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Foundations of Clinical Practice II > STI > Flashcards

STI Flashcards

1
Q

Most common bacterial STI

A

Chylamydia

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2
Q

Most common viral STI

A

HPV, HSV-2

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3
Q

Most common parasitic STI

A

trichomoniasis

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4
Q

Which two groups are most affected by chlamydia

A
  1. Native women

2. Black women

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5
Q

Who is most affected by primary and secondary syphyllis?

A

MSM

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6
Q

1/2 MSM who are diagnosed with syphillis also have what?

A

HIV

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7
Q

What causes Trichomoniasis

A

Trichomonas vaginalis (single celled protozoan)

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8
Q

What is the most common presentation for infection with Trichomonas vaginalis?

A

asymptomatic

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9
Q

Trichomoniasis clinical presentation

A
  • Vaginal pH increases >4.5
  • Frothy, malodorous, yellow-green discharge
  • Petechiae on cervix/vagina (“strawberry cervix”)
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10
Q

What is the initial test to diagnose Trichomoniasis

A

Visualize motile organisms on wet mount**

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11
Q

What is the most sensitive test for Trichomoniasis

A

Nucleic Acid Amplification test (NAAT)

faster than culture

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12
Q

What if you’re doing a pap smear and you find Trich, what tx?

A

NONE, Ignore it

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13
Q

Trichomoniasis: Tx

A

Metronidazole (Flagyl) 1 oral dose

  • abstain from sex during treatment
  • retest within 3 months***
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14
Q

Trichomoniasis: Complications/Pregnancy

A
  • Increased risk of getting/giving HIV

- Lactating women should stop breastfeeding for 12-24 hours after metronidazole

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15
Q

Chlamydia: caused by

A

Chlamydia trachomatis (gram negative)

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16
Q

Who should be screened for Chylamydia?

A

Women under 25 should be screened yearly

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17
Q

What is chylamydia frequently co infected with?

A

gonorrhea

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18
Q

What is the most common clinical presentation of chylamydia?

A

asymptomatic

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19
Q

Chlyamydia: symptoms women vs. men

A

women: cervical discharge, vaginal bleeding, low abdominal pain, fever/chills
men: urethritis, penile discharge, dysuria

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20
Q

Chlamydia: initial test

A

-First catch urine*

Best test = NAAT

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21
Q

Chlamydia: treatment

A

Azithromycin (Zithromax) 1 dose [abstain from sex for a week after treatment]

or

Doxycycline x7 days (avoid in pregnancy)

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22
Q

After treating chlamydia or gonorrhea, when do you need to retest?

A

3-4 months

If pregnant: 3 weeks after treatment

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23
Q

Chlamydia and Gonorrhea: complications

A
  • Increased risk of giving and getting HIV
  • PID
  • epididymitis in men
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24
Q

What is a leading cause of conjunctivitis and pneumonia in newborns?

A

Chlamydia

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25
Q

What is gonorrhea caused by?

A

Neisseria gonorrhea (gram negative diplococci)

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26
Q

Who should be screened for gonorrhea?

A

Annually for sexually active women under 25

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27
Q

What is the clinical presentation of gonorrhea?

A

women: like chlamydia but more severe
- most are asymptomatic

men:
- urethritis
- white/yellow/green discharge
- dysuria

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28
Q

Where else can you be infected with Gonorrhea and Chlamydia?

A

oral and rectal

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29
Q

What will a gram stain show for gonorrhea?

A

PMN with intracellular gram-negative diplococci

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30
Q

Gonorrhea: Treatment

A

Ceftriaxone (Rocephin) 250mg IM
+
Azithromycin 1 gram PO (or doxycycline)

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31
Q

Gonorrhea: initial test

A

first catch urine

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32
Q

What is gonorrhea prophylaxis for newborns?

A

topical erythromycin in the eyes ASAP after delivery

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33
Q

PID

A

refers to spectrum of inflammatory disorders of upper gential tract

(ex. endometritis, salpingitis, tubo-ovarian abscess, pelvic peritonitis)

34
Q

Name some risk factors for PID (7)

A
  1. Age <25
  2. Black
  3. Started having sex early
  4. Multiple partners
  5. Douche
  6. IUD (within 3 weeks)
  7. History of PID
35
Q

PID clinical presentation

A
  1. Low ABD/Pelvic pain
  2. Cervical motion tenderness
  3. Uterine or adnexal tenderness
  4. Fever <101 F (38.3 C)
36
Q

What other tests need to be done if a patient is suspected of PID?

A
  1. Serum quantitiave HCG (pregnancy test)*
    to rule out ectopic
  2. Screen for chlamydia and gonorrhea
  3. WBCs on saline microscopy of vaginal fluid
37
Q

PID: when do you follow up?

A

within 48 hours!!

38
Q

When do you hospitalize a patient for PID

A
  • If you suspect it may be surgical emergency
  • Pregnant with PID
  • Not responding to ABO (48-72 hours)
  • Tubo-ovarian abscess (more severe form)
  • FEVER >102.2 F
39
Q

What are the main complications of PID?

A
  1. Infertility
  2. Ruptured tubo-ovarian abscess
  3. Increased risk of ectopic pregnancy
  4. Fitz-Hugh-Curtis syndrome
40
Q

What is the name for perihepatitis characterized by RUQ pain and adhesions?

A

Fitz-Hugh-Curtis syndrome

41
Q

Genital herpes: cause

A

Herpes simplex virus 1 or 2

**usually 2, acquired from asymptomatic partner

42
Q

What is characteristic about all the herpes viruses

A

remain latent in nerve root ganglions

43
Q

Genital Herpes: clinical presentation

A
  1. Prodrome:
    - burning/tingling/pruitis
  2. Painful vesicles on erythematous base**
44
Q

Which outbreak tends to be the most severe in Herpes?

A

Primary or initial outbreak!

45
Q

What is the method for identifying cytologic detection of cellular changes in herpes?

A

Tzank preparation

46
Q

How do you confirm a herpes infection?

A

blood test for HSV-1 and HSV-2 antibodies

limitation symptoms in first 2 weeks but antibodies not around until 3-4 weeks after exposure

47
Q

Genital herpes: treatment

A

Acyclovir
Valacyclovir
Famciclovir

48
Q

Who must you remember to lower the dose of “-cyclovir” drugs in?

A

renal insufficiency

49
Q

How long do you treat Herpes initial outbreak vs. recurrent outbreak?

A

initial: 7-10 days
recurrent: 1-5 days

50
Q

When can herpes be given to the baby?

A

before, during (vaginal delivery mc***) or after delivery

so, Cesarean section**

51
Q

Where are the 3 places HSV can go in neonates?

A
  1. Skin, eye, mouth
  2. CNS (encephalitis)
  3. Disseminated)
52
Q

Prevention of neonatal HSV

A

A. Acyclovir at 36 wks gestation

B. C-section with active genital lesions (or prodrome)

53
Q

What is the most common STI

A

Human Papillomavirus

54
Q

What is the name for visible genital warts?

A

condyloma acuminata

“cauliflower-like”

55
Q

HPV: diagnosis

A
  1. Visualize warts - vinegar turns them white
  2. Papsmear (can test for HPV dna)
    - NO TEST FOR MEN
56
Q

HPV: treatment (by patient)

A

Patient:
1. Imiquimod (Aldara) - immune enhancer, stimulates interferon

  1. Podofilox- antimitotic causes wart necrosis
57
Q

HPV: provider applied

A
  1. Cryotherapy
  2. Surgical therapy
  3. Trichloroacetic acid (TCA)
58
Q

Which HPVs are most common causes of cervical cancer?

59
Q

HPV vaccine: who? when?

A

<15 get 2 doses

>15 get 3 doses (1 month, 2 month, 6 months)

60
Q

What causes syphilis?

A

Treponema pallidum (gram negative)

61
Q

Secondary Syphylis

A
  1. Epitrochlear lymphadenopathy
  2. Rash (diffuse, symmetric, macular, non pruritic) palms and soles of feet**
  3. Condylomata lata (gluteal folds, perineum, perianal)
    - HIGHLY contagious**
  4. Mucous membrane patches (not painful)
62
Q

What is a uncommon clinical finding of syphilis involving the scalp, eye brows, beard

A

Alopecia “moth-eaten”

63
Q

Late (tertiary) syphilis

A

-Neurogenic deficits (blindness, dementia, CN dysfunction)

–>if neurosyphilis need lumbar puncture

64
Q

How is syphilis diagnosed

A
  1. Direct detection (dark field microscopy, fluorecsent antibody assay)
  2. blood test for antibody (cardiolipin)
65
Q

Syphilis: treatment

A

Benzathine PCN G IM

doxy if PCN allergic. If HIV or pregnant with PCN allergy, need to desensitize them!

66
Q

If someone has had syphilis more than once, what is the treatment

A

Benzathine PCN G IM x3 weeks

67
Q

Syphilis in pregancy: birth defects

A
  • stillbirth
  • neonatal death
  • deafness
  • bone deformities (saber shin, saddle nose)
68
Q

Syphilis Pregancy screening

A

1st prenatal visit

High risk: 1st prenatal, 28 weeks, and delivery

69
Q

Congenital syphilis signs

A
  1. thickened umbilical cord like a barber’s pole
  2. Bloody/purulent, highly contagious nasal discharge
  3. Bone deformities
  4. Rash
  5. Hepatomegaly/jaundice
70
Q

Congential syphilis: early signs

A

Long bone abnormalities
Pneumonia
Severe anemia
CNS syphilis

71
Q

Congential syphilis: late signs

A
  • Gumma (skin granuloma +/-ulceration)

- Hutchinson triad

72
Q

Hutchinson triad

A
  1. Hutchinson teeth (wide spacing)
  2. Interstitial keratitis (inflammation of the corneal with neovascularization)
  3. Sensorineuronal hearing loss
73
Q

Heart issues you could see in tertiary syphilis?

A
  • aortic regurge
  • coronary artery stenosis
  • aortitis
74
Q

What causes chancroid

A

Haemophilus ducreyi

75
Q

Chancroid clinical presentation

A
  • painful, genital ulcer
  • foul smelling discharge (contagious)
  • Swollen inguinal lymph node (buboes)
76
Q

Lymphogranuloma venereum: cause

A

Chlamydia trachomatis

77
Q

Lymphogranuloma venereum:: clinical presentation/diagnosis

A

Groove sign** - inflammation between superficial and deep lymph nodes

  • systemic
  • unilateral inguinal or femoral lymphadenopathy
  • genital ulcer (self-limited)
  • anal discharge & rectal bleeding
78
Q

Scabies (Pediculosis Pubis): Tx

A

Permethrin 1% cream, rinse

79
Q

All pregnant women need to be screened for (3)

A
  1. HIV
  2. Syphilis
  3. Hep B (HBsAg)
80
Q

Who should be screened for HIV

A

Everyone 13-64

screen for HIV everytime someone gets new STI

81
Q

MSM should be screened for what?

A
  1. HIV
  2. Syphilis
  3. Hep B

-offer hep A and hep B vaccine

(also, gonorrhea and chlamydia depending on where the action is)

Foundations of Clinical Practice II (25 decks)

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