STI/ PID Flashcards
Gonorrhea treatment (New update CDC 2015):
treatment of uncomplicated gonorrhea:500 mg injection of ceftriaxone.
Single-Dose Treatment of Uncomplicated Gonococcal Infection of the Cervix, Urethra, or Rectum:
Recommended regimen: Ceftriaxone (Rocephin) 250 mg IM + Azithromycin (Zithromax) 1 g orally once
Alternative regimen: Cefixime (Suprax) 400 mg orally once +Azithromycin 1 g orally once
In cases of cephalosporin allergy, one potential option is single oral doses of gemifloxacin 320 mg plus azithromycin 2 g. Another is single doses of
gentamicin 240 mg IM plus oral azithromycin 2 g. For azithromycin allergy, ceftriaxone alone suffices. However, if the alternative regimen with cefixime
is used, then doxycycline, 100 mg orally twice daily for 7 days, replaces the azithromycin
Diagnostic test for chlamydia and gonorrhea and trichomonas and M genitalium:
nucleic acid amplification test (NAATs)
after chlamydia, gonorrhea, and trichomonas, a three-month test post-therapy is no more recommended with single dose highly effective except for certain high-risk groups (pregnancy,
(ideally to repeat after 3 wks)
Diagnostic method for genital herpes
Physical exam
herpes PCR from the lesions is the preferred diagnostic test.
Nucleic acid amplification test (NAAT) testing is many times more sensitive than culture and can detect HSV DNA shed from epithelia without vesicular lesions
HIV screening and diagnosis
The recommended diagnostic algorithm for HIV infection consists of a laboratory-based immunoassay, which if repeatedly reactive is followed by a supplemental test (e.g., an HIV-1/HIV-2 antibody differentiation assay, Western blot, or indirect immunofluorescence assay).
Acute retroviral syndrome is characterized by
is the first stage of infection with the human immunodeficiency virus (HIV). nonspecific symptoms, including fever, malaise, lymphadenopathy, and skin rash.
Treatment of HSV
if First clinical episode:
Acyclovir 400 mg three times daily for 7–10 days
or Acyclovir 200 mg five times daily for 7–10 days
or Famciclovir (Famvir) 250 mg three times daily for 7–10 days
or Valacyclovir (Valtrex) 1 g twice daily for 7–10 days
(CDC-2015)
HPV couliflower vs. Molluscum contagiousum
-
Syphillis dx test
Syphillis specific Ab with clinical suspicion enough to diagnose
If not sure can be
Followed by (RPR) A rapid plasma reagin
If +ve > diagnostic
the vaginal pH ranges between 4 and 4.5. This is due in part to
gram-positive aerobic Lactobacillus species producing lactic acid, fatty acids, and other organic acids.
the most reliable indicators of BV
Clue cells
whiff test
10-percent potassium hydroxide (KOH) to a fresh sample of vaginal secretions releases volatile amines that have a fishy odor in bacterial vaginosis.
Pregnant patients with BV have an elevated risk of
preterm delivery and postpartum endometritis
BV treatment options:
Recommended regimens:
Metronidazole (Flagyl) 500 mg PO BID dailyx7 days
Metronidazole gel 0.75% (Metrogel vaginal) 5 g (1 full applicator) intravaginally OD X5 days
Clindamycin cream 2% (Cleocin, Clindesse) 5 g (1 full applicator) intravaginally at bedtimeX 7 days
Alternative regimens:
Secnidazole (Solosec) 2 g orally once
Tinidazole (Tindamax) 2 g orally once daily for 2 days OR 1 g orally once daily for 5 days
Clindamycin 300 mg orally twice daily for 7 days
Clindamycin ovulesa (Cleocin) 100 mg intravaginally at bedtime for 3 days
this virus enters sensory nerve endings and undergoes retrograde axonal transport to the dorsal root ganglion. Here, the virus develops lifelong latency.
Herpes Simplex Virus
The three stages of HSV lesions are:
(1) vesicle with or without pustule formation, which lasts approximately a week; (2) ulceration; and (3) crusting. Virus is predictably shed during the first two phases.
Episodic therapy for recurrent HSV disease
ideally initiated at least within 1 day of lesion outbreak or during the prodrome.
Acyclovir 400 mg three times daily for 5 days
or Acyclovir 800 mg twice daily for 5 days
or Acyclovir 800 mg three times daily for 2 days
or Famciclovir 125 mg twice daily for 5 days
or Famciclovir 1 g twice daily for 1 day
or Famciclovir 500 mg once, then 250 mg twice daily for 2 days
or Valacyclovir 500 mg twice daily for 3 days
or Valacyclovir 1 g once daily for 5 days
(CDC-2015)
Suppressive therapy FOR HSV:
If episodes recur at frequent intervals, a woman may elect daily suppressive therapy, which reduces recurrences by 70 to 80 percent
Suppressive therapy Acyclovir 400 mg twice daily or Famciclovir 250 mg twice daily or Valacyclovir 0.5 or 1 g once daily (CDC-2015)
Syphilis is caused by
the spirochete Treponema pallidum, which is a slender, spiral-shaped organism with tapered ends.
- primary syphilis Characteristics:
-primary syphilis: the hallmark lesion is the chancre (an isolated, nontender ulcer with raised, rounded borders and an uninfected base) it may become secondarily infected and painful. often found on the cervix, vagina, or vulva but may also form in the mouth or around the anus. The mean incubation period is 3 weeks, but lesions can develop 10 days to 3 months after exposure. Without treatment, lesions spontaneously heal within 6 weeks.
The natural history of syphilis in untreated patients can be divided into four stages WHICH IS :
1-1RY: chancre lesions btw 10 d - 3 mon
2- 2ry: bacteremia with maculopapular rash btw 6 wks- 6 mon
3- LATENT PAHSE:
A- Early latent syphilis: resolved symptoms, diagnosed within 1 year of infection.
B- late latent syphilis: a period greater than 1 year after the initial infection.
4- Tertiary syphilis: appear up to 20 years after latency, CVS, CNS, MSK involvement become apparent.
secondary syphilis Characteristics:
bacteremia develops 6 weeks to 6 months after a chancre appears. Its hallmark is a maculopapular rash that may involve the entire body and includes the palms, soles, and mucous membranes called mucous patches, actively shed spirochetes. In warm, moist body areas, this rash may produce broad, pink or gray-white, highly infectious plaques called condylomata lata. Because syphilis is a systemic infection, other manifestations may include fever and malaise. Less commonly, cranial nerve dysfunction, meningitis, hepatitis, nephrotic syndrome, and arthritis develop.
Early latent syphilis:
Untreated, the manifestations of secondary syphilis resolve, and latent syphilis is diagnosed using serologic tests. During early latent syphilis, which is diagnosed within 1 year of infection, secondary signs and symptoms may recur.
Tertiary syphilis is
the phase of untreated syphilis that may appear up to 20 years after latency. During this phase, cardiovascular, central nervous system, and musculoskeletal involvement become apparent. However, cardiovascular and neurosyphilis are half as common in females as in males.
((gumma)) characteristic lesion of tertiary syphilis
A definitive diagnosis of syphilis by:
direct detection of spirochetes within a lesion sample.
but can be diagnosed presumptively using clinical assessment plus serologic testing. Serologic testing includes both nontreponemal and treponemal-specific tests. The two nontreponemal tests are the Venereal Disease Research Laboratory (VDRL) and the rapid plasma reagin (RPR) tests.
In a woman previously treated for syphilis, a fourfold (two dilution) rise in nontreponemal titer suggests reinfection, and retreatment is provided.
a Jarisch-Herxheimer reaction
Within the first 24 hours after treatment of early syphilis disease, an acute, self-limited febrile response may develop and is associated with headache and myalgia, uterine contractions and fetal late decelations , they resolve in 24 hours.
treatment of Primary, secondary, early latent (<1 year) syphilis
Recommended regimen:
- Benzathine penicillin G, 2.4 million units IM once
- Alternative oral regimens (penicillin-allergic, nonpregnant women): Doxycycline 100 mg orally twice daily for 2 weeks
treatment of Late latent, tertiary, and cardiovascular syphilis
Recommended regimen:
- Benzathine penicillin G, 2.4 million units IM weekly times 3 doses
- Alternative oral regimen (penicillin-allergic, nonpregnant women): Doxycycline 100 mg orally twice daily for 4 weeks.
Chancroid is caused by
Haemophilus ducreyi, and following exposure, incubation usually spans 3 to 10 days.
painful genital ulcers classically have soft irregular margins and friable bases. In addition, many patients develop tender inguinal lymphadenopathy. If large and fluctuant, these buboes may suppurate and form fistulas.
standard method of diagnosis of Chancroid is
a NAAT
Chancroid treatment, the CDC’s (2015) recommended regimens include
either a single dose of oral azithromycin (1 g) or of IM ceftriaxone (250 mg). Second-line, multidose options are ciprofloxacin or erythromycin base.
Also known as donovanosis, granuloma inguinale is caused by
the gram-negative bacterium Klebsiella granulomatis. Incubation may last from days to weeks, and infection presents with painless inflammatory nodules that progress to highly vascular, nontender ulcers. These ulcers heal by fibrosis, which can result in scarring resembling keloids. Lymph nodes are usually uninvolved.
granuloma inguinale diagnosis is confirmed by
identification of Donovan bodies, which appear as a “closed safety pin” during microscopic cytologic evaluation following Wright-Giemsa staining.
granuloma inguinale Treatment recommended by the CDC (2015) is
azithromycin 1 g once weekly for at least 3 weeks and until lesions are completely healed. Alternative regimens include doxycycline, ciprofloxacin, trimethoprim-sulfamethoxazole, or erythromycin base.
Lymphogranuloma Venereum
This ulcerative painless genital disease is caused by
C trachomatis serotypes L1, L2, and L3.
Incubation ranges from 3 days to 2 weeks.
lymphogranuloma venereum (LGV) is divided into three stages:
(1) small painless papule, (2) regional lymphadenopathy, and (3) anogenitorectal fibrosis.
lymphogranuloma venereum (LGV) treatment:
the CDC (2015) recommends doxycycline, 100 mg orally twice daily for 21 days. An alternative is erythromycin base.
recurrent candidiasis disease definition
four or more candidal infections during a year.
recurrent candidiasis disease treatment
For recurrent C albicans disease, local intravaginal therapy for 7-14 days is an option. or oral fluconazole (Diflucan) in 100-mg, 150-mg, or 200-mg strengths once every third day for a total of three doses
(day 1, 4, and 7). Suppressive maintenance for recurrence prevention is with oral fluconazole, 100 to 200 mg weekly for 6 months. Nonalbicans candidal species are less responsive to topical azole therapy. For non-albicans recurrent infection, a 600-mg boric acid gelatin capsule intravaginally at bedtime for 2 weeks may be successful.
the most prevalent nonviral STD worldwide is
Trichomoniasis
