STI Flashcards
tx duration of prostatitis
- 4-6 weeks
- if tx for less and sx persist - retreat with appropriate abx for adequate duration
- if doesn’t respond, order transrectal u/s to eval for abscess
Tx proctitis
- Generally: CRO 250 x1 + doxy x7 days
- Tx for LGV ifmod-severe or if: bloody dc, perianal ulcers, mucosal ulcers
- Tx for HSV if: painful perianal ulcers/mucosal ulcers
Common (and uncommon) causes of proctitis/proctocolitis
Common: gonorrhea, chlaymdia (D-K, L1-L3), syphilis, HSV (especially among HIV+)
Uncommon: campy, shigella, entamoeba, CMV, Giardia (mainly enteritis, esp among MSM)
Tx of epididymitis
- CRO 250mg IM x1 + doxy x10 days
- levo instead of doxy in older men or MSM (higher likelihood of enteric organisms like E coli)
Tx of PID
CRO 250mg IM x1 + doxy x14 days +/- metronidazole x14 days
Amsel’s criteria
(for BV)
- Discharge
- pH > 4.5
- clue cells
- amine odor w/ KOH
Tx of Trich
Previously has been metro 2g PO x1. Now metronidazole 500mg PO BID x7 days (new recs) OR tinidazole 2g PO x1. Tx Partner (can do just 2g x1)!
– 5% strains have low-level resistance
If fails: tinidazole 2g PO daily x5 days OR metro 2g PO daily x5 days
**Tinidazole = incr level in genital tract + longer 1/2-life + few SEs (but $$$)
Tx for M genitalium
- Azithro 1g PO x1 (<50% success rate) > doxy x7 days (~30% success rate)
- if azithro fails - moxi x7-14 days (many will still fail, as emerging R to quinolones)
- If macrolide and quinolone-R: pristinamycin has been effective
If person fails to respond to tx for NGU, what to think of…
- Reinfection
- M genitalium that didn’t respond - there is rx resistance
- Trich (rare in MSM) - tx w/ metro
- HSV
Etiologies, dx, and tx of non-gonococcal urethritis
- Etiologies: Chl (25%), M genitalium (30%), trich, ureaplasma (controversial), anaerobes, enterobacterales, Haemophilus, adenovirus
- Dx: Gm stain of urethral secretions = >2WBC; first void urine = +LE, >10WBC from spun specimen
- Tx: doxy x7 days or azitrho 1g PO x1
RF for disseminated gonococcal infection
- terminal complement deficiency
- (can be acq in pts with SLE)
Presentation of disseminated gonococcal infection
Often: petechial/pustular rash (<12 lesions), asym arthalgia, tenosynovitis, monoarticular septic arthritis
Occasionally: perihepatitis, endocarditis, meningitis
Tx of Chlamydia trachomatis
(depends on serotype)
- D-K: azithro 1g PO x1 OR doxy x7D
- L1-3 (or mod-sev disease): doxy x3wks (pref) OR azithro 1g PO qWeek x3 weeks
**does NOT require TOC
MCC epididymitis
Chlaymidia (gonorrhea 2nd MCC)
Chlamydia tranchomatis
- A, B, Ba, C -
- D-K -
- L1-L3 -
- A, B, Ba, C - common cause of blindness WW
- D-K - GU and ocular
- L1-3 - LGV
Annual screening recommendations for STI
- GC/C - all sexually active persons <25yo (or older with risk factors)
- Trich - only in HIV+, no screening in HIV-
- no recs for BV, HSV
Chart of all GUD
Dx/Tx of Granuloma Inguinale
(Kleb granulomatis)
*NOT endemic in US. Seen in SE Asia, S Africa
- tissue bx → Donovan bodies with WGS
- Tx - doxy x3wks OR azithro 1g PO qWk x3 (or bactrim or cipro). Can add aminoglycoside if slow to improve
Dx/Tx of chancroid
(H ducreyi)
*10% co-infected w HSV or syphilis.
**Bacterial superinfection common
- Gram stain =”school of fish”. Culture (80% sens). PCR great, but not widely available
- Azithro 1g PO x1 OR CRO 250mg IM x1
- TREAT ALL PARTNERS IN LAST 2mos
Dx/Tx of LGV
-
Multiplex PCR for specific serotypes (routine NAAT do not distinguish b/w D-K and L1-3)
- if available: molecular testing for ompA
- serology = supportive, not dx. 4-fold rise of IgM/G OR IgM>1:64 IgG>1:256 = active infection.
- Tx: doxy x3wk or azithro 1g PO qWk x3wk
LGV
STI a/w proctitis
LGV (Chlamydia trachomatis L1-3)
- rectal pain, tenesmus, rectal bleeding/dx
- may be mistaken for IBD on histo (so can syphilis, btw)
dx of syphilis
- genital ulcers (primary syphilis) - darkfield microscopy with 70% sensitivity
- secondary/early latent - serology with ~100% sensitivity (non-trep titers decline over time even w/o tx)
- neuro - CSF RPR/VDRL highly specific but VERY insensitive; CSF trep are very sensitive but not specific (high FP!).
+EIA/-RPR/+FTA Abs
(trep/non-trep/trep)
- past and adequately tx syphilis
- had syphilis in past, but NOT adequately tx (RPR can become NR w/o tx over time)
- early syphilis with EIA+ before RPR (super rare)
- prozone reaction in secondary syphilis (RPR = FN)
Typical ocular and audio manifestations of syphilis
Ocular (any stage, any portion of the eye)
- Classic: uveitis, neuroretinitis (secondary stage)
- Interstitial keratitis (both congenital and acquired)
Ears - sensorineural hearing loss + vestibular complaints
**CSF often normal in these cases (though + in ocular > ear)
typical CV manifestations of syphilis
(usually 15-30yrs after latency)
- Ao aneurysm
- AI
- coronary a stenosis
- myocarditis
Neuro manifestations of syphilis
Early - w/in 1st yr, mainly among HIV pts. Presents as meningitis (basilar often, with CN abnormalities)
- meningovascular - endarteritis of small vessels in meninges/brain/spinal cord –> strokes/seizures
Late - ~10yrs after primary
- parenchymatous - destruction of nerve cells –> tabes dorsalis (paresthesias, ataxia, CN abn), general paresis (dementia, psychosis, slurring speech)
mild elevation of aminotransferases w/ disproportionately high AP (often in the thousands)
think of syphilis
short-lived, painless genital ulcer
painful suppurative inguinal LAD
groove sign (swollen matted LNs along inguinal ligament)
LGV
painless
progressive/destructive ulcers
“serpiginous”
w/o regional LAD
beefy red w/ white border
highly vascular
granuloma inguinale
painful, indurated, “ragged” genital ulcers
tender/suppurative inguinal LAD (50%)
kissing lesions on thigh (d/t self-inoculation)
Chancroid (H ducryei)
multiple, painful, superficial
vesicular or ulcerative lesions
erythematous base
HSV
single, painless ulcer/chancre at inoculation site
heaped-up borders
clean base
painless bilateral LAD
syphilis
Painless genital ulcers
- syphilis (irl, but not on boards, >30% will have multiple painful lesions)
- LGV (but with painful LAD)
- granuloma inguinale
painful genital ulcers
- HSV
- chancroid (H ducryei)
Culture requirements for gonorrhea
- nonsterile site - Thayer-Martin agar
- sterile site - chocolate agar
requires CO2 enrichment
Virulence factors of N gonorrhoeae
- type IV pili - attachesto mucosal epithelial cells and PMNs
- doesn’t elicit protective immune response
- antigenic variation → express different surface Ags, helping evade Ab response
Pap recs
- q3yrs for 21-29yo
- q3yrs or q5 w/ HPV testinf for 30-65yo
