STI's and other genital tract infections Flashcards
STI risk factors
known contact with STI anonymous sex <25 y.o new partner multiple partner no barrier contraception drugs, alcohol, IDU sex workers/ survival sex sexual assault Hx of STI
Urethritis/cervicitis
-S/S
Men:
Burning or pain during urination
Discharge from penis
Women: Vaginal discharge/Abnormal bleeding Pain during sex Dysuria ***can be asymptomatic***
Urethritis/cervicitis
-etiology
Neisseria gonorrhea
Chlamydia trachomatis
How to diagnose gonorrhea or chlamydia
Swab the urethra/cervix and culture
OR
Send first-catch urine to lab for NAAT
Gonorrhea management
- Cefixime or IM ceftriaxone (but resistance is growing)
- contact tracing (reportable)
- test for other STIs
- determine vaccination status of HBV and HPV
Chlamydia management
- doxycycline or azithromycin
- contact tracing (reportable)
- test for other STIs
- determine vaccination status of HBV and HPV
Pelvic Inflammatory Disease
-definition
infection of the female upper genital tract (uterus, fallopian tubes, ovaries
Pelvic inflammatory disease
-etiology
Usually polymicorbial:
STI+ endogenous
(STI: gonorrhea/chlamydia)
(endogenous is local flora, aerobic and anaerobic)
Pelvic inflammatory disease
- S/S
- complications
Abdominal pain
Fever
cervical motion tenderness
adnexal tenderness
Complications: infertility, ectopic pregnancy, chronic pelvic pain
Pelvic inflammatory disease
-management
- Antibiotics to cover STI and endogenous (aerobic and anaerobic)
- report any confirmed STIs
- test for other STIs
- determine vaccination status of HBV and HPV
Genital ulcer disease
-etiology
- usually HSV-2, HSV-1
- sometimes syphilis (Treponema pallidum)
HSV course of infection
Primary infection:
- painful vesiculoulcerative lesions
- fever
- lymphadenopathy
- rarely: urethritis/cervicitis or meningitis
Then infects the sacral sensory ganglion and becomes latent.
Reactivation has a prodrome of burning/itching/tingling.
Diagnosis of HSV
Viral swab of open vesicle
Management of HSV
Oral antiviral: -valacyclovir -famciclovir -acyclovir NOT REPORTABLE Test for other STIs Determine HBV and HPV vaccination status
Primary syphilis
-S/S
-painless chancre of mouth/penis/rectum
Diagnosis of syphillis
- RPR (rapid plasma reagin) serology test
- PCR on fluid from chancre
- Special stain on fluid from chancre
Management of syphillis
- IM benzathine penicillin
- Contact tracing (reportable)
- Test for other STIs
- Determine HBV and HPV vaccination status
Causes of vaginal discharge
1) bacterial vaginosis
2) vulvovaginal candidiasis
3) Trichomonas vaginalis infection
How to find out what’s causing vaginal discharge
Take a vaginal swab, gram stain, smear. Look at the type of discharge: -White clumpy (candidiasis) -watery white/grey, copious (bacterial vaginosis) -frothy white or yellow (Trichomoniasis)
Management of vulvovaginal candidiasis
- OTC antifungals or fluconazole PO
- Eliminate risk factors like Ab use
- NOT REPORTABLE
Management of Trichomonas
- metronidazole for patient and partner
- NOT REPORTABLE
Bacterial vaginosis
- metronidazole of clindamycin PO/topical for patient only
- NOT REPORTABLE
Prostatitis
-S/S
Fever, chills, pain in rectum, dysuria
tender, boggy prostate on exam
Prostatitis
-etiology
Gram-negative bacilli (e.g. E. coli)
Sometimes gonorhhea or chlamydia (but not usually)
