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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
PID inpatient for who?
``` pregnant do not respond within 72 hours fever hemodynamically unstable CBC inability to tolerate oral, swallow, noncompliance, n/v, fever tubo-ovarian abscess ```
26
``` Syphillis Causative organism? incidence is ___? Groups at high risk? Incubation? ```
- bacteria Treponema pallidum spirochete* - increasing incidence - Men with men: AA, more in elderly than young - 10-90 days incubation 3 weeks!!!
27
Syphillis symptoms PRIMARY
- painless unnoticed ulcer with raised border, firm round | - lasts 3-6 weeks goes away regardless if tx
28
Syphillis symptoms SECONDARY
-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
29
Syphillis symptoms TERTIARY
-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
30
Latent hidden syphillis - - Exam:
Screening (just came in and got testing) Early latent: + serology, 1 yr exposure Exam: adenopathy, alopecia, ulcerative lesions
31
Congenital syphillis
- placenta or birth - palmar rash hands and soles - late: deafness, teeth deformities, saddle nose
32
Syphillis diagnosis
- 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
Syphillis treatment Primary secondary or early latent: Tertiary or late latent: Allergic to PCN pediatrics:
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
Syphillis treatment | reaction to PCN
Jarisch-Herxheimer Reaction: endotoxins released from spirochetes eradication (fever, chills, hypotension, tachycardia)
35
Syphillis F/U and education
Treatment of all sexual partners within 90 days >90 days expsoure tx if cant get serology on no f/u possible reportable
36
most common viral STI
HPV | 100 different types
37
HPV incidence Cervical vulvar Head and neck cancer Incubation
cervical: decreasing vulvar: diff to dx head and neck: on rise Incubation 1-6 months, may be up to 30 years
38
HPV symptoms
``` Small papules Cauliflower flesh colored growths Clusters Labia, clitoris, urethera, vagina, rectum, perineum, penis, oropharynx Itching, clear vaginal discharge ```
39
Condyloma lata
bigger lesions than warts seen in HPV, more resistant, need surgical excision
40
Bubble lesions, bluish grey border spider vascularity occur:
Penile warts formed after removal of condyloma
41
Hypopigmented tissue on vulvar
Obtain biopsy, excision required
42
HPV diagnostics
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
HPV tx | Don't need to memorize meds
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
HPV f.u education
``` 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
HPV prevention
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
HSV Herpes Simplex Virus Types incubation period
HSV 1: cold sores more responsive longer windows between episodes less severe HSV 2: genital incubation short period: 4-7 days
47
HSV presentation Subjective: PE:
fever, abdominal pain, itching, dysuria, painful sex, malaise, acches vesicular lesions progressing to ulcers irregular borders, lymphadenopathy INGUINAL adenopathy pain upper thigh
48
HSV diagnostics
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
HSV treatment
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
Syphillis vs. Herpes lesion vs. chanroid
syphillis: round raised border one herpes: vesicular multiple not as much induration chancroid: jagged, excoriated, blue grey base hue kissing lesions
51
HSV treatment with HIV
COURSE OF THERAPY IS LONGER AND EXTRA DOSE
52
HSV suppressive therapy decreases by and reserved for:
``` 70-80% -frequency -severe -debilitating -immunocompromised -pregnancy*** remember these acyclovir- 6 years, fam/val- 1 year ```
53
pregnant HSV
acycolivr at 32-34 weeks indicated if pt + or if FOB is +
54
HSV education | transmission
``` 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
``` Chanchroid Bacteria: Incubation: Subjective: Objective ```
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
Chancroid diagnosis treatment F/U
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
``` Lymphogranuloma venereum organism: incubation: where: subj: ```
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
Lymphogranuloma venereum diagnosis | treatment
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
``` Granuloma inguinale AKA bacteria: incubation: found where: subj: obj: ```
donovanosis bacteria: colymmatobacterium granulomatis incubation: long 5-6 weeks found: tropical subj: painless ulcer obj: vascular ulcer, BEEFY RED*, no lymphadenopathy
60
granuloma inguinale (donovanosis) dx tx
dx: dark staining donovan tx: doxy x 21 d azithro q week cirpo emycin bactrim
61
Vulvovaginal candidiasis Organisms: subj: obj:
candida albicans, tropicalis, galbrata subj: itching irritation dysuria, thick white discharge* object: red, erythema or vuluva and introitus, white clumpy discharge
62
Vulvovaginal candidiasis | Diagnosis
Wet mount
63
Vulvovaginal candidiasis | Treatment
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
recurrent yeast
diabetes, high glucose, BMP, immunocompromised
65
Bacterial vaginosis organism define
gardneraella vaginallis alteration in normal flora infection typically corrects itself (happens a lot with periods d/t hormones)
66
BV subj obj dx:
subj: grey/white d/c ODOR, burning, odor after sex ob: erythemic vulva, *THIN white grey d/c dx: wet mount
67
BV treatment f/u
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
Microscopic exam of BV see
Clue cells Lactobacilli- rod shaped, protective Yellowish hue around clue cells
69
recurrent BV
clindamycin resistance, failure to establish lactobacilli longer initial tx and suppressive 10-14 d then metroge; 2 x week consecutive nights every month
70
Trichomoniasis bacteria: subj: obj:
trichomoniasis vaginalis PROTOZOAN subj: malodor, yellow-green frothy discharge, burning, dysuria obj: green yellow frothy discharge, strawberry lesions on cervix, friable
71
Trichomoniasis
Dx: wet mount
72
UTI | diagnoses
acute cystitis or bladder infection Simple cystitis: cloudy urine lower abd pressure Pyelonephritis: fever, flank pain elderly: incontinence pedi: fever
73
UTI risk factors
``` female diabetes advanced age problems emptying catheter enlarged prostate narrow urethra kidney stones immobility pregnancy ```
74
``` Urinalysis pH protein sugar nitrites ketones bilirubin urobilinogen RBC WBC ```
``` 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
``` urine culture UTI most common pathogen What indicates infection? whats negative? If several types of bacteria? ```
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
Treatment of UTI
``` Bactrim Macrobid- tolerated well Fosomycin- expensive Cirpo- some resistance Levofloxacin- Augmentin pyridium ```

Primary care (16 decks)

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