STI Flashcards
What history questions are important to ask when assessing for STI
Genital symptoms -Discharge -Dysuria -Abdominal pain -skin changes -Testicular pain Systemic symptoms Partners in the past 5 years Practices Prevention (condoms, vaccinations) Pregnancy/contraception Previous STI testing IVDU Sex worker LMP, Pap
Risk factors for STI
- Previous STI
- Contact with person with STI
- Age under 25
- New sexual partner
- More than two sexual partners in the past year
- No condom use
- IVDU
- Homelessness
- Substance use
- Sex workers
- Sexual assault
Physical exam for STI
Vitals (temp) Oropharynx Inguinal lymph nodes External genitalia Perianal inspection +/- DRE Scrotum (elevate, if relieve signs for epididymitis=Prehns sign) Pelvic exam (Bimanual, speculum)
How to test for Gonorrhea
Gold Standard=NAAT swabs with culture (due to resistance)
Other options -first catch urine
How to test for Chlamydia
Naat ideally swab, less improtant to get culture vs gonorrhea
Can also be first catch urine
Testing for VRDL
Trepenomal testing (reactive for life) Non Treponomal (Acute infection)
Treatment for Gonorrhea
- also treat for chlamydia
1. Ceftriaxone 500 mg IM x1 and Azithromycin
2. Ceftriazone (Or cefixime) and Doxycycline
Gentamicin +Azithro or doxy
Chlamydia Treatment
Doxycycline 100 mg po bid x 7 days
Azithromycin 1 g po x1 (safe in pregnancy)
Treatment for Syphillis
Penicillin G IM x1 ( primary, seconday or early latent)
Pen G IM weekly x 3 weeks (tertiary)
Neurosyph=IV Penicillin
Treatment of trich
Metro
Treat the partner
Counseling around STI treatment
Treat
Abstain for 7 days
Track and treat partners (within 2 months, C+G, and 90 days for syphilis)
Report to public health
Discuss future safe sex
Consider Hep A/B vaccinations
Follow up Syphilis at 1, 3, 6, and 12 months
Risks for epididymitis
Risks for STI
Instrumentation
Hx of UTI
Strenuous exercise
DDx for Epididymitis
Torsion
Mumps
TB
Physical exam for testicular pain
- Temp
- HR
- BP
- Cremasteric
- Palpate testes and epididimi
- Prehns
Female lower pelvic pain ddx and how to diferentiate
Ectopic (HCG, US, spotting)
PID (Temp, discharge, cervical motion tenderness, WBC and elevated ESR)
Ovarian Torsion (nausea, vomiting, ultrasound)
Appendicitis (McBurney’s point, fever, nausea, diffuse to local tenderness, peritonitis)
Ovarian cyst (US, rule out others)
Constipation
Diverticulitis (LLQ, diarrhea, peritonitis)
Cystitis (Urine dip, frequency, urgency)
Treatment of PID
Ceftriaxone and Doxy, think about adding Metro
Consider clinda and gentamycin in severe
Treat partner within 2 months
Genital lesion ddx
Chancroid HSV Syphillis HPV Cyst Folliculitis Abscess SCC
When should you screen for BV and yeast
You shouldn’t
Not even during pregnancy
Only screen these specifically if symptoms
But can screen for STI
What to think if vaginitis in children
Foreign body
STI
Contact irritant
Unlikely to be yeast
DDX. for vaginitis
Exzema Lichen sclerosis Lichen simplex chronicus Neoplasm Atrophic caginitis Contact dermatitis Trich Bacterial vaginosis Yeast
Test to do for vaginitis
Swabs for STI, BV, and yeast
KOH
Wet mount:
Look for clue cells-Bacteria
Psedohyphae-Yeast
Treatment of genital warts
Cryotherapy
Trichoroacetic acid
Excision cautery laser
Can use imiquirmod or podofilox if on external skin and not pregnant
Treatment of lice and scabies
Wash everything
Treat partners
Permetrin cream
Pubic lice: Just to affected area x 10 minutes and repeat in 1 week
Scabies : Head to toe and leave for 8-14 hours
Can use oral ivermectin for scabies
Scabies has that burrows and affects the finger webs
Public lice has more erythema and small blue spots
A woman comes in with terrible RUQ pain. She’s also had some vaginal discharge and a new partner a few weeks go. What does she have
Fitx hugh curtis from C or G
