STI Flashcards
Diagnose and treat Chlamydia
NAAT
Doxycycline 100 mg BID x 7 days
Diagnose and treat trichomoniasis
Naat or Wet mount
Metronidazole (Flagyl) 5000 mg BID x 7 days
Diagnose and treat Syphillis
FTA-ABS
Benzathine penicillin G 2.4 million units IM once
Diagnose and treat Gonorrehea
NAAT or culture on Thayer Martin media
ceftriaxone (Rocephin) 500 mg IM once
Diagnose and treat HSV
Viral culture/PCR or serum type specific
Acyclovir 400 mg po tid x 7 -10 days
Diagnose and treat Human Papilloma virus-condylomata acuminata
Visual observation, confirmed by biopsy if necessary
imiquimod 5% cream
Diagnose and treat HIV
Westernblot
Truvada 200/300mg 1 tab PO daily
Treatment for BV
metronidazole (Flagyl) 500 mg po bid x 7 days
Treatment for Candida
miconazole 2% vaginal cream 5 gm intravaginally x 3 days
5 P’s of sexual history
Partners
Prevention of Pregnancy
Protection of STIs
Practices
Past hx of STIs
Signs and sx of Chancroid
Single painful ulcer,
Erythematous,
Unilateral painful abscess
painful lymphadenopathy
signs and sx of chlamydia
Most will not report symptoms
May describe mucopurulent discharge
bleeding with intercourse
dysuria
Bartholin gland infection
signs and sx of Gonorrhea
Usually asymptomatic
Purulent Yellow/green discharge
signs and sx of nongonococcal urethritis (males)
Dysuria and urethral discharge
Mucoid penile discharge after milking penis
Signs and sx of syphillis
Primary-painless indurated ulcer at initial site with adenopathy
Secondary-maculopapular rash on palms and soles, flat wart-like lesions, adenopathy
Tertiary- cardiac neurological, auditory and gummatous lesions
Latent infection: No symptom
Signs and sx of HSV
Flu-like symptoms,
tingling before outbreak
painful vesicular lesions
white exudate centrally
Signs and sx of HIV
Fever
Malaise
adenopathy
rash in first few weeks
Blood diarrhea
signs and sx of HPV
May be asymptomatic
Fleshy
soft
pale-colored growths
signs and sx of trichomonas
itching
yellow/green discharge
postcoital bleeding
intramenstrual bleeding
friable cervix
strawberry spots
Treatment for molloscum contagious
cryotherapy with liquid nitrogen
Signs and sx of molloscum contagious
light colored papules
umbilicate centers
Retest for chlamydia
non-pregnant women should be retested in 3 months or at the next possible outpatient visit
Pregnant women should be should be retested no sooner than 3 weeks after tx
and
then rescreened again 3 months later or in the 3rd trimester
Bacterial STI
Chlamydia (Chlamydia trachomatis)
Gonorrhea (Neisseria gonorrhoeae)
Syphilis (Treponema pallidum)
Chancroid (Haemophilus ducreyi)
Lymphogranuloma venereum (Chlamydia Trachomatis serovars L1, L2, L3
Granuloma inguinale (Klebsiella granulomatis)
Molluscum contagiosum
Viral STI
Human Papillomavirus (HPV)
Herpes simplex virus (HSV 1 and HSV 2)
Human immunodeficiency virus (HIV)
Zika virus
Protozoal and Parastic sti
Trichomoniasis (trichomonas vaginalis)
Pubic lice/crabs (phthirus pubis)
Scabies (Sarcoptes scabiei)
STI presents with increased discharge
Chlamydia
Gonorrhea
Trichomoniasis
STI presents with sores
Herpes
Syphilis
Chancroid
Lymphogranuloma venereum
Granuloma inguinale
STI presents with lesions
Genital warts
Condyloma acuita (HPV)
Condylomata lata (Treponema pallidum)
Gonorrhea retest
rescreen 3 months after tx for possible reinfection
or at next health care visit after 3 mo.
Test for syphilis (info)
VDRL or RPR (these are non-treponemal tests)
they look for the NON-specific antibodies
that develop during syphilis
have a high false-positive rate
It is sensitive, not specific
Factors for false-positive:
pregnancy
autoimmune disorders
acute bacterial or viral infections
if no chancre is present, there may be a false-negative for 1st few weeks of infection.
Next step if VDRL or RPR are positive to diagnose
if positive VDRL or RPR:
need a confirmatory treponemal test -
VERY important to confirm Diagnosis- Pos VDRL or RPR is a screen only
What are the treponemal tests for syphilis
(FTA-ABS) fluorescent treponemal antibody absorption test
or passive particle agglutination assay (TP-PA)
or enzyme immunoassays (EIAs) or
chemiluminescent immunoassays (CLIAs)
6 months to 1 year following tx,
VDRL or RPR (non-treponemal tests)
titers should decrease 4-fold with adequate tx
ex: 1:128 down to 1:32
an increase in titers following tx
indicates treatment failure or reinfection
offer HIV screening
tx all sexual partners from the last 90 days presumptively for syphilis
if the person has secondary or early latent syphilis,
previous sex partners in the last year may need to be notified
Reportable disease to the health department
What is Lymphogranuloma Venereum
caused by C. trachomatis
different subtypes than those that cause chlamydial infection of the vagina
distinct disorder than Chlamydia
primarily an infection of the lymphatic system
Subjective complains of Lymphogranuloma venereum
unilateral
painful inguinal lymphadenopathy or pelvic pain
about 1/3 of infected individuals recall having a nontender genital lesion
rectal infection is common
symptoms
–constipation, anal pain, tenesmus & bloody & mucoid anal discharge
Clinical presentation for lymphogranuloma venereum
unilateral, painful, inguinal lymphadenopathy
lymph nodes may be fluctuant and rupture on compression
Subjective sx of Granduloma Inguinale
painless beefy-red lesions that bleed on contact
genital lesions progressive
spread across the anogenital and inguinal areas
objective findings for Granduloma Inguinale
ulcerative lesions that are red and bleed easily
Treatment for Granduloma Inguinale
Azithromycin Z-pak 1 g orally /week once
What are the main subtypes of HPV that causes genital warts
6, 11
causes 90% of genital wart
Objective findings for genital wart (HPV)
on Physical exam
fleshy papules or pedunculated warty lesions
on the vulva, introitus, perineum, anus, cervix and vaginal walls
Large warts = condylomata acuminata
cauliflower-like appearance
may bleed when abraded
Patient’s applied treatment for warts
Imiquimod
Provider applied treatment for warts
Cryptotherapy with liquid nitrogen
CDC recommendation for PID treatment f/u
within 72 hours
