STDs (part 2- slide 119-173)- Schoenwald Flashcards
Epididymitis= Pain, swelling and inflammation of epididymis for < ___ weeks
Chronic epididymitis if Sx > ___months
- 6 weeks
- 3 months
Epididymitis: demographic
-IF Sexually active men <35, most likely ______ or _____
**Gonorroeae or Chlamydia
Epididymitis:
IF Age >35, enteric organisms more likely ie _____
E coli
Epididymitis:
-unilateral or bilateral testicular pain?
*unilateral
Epididymitis:
tx for GC/Chlamydia=
**Ceftriaxone 250 mg IM x 1 plus doxycycline100 mg bid x 10 days (GC/chlamydia)
Epididymitis:
tx if enteric organism suspected:
**Levofloxacin 500 mg po q day x 10 days
Prostatitis is NOT part of STD tx guidelines, but less than 35 yo male with prostatitis–> MOST likely ______
GC/chlamydia
Prostatitis= acute swelling and inflammation of the prostate gland usually due to ______
*infection
Prostatitis: etiology?
**Etiology same as with epididymitis (GC/Chlamydia, or in older Pts enteric organisms)
Prostatitis:
Sx?
-Dx w/:
- dysuria, pain with erection, fever, chills, low back pain
- UA/culture pre and post prostate exam (pre prostate exam culture would be likely negative, but the post culture (after you massage prostate gland) would most likely be positive)
Prostatitis: tx?
-similar to epididymitis but longer duration.
(Ceftriaxone 250 mg IM x 1 plus doxycycline100 mg bid x 10 days (GC/chlamydia)
If enteric organism suspected-Levofloxacin 500 mg po q day x 10 days
normal prostate is about the size of a _____
walnut (and there’s no obstruction of the urethra)
Bacterial Vaginosis: Controversy: STD - yes or no
- need for tx:
- -in 1980: only if Pt complains
- -in 2002: increased risk of:
Preterm birth / premature rupture of membranes
Amniotic fluid infection
Chorioamnionitis / Postpartum endometritis
PID
Postsurgical infection
Cervical intraepithelial neoplasia
Mucopurulent cervicitis
Acquisition of HIV infection
Bacterial Vaginosis= alteration in ______
**vaginal flora
_________ makes up 95% of normal vaginal flora
**lactobacillus
BV:
-list 5 known risk factors
New sex partners Douching Decrease in normal flora Absence of barrier methods IUDs
BV:
-MC etiology?
**Gardnerella vaginosis
BV:
-Wet prep shows _____** and positive _____ test
**Clue cells, positive whiff test
KNOW
BV:
-Discharge appearance, odor and vaginal pH?
**White discharge, fishy odor, pH >4.5
BV:
tx regimens:
**Metronidazole 500 mg BID for 7 days
or
Metronidazole gel 0.75%, 5 g intravaginally QD for 5 days
or
Clindamycin cream 5%, 5 g intravaginally q hs for 7 days
BV: tx in pregnancy
-symptomatic women should be treated due to:
- **association with adverse pregnancy outcomes
- Existing data do not support use of topical agents in pregnancy
- Some experts recommend screening and treatment of asymptomatic women at high risk for preterm delivery (previous preterm birth) at the first prenatal visit; optimal regimen not established
BV tx in Pregnancy:
-Specific regimen ?
**Metronidazole 500 mg po bid x 7 days
or
Metronidazole 250 mg three times daily for 7 days
or
Clindamycin 300 mg twice daily for 7 days
BV: Management of Sex Partners
Woman’s response to therapy and the likelihood of relapse or recurrence not affected by tx of sex partner
Recurrent Vulvovaginal Candidiasis is defined as __ or more symptomatic episodes/year
4**
Recurrent Vulvovaginal Candidiasis:
What is useful to confirm the dx and identify unusual species?
-**vaginal culture
Recurrent Vulvovaginal Candidiasis:
- initial tx regimen=
- Maintenance regimens=
- 7-14 days topical therapy or fluconazole 150 mg (repeat 72 hr)
- Maintenance: clotrimazole, ketoconazole, fluconazole, itraconazole
For Non-Albicans Vulvovaginal Candidiasis (VVC)–>
tx regimen?
**longer duration of therapy with non-azole regimen
Vulvovaginal Candidiasis:Management of Sex Partners
- Tx not recommended
- tx of male partners does not reduce frequency of recurrences in the female
-*Male partners with balanitis may benefit from tx
The Pt cannot have ______ with usage of metronidazole
ALCOHOL** (KNOW!)
–also w/ first trimester AVOID metronidazole, give the Pt clindamycin
Vulvovaginal Candidiasis: Tx in Pregnancy
- **Only topical intravaginal regimens recommended
- 7 days of therapy
Trichomoniasis:
- organism?
- is assoc. with ___x risk of HIV acquisition
- Protozoan= Trichomonas vaginalis***
- 2-3x
Trichomoniasis:
- Sx? (describe the discharge**)
- Gold standard dx test=
**Diffuse, malodorous yellow to green discharge
-**Gold Standard= historically wet prep, BUT NAAT is more sensitive and recommended by 2015 guideline= NEW gold standard (board exams will now have gold standard test for trich= NAAT
“strawberry cervix” =
**TRICHOMONIASIS
Trichomoniasis:
-1st line tx:
Metronidazole 2 gm orally in a single dose
or
Tinidazole 2 grams orally in a single dose
Trichomoniasis:
IFTreatment Failure–> next steps?
Re-treat with metronidazole 500 mg twice daily for 7 days
- If repeated failure occurs, treat with metronidazole 2 gm single dose for 3-5 days
- If repeated failure, consider metronidazole susceptibility testing through the CDC
Trichomoniasis: Management of Sex Partners
- Sex partners should be treated
- Avoid intercourse until therapy is completed and patient and partner are asymptomatic
Human Papillomavirus (HPV): -over \_\_\_ different strains/40 strains infect the genital area
100**
HPV:
-High risk (=oncogenic) are types ___ and ___
**16 & 18. (KNOW)
HPV:
-Low risk (nononcogenic)= Types __ and ___
6 & 11 (warts)
HPV and Cervical Cancer:
-infection is generally indicated by the detection of ____
HPV DNA**
HPV infection is causally associated with _____ cancer and probably other _______ squamous cell cancers (e.g. anal, penile, vulvar, vaginal)
- cervical cancer
- anogenital
Over ___% of cervical cancers have HPV DNA detected within the tumor
-What routine screening ensures EARLY detection (and tx) of pre cancerous lesions?
-99%
**Routine Pap smear!!!
Cervical cancer:
- In the US– ____ cases
- Worldwide: ______ cases
- 14,000 cases and 5,000 deaths
- 450,000 cases and 200,000 deaths
Anogenital Warts:
-___% caused by HPV type 6 or Type ___
- **90%
- Type 6 or type 11**
KNOW!
Anogenital Warts:
-Sx?
Usually asymptomatic, but if large, can cause obstructive Sx
Papillomavirus Treatment:
-primary goal for tx of visible warts is=
- removal of symptomatic warts
- Therapy may reduce but probably does not eradicate infectivity
Papillomavirus: tx
-difficult to determine if tx reduces ________
transmission
-No laboratory marker of infectivity
Papillomavirus:
-Source of therapy guided by preference of patient, experience of provider, and _____
resources
- No evidence that any regimen is superior
- Locally developed/monitored treatment algorithms assoc. w/ improved clinical outcomes
Papillomavirus:
Acceptable alternative tx option may be to:
observe; possible regression/uncertain transmission
Papillomavirus/Warts: tx regimen
-Patient applied: ______
Podofilox 0.5% solution or gel or Imiquimod 5% cream Or Sinecatechins 15% ointment
Papillomavirus/Warts: tx regimen
Provider-administered: ________
Cryotherapy or Trichloroacetic or Bichloroacetic acid 80-90% or Surgical removal
Papillomavirus: tx in Pregnancy
-which ABX should NOT be used?
Imiquimod, podophyllin, podofilox, sinecatechins
Papillomavirus: tx in Pregnancy
Many specialists advocate _____ ______ due to possible proliferation and friability
*wart removal
Papillomavirus: tx in Pregnancy
HPV types __ and ___ can cause respiratory papillomatosis in infants and children
-Preventative value of cesarean section is ______; may be indicated for pelvic outlet obstruction
6, 11
-unknown
Women w/ STD hx may be at increased risk of ______ cancer
*cervical
Cervical Cancer Screening:Women with Hx of STDs
- Clinics that offer pap screening without colposcopic f/u should arrange for _____
- Management of abnormal pap provided per:
referral
-Interim Guidelines for Management of Abnormal Cervical Cytology (NCI Consensus Panel)
–Emerging data support HPV testing for the triage of women with ASCUS Pap tests
HPV vaccines: Ages \_\_\_\_ (ACIP recommended) --FDA approved to age \_\_\_
- 9-26 yo
- up to age 45
HPV vaccines:
-Gardisil quadravalent: Has coverage for which HPV types?
6,11,16 and 18
HPV vaccines:
-Gardisil 9 valent–>Has coverage for which types?
6,11,16,18,31,33,45,52,and 58
Scabies= parastic infection by the ___
**mite Sarcoptes scabiei
Scabies:
-Sx?
- **Intense itching
- contagious
Scabies:
-tx?
**Permethrin 5% cream to all areas of body
Or
Ivermectin 200 ug/kg po repeat in 2 weeks
Scabiesw/ Persistent Sx:
-Rash and pruritus may persist for ___
2 weeks
Scabiesw/ persistence >2 weeks: (indicates?)
tx failure, resistance, reinfection, drug allergy, cross reactivity with household mites
Scabies:
- Pay attention to _______ of infected Pts
- treat close contacts _____
- management includes washing: ______
- fingernails
- empirically
- Wash linens, bedding and clothing
Norwegian Scabies= an aggressive infestation in ______ (which population?)
**immunodeficient, debilitated, or malnourished
Norwegian Scabies:
- ______ transmissibility
- substantial tx failure with _____ or ______
- greater**
- topical scabicide or oral ivermectin
Norwegian scabies:
tx recommendations?
**combination topical scabicide with ivermectin or repeated treatments with ivermectin
Pediculosis Pubis=
Pruritus or lice or nits on pubic hair
Pediculosis Pubis:
- management?
- Tx regimens:
- *Decontaminate bedding and clothing
- Recommended tx:
- -Permethrin 1%
- -Lindane 1% shampoo
- -Pyrethrins with piperonyl butoxide
Pediculosis Pubis:
- re-treatment may be necessary if ______
- tx of sex partners within:
- *sx persist
- the last month
**Vaccine Preventable STDs: list 4 Ex’s
- Hep A
- Hep B
- Hep C
- HPV
Hepatitis A:
- incubation period:
- Demographic ?
- Associated with _____
**Incubation 28 days
-MSM
I-llegal drug users
-Chronic liver disease, hepatitis B and C infection
Hepatitis B:
-Hx of _____
-**Hx of STD, multiple sex partners, sexually active MSM
Illegal drug use
- Household members, sex partners of those with chronic hepatitis B
- Hemodialysis, occupational blood exposure
HPV:
How many vaccines available ?
2 available: Quadrivalent and 9 valent
HPV:
Quadrivalent Vaccine covers _____ (which HPV types?)
HPV 16 and 18 (cancer associated) HPV 6 and 11 (wart)
HPV:
9 valent vaccine covers which HPV types?
HPV 6, 11, 16, 18, 31, 33, 45, 52, 58
Hepatitis C:
- how common?
- is it sexually transmitted?
- **MC bloodborne infection in US
- Not efficiently sexually transmitted but persons at risk may seek tx for other STDs
Hepatitis C:
- coinfection with ____ common
- Vaccine available?
HIV**
-NO vaccine
“Burrowing on skin”=
think scabies!!!
tx: permethrin full body, head to toe
(scabies can be sexually transmitted, can be spread through pets, etc)