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ID Boards > STI > Flashcards

STI Flashcards

1
Q

tx duration of prostatitis

A
  • 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
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2
Q

Tx proctitis

A
  • 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
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3
Q

Common (and uncommon) causes of proctitis/proctocolitis

A

Common: gonorrhea, chlaymdia (D-K, L1-L3), syphilis, HSV (especially among HIV+)

Uncommon: campy, shigella, entamoeba, CMV, Giardia (mainly enteritis, esp among MSM)

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4
Q

Tx of epididymitis

A
  • CRO 250mg IM x1 + doxy x10 days
  • levo instead of doxy in older men or MSM (higher likelihood of enteric organisms like E coli)
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5
Q

Tx of PID

A

CRO 250mg IM x1 + doxy x14 days +/- metronidazole x14 days

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6
Q

Amsel’s criteria

A

(for BV)

  • Discharge
  • pH > 4.5
  • clue cells
  • amine odor w/ KOH
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7
Q

Tx of Trich

A

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 $$$)

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8
Q

Tx for M genitalium

A
  • 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
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9
Q

If person fails to respond to tx for NGU, what to think of…

A
  • Reinfection
  • M genitalium that didn’t respond - there is rx resistance
  • Trich (rare in MSM) - tx w/ metro
  • HSV
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10
Q

Etiologies, dx, and tx of non-gonococcal urethritis

A
  • 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
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11
Q

RF for disseminated gonococcal infection

A
  • terminal complement deficiency
  • (can be acq in pts with SLE)
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12
Q

Presentation of disseminated gonococcal infection

A

Often: petechial/pustular rash (<12 lesions), asym arthalgia, tenosynovitis, monoarticular septic arthritis

Occasionally: perihepatitis, endocarditis, meningitis

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13
Q

Tx of Chlamydia trachomatis

A

(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

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14
Q

MCC epididymitis

A

Chlaymidia (gonorrhea 2nd MCC)

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15
Q

Chlamydia tranchomatis

  • A, B, Ba, C -
  • D-K -
  • L1-L3 -
A
  • A, B, Ba, C - common cause of blindness WW
  • D-K - GU and ocular
  • L1-3 - LGV
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16
Q

Annual screening recommendations for STI

A
  • 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
17
Q

Chart of all GUD

A
18
Q

Dx/Tx of Granuloma Inguinale

A

(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
19
Q

Dx/Tx of chancroid

A

(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
20
Q

Dx/Tx of LGV

A
  • 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
21
Q
A

LGV

22
Q

STI a/w proctitis

A

LGV (Chlamydia trachomatis L1-3)

  • rectal pain, tenesmus, rectal bleeding/dx
  • may be mistaken for IBD on histo (so can syphilis, btw)
23
Q

dx of syphilis

A
  • 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!).
24
Q

+EIA/-RPR/+FTA Abs

A

(trep/non-trep/trep)

  1. past and adequately tx syphilis
  2. had syphilis in past, but NOT adequately tx (RPR can become NR w/o tx over time)
  3. early syphilis with EIA+ before RPR (super rare)
  4. prozone reaction in secondary syphilis (RPR = FN)
25
Q

Typical ocular and audio manifestations of syphilis

A

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)

26
Q

typical CV manifestations of syphilis

A

(usually 15-30yrs after latency)

  • Ao aneurysm
  • AI
  • coronary a stenosis
  • myocarditis
27
Q

Neuro manifestations of syphilis

A

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)
28
Q

mild elevation of aminotransferases w/ disproportionately high AP (often in the thousands)

A

think of syphilis

29
Q

short-lived, painless genital ulcer

painful suppurative inguinal LAD

groove sign (swollen matted LNs along inguinal ligament)

A

LGV

30
Q

painless

progressive/destructive ulcers

“serpiginous”

w/o regional LAD

beefy red w/ white border

highly vascular

A

granuloma inguinale

31
Q

painful, indurated, “ragged” genital ulcers

tender/suppurative inguinal LAD (50%)

kissing lesions on thigh (d/t self-inoculation)

A

Chancroid (H ducryei)

32
Q

multiple, painful, superficial

vesicular or ulcerative lesions

erythematous base

A

HSV

33
Q

single, painless ulcer/chancre at inoculation site

heaped-up borders

clean base

painless bilateral LAD

A

syphilis

34
Q

Painless genital ulcers

A
  • syphilis (irl, but not on boards, >30% will have multiple painful lesions)
  • LGV (but with painful LAD)
  • granuloma inguinale
35
Q

painful genital ulcers

A
  • HSV
  • chancroid (H ducryei)
36
Q

Culture requirements for gonorrhea

A
  • nonsterile site - Thayer-Martin agar
  • sterile site - chocolate agar

requires CO2 enrichment

37
Q

Virulence factors of N gonorrhoeae

A
  • 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
38
Q

Pap recs

A
  • q3yrs for 21-29yo
  • q3yrs or q5 w/ HPV testinf for 30-65yo

ID Boards (24 decks)

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