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CMT-uno > STI and PID > Flashcards

STI and PID Flashcards

1
Q

Chlamydia

Agent

A

bacteria Chlamydia trachomatis
Gram negative
Can be spread via intercourse, anal or oral sex

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2
Q

Chlamydia

Tx (2)

A

Doxycycline 100 mg po bid x 7 days
Azithromycin 1-gram po x 1 dose
Can be used in pregnancy

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3
Q

Chalmydia

Dx

A

Nucleic acid amplification tests (NAAT)
from urine or swab

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4
Q

chlamydia

follow up

A

Test of cure within 3 weeks
Pregnant patients

Persistent symptoms
Rx with erythromycin or amoxicillin (suboptimal)

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5
Q

Chlamydia

Screening

A

Regular screening recommended if you are high risk:
Under 25 years old
Pregnant
New or multiple partners
Have had chlamydia before

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6
Q

Chlamydia

complications in females

A

PID: increased risk for chronic pelvic pain, infertility, ectopic pregnancy

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7
Q

Chlamydia

Complicationns in pregnancy

A

Pregnancy: preterm delivery, neonatal conjunctivitis (blindness), neonatal pneumonia

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8
Q

Chlamydia

complications in men

A

Men: Reduced fertility and pain, swelling, tenderness in testicles (epididymitis)

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9
Q

Chlamydia

Complications in any gender

A

Reactive arthritis, Conjunctivitis

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10
Q

Gonorrhea

agent

A

by bacteria Neisseria gonorrhoeae
Gram negative intracellular diplococci
Can be spread via intercourse, anal or oral sex

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11
Q

Gonorrhea

prevalence

A

Second most common communicable disease in US
Highest rates among sexually active teenagers and adults

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12
Q

chlamydia

prevalence

A

most common STD in US

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13
Q

Gonnorhea

Sx in females

A

Often asymptomatic
White or yellow vaginal discharge,
Metrorrhagia (bleeding between periods) postcoital bleeding
PID: pelvic pain, fever, chills
Urethritis: UTI symptoms (frequency, dysuria)

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14
Q

Gonorrhea

Sx for men

A

Sx more common here than for chlamydia
White or yellow penile discharge
Burning with urination
Testicular/scrotal pain or swelling

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15
Q

Gonorrhea

Rectal symptoms

A

Anal discharge, pain, pruritis
Anal bleeding
Painful bowel movements

Can also include throat infection and pain

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16
Q

Gonorrhea

PE in women

A

Mucopurulent discharge, friable cervix, SEVERE cervical motion tenderness

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17
Q

Gonorrhea

PE in men

A

Mucopurulent urethral discharge

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18
Q

gonorrhea

dx

A

NAAT with swab
Test for other infections

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19
Q

gonorrhea

complications in females

A

PID: chronic pelvic pain, infertility, ectopic pregnancy

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20
Q

gonorrhea

complications in infants

A

ophthalmia neonatorum (can cause perforation of globe and blindness), sepsis, meningitis, scalp abscesses

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21
Q

gonorrhea

complications in men

A

scars in urethra, inflammation of testicles, infertility, chronic prostate pain

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22
Q

gonorrhea

complications in all genders (4 areas)

A

Disseminated infection: septic arthritis, skin lesions, pericarditis, endocarditis, meningitis

23
Q

Syphilis

agent

A

Spirochete: Treponema pallidum

24
Q

Spirochete: Treponema pallidum

overview

A

Increasing incidence
Disproportionate disease burden disease in Black individuals
Association with HIV coinfection among MSM

25
Q

Syphilis

How is it spread

A

Direct contact with lesion
crosses placenta

26
Q

Syphilis

Primary stage Sx and incubation

A

2 to 12 weeks after exposure; small, painless chancre develops and heals spontaneously (may go unnoticed)

27
Q

Syphilis

Secondary Stage when does it start, and what do you see?

A

~1 to 6 months after chancre healing; raised rash appears on palms and soles with generalized symptoms such as fever, adenopathy fatigue, myalgias, sore throat, eye and GI involvement

28
Q

Syphilis

Latent stage

A

Can move here if left untreated and has no symptoms; early and late stages

29
Q

Syphilis

Tertiary stage incubation and what areas are affected?

A

Can move here if left untreated 1 to 30 years after primary infection; cause damage with CNS, cardiovascular, nodular lesions

30
Q

Syphilis

Primary essentials of DX

A

Painless chancre ulcer on genitalia, perianal area, rectum, pharynx, tongue, lip, or elsewhere.
“Classic” ulcer: nontender, nonpurulent, indurated
Fluid expressed from ulcer containsT pallidumby immunofluorescence or darkfield microscopy
Nontender enlargement of regional lymph nodes
Serologic nontreponemal and treponemal tests may be positive.

31
Q

Syphilis

Maculopapular rash

A

some raised some not, on palms and soles.

32
Q

Syphilis

secondary essentials of Dx

A

Generalized maculopapular rash on palms and soles
Mucous membrane lesions.
Condylomata lata in moist skin areas-mistaken for genital warts
Generalized nontender lymphadenopathy
Fever may be present
Meningitis, hepatitis, osteitis, arthritis, iritis
Many treponemes in moist lesions by immunofluorescence or darkfield microscopy
Positive serologic tests for syphilis

33
Q

syphilis

latent stages

A

Early latent syphilis:infection < 1 year
Late latent syphilis:infection > 1 year
still + for syph

34
Q

syphilis

Tertiary Syphilis Essentials of Dx

A

Gummas:infiltrative tumors of skin, bones, liver
Cardiovascular damage: aortitis, aortic aneurysms, aortic regurgitation
CNS damage:meningovascular and degenerative changes, paresthesias, abnormal reflexes, dementia, or psychosis
May occur at any time after secondary syphilis, even after years of latency; rarely seen in developed countries

35
Q

syphilis

Neuro Sx

A

Can occur at any stage of disease
Meningitis: Headache, stiff neck, fever
*Argyll-Robertson pupil: accommodates but does not react to light
Tabes dorsalis (Damaged posterior columns and dorsal roots of spinal cord)

36
Q

Syph

How do we dx Neuro Syph

A

Consider CSF evaluation for atypical symptoms or lack of decrease in nontreponemal serology titers.
neuro exam

37
Q

Congenital Syphilis Diagnosis

A

maternal nontreponemal and treponemal antibodies can be transferred through placenta to fetus
Miscarriage, stillbirth, early neonatal death
Desquamating maculopapular rash of skin/mucus membranes; condylomas
Serous rhinitis (snuffles)
Saddle nose deformity due to damage to cartilage of nasal septum
*Hutchinson’s teeth
Chorioretinopathy and optic neuritis
Deafness

38
Q

syph

Nontreponemal

A

1st step know this!!
nonspecific, not definitive, but low cost, easy to perform, and quantifiable to follow response to therapy.
Rapid plasma reagin (RPR)
Venereal Disease Research Laboratory (VDRL)
Toluidine Red Unheated Serum Test (TRUST)
Amount of antibody present (IgM and IgG) reflects activity of infection. Positive tests reported as a titer of antibody (eg, 1:32, - detection of antibody in serum diluted 32-fold).

39
Q

Syphilis

Treponemal Dx

A

confirmatory if nontreponemal tests are reactive. Qualitative only - reported as “reactive” or “nonreactive“
Once positive, usually positive for life, not useful for confirming new diagnosis of syphilis in patient with prior treated disease.
Increasingly used as initial screening test.
Fluorescent treponemal antibody absorption (FTA-ABS)
Microhemagglutination test for antibodies toT. pallidum(MHA-TP)
T. pallidumparticle agglutination assay (TPPA)
T. pallidumenzyme immunoassay (TP-EIA)
Chemiluminescence immunoassay (CIA)

40
Q

Syph

Tx

A

Penicillin G benzathine

41
Q

Syph

Jarisch-Herxheimer reaction

A

Acute worsening of symptoms and fever after treatment has started
Here the toxins are released when treatment kills spirochetes and they blow apart, triggering cytokine release know this

42
Q

Trich

agent and overview

A

by protozoan: Trichomonas vaginalis
Symptoms
Can be asymptomatic in both male and females

43
Q

Trich

Female Sx

A

Females:
Frothy discharge (yellow, green) with foul fishy odor
Can be intensely pruritic- can be mistaken for yeast
Swelling, pain, redness in vulva
Dysuria
Strawberry cervix

44
Q

trich

males Sx

A

urethral discharge

45
Q

Trich

PE in females

A

females-strawberry cervix

Have high suspicion if pH >4.5, amine/fishy odor, many white blood cells (even if trich is not seen)

46
Q

trich

Tx

A

Treatment of both partners
Metronidazole 500mg twice daily for 7 days

47
Q

Vulvovaginal Candidiasis agent and agent type

A

Candida albicans
Not an STI
Fungal

48
Q

Vuvlovaginal candidiasis

Sx

A

pruritis, thick white curd-like vaginal discharge without odor
Vulvar erythema, edema, excoriation
KOH prep shows spores and hyphae

49
Q

Vulvovaginal Candidiasis

Tx

A

Non-pregnant
Vaginal topical azoles (1-3 day regimen)
Miconazole, tioconazole
Oral azoles (one time dose)
Fluconazole 150mg oral tablet

50
Q

Vuvlovaginal candidiasis

Prgenant Tx

A

Vaginal topical azoles (longer course)

51
Q

Vulvovaginal candidiasis

risk factors

A

Diabetes mellitus
Broad spectrum antibiotic use
Increased estrogen: OCPs
Pregnancy
Corticosteroid usage
Immunosuppression
IUD?
Vaginal Candida may form biofilm on IUD strings

52
Q

Pelvic Inflammatory Disease (PID)

A

External genitalia without skin lesions or edema/erythema. Vaginal mucosa without lesions or discharge. Cervix without erythema, lesions, contact bleeding, discharge. Cervical motion tenderness present.

Chandelier sign

53
Q

PID definition

A

Polymicrobial infection of upper genital tract associated with sexually transmitted organisms N gonorrhoeae and Chlamydia trachomatis as well as endogenous organisms

54
Q
A

CMT-uno (54 decks)

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