STI Flashcards
1
Q
Most common bacterial STI
A
Chylamydia
2
Q
Most common viral STI
A
HPV, HSV-2
3
Q
Most common parasitic STI
A
trichomoniasis
4
Q
Which two groups are most affected by chlamydia
A
- Native women
2. Black women
5
Q
Who is most affected by primary and secondary syphyllis?
A
MSM
6
Q
1/2 MSM who are diagnosed with syphillis also have what?
A
HIV
7
Q
What causes Trichomoniasis
A
Trichomonas vaginalis (single celled protozoan)
8
Q
What is the most common presentation for infection with Trichomonas vaginalis?
A
asymptomatic
9
Q
Trichomoniasis clinical presentation
A
- Vaginal pH increases >4.5
- Frothy, malodorous, yellow-green discharge
- Petechiae on cervix/vagina (“strawberry cervix”)
10
Q
What is the initial test to diagnose Trichomoniasis
A
Visualize motile organisms on wet mount**
11
Q
What is the most sensitive test for Trichomoniasis
A
Nucleic Acid Amplification test (NAAT)
faster than culture
12
Q
What if you’re doing a pap smear and you find Trich, what tx?
A
NONE, Ignore it
13
Q
Trichomoniasis: Tx
A
Metronidazole (Flagyl) 1 oral dose
- abstain from sex during treatment
- retest within 3 months***
14
Q
Trichomoniasis: Complications/Pregnancy
A
- Increased risk of getting/giving HIV
- Lactating women should stop breastfeeding for 12-24 hours after metronidazole
15
Q
Chlamydia: caused by
A
Chlamydia trachomatis (gram negative)
16
Q
Who should be screened for Chylamydia?
A
Women under 25 should be screened yearly
17
Q
What is chylamydia frequently co infected with?
A
gonorrhea
18
Q
What is the most common clinical presentation of chylamydia?
A
asymptomatic
19
Q
Chlyamydia: symptoms women vs. men
A
women: cervical discharge, vaginal bleeding, low abdominal pain, fever/chills
men: urethritis, penile discharge, dysuria
20
Q
Chlamydia: initial test
A
-First catch urine*
Best test = NAAT
21
Q
Chlamydia: treatment
A
Azithromycin (Zithromax) 1 dose [abstain from sex for a week after treatment]
or
Doxycycline x7 days (avoid in pregnancy)
22
Q
After treating chlamydia or gonorrhea, when do you need to retest?
A
3-4 months
If pregnant: 3 weeks after treatment
23
Q
Chlamydia and Gonorrhea: complications
A
- Increased risk of giving and getting HIV
- PID
- epididymitis in men
24
Q
What is a leading cause of conjunctivitis and pneumonia in newborns?
A
Chlamydia
25
What is gonorrhea caused by?
Neisseria gonorrhea (gram negative diplococci)
26
Who should be screened for gonorrhea?
Annually for sexually active women under 25
27
What is the clinical presentation of gonorrhea?
women: like chlamydia but more severe
- most are asymptomatic
men:
- urethritis
- white/yellow/green discharge
- dysuria
28
Where else can you be infected with Gonorrhea and Chlamydia?
oral and rectal
29
What will a gram stain show for gonorrhea?
PMN with intracellular gram-negative diplococci
30
Gonorrhea: Treatment
Ceftriaxone (Rocephin) 250mg IM
+
Azithromycin 1 gram PO (or doxycycline)
31
Gonorrhea: initial test
first catch urine
32
What is gonorrhea prophylaxis for newborns?
topical erythromycin in the eyes ASAP after delivery
33
PID
refers to spectrum of inflammatory disorders of upper gential tract
(ex. endometritis, salpingitis, tubo-ovarian abscess, pelvic peritonitis)
34
Name some risk factors for PID (7)
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
PID clinical presentation
1. Low ABD/Pelvic pain
2. Cervical motion tenderness
3. Uterine or adnexal tenderness
4. Fever <101 F (38.3 C)
36
What other tests need to be done if a patient is suspected of PID?
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
PID: when do you follow up?
within 48 hours!!
38
When do you hospitalize a patient for PID
- 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
What are the main complications of PID?
1. Infertility
2. Ruptured tubo-ovarian abscess
3. Increased risk of ectopic pregnancy
4. Fitz-Hugh-Curtis syndrome
40
What is the name for perihepatitis characterized by RUQ pain and adhesions?
Fitz-Hugh-Curtis syndrome
41
Genital herpes: cause
Herpes simplex virus 1 or 2
**usually 2, acquired from asymptomatic partner
42
What is characteristic about all the herpes viruses
remain latent in nerve root ganglions
43
Genital Herpes: clinical presentation
1. Prodrome:
- burning/tingling/pruitis
2. Painful vesicles on erythematous base**
44
Which outbreak tends to be the most severe in Herpes?
Primary or initial outbreak!
45
What is the method for identifying cytologic detection of cellular changes in herpes?
Tzank preparation
46
How do you confirm a herpes infection?
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
Genital herpes: treatment
Acyclovir
Valacyclovir
Famciclovir
48
Who must you remember to lower the dose of "-cyclovir" drugs in?
renal insufficiency
49
How long do you treat Herpes initial outbreak vs. recurrent outbreak?
initial: 7-10 days
recurrent: 1-5 days
50
When can herpes be given to the baby?
before, during (vaginal delivery mc***) or after delivery
so, Cesarean section****
51
Where are the 3 places HSV can go in neonates?
1. Skin, eye, mouth
2. CNS (encephalitis)
3. Disseminated)
52
Prevention of neonatal HSV
A. Acyclovir at 36 wks gestation
B. C-section with active genital lesions (or prodrome)
53
What is the most common STI
Human Papillomavirus
54
What is the name for visible genital warts?
condyloma acuminata
"cauliflower-like"
55
HPV: diagnosis
1. Visualize warts - vinegar turns them white
2. Papsmear (can test for HPV dna)
- NO TEST FOR MEN
56
HPV: treatment (by patient)
Patient:
1. Imiquimod (Aldara) - immune enhancer, stimulates interferon
2. Podofilox- antimitotic causes wart necrosis
57
HPV: provider applied
1. Cryotherapy
2. Surgical therapy
3. Trichloroacetic acid (TCA)
58
Which HPVs are most common causes of cervical cancer?
16 & 18
59
HPV vaccine: who? when?
<15 get 2 doses
| >15 get 3 doses (1 month, 2 month, 6 months)
60
What causes syphilis?
Treponema pallidum (gram negative)
61
Secondary Syphylis
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
What is a uncommon clinical finding of syphilis involving the scalp, eye brows, beard
Alopecia "moth-eaten"
63
Late (tertiary) syphilis
-Neurogenic deficits (blindness, dementia, CN dysfunction)
-->if neurosyphilis need lumbar puncture
64
How is syphilis diagnosed
1. Direct detection (dark field microscopy, fluorecsent antibody assay)
2. blood test for antibody (cardiolipin)
65
Syphilis: treatment
Benzathine PCN G IM
| doxy if PCN allergic. If HIV or pregnant with PCN allergy, need to desensitize them!
66
If someone has had syphilis more than once, what is the treatment
Benzathine PCN G IM x3 weeks
67
Syphilis in pregancy: birth defects
- stillbirth
- neonatal death
- deafness
- bone deformities (saber shin, saddle nose)
68
Syphilis Pregancy screening
1st prenatal visit
High risk: 1st prenatal, 28 weeks, and delivery
69
Congenital syphilis signs
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
Congential syphilis: early signs
Long bone abnormalities
Pneumonia
Severe anemia
CNS syphilis
71
Congential syphilis: late signs
- Gumma (skin granuloma +/-ulceration)
| - Hutchinson triad
72
Hutchinson triad
1. Hutchinson teeth (wide spacing)
2. Interstitial keratitis (inflammation of the corneal with neovascularization)
3. Sensorineuronal hearing loss
73
Heart issues you could see in tertiary syphilis?
- aortic regurge
- coronary artery stenosis
- aortitis
74
What causes chancroid
Haemophilus ducreyi
75
Chancroid clinical presentation
- painful, genital ulcer
- foul smelling discharge (contagious)
- Swollen inguinal lymph node (buboes)
76
Lymphogranuloma venereum: cause
Chlamydia trachomatis
77
Lymphogranuloma venereum:: clinical presentation/diagnosis
Groove sign** - inflammation between superficial and deep lymph nodes
- systemic
- unilateral inguinal or femoral lymphadenopathy
- genital ulcer (self-limited)
- anal discharge & rectal bleeding
78
Scabies (Pediculosis Pubis): Tx
Permethrin 1% cream, rinse
79
All pregnant women need to be screened for (3)
1. HIV
2. Syphilis
3. Hep B (HBsAg)
80
Who should be screened for HIV
Everyone 13-64
| screen for HIV everytime someone gets new STI
81
MSM should be screened for what?
1. HIV
2. Syphilis
3. Hep B
-offer hep A and hep B vaccine
(also, gonorrhea and chlamydia depending on where the action is)
