STI and PID Flashcards
Chlamydia
Agent
bacteria Chlamydia trachomatis
Gram negative
Can be spread via intercourse, anal or oral sex
Chlamydia
Tx (2)
Doxycycline 100 mg po bid x 7 days
Azithromycin 1-gram po x 1 dose
Can be used in pregnancy
Chalmydia
Dx
Nucleic acid amplification tests (NAAT)
from urine or swab
chlamydia
follow up
Test of cure within 3 weeks
Pregnant patients
Persistent symptoms
Rx with erythromycin or amoxicillin (suboptimal)
Chlamydia
Screening
Regular screening recommended if you are high risk:
Under 25 years old
Pregnant
New or multiple partners
Have had chlamydia before
Chlamydia
complications in females
PID: increased risk for chronic pelvic pain, infertility, ectopic pregnancy
Chlamydia
Complicationns in pregnancy
Pregnancy: preterm delivery, neonatal conjunctivitis (blindness), neonatal pneumonia
Chlamydia
complications in men
Men: Reduced fertility and pain, swelling, tenderness in testicles (epididymitis)
Chlamydia
Complications in any gender
Reactive arthritis, Conjunctivitis
Gonorrhea
agent
by bacteria Neisseria gonorrhoeae
Gram negative intracellular diplococci
Can be spread via intercourse, anal or oral sex
Gonorrhea
prevalence
Second most common communicable disease in US
Highest rates among sexually active teenagers and adults
chlamydia
prevalence
most common STD in US
Gonnorhea
Sx in females
Often asymptomatic
White or yellow vaginal discharge,
Metrorrhagia (bleeding between periods) postcoital bleeding
PID: pelvic pain, fever, chills
Urethritis: UTI symptoms (frequency, dysuria)
Gonorrhea
Sx for men
Sx more common here than for chlamydia
White or yellow penile discharge
Burning with urination
Testicular/scrotal pain or swelling
Gonorrhea
Rectal symptoms
Anal discharge, pain, pruritis
Anal bleeding
Painful bowel movements
Can also include throat infection and pain
Gonorrhea
PE in women
Mucopurulent discharge, friable cervix, SEVERE cervical motion tenderness
Gonorrhea
PE in men
Mucopurulent urethral discharge
gonorrhea
dx
NAAT with swab
Test for other infections
gonorrhea
complications in females
PID: chronic pelvic pain, infertility, ectopic pregnancy
gonorrhea
complications in infants
ophthalmia neonatorum (can cause perforation of globe and blindness), sepsis, meningitis, scalp abscesses
gonorrhea
complications in men
scars in urethra, inflammation of testicles, infertility, chronic prostate pain
gonorrhea
complications in all genders (4 areas)
Disseminated infection: septic arthritis, skin lesions, pericarditis, endocarditis, meningitis
Syphilis
agent
Spirochete: Treponema pallidum
Spirochete: Treponema pallidum
overview
Increasing incidence
Disproportionate disease burden disease in Black individuals
Association with HIV coinfection among MSM
Syphilis
How is it spread
Direct contact with lesion
crosses placenta
Syphilis
Primary stage Sx and incubation
2 to 12 weeks after exposure; small, painless chancre develops and heals spontaneously (may go unnoticed)
Syphilis
Secondary Stage when does it start, and what do you see?
~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
Syphilis
Latent stage
Can move here if left untreated and has no symptoms; early and late stages
Syphilis
Tertiary stage incubation and what areas are affected?
Can move here if left untreated 1 to 30 years after primary infection; cause damage with CNS, cardiovascular, nodular lesions
Syphilis
Primary essentials of DX
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.
Syphilis
Maculopapular rash
some raised some not, on palms and soles.
Syphilis
secondary essentials of Dx
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
syphilis
latent stages
Early latent syphilis:infection < 1 year
Late latent syphilis:infection > 1 year
still + for syph
syphilis
Tertiary Syphilis Essentials of Dx
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
syphilis
Neuro Sx
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)
Syph
How do we dx Neuro Syph
Consider CSF evaluation for atypical symptoms or lack of decrease in nontreponemal serology titers.
neuro exam
Congenital Syphilis Diagnosis
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
syph
Nontreponemal
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).
Syphilis
Treponemal Dx
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)
Syph
Tx
Penicillin G benzathine
Syph
Jarisch-Herxheimer reaction
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
Trich
agent and overview
by protozoan: Trichomonas vaginalis
Symptoms
Can be asymptomatic in both male and females
Trich
Female Sx
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
trich
males Sx
urethral discharge
Trich
PE in females
females-strawberry cervix
Have high suspicion if pH >4.5, amine/fishy odor, many white blood cells (even if trich is not seen)
trich
Tx
Treatment of both partners
Metronidazole 500mg twice daily for 7 days
Vulvovaginal Candidiasis agent and agent type
Candida albicans
Not an STI
Fungal
Vuvlovaginal candidiasis
Sx
pruritis, thick white curd-like vaginal discharge without odor
Vulvar erythema, edema, excoriation
KOH prep shows spores and hyphae
Vulvovaginal Candidiasis
Tx
Non-pregnant
Vaginal topical azoles (1-3 day regimen)
Miconazole, tioconazole
Oral azoles (one time dose)
Fluconazole 150mg oral tablet
Vuvlovaginal candidiasis
Prgenant Tx
Vaginal topical azoles (longer course)
Vulvovaginal candidiasis
risk factors
Diabetes mellitus
Broad spectrum antibiotic use
Increased estrogen: OCPs
Pregnancy
Corticosteroid usage
Immunosuppression
IUD?
Vaginal Candida may form biofilm on IUD strings
Pelvic Inflammatory Disease (PID)
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
PID definition
Polymicrobial infection of upper genital tract associated with sexually transmitted organisms N gonorrhoeae and Chlamydia trachomatis as well as endogenous organisms
