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Clin Med Final Material- Semester 2 > STDs (part 2- slide 119-173)- Schoenwald > Flashcards

STDs (part 2- slide 119-173)- Schoenwald Flashcards

1
Q

Epididymitis= Pain, swelling and inflammation of epididymis for < ___ weeks

Chronic epididymitis if Sx > ___months

A
  • 6 weeks

- 3 months

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2
Q

Epididymitis: demographic

-IF Sexually active men <35, most likely ______ or _____

A

**Gonorroeae or Chlamydia

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3
Q

Epididymitis:

IF Age >35, enteric organisms more likely ie _____

A

E coli

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4
Q

Epididymitis:

-unilateral or bilateral testicular pain?

A

*unilateral

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5
Q

Epididymitis:

tx for GC/Chlamydia=

A

**Ceftriaxone 250 mg IM x 1 plus doxycycline100 mg bid x 10 days (GC/chlamydia)

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6
Q

Epididymitis:

tx if enteric organism suspected:

A

**Levofloxacin 500 mg po q day x 10 days

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7
Q

Prostatitis is NOT part of STD tx guidelines, but less than 35 yo male with prostatitis–> MOST likely ______

A

GC/chlamydia

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8
Q

Prostatitis= acute swelling and inflammation of the prostate gland usually due to ______

A

*infection

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9
Q

Prostatitis: etiology?

A

**Etiology same as with epididymitis (GC/Chlamydia, or in older Pts enteric organisms)

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10
Q

Prostatitis:
Sx?
-Dx w/:

A
  • 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)
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11
Q

Prostatitis: tx?

A

-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

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12
Q

normal prostate is about the size of a _____

A

walnut (and there’s no obstruction of the urethra)

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13
Q

Bacterial Vaginosis: Controversy: STD - yes or no

  • need for tx:
  • -in 1980: only if Pt complains
  • -in 2002: increased risk of:
A

Preterm birth / premature rupture of membranes

Amniotic fluid infection

Chorioamnionitis / Postpartum endometritis

PID

Postsurgical infection

Cervical intraepithelial neoplasia

Mucopurulent cervicitis

Acquisition of HIV infection

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14
Q

Bacterial Vaginosis= alteration in ______

A

**vaginal flora

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15
Q

_________ makes up 95% of normal vaginal flora

A

**lactobacillus

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16
Q

BV:

-list 5 known risk factors

A 
New sex partners
Douching
Decrease in normal flora
Absence of barrier methods
IUDs
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17
Q

BV:

-MC etiology?

A

**Gardnerella vaginosis

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18
Q

BV:

-Wet prep shows _____** and positive _____ test

A

**Clue cells, positive whiff test

KNOW

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19
Q

BV:

-Discharge appearance, odor and vaginal pH?

A

**White discharge, fishy odor, pH >4.5

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20
Q

BV:

tx regimens:

A

**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

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21
Q

BV: tx in pregnancy

-symptomatic women should be treated due to:

A
  • **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
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22
Q

BV tx in Pregnancy:

-Specific regimen ?

A

**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

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23
Q

BV: Management of Sex Partners

A

Woman’s response to therapy and the likelihood of relapse or recurrence not affected by tx of sex partner

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24
Q

Recurrent Vulvovaginal Candidiasis is defined as __ or more symptomatic episodes/year

A

4**

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25
Q

Recurrent Vulvovaginal Candidiasis:

What is useful to confirm the dx and identify unusual species?

A

-**vaginal culture

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26
Q

Recurrent Vulvovaginal Candidiasis:

  • initial tx regimen=
  • Maintenance regimens=
A
  • 7-14 days topical therapy or fluconazole 150 mg (repeat 72 hr)
  • Maintenance: clotrimazole, ketoconazole, fluconazole, itraconazole
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27
Q

For Non-Albicans Vulvovaginal Candidiasis (VVC)–>

tx regimen?

A

**longer duration of therapy with non-azole regimen

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28
Q

Vulvovaginal Candidiasis:Management of Sex Partners

A
  • Tx not recommended
  • tx of male partners does not reduce frequency of recurrences in the female

-*Male partners with balanitis may benefit from tx

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29
Q

The Pt cannot have ______ with usage of metronidazole

A

ALCOHOL** (KNOW!)

–also w/ first trimester AVOID metronidazole, give the Pt clindamycin

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30
Q

Vulvovaginal Candidiasis: Tx in Pregnancy

A
  • **Only topical intravaginal regimens recommended

- 7 days of therapy

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31
Q

Trichomoniasis:

  • organism?
  • is assoc. with ___x risk of HIV acquisition
A
  • Protozoan= Trichomonas vaginalis***

- 2-3x

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32
Q

Trichomoniasis:

  • Sx? (describe the discharge**)
  • Gold standard dx test=
A

**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

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33
Q

“strawberry cervix” =

A

**TRICHOMONIASIS

34
Q

Trichomoniasis:

-1st line tx:

A

Metronidazole 2 gm orally in a single dose
or
Tinidazole 2 grams orally in a single dose

35
Q

Trichomoniasis:

IFTreatment Failure–> next steps?

A

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
36
Q

Trichomoniasis: Management of Sex Partners

A
  • Sex partners should be treated

- Avoid intercourse until therapy is completed and patient and partner are asymptomatic

37
Q 
Human Papillomavirus (HPV):
-over \_\_\_ different strains/40 strains infect the genital area
38
Q

HPV:

-High risk (=oncogenic) are types ___ and ___

A

**16 & 18. (KNOW)

39
Q

HPV:

-Low risk (nononcogenic)= Types __ and ___

A

6 & 11 (warts)

40
Q

HPV and Cervical Cancer:

-infection is generally indicated by the detection of ____

41
Q

HPV infection is causally associated with _____ cancer and probably other _______ squamous cell cancers (e.g. anal, penile, vulvar, vaginal)

A
  • cervical cancer

- anogenital

42
Q

Over ___% of cervical cancers have HPV DNA detected within the tumor

-What routine screening ensures EARLY detection (and tx) of pre cancerous lesions?

A

-99%

**Routine Pap smear!!!

43
Q

Cervical cancer:

  • In the US– ____ cases
  • Worldwide: ______ cases
A
  • 14,000 cases and 5,000 deaths

- 450,000 cases and 200,000 deaths

44
Q

Anogenital Warts:

-___% caused by HPV type 6 or Type ___

A
  • **90%
  • Type 6 or type 11**

KNOW!

45
Q

Anogenital Warts:

-Sx?

A

Usually asymptomatic, but if large, can cause obstructive Sx

46
Q

Papillomavirus Treatment:

-primary goal for tx of visible warts is=

A
  • removal of symptomatic warts

- Therapy may reduce but probably does not eradicate infectivity

47
Q

Papillomavirus: tx

-difficult to determine if tx reduces ________

A

transmission

-No laboratory marker of infectivity

48
Q

Papillomavirus:

-Source of therapy guided by preference of patient, experience of provider, and _____

A

resources

  • No evidence that any regimen is superior
  • Locally developed/monitored treatment algorithms assoc. w/ improved clinical outcomes
49
Q

Papillomavirus:

Acceptable alternative tx option may be to:

A

observe; possible regression/uncertain transmission

50
Q

Papillomavirus/Warts: tx regimen

-Patient applied: ______

A 
Podofilox 0.5% solution or gel
or
Imiquimod 5% cream
Or
Sinecatechins 15% ointment
51
Q

Papillomavirus/Warts: tx regimen

Provider-administered: ________

A 
Cryotherapy
or
Trichloroacetic or Bichloroacetic acid 80-90%
or
Surgical removal
52
Q

Papillomavirus: tx in Pregnancy

-which ABX should NOT be used?

A

Imiquimod, podophyllin, podofilox, sinecatechins

53
Q

Papillomavirus: tx in Pregnancy

Many specialists advocate _____ ______ due to possible proliferation and friability

A

*wart removal

54
Q

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

A

6, 11

-unknown

55
Q

Women w/ STD hx may be at increased risk of ______ cancer

56
Q

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:
A

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

57
Q 
HPV vaccines:
Ages \_\_\_\_ (ACIP recommended) --FDA approved to age \_\_\_
A
  • 9-26 yo

- up to age 45

58
Q

HPV vaccines:

-Gardisil quadravalent: Has coverage for which HPV types?

A

6,11,16 and 18

59
Q

HPV vaccines:

-Gardisil 9 valent–>Has coverage for which types?

A

6,11,16,18,31,33,45,52,and 58

60
Q

Scabies= parastic infection by the ___

A

**mite Sarcoptes scabiei

61
Q

Scabies:

-Sx?

A
  • **Intense itching

- contagious

62
Q

Scabies:

-tx?

A

**Permethrin 5% cream to all areas of body
Or
Ivermectin 200 ug/kg po repeat in 2 weeks

63
Q

Scabiesw/ Persistent Sx:

-Rash and pruritus may persist for ___

64
Q

Scabiesw/ persistence >2 weeks: (indicates?)

A

tx failure, resistance, reinfection, drug allergy, cross reactivity with household mites

65
Q

Scabies:

  • Pay attention to _______ of infected Pts
  • treat close contacts _____
  • management includes washing: ______
A
  • fingernails
  • empirically
  • Wash linens, bedding and clothing
66
Q

Norwegian Scabies= an aggressive infestation in ______ (which population?)

A

**immunodeficient, debilitated, or malnourished

67
Q

Norwegian Scabies:

  • ______ transmissibility
  • substantial tx failure with _____ or ______
A
  • greater**

- topical scabicide or oral ivermectin

68
Q

Norwegian scabies:

tx recommendations?

A

**combination topical scabicide with ivermectin or repeated treatments with ivermectin

69
Q

Pediculosis Pubis=

A

Pruritus or lice or nits on pubic hair

70
Q

Pediculosis Pubis:

  • management?
  • Tx regimens:
A
  • *Decontaminate bedding and clothing
  • Recommended tx:
  • -Permethrin 1%
  • -Lindane 1% shampoo
  • -Pyrethrins with piperonyl butoxide
71
Q

Pediculosis Pubis:

  • re-treatment may be necessary if ______
  • tx of sex partners within:
A
  • *sx persist

- the last month

72
Q

**Vaccine Preventable STDs: list 4 Ex’s

A
  • Hep A
  • Hep B
  • Hep C
  • HPV
73
Q

Hepatitis A:

  • incubation period:
  • Demographic ?
  • Associated with _____
A

**Incubation 28 days
-MSM
I-llegal drug users
-Chronic liver disease, hepatitis B and C infection

74
Q

Hepatitis B:

-Hx of _____

A

-**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
75
Q

HPV:

How many vaccines available ?

A

2 available: Quadrivalent and 9 valent

76
Q

HPV:

Quadrivalent Vaccine covers _____ (which HPV types?)

A

HPV 16 and 18 (cancer associated) HPV 6 and 11 (wart)

77
Q

HPV:

9 valent vaccine covers which HPV types?

A

HPV 6, 11, 16, 18, 31, 33, 45, 52, 58

78
Q

Hepatitis C:

  • how common?
  • is it sexually transmitted?
A
  • **MC bloodborne infection in US

- Not efficiently sexually transmitted but persons at risk may seek tx for other STDs

79
Q

Hepatitis C:

  • coinfection with ____ common
  • Vaccine available?
A

HIV**

-NO vaccine

80
Q

“Burrowing on skin”=

A

think scabies!!!
tx: permethrin full body, head to toe
(scabies can be sexually transmitted, can be spread through pets, etc)

Clin Med Final Material- Semester 2 (22 decks)

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