STI Flashcards
Viral transmission through genital contact; “common wart”
Asymptomatic genital warts; recurrent respiratory papillomatosis with warts in the throat
Human Papilloma Virus
Topical Immunotherapies (podofilox/imiquimoid)
Cryotherapy/surgical resection
Laser
Intra-lesion interferon
Human Papilloma Virus treatment
Vesicular lesions, ulcers, leucorrhea, dysuria, inguinal adenopathy
Herpes Simplex Virus
How do you diagnosis HSV?
Viral culture
PCR (higher sensitivity)
HSV Assay
Acyclovir
Famciclovir
Valacyclovir
HSV treatment
2nd most common STI in US
Gonorrhea
Urinary frequency, urgency, and burning with urination
Inflammation of Batholian and Skene glands, cervical mucoid discharge (yellow-green), can be asymptomatic until complications occur; penile discharge
Gonorrhea
NAATs
Gonorrhea diagnosis
Cervicitis, urethritis, PID, ectopic pregnancy, infertility, pharyngitis, conjunctivitis
Gonorrhea complications
Ceftriaxone + Azithromycin/Doxycycline
Gonorrhea
Most common STI in US
Chlamydia
Vaginitis, cervicitis, endometriosis, salpingitis, pelvic inflammatory disorder, vaginal discharge or dysuria; urethritis
Chlamydia
NAATs are test of choice
Chlamydia
Azithromycin x1
Doxycycline BID x7d
Chlamydia treatment
What is the leading cause of PID–infertility and chronic pelvic pain?
Chlamydia
Caused by Spirochete Treponema pallidum
Syphilis
Develops 10-90 days after exposure
Single painless chancre at site of inoculation accompanied by regional adenopathy
Primary Syphilis
Develops 4 to 10 weeks after primary infection
Systemic illness with disseminated rash involving palms and soles, fever, malaise, and pharyngitis, hepatitis, mucous patches, condyloma lata, alopecia
Secondary Syphilis
Develops 2 to 19 years after primary infection in untreated individuals
Cardiovascular system or gummatous disease (granulomatous disease of skin and subcutaneous tissues, bones, or viscera)
Tertiary Syphilis
DFA detection in lesion exudate or tissue
Primary diagnosis of syphilis
Dual serological testing Venereal Disease Research Laboratory rapid plasma reagin tests Fluorescent treponemal antibody absorption tests EIA
Latent, secondary, and tertiary syphilis
Penicillin G benzathine IM once
Primary syphilis treatment
Penicillin G benzathine IM once weekly for 2 weeks
Late syphilis treatment
Replacement of normal Lactobacillus species in the vagina with anaerobic bacteria (prevotella species and mobiluncusspecies), Gardnerella vaginalis, and mycoplasma hominis
Bacterial vaginosis
Vaginal discharge with cottage cheese-like appearance, intense vaginal irritation or pruritus, vulvar and vaginal inflammation
Vulvovaginal candidiasis
Vulvar irritation, dysuria, urinary frequency, vaginal odor, green/yellow vaginal discharge
Trichomonas vaginalis
Vaginal discharge or malodor; may be asymptomatic
Bacterial vaginosis
Asmel’s Diagnostic Criteria (3 out of 4)
Homogenous thin, white discharge that smoothly coats vaginal wall
Presence of clue cells on microscopic examination
Vaginal fluid pH >4.5
“Fishy” odor of vaginal discharge or after addition of 10% potassium hydroxide (“whiff test”)
Oral fluconazole or OTC intravaginal anti fungal creams or suppositories
Vuvlovaginal candidiasis treatment
Oral metronidazole
Trichomonas vaginalis treatment
Oral metronidazole or intravaginal metronidazole or clindamycin
Bacterial vaginalis treatment
Polymicrobial infection of upper female genital tract with any combination of endometriosis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis
Most common STIs–gonorrhea, chlamydia, mycoplasma genitalium
Pelvic Inflammatory Disease
fever with pelvic/abdominal pain, dyspareunia
mucopurulent cervical or vaginal discharge, abdominal vaginal bleeding
cervical motion tenderness, uterine tenderness, adnexal tenderness
Pelvic Inflammatory Disease
Diagnosis:
- oral temp >101F
- abnormal cervical or vaginal mucopurulent discharge or cervical friability
- abundant numbers of WBCs vaginal secretions
- gonorrhea and/or chlamydial infection
- elevated CRP/ESR
- MRI/transvaginal US/Doppler US
Pelvic Inflammatory Disease
Influenza-like symptoms from 2-4 weeks
Asymptomatic infection for months to 15 years
Newborn examinations usually normal
Lymphadenopathy, hepatomegaly occur first
FTT, diarrhea, pneumonia, recurrent infections
Opportunistic diseases occur
More recurrent bacterial infections, parotid gland swelling, lymphoid interstitial pneumonitis
Human Immunodeficiency Virus
Antigen/antibody immunoassay
HIV viral load test
Repeat if negative but high index of suspicion
Human Immunodeficiency Virus
Average age of coitus in US
16 years
___ of all STIs occur in adolescents (15-24 years)
1/2
Variety of clinical syndromes caused by pathogens that can be acquired and transmitted through sexual activity
STIs
Prevention Education
Counseling
Referral of Partner
Trust
Keys to Management for STIs
9-valent vaccination recommended for age ____
11 years and older for both male and female
Diagnosis of HPV
Physical exam
HPV testing on swab
Viral culture
PCR
HSV assay
Diagnosis of HSV
Urine, endocervical, vaginal, urethral (men), rectal, and oropharyngeal swabs
Diagnosis of Chlamydia
Microscopic evaluation–hyphae, pseudohyphae or budding yeast, vaginal discharge culture
Diagnosis of vulvovaginal candidiasis
Females–microscopic evaluation of vaginal discharge
Males–culture testing of urethral swab, urine, or seme
Diagnosis of trichomonas
Gram staining or Asmel’s Diagnostic Criteria
Diagnosis of bacterial vaginosis
What is the acute care role for HIV?
Vigilance for infections/complications
Number of sexual partners
Risky behavior associations
Vertical transmission (mother to infant)
Risk Factors for HIV
