STI's Flashcards
What are the different ways that gonorrhea can present?
Urethritis (males), urogenital infection (women), and Opthalmia neonatorum (babies)
In general: dysuria, discharge, abdominal pain
How do we detect gonorrhea?
NAAT
Vaginal swab
how do you treat gonorrhea?
*resistance to antibiotic is the hallmark of GC
Ceftriaxone 250mg IM single dose PLUS Azith 1 gram
OR
Doxycycline 100mg BID x 7 days
What should we always do after we after treatment for gonorrhea?
Re-test for cure in 3 months
Chlamydia can also present in men, women, and babies as asymptomatic, discharge, or painful. How do we test for it?
NAAT – URINE for men
NAAT – VAGINAL swab for women
Can also do tissue culture SWAB followed with an enzyme immunoassay (EIA)
How do we treat chlamydia?
Azithromycin 1g x 7 days
OR
Doxy 100mg BID x 7 days
What should we do after treatment for chlamydia?
Test for cure is NOT advised (except in preggo women; if done do after 3-4 weeks, concern for false +)
A pt presents with pruritus and malodorous discharge, dx? What will you see on PE?
Trichomonas
PE: vaginal and cervix erythema, + wiff test with wet mount showing motile flagellates
How do you treat trich?
Metronidazole
*Treat all partners
What causes syphilis?
Treponema pallidum (corkscrew shaped)
how does syphilis transmit?
direct contact with syphilis chancre during primary and secondary stages
What are the 3 stages of syphilis, what are the sxs associated with each?
Primary – Chancer at sit of inoculation, painless, becomes systemic within 30 hours
Secondary – weeks to months later rash (MC), fever, HA, malaise, diffuse LAD
Tertiary – from 1-30 years, ASX or Gummas (nodular lesions on skin & bones), CV (aortitis, aortic aneurysm, and aortic regurg)
Neurosyphillis – Insanity (personality change, sensory deficits, Argyll-roberston pupils), tabes dorsalis (shuffling gate), ophthalmic involvement
When is a person with syphilis infectious?
Primary and Secondary
Less than 1 year = Early Latent – Asx, detectable with serologic testing, still infectious
Greater than 1 year = Late Latent – Asx, not infectious, requires longer treatment
How do you diagnose syphilis?
Darkfield microscopy (direct vizulization of spirochete from chancre, rarely used in general practice)
Serologic – Nontreponeal test (screening or confirm success of treatment) or Treponemal (Detect antiobdies)
PCR – High sensitivity and specificity (not used in practice thus far)
How do you treat primary, secondary, or early latent syphilis?
PCN 2.4 million units IM
Or Doxy
How do you treat late latent syphilis?
PCN IM weekly x 3 weeks
Doxy x 4 weeks
How do you treat tertiary syphilis?
PCN weekly x3 weeks
How do you treat neurosyphilis?
PCN IV
When treating someone for syphilis what else should we consider?
- Treating sex partners
- Test all Pts with syphilis for HIV!! (and repeat in 3 months)
What is the F/U for syphilis?
reassess response at 6 and 12 months with titers
What type of herpes causes oral infections?
HSV-1
What type of herpes causes genital infections?
HSV-2
A pt presents with numerous painful lesions with vesicles on the vaginal and inner thighs with painful urination – dx?
Herpes (primary infection is often asx)
How is herpes transmitted?
Direct contact
How do we test for herpes? Tx?
Culturing the lesion, PCR
– Cannot be cured –
What causes genital warts? How do we detect?
Low-risk HPV
Clinical diagnosis
What causes cervical lesions/cervical cancer? How do we detect?
High-risk HPV (usually asx)
- HPV DNA on pap smear
How do we prevent HPV?
2 vaccines for girls and boys
- Quadrivalent – 6, 11, 16, 18
What viral disease is common in children but can present in adults in the groin as flesh-colored, waxy, domed, umbilicated papules?
Molluscum Contagiosum
How do we confirm dx of Molluscum Contagiosum?
Biopsy only in immunocompromised (otherwise clinical dx)
How do you treat Molluscum Contagiosum?
Self-limiting
How is AIDS defined from HIV?
AIDS = CD4 count below 200 cells/uL or the development of an AIDS indicator disease
When you screen for HIV what are you detecting?
Antibodies (usually developed within 6 months)
How do we diagnose HIV?
ELISA test followed by Western Blot to confirm
What does the viral load measure?
Actively replicating virus
How do we treat HIV?
Antiretrovirals
