STI Flashcards
Discuss risk factors for the development of STI
High risk sexual practices
- Multiple sex partners
- Substance abuse
- Commercial sex workers
- Men who have sex with men
- unsafe sex practices
Socio-economic factors
- adolescents and young adults
- minorities
- low socioeconomic status
Discuss why the management of STDs can be challenging in the ED ( 4 points)
1) clinical presentation is highly varibale
2) avialble diagnostic test have limited senisitivty and results are usually delayed
3) compliance with treatment follow-up and partner notification is often poor
4) misdiangosis and suboptimal treatment can result in serious sequalae
List DDX of genital ulcers
Herpes Primary syphilis Chancroid Lymphogranuloma venerum Granuloma inguinale Trauma Neoplasm Behcets disease
Discuss DDX of genital discahrge
Gonorrhea Chlaymydia Nongonococcal urethritis PID Trichomoniasis Bacterial vaginosis Candida vagintiis Foreign body
Discuss DDX of epithelial cell lesions
Genital warts Secondary sypillis Molluscum contagiosum Neoplasm Nevi Skin tag
Discuss DDX of ectoparasites
Pubic lice
scabies
other lice
Ticks
Discuss Herpes infection
Lifelong infection caused by one of two types
Sexual transmission occurs more commonly with HSV2
Transmission occurs through viral contact with a break in the skin or itnact mucous membrane
The virus ascends to the dorsal root ganglia where it becomes latent but may reactive periodically
Discuss management of herpes infection
Antiviral therapy is not curative but has been shown to decrease the duration and severity of symptoms
Prompt initiation of antiviral treatment is key to its success
Primary episode
- aciclovir 400mg PO TDS for 7-10 days
- Valacyclovir 1000mg PO BD for 7-10 days
Recurrent episodes
- aciclovir 400mg PO BD for 5 days
- valacyvlovir 1000mg daily for 5 days
What is the causitive organism of syphilis
Humans are the only known host for treponema pallidum the spirochete that causes syphilis
Discuss clinical features of syphilis
Average incubation is 21 days but can range from 3-90 days
Primary syhpilis
- Manifested by a painless papule at the site of inoculation
- the lesion ulcerates froming the chancre of primary syphilis
- relative painless clean based ulcer with well demarcated edges measuring appproximatley 1-2cm in size
- Will heal spontaneously over the course of 3-6 weeks
Secondary
- develops in 25% of cases of primary syphilis
- Rash diffuse involving the face trunk, extremities including the p[lams and soles of the feet. Lesions are variable may be macular papular scaly or pustular in appearance
- generalised lymphadenopathy
- mucous membrane lesions and systemic features
- Condyloma lata which resembles genital warts are broad based papular lesions that are common in secondary syphiliis
Latent:
- Serological evidecne of syphilis infection in the absence of any clinical signs or symptoms
- latent infection acquried within 12 months is defined as early and those more than 12 months are late latent
- generally not infective with the significant expection vertical transmission in pregnant women
- can persist indefinitely beofre progressing to tertiary syphilis
Tertiary
- Cardiovascular manifestation: aortitis, aortic aneurysm
- gummatous disease: granulomatous lesions, called gummas, which are characterized by a center of necrotic tissue with a rubbery texture. They form in the liver, bones, and testes but may affect any organ
- Neurosyphilis refers to infection of the CNS manifesting in altered mental status, meningitis, cranila nerve abnormalities, CVA, peripheral neuropathy and auditory and ophtlamic abnormalities
Discuss IX of syphilis
Veneral disase research lab and the rapid plasma reagin PCR test are both requried for proper diagnosis of syphilus
Discuss management of syphilis
T.pallidium is highly sensitive to penicillin
A single dose of long acting benzathine penicillin G 2.4 million units IM is curative in most cases.
Signfiiacnt pencillin allergy can be treated with doxy or tetracycline for 2 weeks.
The Jarish Herxheimer reaction is an acute worsening of symptoms that may develop mafter antibiotic therapy is iniaited - patient typically reports worsening of myalgias and fever within 24 hours of treatment.
Discuss chancroid
An ulcerating STD caused by the gram negative organism haemophilus ducreyi.
Most commonly seen in the developing world - like other ulcerative STDs chancroid is a cofact for the transmission of HIV
After less than week a tneder erythamtous papule develops at the site of inoculation. The initial lesions rapidly ulcerates and multiple painful ulcers subsequently develop.
Typically have an irregular inflamed and dirty appearance compated to the well circumscribed clean based chancre of syphillus
Single dose therapy with either azirthromycin or ceftriaxone is recomended
Discuss Urethritis
Can occur in both men and women
Generally divided into gonococcal urethritis and non gonococcal
When present syumptoms include, dysuria, urethral pruritis and urethral discahrge
Abscence of discharge does not exclude the diagnosis
Diagnosis can be made from any one of the following
1) Mucoid mucopurulent urethral discharge
2) gram stain of urethral discharge containing two or more WBC
3) first pass urine containing more than 10 WBC on high power field
4) positive leukocyte esterase test on first void urine
Discuss cervicitis’
Characterised by the presence of purulent or mucopurulent discharge from the endocervix and the presence of cervical friability.
Many women with cervicitis are asymptomatic
-Cervical friability is demonstarted when endocervical bleeding is easily idnuced with gental passage of a swab through the cervical os.
Gonorrhea and chlaymdia are the most common causes but tichomonas and HSV also cause.
Women with cervicitis complaing of abnormal vaginal discharge, dyspareunia and postcoital vaginal bleeding.
