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Primary care > STI > Flashcards

STI Flashcards

1
Q

STI incidence

A

age 15-24 make up 27% sexual active

50% of STIs

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2
Q

4 of top 10 reportable diseases are STDs and are

A

Chalmydia, gonorrhea, AIDS, syphillis

HSV/ HPV NOT REPORTABLE

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3
Q

Youth risk factors STI

A 
women (higher susceptibility)
insufficient screening 
confidentiality concern 
lack of access 
multiple partners
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4
Q

General STI risk factors

A 
young age sex
adolescence 
multiple/new partners 
drug ETOH
cervical etiology (OCP) 
unprotected 
prior hx 
poor condom use 
men with men, sex workers, imprisoned 
sexual abuse
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5
Q

Chlamydia trachamatis
Transmission:
Incubation:

A

Transmission: sexual or birth
Incubation: 1-3 weeks before symptoms, sometimes no symptoms

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6
Q

Most common bacterial STD?

A

Chlamydia

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7
Q

Chlamydia Symptoms
Male:
Female:
PE:

A

Male: Reiters (conjuctivitis, urethritis, arthritis, skin lesions), epididymitis, proctitis, THICK DISCHARGE dysuria
Female: cervicitis, urethritis, PID, dysuria, dysparunia, post-coital bleeding*, irregular bleeding, adominal pain, rectal pain

PE:: BEEFY RED CERVIX, THICK YELLOW DISCHARGE, cmt, friable cervix

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8
Q

Chlamydia higher prevalnce than incidence because

A

asymptomatic

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9
Q

Chlamydia
Diagnosis:
Screening:

A

Diagnosis: culture (gen-probe DNA, aptima combo 2 for G/C- newer more specific, first catch urine- dirty urine, no wipes, serology not helpful, wet prep- elevated WBC

Screening: women annual 25 risk
all pregnant women
Men: 25 new partner high risk
Male diagnosis: urine

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10
Q

Chlamydia in mouth:

A

white plaque formations

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11
Q

Chlamydia treatment:

Alternative:

pregnancy:
children:

A

Azithroymcin 1 gm PO stat or
Doxy 100 mg BID X 7d

Alternative:
Erythromycin
Erythromycin ethysuccinate
Ofloxacin

Pregnancy: Azithromycin 1g or Amoxicillin 500 TID x 7 d
Children: Emycin x 14 d

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12
Q

Gen probe use

A

insert 2-4 cm best time not voided for an hour

in place 15-20 seconds

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13
Q

Chlamydia education f/u

A 
abstain 7 days after tx starts 
partners within 60 days need tx 
reportable 
TOC if emycin or pregnant or sx 
counsel hiv/hep/rpr testing 
partner therapy
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14
Q

Neisseria Gonorrhea
increase in:
transmitted:

A

adolescence, young adults, AA

sexually

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15
Q

Gonorrhea

PE:

A

THICK PROFUSE YELLOW/GREEN MUCUS DISCHARGE
not as red as chlamydia
adnexal tenderness
friable cervix, CMT
- 45% asymptomatic (less than chlamydia)
post-coital bleeding, pain lower abdomen, dysparunia, dysuria, urethritis, cervicitis, proctitis, epidiymitis, penile edema, bartholin/skene infection

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16
Q

Gonorrhea can also see

A

abscess, pediatric conjunctivitis thick copious mucus d/c

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17
Q

Gonorrhea diagnosis

Screening

A

Nucleic acid amplification (NAAT)- genetic material (via dirty urine or body fluids)
Gonorrhea culture- plates on culture
CBC (increased, not best criteria)

Screening: all 25 new multiple partners pregnant women high risk behaviors

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18
Q

Gonorrhea treatment
Alternative?
Allergy?
Children?

A

*changes every couple years because of resistance
Ceftriaxone 250 mg IM PLUS Azithromycin 1g
to cover chlamydia
Alternative: cefixime 400 mg x1 + azithromycin

Allergy- gemifloxacin + Azithro 2gm!
Children- cefrtiaxone 125 mg IM (eval syphillis and chlamydia)

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19
Q

Gonorrhea f.u and education

A

TOC 1 week after tx (consult infectious disease) BECAUSE OF RESISTANCE
partners within 60 days
reportable
abstain intercourse until TOC

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20
Q 
PID 
Incidence
Infection of
STI's associated with:
particular risk factor:
A
  • 1 million each year
  • upper genital tract: uterine lining, connective tissue around uterus, fallopian tubes, abdominal cavity, tubo-ovarian
  • Chlamydia, gonorrhea, BV
  • douching
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21
Q

If sx of vaginal infection + fever what do you do?

A

treat PID

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22
Q

PID presentation

A 
UTI sx 
Abdominal pain 
painful sex 
adnexal tenderness 
postcoital bleeding 
fever
CMT 
Fitz-hugh curtis: 20% RUQ pain dt peri-hepatitis (inflammation connective tissue of liver)
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23
Q

PID dx

A 
Cultures 
CBC 
HCG r/o ectopic (amenorrhea, tenderness)
US- depending on severity 
UA
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24
Q

PID tx

A

Ceftriaxone 250 mg IM
Doxycycline 100 mg BID x 14d (used to be az)
With or without Flagyl 500 BID x14d

OR

Cefoxitin 2gr IM + Probenecid 1g PO
Doxy like above
With or without flagyl

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25
Q

PID inpatient for who?

A 
pregnant 
do not respond within 72 hours fever
hemodynamically unstable CBC 
inability to tolerate oral, swallow, noncompliance, n/v, fever 
tubo-ovarian abscess
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26
Q 
Syphillis 
Causative organism? 
incidence is \_\_\_?
Groups at high risk? 
Incubation?
A
  • bacteria Treponema pallidum spirochete*
  • increasing incidence
  • Men with men: AA, more in elderly than young
  • 10-90 days incubation 3 weeks!!!
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27
Q

Syphillis symptoms PRIMARY

A
  • painless unnoticed ulcer with raised border, firm round

- lasts 3-6 weeks goes away regardless if tx

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28
Q

Syphillis symptoms SECONDARY

A

-rash on palms and soles (maculopapular, scaly not pruritis)
- mucocutaneous lesions- mouth, vagina, anus
- fever, alopecia, adenopathy
- can occur immediately after or 2 years after transmission
- malaise
progresses to latent/late stage disease

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29
Q

Syphillis symptoms TERTIARY

A

-occurs 3-15 years after transmission
3 forms:
-Gummatous- soft tissue masses primarily face, lungs, skin, bone, liver
-Neurosyphillis- CBS balance dementia seizures
-Cardiovascular syphillis- aoritis aortic aneurysm

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30
Q

  • Exam:
A

Screening (just came in and got testing)
Early latent: + serology, 1 yr exposure
Exam: adenopathy, alopecia, ulcerative lesions

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31
Q

Congenital syphillis

A
  • placenta or birth
  • palmar rash hands and soles
  • late: deafness, teeth deformities, saddle nose
32
Q

Syphillis diagnosis

A
  • darkfield exam or direct fluroescent Ab test of lesion exudate
  • presumptive
  • NONTREPONEMAL: VDRL/RPR titre (can be positive lupud/mono) some remain positive for life
  • TREPONEMAL: FTA_ABS, MHA-TP confirmatory*** most positive for life

VDRL/RPR—> FTA

33
Q

Syphillis treatment
Primary secondary or early latent:
Tertiary or late latent:

Allergic to PCN

pediatrics:

A

1/2/early latent:
Benzanthine PCN G 2.4 mil IM
3/late latent:
Benzanthine PCN G 2.4 mil IM EVERY WEEK FOR 3 weeks

Allergic: need to be desensitized and treated
Pediatric: Benzanthine PCN G as well but different dosing

34
Q

Syphillis treatment

reaction to PCN

A

Jarisch-Herxheimer Reaction: endotoxins released from spirochetes eradication (fever, chills, hypotension, tachycardia)

35
Q

Syphillis F/U and education

A

Treatment of all sexual partners within 90 days
>90 days expsoure tx if cant get serology on no f/u possible
reportable

36
Q

most common viral STI

A

HPV

100 different types

37
Q

HPV incidence
Cervical
vulvar
Head and neck cancer

Incubation

A

cervical: decreasing
vulvar: diff to dx
head and neck: on rise

Incubation 1-6 months, may be up to 30 years

38
Q

HPV symptoms

A 
Small papules 
Cauliflower flesh colored growths 
Clusters 
Labia, clitoris, urethera, vagina, rectum, perineum, penis, oropharynx 
Itching, clear vaginal discharge
39
Q

Condyloma lata

A

bigger lesions than warts seen in HPV, more resistant, need surgical excision

40
Q

Bubble lesions, bluish grey border spider vascularity occur:

A

Penile warts formed after removal of condyloma

41
Q

Hypopigmented tissue on vulvar

A

Obtain biopsy, excision required

42
Q

HPV diagnostics

A

Biopsy of lesions- colposcopic exam
External- dont need biopdy unless treatment failure, immunocompromised, pigmented, fixed, ulcerative
Acetowhite (vinegar) light up HPV
HPV DNA titre

HPV 6+11 are genital warts

43
Q

HPV tx

Don’t need to memorize meds

A

Start with provider applied: cryotherapy q 1-2 weeks or TCA/BCA q wk or polophylin resin q wk
(after 3-4 times need biopsy and refer)

Podofilox BID X 3 d (off for 4) repeat x 4 cycles wash off 1-4 hours
Imoquimod or Aldara 3 x week x 16 weeks (wash off in am)
Sinecatchin apply TID x 16 weeks

Do in office a couple of times, then send them with at home stuff

44
Q

HPV f.u education

A 
partner self exams 
info change after 3 tx or not cleared after 6- change tx 
pap/hpv 
condoms 
transmitted w/ or w/o lesions 
No cure (may clear 21-24) 
VAGINAL/URETHRAL/ANAL/ORAL/ >2cm- refer
45
Q

HPV prevention

A

Gardasil 6,11,16,18,31,33,45,52,58
3 doses girls 9-26 initial, 2 months, 6 months
contraindicated: allergic egg based

46
Q

HSV Herpes Simplex Virus
Types

incubation period

A

HSV 1: cold sores more responsive longer windows between episodes less severe
HSV 2: genital
incubation short period: 4-7 days

47
Q

HSV presentation
Subjective:

PE:

A

fever, abdominal pain, itching, dysuria, painful sex, malaise, acches

vesicular lesions progressing to ulcers irregular borders, lymphadenopathy
INGUINAL adenopathy pain upper thigh

48
Q

HSV diagnostics

A

Virology vs. Serology
Culture: microscope
PCR: DNA from ulcer blood spinal fluid
Antibody test: blood: not as accurate doesn’t associate HSV1 or HSV2 NOT RECOMMENDED for diagnostics
indications serology: someone with atypical presentation, tried to culture and was negative, partner with HSV (PREGNANT or no hx) consider for: evaluation of STD, HIV+, MSM, NOT GENERALLY INDICATED will know in a few days

49
Q

HSV treatment

A

Initial: Acyclovir 400 TID x 7-10 d
famicyclovir 250 TID x 7-10 d
Valcylcovir 1gr BID x 7-10 d

Recurrent: lower doses of the above less days
start within 24 hours prodrome shedding phase (itching, tingling, numbness)

50
Q

Syphillis vs. Herpes lesion vs. chanroid

A

syphillis: round raised border one
herpes: vesicular multiple not as much induration
chancroid: jagged, excoriated, blue grey base hue kissing lesions

51
Q

HSV treatment with HIV

A

COURSE OF THERAPY IS LONGER AND EXTRA DOSE

52
Q

HSV suppressive therapy decreases by and reserved for:

A 
70-80% 
-frequency 
-severe
-debilitating 
-immunocompromised
-pregnancy*** remember these 
acyclovir- 6 years, fam/val- 1 year
53
Q

pregnant HSV

A

acycolivr at 32-34 weeks indicated if pt + or if FOB is +

54
Q

HSV education

transmission

A 
with or without active lesions 
barrier methods 
pregnancy risk: 30-50% risk transmision 
sitz bath 
no f.u needed: but f/u for education
55
Q 
Chanchroid 
Bacteria: 
Incubation: 
Subjective: 
Objective
A

Haemophilus ducreyi
4-7 days (short)
Subj: painful macule pustule to ulceration, kissing lesions, lymphadenopathy, abscess
Obj: lymph, shallow not indurated painful ulcer with ragged edges and blue/grey base
TRAVEL TO AFRICA CARIBBEAN

56
Q

Chancroid diagnosis
treatment

F/U

A

PE + culture for ducreyi (only 85% acc)
treatment: Azithroymcin 1g like chlamydia; or ceftriaxone 250 IM like gonorrhea; or emycin or cipro
F/U: 3-7 days partners within 10 days

57
Q 
Lymphogranuloma venereum 
organism: 
incubation:
where:
subj:
A

chlaymida trachomatis
incubation: longer 3d-3 weeks
tropical subtropical
subj: joint pain, painless vesicle, no induration, fever malaise
obj: similar to herpes lesion, ENLARGED TENDER INGUINAL ADENOPATHY** + serosanguinois drainage, erythemic top (bubo)

58
Q

Lymphogranuloma venereum diagnosis

treatment

A

dx: LGV compliment fixation Ab screen
Tx: doxy x 21 d, Emycin x 21d
F/U until resolved, treat partners within 60 days, consult MD

59
Q 
Granuloma inguinale AKA
bacteria:
incubation:
found where: 
subj: 
obj:
A

donovanosis

bacteria: colymmatobacterium granulomatis
incubation: long 5-6 weeks
found: tropical
subj: painless ulcer
obj: vascular ulcer, BEEFY RED*, no lymphadenopathy

60
Q

granuloma inguinale (donovanosis)
dx
tx

A

dx: dark staining donovan
tx: doxy x 21 d azithro q week cirpo emycin bactrim

61
Q

Vulvovaginal candidiasis
Organisms:
subj:
obj:

A

candida albicans, tropicalis, galbrata

subj: itching irritation dysuria, thick white discharge*
object: red, erythema or vuluva and introitus, white clumpy discharge

62
Q

Vulvovaginal candidiasis

Diagnosis

A

Wet mount

63
Q

Vulvovaginal candidiasis

Treatment

A

Oral fluconazole 150 mg PO X 1 42-72 hrs for effect may repeat in 72 hrs
Butoconazole vaginal cream (1x)
Terconazole*** supporsitory best at sight

64
Q

recurrent yeast

A

diabetes, high glucose, BMP, immunocompromised

65
Q

Bacterial vaginosis
organism
define

A

gardneraella vaginallis
alteration in normal flora infection
typically corrects itself (happens a lot with periods d/t hormones)

66
Q

BV
subj
obj
dx:

A

subj: grey/white d/c ODOR, burning, odor after sex
ob: erythemic vulva, *THIN white grey d/c
dx: wet mount

67
Q

BV treatment

f/u

A

Flagyl x 7 days
Clindess (clindamycin) 1 applicator x 5 days
metrogl at HS x 5 nights (eradicates normal flora)
tinidazole not really used

f/u if pregnant or sx
Pregnant tx: Flagyl TID 250 mg (more doses lower concentration) x 7d or clindamycin want TOC- preterm labor

68
Q

Microscopic exam of BV see

A

Clue cells
Lactobacilli- rod shaped, protective
Yellowish hue around clue cells

69
Q

recurrent BV

A

clindamycin resistance, failure to establish lactobacilli
longer initial tx and suppressive 10-14 d
then metroge; 2 x week consecutive nights every month

70
Q

Trichomoniasis
bacteria:
subj:
obj:

A

trichomoniasis vaginalis PROTOZOAN

subj: malodor, yellow-green frothy discharge, burning, dysuria
obj: green yellow frothy discharge, strawberry lesions on cervix, friable

71
Q

Trichomoniasis

A

Dx: wet mount

72
Q

UTI

diagnoses

A

acute cystitis or bladder infection

Simple cystitis: cloudy urine lower abd pressure
Pyelonephritis: fever, flank pain
elderly: incontinence pedi: fever

73
Q

UTI risk factors

A 
female 
diabetes 
advanced age 
problems emptying 
catheter
enlarged prostate 
narrow urethra 
kidney stones 
immobility 
pregnancy
74
Q 
Urinalysis 
pH
protein 
sugar
nitrites 
ketones 
bilirubin 
urobilinogen 
RBC
WBC
A 
pH 5-7 
protein inflammation of kidneys
sugar diabetes 
nitrites enzymes given off by bacteria in uti 
ketones sugar
bilirubin breakdown hemoglobin
urobilinogen breakdown of bilirubin
RBC bleeding
WBC infection
75
Q 
urine culture UTI 
most common pathogen
What indicates infection?
whats negative?
If several types of bacteria?
A

e.coli
100,000 CFU or 1,000-100,000 in catheterized
No growth in 24-48 hours
several types of bacteria then contaminated (if no symptoms consider -, if + do another)

76
Q

Treatment of UTI

A 
Bactrim 
Macrobid- tolerated well 
Fosomycin- expensive 
Cirpo- some resistance 
Levofloxacin- 
Augmentin
pyridium

Primary care (16 decks)

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