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obgyn > STI > Flashcards

STI Flashcards

1
Q

chlamydia biology

A

obligate intracellular bacteria w/ 15 serovars, gram negative

trachoma: A, B, Ba, C

genital tract/conjunctivitis: D-K

LGV (lymphogranuloma venereum): L1, L2, L3

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2
Q

chlamydia female presentation

A

cervicitis, PID, fitz-hugh-curtis, tubo-ovarian abscess

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3
Q

what is fitz-hugh-curtis

A

hepatic fibrosis and scarring w/ PID (10%), presents with RUQ tenderness and pain

“violin-string” adhesions on upper liver surface

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4
Q

incubation period for chlamydia

A

7-21 days

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5
Q

best test for chlamydia diagnosis

A

Nucleic acid amplification test (NAAT) - cervical/vaginal swab

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6
Q

When should I treat someone for chlamydia?

A

test positive, tests positive for gonorrhea, clinical syndrome suspicious for chlamydia (PID, cervicitis, urethritis), known or possible sexual exposure

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7
Q

how do I treat chlamydia?

A

doxycycline 100mg PO q 12 hours x 7 days

or

azithro 1 g PO once, or levofloxacin 500mg x 7

TREAT PARTNERS

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8
Q

Neisseria gonorrhea biology

A

gram negative diplococci, obligate aerobe

catalase +, oxidase +

can be cultured on thayer-marten agar (chocolate agar)

can’t ferment maltose (stays red)

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9
Q

is chlamydia or gonorrhea more symptomatic?

A

gonorrhea - espeically in wimpy men

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10
Q

incubation period for gonorrhea

A

2-5 days

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11
Q

gonorrhea in men

A

urethritis (PURULENT discharge, usually more than chlamydia), epididymitis, prostatitis, proctatis

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12
Q

gonorrhea in women

A

cervicitis (purulent!), PID, perihepatitis (fitz), inflammation of bartholin’s glands

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13
Q

gonorrhea common presentations

A

pharyngitis (associated with higher risk of disseminated + can be more resistant to treatment), proctitis (tenesmus, bleeding, discharge)

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14
Q

what are some of the disseminated gonococcal infections

A

arthritis-dermatitis syndrome
purulent arthritis
endocarditis
meningitis

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15
Q

Arthritis-Dermatitis Syndrome

A

Triad of polyarthralgia (joint pain - can migrate), tenosynovitis (infection of tendon - wrists, fingers, ankles, toes), + dermatitis (painful lesions - pustular or vesicular)

usually have fever/constitutional symptoms

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16
Q

Purulent arthritis

A

Mono or oligo-articular arthritis, joint pain/swelling, distal joints (knee, wrist, ankle), need to culture synovial fluid

17
Q

Best way to diagnose gonorrhea

A

NAAT (urine, rectal, cervical/vaginal, throat)

Culture is necessary for sites of dissemination (blood, synovial fluid) - gram negative diplococci

18
Q

When should I treat for gonorrhea?

A

+ test, + for chlamydia, clinical syndrome suspicious (PID, cervicitis, urethritis), known/possible exposure

TREAT PARTNERS

19
Q

how do I treat gonorrhea?

A

Ceftriaxone 500mg IM x1

Disseminated infection requires longer course (depends on type)

20
Q

incubation period for HSV2

A

2-12 days - most transmission occurs while contact case is asymptomatic

21
Q

primary herpes infection

A

more severe + longer (can last 2-4 weeks)
local symptoms: pain, itching, dysuria, discharge, inguinal lymphadenopathy

systemic: fever, headache, myalgia

22
Q

recurrent herpes infection

A

milder - prodrome of tingling/irritation then lesion develops ~12-24 hours later

more likely to have recurrent episodes if primary infection was prolonged

usually 2-6/year

23
Q

how should I diagnose herpes?

A

NAAT - swab a lesion

24
Q

How should I treat herpes?

A

Primary infection - antiviral therapy

Further treatment depends on patient (episodic treatment, chronic suppression, no tx)

25
Q

HSV drugs

A

Acyclovir
Famciclovir
Valacyclovir

HSV is my FAV

26
Q

Primary HSV infection

A

Acyclovir, famciclovir, valacyclovir for 7-10 days

27
Q

Episodic tx of HSV

A

start tx when patient has prodromal symptoms or w/in one day of developing lesions (same FAV drugs)

28
Q

HSV suppressive therapy

A

reduces frequency of recurrences and shedding (decrease by 70-80%)
frequency of outbreaks naturally decreases over time (assess if need for chronic suppression)

29
Q

trichomonas vaginalis

A

protozoa, flagellated organism, exclusively sexually transmitted

30
Q

trichomonas in males

A

usually asymptomatic!!

urethritis, increased risk for getting HIV

31
Q

trichomonas in women

A

vaginitis - profuse, frothy discharge (often malodorous), genital irritation, mucosal erythema, cervical petechiae (strawberry cervix)

32
Q

how to diagnose trichomonas

A

NAAT is best

could see on wet mount

33
Q

trichomonas treatment

A

women: metronidazole 500mg q12 x7
men: metronidazole 2g PO x 1

Treat everyone!

obgyn (14 decks)

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