STI Cards Flashcards
What virses cause genital herpes?
80-90% are HSV-2; 10% are HSV-1 (more often associated with cold sores)
What is the most common cause of genital ulcers?
HSV
Is HSV infectious in the asymptomatic latent phase?
Yes. There is intermittent shedding of virus at the genital skin
What is the clinical presentation of genital herpes?
Often asymptomatic. If symptomatic: Multiple painful vesicular lesions over erythematous base. Self-resolving in 2-4 weeks, worse in primary disease than secondary.
What histology test is used to diagnose genital herpes?
Tzanck smear (showing multinucleated giant cells)
What is the treatment for genital herpes?
Acyclovir, famciclovir, valacyclovir
What causes syphilis?
Spirochete Treponema pallidum
In which populations are syphilis infections increasing?
MSM population in the US, Canada, Europe, and Australia
How is T. pallidum transmitted?
Sexual contact or maternal-fetal
What are the clinical manifestations of syphilis in the early stage?
Primary: single painless indurated chancre, condylomata lata; Secondary: fever, lymphadenopathy, rash on palms and soles
What are the clinical manifestations of syphilis in the latent stage?
None. Latent syphilis is asymptomatic.
What are the clinical manifestations of syphilis in the late stage?
Tertiary syphilis: CNS involvement, skin involvement, CVD, gumma (granulomatous disease)
What are the outcomes of early stage syphilis?
1/3 of patient self-cure; 2/3 progress to latent infection
What is a common presentation of neurosyphilis?
Infection of the posterior column of the spinal cord leads to demyelinization resulting in Tabes Dorsalis: ataxia, areflexia, loss of proprioception, and Argyll Robertson pupil
What are possible CNS manifestations of syphilis?
Asymptomatic; acute syphilitic meningitis; general paresis; tabes dorsalis
What are the outcomes of untreated syphilis infection in pregnancy?
80% of cases are miscarriage, stillbirth, or congenital infeciton
What are the early clinical manifestations of congenital syphilis?
Snuffles, pneumonia, hepatitis, bone involvement, meningitis
What are the late clinical manifestations of congenital syphilis?
Hutchinson’s incisors, keratitis, deafness, Saber shins, iritis
How is an active syphilis infection most specificially diagnosed?
Dark field microscopy
What tests are used to screen or monitor syphilis infection?
Non-treponemal rapid plasma reagin antibodies or VDRL
When are screening tests for syphilis likely to give a false positive result?
Patients with autoimmune disease, mononucleosis, and elderly
What test is used to confirm syphilis infection?
Treponemal antibody test (FTA-ABS), which remains positive for life
What causes chancroid?
H. ducreyi, a small GNR
What is the clinical presentation of chancroid?
Painful genital ulcers + marked regional lymphadenopathy
What is the treatment for chancroid?
Azithromycin
How is chancroid diagnosed?
PCR
What causes lymphogranuloma venerum?
Chlamydia trachomatis serovars L1-L3
What populations does lymphogranuloma venerum usually affect?
Tropics (endemic) or MSM in developed countries
What is the clinical presentation of lymphogranuloma venerum?
Painless papules, lymphadenopathy in groin or axilla (buboes/”groove sign”, proctitis, and ulcers
What is the treatment for lymphogranuloma venerum?
Doxycycline
What are four reportable STIs to the US public health departments?
Chlamydia, gonorrhea, syphilis, and trichomonas
What % of the US population has HSV?
25% have serological evidence of HSV
What is the predominant normal vaginal flora?
Lactobacillus
What are normal variations on vaginal discharge?
Mycoid, especially at midcycle; thicker/whiter during pregnancy
How does candida vaginitis present?
“Cottage cheese” white and clumpy discharge
How is candida vaginitis diagnosed?
Wet mount KOH stain showing yeast and pseudohyphae
What is the treatment for vaginal candidiasis?
Oral fluconazole, micinazole suppository, or butoconazole cream
What causes bacterial vaginosis?
Gardnerella vaginalis or other anaerobes
How does bacterial vaginosis present?
Malororous, grey, thin discharge
How is bacterial vaginosis diagnosed?
“Clue cells” on wet mount, fish odor on KOH stain.
What is the treatment for bacterial vaginosis?
Metronidazole (oral or gel) or tinidazole (oral)
How does trichomonas vaginalis present?
Foul-smelling, green-yellow vaginal discharge + itching or burning
How is trichomonas vaginalis diagnosed?
Wet mount shows motile trophozoites. May see “Strawberry cervix” on physical exam
How is trichomonas vaginalis transmitted?
Sexually transmission (so treat partners!)
How is trichomonas vaginalis treated?
Metronidazole or tinidazole (oral)
What are the two most common causes of urethritis?
N. gonorrhoeae and C. trachomatis
What are the 4 clinical presentations of chlamydia?
Genital tract infection, trachoma, atypical pneumonia, and psittacosis
What species of chlamydia causes genital tract infection?
C. trachomatis D-K
What is the treatment for chlamydia?
Doxycycline or azithromycin
How does chlamydia present in neonates?
Conjunctivitis and pneumonitis
What is one uncommon but serious sequelae of chlamydia infection?
Reactive arthritis (post-infectious uveitis, urethritis and arthritis)
How is reactive arthritis treated?
NSAIDS
What is the gram stain and shape of N. gonorroeae?
Gram negative, diplococci
What different ways can N. gonorroeae present?
Men: urethritis, epididymitis, prostatitis. Women: cervicitis, PID. Infants: conjunctivitis.
How does N. gonorroeae present if infection is disseminated?
Arthritis, rash.
How is N. gonorroeae diagnosed?
Postiive graim stain, cultures on Thayer-Martin media, or nucleic acid testing
What is the treatment of N. gonorrhoeae?
Ceftriazone IM plus azithromycin oral, one-time
What are the minimum clinical criteria for PID?
Uterine tenderness OR adnexal tenderness OR cervical motion tenderness
Describe the presentation of N. gonorrhoeae and C. trachomatis in infants
Neonatal conjunctivitis (opthalmia neonatorum)
How can opthalmia neonatorum be prevented?
Prophylactic erythromycin ointment at delivery protects againt N. gonorrhoeae, although not C. trichomatas.
