STI Flashcards
- 85% of primary & secondary syphilis
- 51% also w/ HIV
MSM
- Most prevalent NON-VIRAL STI in United States?
- MC presentation?
- When do sxs occur?
Trichomoniasis
- Asymptomatic
- 1-4 weeks after exposure
- urethritis
- epididymitis
- prostatitis
3 sxs of Trichomoniasis in men
(but men are usually asymptomatic)
- Increased vag pH >4.5
- Vag irritation, malodorous, frothy, yellow/green discharge
- LOTS of discharge
- Petechiae on cervix or vagina (what’s this called)?
- Organism?
Trichomoniasis
- Strawberry Cervix
- Trichomonas vaginalis
Dx of Trichomoniasis
- 60% accurate?
- Most accurate?
- 60% - wet mount w/ flagellated organisms
- Swab –> culture (takes 7 days)
- NAAT = fast and most accurate
Tx of what?
- Metronidazole (oral)
- Tinidazole (single dose)
- Retest in __
- Test of cure in ___ (for pregnant pts)
Trichomoniasis
Increases risk of premature rupture of membranes, preterm deliv, low birth weight
(but tx does NOT reduce risk)
Trich
(can tx pregnant women w/ Metronidazole)
(Lactating women should not breast feed 12-24 hrs after Metron single dose)
- MC bacterial STI in United States
- Organism?
- Peaks in late teens/early 20s
- Screening?
Chlamydia
- Chlamydia trachomatis (gram -)
- Women 25 or younger screened yearly
- cervical dsch
- vag bleeding
- low abd pain
- F/chills
- adnexal tenderness
- burning
- SMALL amt discharge
Chlamydia sxs of women
- Oral & Rectal infections are more common in Trich or Chlamydia??***
- Possible in which other infection?
Chlamydia
- Gonorrhea
- 1st catch urine
- NAAT
- Pharynx/Rectal swab
- Tx: Azithromycin single dose or Doxy x7 days
- Don’t use which med in pregnant pts?? Cat D
- Chlamydia
- Doxy is Class D Preg
- Increased risk of HIV
- Untreated –> PID
- Males –> epididymitis
Chlamydia & Gonorrhea
- May lead to preterm delivery
- Leading cause of MILD conjunctivitis and PNA in newborns (ophthalmia neonatorum)
Chlamydia
- Severe conjunctivitis in newborns
Gonorrhea
- sxs 1-14 days after exposure
- Screen sexually act women under 25
- NO recommendations for men or women over 25
Gonorrhea
(Neisseria gonorrhea = gram -)
-
Women:
- Usually asymptomatic
- cervical motion tenderness
-
Men:
- urethritis, dysuria
- white/yellow/green discharge
Gonorrhea
- 1st catch urine
- NAAT
- Gram stain: PMN leuks w/ intracellular Gram-negative diploccoci**
(On exam)
Dx of Gonorrhea
- IM Ceftriaxone + Azithromycin PO
- or DOxy
Tx of Gonorrhea
Newborns: perforation of globe & blindness
Gonorrhea
MC cause of PID
- STI organisms
- Chlamydia & Gonorrhea
IUD within ___ of insertion can be cause of PID
3 weeks
- Lower abd/pelvic pain
- Cervical Motion Tenderness (Chandelier sign)
- Uterine or adnexal tenderness
- Cervical friability
PID
- Get serum quant HCG
- US to r/o ectopic
PID
Outpatient regimen:
- Cef
- Doxy x 14 days
- +/- Metronidazole x 14 days
Inpatient: IV
**FU in 48 hrs**
PID
Hospitalize pts w/ ___ if:**
- cannot r/o ectopic, appy, torsion
- pregnant
- Unresponsive to oral abx (48-72 hrs)
- Tubo-ovarian abscess
- Pt is VERY ill w/ 102.2F, N/V, looks sick
PID
Main compliation of PID?
Infertility
Fitz-Hugh -Curtis syndrome
- What is it? / Which disease?
- WHat 2 sxs?
PID
- Perihepatitis
- RUQ pain & Adhesions
- Adhesions between liver & diaphragm
- Acyclovir
- Valacyclovir
- Famciclovir
- Reduce dose if renal insufficiency
- Initial outbreak: ___ days
- Recurrent outbreak ___ days
Tx of Genital Herpes
- initial: 7-10 days
- recurrent: 1-5 days
Transmission during vaginal delivery MC
C-section to reduce transmission
Genital Herpes
MC syndrome of Neonate HSV from genital herpes
Localized Skin, Eye, Mouth (SEM disease) 4 weeks after birth
MC STI overall?***
on exam
HPV
6&11 are sexually transmitted
- Most asymptomatic
- Condyloma acuminata
- flesh colored / soft
- cauliflower
- Persistence of this infection is MCC of ____
HPV
- Cervical Cancer
Pt applied therapy:
- Imiquimod
- Podofilox
Provider applied:
- Cryotherapy
- Surgical therapy
- Trichloroacetic Acid (TCA)
(NO CURE of this)
HPV
Vaccine for HPV?
9-valent HPV (Gardasil 9)
- Treponema pallidum
- painless chancre
Syphilis
Primary Syphilis
Painless Chancre
Secondary Syphilis
-
Rash
- diffuse, symmetric, macular/papular, NON-pruritic
- Palms and soles of feet
- Salmon colored lesions
When is syphilis no longer sexually transmittable?
Latent
(asymptomatic)
Late syphilis
- 10-20 yrs after infection
- Neuro deficits: blindness, dementia, damage to internal organs
What type of syphilis can happen at ANY stage?
Neurosyphilis
Dx of syphilis
- Non-treponemal serological assays
- RPR (MC used) = rapid plasma reagin
- Benzathine PCN G (IM)
- If PCN allergy: oral doxy
- retreatment: weekly Benzathine PCN G (IM x 3 weeks)
Tx of Syphilis
Early Congenital Syphilis
- Manifests prior to __ yrs
Late Congenital Syphilis
- Manifests after __ yrs
- 2
- 2
- CNS syphilis
- Long bone abnorm
- PNA
- Severe anemia
Early COngenital Syphilis
- Gumma Formation (granulomatous lesion)
- Hutchinson Triad***??
(On exam)
Late Congential Syphilis
- Hutchinson teeth
- Interstitial keratitis
- Sensorineural hearing loss
Tertiary Syphilis
- Multi-organ involvement
- Gummatous syphilis (skeletal, spinal, mucosal)
- CV syphilis: aortic regurg, CAS, aortitis
- Haemophilus ducreyi
- Sporadic outbreak in US
- Painful ulcer
- fould discharge
- buboes
- Contact County Health Dept
Chancroid
- Chlamydia trachomatis
- “groove sign”
- rectal bleeding
- Contact County Health Dept
Lymphogranuloma venereum (LGV)
- Pthirus pubis
- Crab louse
- Tx: Permethrin cream rinse
Pediculosis Pubis
All pregnant women should be screened for what 3 things?
- HIV
- Syphilis
- HBsAg
Annual screenings for which 2?
- Chlamydia
- Gonorrhea
Screen MSM annually for what 2?
- HIV
- Syphilis
Screen 13-64 y/o
HIV
9-Valent HPV (Gardasil 9) vaccine for <15 y/o
2 doses
- 0 months
- 6-12 months
9-Valent HPV (Gardasil 9) vaccine for 15+ y/o
3 doses
- 0 months
- 1-2 months
- 6 months
