STI's Flashcards
What is the number one cause of vaginal discharge?
Bacterial vaginosis
What are risk factors for BV?
- Multiple partners
- Female partners
- Not using condoms
- Douching
- HSV
- Menses
- Copper IUD
What is the presentation of BV?
- Most patient’s are asymptomatic
- Discharge is milky with a fishy odor
- Worse after unprotected intercourse
What is the work-up for BV?
KOH prep - positive if fishy amine odor present and clue cells
What are the first line treatments for BV?
- Metronidazole PO or gel
- Clindamycin gel
What are risks for untreated BV?
- Increased risk for STI’s, including HIV
- Increased risk for preterm birth (for pregnant women)
- Risk of candidiasis
What is the epidemiology for gonorrhea?
- Highest incidence in ages 15-24
- Higher rates in Black patients
- Common co-infection with chlamydia
- Increased risk for HIV
What is the presentation of gonorrhea?
*Often asymptomatic
Wide range of presenting sx:
- Dysuria
- Purulent discharge (white, green, yellow)
- Friable cervix
- Vaginal bleeding
What is the diagnosis for gonorrhea?
- Nucleic acid amplification test (NAAT): Urine or swab
- Screening in sexually active patients
What is the treatment for gonorrhea?
- Ceftriaxone IM single dose + Azithro or doxy for likely co-infection with chlamydia
- No intercourse for 7 days
- Test and treat partners
- Re-test in 3 months after treatment
What are the complications associated with gonorrhea?
- PID
- Epididymitis (infertility)
- Mom-to-baby transmission (blindness, joint infections, sepsis)
What is the epidemiology of chlamydia?
- Most frequent bacterial STI
- Highest in ages 15-24
- Highest rates amongst black patients and MSM
What is the work-up for chlamydia?
- Nucleic acid amplification test (NAAT): urine or swab
- Screening recommended in sexually active patients
What is the treatment for chlaymdia?
- Doxy 100mg x7 days
*consider addition of ceftriaxone IM single dose to cover gonorrhea
What STI is associated with “frothy” discharge?
Trichomonas Vaginitis
What is the diagnosis for trichomonas vaginitis?
Microscopy/wet mount (POC)
Nucleic acid type testing
Culture
What is the treatment for trichomonas vaginitis?
Metronidazole PO
*gel can’t be used because it won’t reach theraputic concentrations
What are complications of trichomonas vaginitis?
- Preterm labor
- PROM
- SGA status
- Increased cervical cancer risk
- HIV infection
What patients are at higher risk for complicated candidiasis?
Diabetics or immunocompromised patients
What are the vaginal discharge characteristics of candidiasis?
Thick, “curdy,” or “cottage-cheese” like
What is the gold standard test for diagnosing candidiasis?
Culture
Reliable diagnosis of PID includes which three findings?
- Cervical motion tenderness
- Uterine tenderness
- Adnexal tenderness
What is the presentation of PID?
Abdominal or lower pelvic pain
Suspect PID in any young, sexually active person AFAB with abdominal or pelvic pain
Vaginal discharge
Dyspareunia
Abnormal vaginal bleeding
What are the indications for admission of a patient with PID?
Need to r/o other surgical emergency
Presence of tubo-ovarian abscess
Patient is pregnant
Severe infection (+n/v, temp >101)
Patient can’t tolerate PO treatment
No response to PO treatment
What is the first line treatment for PID?
Ceftriaxone 1g IM or IV q24h
PLUS Doxycycline 100mg PO or IV q12h
PLUS Metronidazole 500mg PO or IV q12h
