116
Q

Types of syphilis

A

primary, secondary, latent, late (tertiary)

117
Q

Primary syphilis clinical presentation

A

painless chancre appears at location where syphilis entered body, persists for 4-6 weeks

118
Q

Secondary syphilis clinical manifestation (4)

A
  1. Rash (very common); (U) non-pruritic, characteristically on palms & soles of feet, not contagious
  2. Condyloma lata: moist, heaped, wart-like papules; occur in intertriginous areas (most commonly gluteal folds, perineum, perianal area), highly contagious
  3. Mucous patches: painless flat patches involving the oral cavity, pharynx, genitals, not painful (pt may be unaware of patches), occur in 6-30% of cases of secondary syphilis, highly infectious
  4. may exp systemic sxs such as malaise, lymphadenopathy
119
Q

Secondary syphilis length

A

generally persists 2-6 weeks, then enters latent phase

120
Q

Latent syphilis clinical presentation

A

asymptomatic, syphilis no longer sexually transmittable, may persist for years

121
Q

Late syphilis clinical presentation

A

may appear 10-20 yrs after infection acquired
develops in 15% of those untreated
causes neurologic deficits (eg. blindness, dementia) & damage to internal organs
NEUROSYPHILIS

122
Q

Syphilis diagnosis

A

bacteria (from chancre) visible under darkfield microscopy

SEROLOGY: Rapid Plasma Reasin (RPR) or venereal dz research laboratory (VDRL) test
-titer indicates dz activity, may be low if false positive (eg. low titer is 1:4) false positives can occur from autoimmune dz, illness, pregnancy
CONFIRM RPR w/antibody test: FTA-ABS

123
Q

Causes of false positive on syphilis serology & which tests are affected

A

autoimmune dz, illness, pregnancy

RPR and VDRL are affected and may show a low titer if false positive

124
Q

Syphilis, what to do if neurosyphilis (late stage is suspected)?

A

must do lumbar puncture & perform VDRL on spinal fluid to confirm
(U) refer to neurologist

125
Q

Syphilis tx

A 
treat everybody (test & tx sex parners)
Benzathine PCN G, 2.4 mu IM x 1 (a shot)
-additional doses required if syphilis present for >1yr: obtain pt history & contact county health dept for advice
in PCN allergy, can use ORAL DOXYCYCLINE (exception: tx HIV & preg pts w/PCN)
-check RPR titer to confirm tx success (at 3,6,12,24mos) 4 fold decrease=adequate response
126
Q

How to monitor for syphilis tx success

A

check RPR titer to confirm tx success (at 3,4,12,24 months), 4 fold decrease=adequate response

127
Q

Syphilis: complications

A
  • having a chancre increases risk of acquiring & transmitting HIV
  • late syphilis
128
Q

Untreated syphilis in pregnancy: any problem with that

A

untx syphilis during pregnancy, ESP EARLY SYPHILIS, can lead to:
stillbirth, neonatal death, or infant disorders such as deafness, neurological impairment & bone deformities

129
Q

Syphilis prevention (pregnancy)

A
  • screen pregnant women at 1st prenatal visit
  • if risk is high, screen & obtain sexual history again at 28 weeks & at delivery
  • if pregnant pt is PCN allergic, consider desensitization with oral PCN
  • monitor serology closely to confirm successful tx
130
Q

Chancroid: causative organism

A

Haemophilus ducreyi

131
Q

Chancroid epi

A

sporadic outbreak in US

132
Q

Chancroid clinical presentation

A
  • painful tender genital ulcer
  • lesion produces foul-smelling discharge (that’s contagious)
  • inguinal adnitis (buboes)
133
Q

Chancroid dx

A
  • rule out syphilis

- if chancroid suspected contact county health department

134
Q

Lymphogranuloma venerum (LGV): causative organism & epidemiology

A

serotype of Chlamydia trachomatis

background: rare in US, in US most commonly occurs in MSM

135
Q

Lympogranuloma venereum (LGV) clinical presentation

A
  • causes systemic infection
  • unilateral inguinal bubo
  • self-limited genital ulcer or papule at site of inoculation
  • anal discharge & rectal bleeding
136
Q

Lyphogranuloma venereum (LGV) dx

A

rule out syphilis

if LGV suspected, contact County Health Dept

137
Q

Pediculosis Pubis: causative organisms

A

pubic lice, parasite Pthirus pubis (“crab” louse)

  • Clinical presentation
  • tx: permethrin 1% cream rinse, others
138
Q

Pregnant women: what STDs to screen for at first visit

A
  • HIV, syphilis, Hep B, GC/Chlamydia
  • Hep C for those at risk
  • take history to assess for HSV
139
Q

Prevalence of many STDs are highest in which age group?

A

Adolescents

140
Q

Can minors consent to STD services?

A

yes, in all 50 states (but some states regard HIV tx separately)

141
Q

Who should be routinely screened for GC/Chlamydia

A

women<25 years old

142
Q

CDC recommends discussing HIV screening with who

A

everyone 13-64 years old

143
Q

MSM what do you do w/this pop (re: STDs)

A
  • may be at higher risk for some STDs so take a good history
  • screen for HIV & syphilis annually
  • offer Hep A & Hep B vaccines
144
Q

WSW: STD risk

A

DO NOT ASSUME LOW RISK

145
Q

Children w/STDs: what should be done

A

prompt involvement of child protective services

146
Q

STDs: prevetion & counseling

A

history: assess pt risk factors

test & treat (until all sxs resolve) everybody before resuming sexual activity

147
Q

STD screening

A

screen pts age 13-64 yo for HIV

  • screen those w/risk factors annually, opt out testing
  • all pts with an STD should be screened for HIC (test for HIV with each new STD)
148
Q

Which STDs to report

A

HIV and most STDs are reportable to azdhs

149
Q

STD prevention: your role

A

talk to pts abt pre-exposure vaccines
provide prevention/risk-reduction counseling
-talk to pts about testing
-asses pts risk & test accordingly
-dx & tx infected pts
-provide or refere services for partners
-report STD/HIV in accordance with state & local laws
-keep STD/HIV reports confidential (it’s the law)

Women's health (1 decks)

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