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Men's Health Module > STI's > Flashcards

STI's Flashcards

1
Q

“5 P’s” of sexual history

A 
Partners
Practice
Past history of STI
Pregnancy plans
Protection from STI

*ask about partner’s hx and partners too

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2
Q

Chlamydia commonly co-infected with _________.

A

gonorrhea

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3
Q

Non-reportable STI

A

HPV

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4
Q

Signs of HPV infection

A

most asymptomatic

genital warts main sign

  • smooth papules
  • flat papules
  • Kerratotic warts (resemble common wart)
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5
Q

Main HPV treatment

A

Podofilox 0.5% gel applied to warts BID x 3 days

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6
Q

HPV transmission

A

skin to skin contact

sex primarily (but doesn’t have to be) - intercourse, genital contact

fomites???

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7
Q

How to prevent condylomata acuminata and cervical cancer?

A

HPV vaccine (quadrivalent 6, 11, 16, 18 = Gardisil)

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8
Q

When is HPV vaccine given? shot series?

A

recommended in males 11 or 12 yo (can be given 9-26 yo)

3 shot series: dose 1, then 2 mon, then 6 mon

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9
Q

2 kinds of herpes

A

HSV 1 = oral

HSV 2 = genital

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10
Q

Most common STI in the U.S.

A

HPV

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11
Q

When should genital warts be biopsied?

A
  • atypical appearance of warts
  • pt immunocompromised
  • warts don’t resolve or worsen with standard treatment
  • persistent ulceration/bleeding
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12
Q

herpes transmission

A

sexual and vertical (mother to fetus)

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13
Q

HSV-1 symptoms

A

cold sores or fever blisters

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14
Q

Progression of herpes lesions

A

burning/stinging skin -> papules -> painful vesicles -> fills with pus -> ulcers -> crusts -> healed

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15
Q

herpes keratitis

A

complication of HSV-1 where it gets on eye; emergency because may cause blindness

vesicular lesions on tip of nose & dendritic lesions on eye

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16
Q

Complications of HSV

A 
blindness
neonatal herpes
herpes encephalitis
aseptic meningitis
radicular pain
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17
Q

Recurrence of herpes triggered by what?

A

stress, fatigue, exposure to sun, skin trauma

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18
Q

Gold standard diagnosis for HSV

A

viral culture of lesion (can be typed but doesn’t change tx)

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19
Q

Best HSV treatment for first episode, episodic, and chronic suppression?

A

First episode (w/i 24 hrs of sx’s):
◦ Acyclovir 800 mg TID x 7-10 d
◦ Valacyclovir 1000 mg BID x 7-10 d

Episodic; 1-5 days:
◦ Acyclovir x 3-5 d
◦ Valacyclovir x 5 d
◦ Famciclovir x 1 d

Chronic suppression (1-2 per month); year:
◦ Acyclovir (safe for 5 yrs)
◦ Famiciclovir (1 yr)
◦ Valacyclovir (1 yr)

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20
Q

What test is no longer used as gold standard for herpes?

A

Tzanck smear

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21
Q

Most commonly reported notifiable disease in U.S.? 2nd most common?

A
  1. Chlamydia

2. Gonorrea

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22
Q

Age group most affected by chlamydia and gonnorhea

A

20-24 yo

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23
Q

transmission of chlamydia

A

body fluids; highly transmissible

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24
Q

Signs/sx of Chlamydia

A

85% asymptomatic

mild dysuria, burning urination, watery penile discharge, conjunctivitis, erythematous oropharynx, joint pain (Reiters syndrome), abd pain

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25
Q

How to dx Chlamydia and Gonorrhea?

A

nucleic acid amplification (NAAT) of dirty urine or of swab

culture (kids and used in all legal matters)

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26
Q

Chlamydia treatment

A

Azithromycin 1 g PO x 1 dose (doxy if allergic)

ALWAYS treat for gonorrhea too!

TREAT PARTNER

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27
Q

Patient education about STIs

A

Discuss prevention strategies: abstinence, monogamy, limit # of sex partners, barrier methods

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28
Q

Sex partners should be evaluated, tested, and treated if they had sexual contact with STI patient during what time frame?

A

previous 60 days

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29
Q

STI’s with vertical transmission

A

herpes, gonorrhea, syphilis

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30
Q

Urban residence is a risk factor for what STI?

A

Gonorrhea

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31
Q

Signs of Gonorrhea

A 
urethritis
epididymitis (scrotal pain, edema)
yellow discharge of erythema of oropharynx
proctitis (common MSM)
prostatitis
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32
Q

STI with yellow purulent discharge of urethra and erythematous throat?

A

Gonorrhea

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33
Q

Differences in discharge of Chlamydia and Gonorrhea

A

Chlamydia - mucoid watery

Gonorrhea - yellow purulent

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34
Q

Rare and serious complication of Gonorrhea

A

DGI = disseminated gonococcal infection

red maculopapular skin lesions, arthralgias, tenosynovitis, arthritis, hepatitis, myocarditis, endocarditis, and meningitis

ADMIT!

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35
Q

Gonorrhea treatment

A

Ceftriaxone 250 mg IM x 1 dose

PLUS Azithromycin 1 g to cover for Chlamydia

Treat partners

36
Q

Etiology of trichomoniasis

A

T. vaginalis (protozoa)

37
Q

Trichomoniasis treatment

A

Metronidazole 2 g PO x 1 dose

No ETOH x 24 hrs after treatment

38
Q

Man who is asx, but has grayish green penile discharge with some mild dysuria

A

Trichomoniasis

39
Q

How to dx Trich

A

Wet mount - trophozoites with tail on microscope

culture to confirm

40
Q

How long to wait after STI treatment to return to sex?

A

7 days after post treatment or until both partners no longer have sx’s

41
Q

Patient history and symptoms that indicate Granuloma Inguinale

A
  • Live in tropical or developing country
  • initially painless ulcer that later becomes painful (beefy red, discharge)
  • scars from lesions
42
Q

Donovan bodies on biopsy =

A

Granuloma Inguinale

43
Q

Granuloma Inguinale treatment

A

Doxy or Bactrim x 3-4 wks

44
Q
  • Painless ulcer on penis

- Purple painful inguinal lymph nodes (=Bubos)

A

Lymphogranuloma Venereum

45
Q

How to test for Lymphogranuloma Venereum?

A

culture lesion or bubo aspiration

46
Q

Lymphogranuloma Venereum treatment

A

Doxy

47
Q

STI’s seen in South America and Caribbean? (in addiction to Asia and Africa)

A

Lymphogranuloma Venereum

48
Q

PAINFUL genital ulcers. Commonly seen in Asia, Africa, and Caribbean.

A

Chancroid

49
Q

Chancroid treatment

A

Cefriaxone IM or Azithromycin

50
Q

Who needs to be treated for STI with longer course?

A

HIV+

51
Q

STI’s with bubos

A

Chancroid and Lymphogranuloma Venereum

52
Q

bluish/red lesions in pubic region with areas of excoriation. What should you look for?

A

pubic lice

53
Q

Pubic lice treatment

A

Permethrin (Elimite) rinse 1% x 10 min OR cream 5% x 8 hr

54
Q

Healthy young adult comes in with pearly, umbilicated papules on groin region.

A

Molluscum Contagiousum

55
Q

Etiology of Molluscum Contagiosum

A

Pox virus

56
Q

Molluscum Contagiousum treatment

A

Imiquimod (Aldara) 5% x 1-3 mon on lesions

Cryotherapy, curettage, or electrodessication if painful

57
Q

What STI is known as “great masquerader?” Why?

A

Syphilis

variable presentations

58
Q

All patients with syphilis should be tested for ______.

A

HIV

59
Q

Most STI’s highest in ages 20-24, but _______ is slightly older 25-29.

A

Syphilis

60
Q

Signs of primary syphilis?

A

Lesion appears 10-20 days (can be up to 90 days) after infection

CHANCRE = painless lesion with smooth raised border and clean non-necrotic base

Heals spontaneously within 1-6 wks

61
Q

Signs of secondary syphilis?

A

Occur 3-6 weeks after primary chancre

Rash on palms, soles, face; Lymphadenopathy; mucocutaneous lesions

62
Q

Timing of primary and secondary syphilis

A

Primary appears 10-20 days (can be up to 90 days) after infection

Secondary occur 3-6 weeks after primary chancre

primary and secondary may overlap (chancre AND Mucocutaneous lesions)

NEVER go back to primary. only one onset of Chancre

63
Q

When can latent syphilis occur?

A
  • between primary and secondary stages
  • between secondary relapses
  • after secondary stage
64
Q

Duration of early and late latent syphilis

A

Early latent: < 1 year

Late latent: >/= 1 year

65
Q

Hallmarks of tertiary (late) syphilis

A

1-20 years after infection

Gummatous lesions: destruction of nasal bone/septum

Cardiovascular Syphilis: aneurysms, aortic regurg, Coronary Artery Disease

66
Q

tabes dorsalis =

A

syphilitic myelopathy seen in later neurosyphilis

67
Q

What are signs that syphilis has crossed into CNS (Neurosyphilis)?

A 
Early NS (mon-yrs)
cranial nerve dysfunction, meningitis, stroke, altered mental status, loss of vibration sense, and auditory or ophthalmic abnormalities
Late NS (yrs-decades; very rare)
tabes dorsalis (syphilitic myelopathy)
dementia paralytica = emotional lability, delusions, inappropriate social or moral behavior, megalomania
68
Q

How to analyze fluid of lesions from suspected syphilis?

A

Darkfield Microscopy:
+ if treponemes seen

Direct Fluorescent Antibody – T. Pallidum (DFA TP)
+ if treponeme seen
Comparable to Darkfield
1-2 day turnaround

69
Q

Serologic tests for syphilis

A

Nontremponemal: VDRL, RPR

Tremponemal: FTA-ABS (fluorescent treponemal antibody absorption test)

70
Q

Best way to dx syphilis if Chancre/lesion present

A

Darkfield Microscopy + RPR (or VDRL)

71
Q

Best way to dx syphilis if no lesion present

A

RPR (or VDRL)
and
FTA-ABS, TP-PA or EIA

72
Q

Criteria for early latent syphilis

A

+ testing within last 12 months

4-fold increase in comparison with titer obtained within year preceding your eval

Unequivocal symptoms of primary or secondary syphilis reported by patient in past 12 months

Contact with a partner with a documented case of Syphilis

73
Q

When to test for neurosyphilis?

A

Neurologic or ophthalmic signs

Evidence of active tertiary syphilis (e.g., aortitis, gumma, and iritis)

Treatment failure

HIV infection with late latent syphilis or syphilis of unknown duration

74
Q

How to test for neurosyphilis?

A

Serology positive + VDRL-CSF + LP (elevated protein levels in CSF)

75
Q

Primary, Secondary, and early latent syphilis treatment

A

IM Benzathine penicillin G 2.4 million units x 1 dose

  • if PCN allergic, then doxy or tetracycline
76
Q

Treatment of neurosyphilis

A

Hospitalization with IV abx

Aqueous crystalline PCN G

77
Q

Treatment of late latent (or latent unknown duration) and tertiary syphilis

A

IM Benzathine penicillin G x 3 doses

78
Q

Self-limited reaction to anti-treponemal (syphilis) therapy; includes fever, malaise, N/V, rash…

A

Jarisch-Herxheimer Reaction

79
Q

Syphilis titers usually highest at what stage of disease?

A

secondary syphilis

80
Q

What phase of syphilis can neurosyphilis occur?

A

can occur at any stage

81
Q

If HPV is a clinical diagnosis, how do we rule out the possibility of it being a wart from syphillis?

A

HPV lesions are painful vesicular lesions on an erythematous base

Syphilitic lesions are an open sore (chancre) that is painless

Primary a clinical differentiating, but may do HSV culture of the lesion and order an RPR/VDRL

82
Q

What labs confirm primary syphilis?

A

T. pallidum on Darkfield microscopy

RPR and serology tests may be unreactive

83
Q

How to treat syphilis in pregnant mother with allergy to PCN?

A

desensitized in the hospital and treated with penicillin; prevents vertical transmission

no alternative med

84
Q

How should syphilis be followed up if lesion seems to be healing and no ADRs to therapy?

A
  • Repeat HIV antibody test at 3 months

- VDRL or RPR 6 and 12 months after therapy (measure response to therapy)

85
Q

How should gonorrhea and chlamydia patient’s sexual partners be managed?

A

test and treat all contacts within prior 60 days

most recent partner should ALWAYS be treated regardless of of time or test results

avoid intercourse until therapy completed

Men's Health Module (10 decks)

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