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Clin Med Final Material 5 > STI's Schoenwald > Flashcards

STI's Schoenwald Flashcards

1
Q

Who is the Hep B vaccine recommended for?

A

recommended for all sexually active persons

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2
Q

Who is the Hep A vaccine recommended for?

A

recommended for MSM

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3
Q

Who is the HPV vaccine recommended for?

A

recommendation ages 9-26 (males & females)

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4
Q

What should be included in the MSM annual screening?

A
  • HPV screening-anal pap smear
  • HBsAg testing (for active infection)
  • Hep C Ab testing (annually)
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5
Q

What are two painful genital ulcer diseases?

A

Chancroid, genital herpes simplex

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6
Q

A patient complaints of 7-10 days of painful vesicles on erythematour base. Would could the pt have?

A

HSV 2

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7
Q

What is the best way to test for herpes? What about if the patient has meningoencephalitis?

A

Viral studies-culture and PCR of CSF for meningitis

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8
Q

Primary, recurrent or prodrome herpes sxs?

Associated with fever and bilateral adenopathy,

A

Primary (first occurrence)

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9
Q

Primary, recurrent or prodrome herpes sxs?

no fever or adenopathy

A

Recurrent

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10
Q

Primary, recurrent or prodrome herpes sxs?

tingling or burning 18- 36 hours prior lesion

A

Prodrome

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11
Q

Best way to dx herpes?

A

Tzank smear

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12
Q

Presence of multinucleated giant cells on Tzank smear is indicative of what?

A

HSV

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13
Q

What is the duration of tx for herpes?

A

7-10 days

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14
Q

What is the tx for a first episode of herpes?

A

Acyclovir 400 mg TID or 200 mg 5x/day or valacyclovir 1000 mg BID

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15
Q

Episodic tx of herpes?

A

Acyclovir

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16
Q

Tx for daily suppression of herpes?

A

Acyclovir, famcyclovir, valacyclovir

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17
Q

Can you tx herpes in pregnancy?

A

Limited data but yes with acyclovir- C section recommended though if have to deliver baby and have sores present. Otherwise, can safely vag deliver

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18
Q

How do you define early latent syphilis?

A

Reactive testing within 1 year of

infection-no symptoms (infection acquired within one year)

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19
Q

How do you define late latent syphilis?

A

Reactive testing greater than 1 year after onset of infection or timing cannot be determined
-no sxs

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20
Q

Treponema pallidum

A

Syphilis

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21
Q

What is the GS test for syphilis?

A

Darkfield examination of exudate/tissue (gold standard)

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22
Q

WHat is RPR

A

One of the blood tests for syphilis

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23
Q

What is VDRL?

A

One of the CSF tests for syphilis

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24
Q

Once + syphilis does it ever go back to normal?

A

NO

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25
Q

How do you confirm syphilis?

A

RPR ran and + then confirm with antibody test

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26
Q

What stage of syphilis is this (chancre)?

Macule/papule that erodes?

A

Early

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27
Q

What is the syphilis incubation period?

A

10-90 days (avg 3 wks)

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28
Q

What stage of syphilis is this (chancre)?

clean based, painless, indurated ulcer with smooth firm borders

A

Late

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29
Q

Is a chancre painful?

A

Yes

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30
Q

What is secondary syphilis?

A

Usually 2-8 wks after chancre and the patient will develop a maculopapular body wide rash on palms and soles, constitutional sxs, condylomata lata (anorectal syphilis)

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31
Q

Anorectal syphilis that looks like warts is called?

A

Condylomata lata

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32
Q

Treatment of tertiary syphilis (gumma and cardiovascular syphilis)

A

Penicillin G 2.4 million units IM q week x 3 weeks

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33
Q

Tx for tertiary neurosyphilis?

A

Treat with Aqueous Penicillin G 18-24 million units/day for 10-14 days (24 hr infusion)

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34
Q

What is a Jarisch-Herxheimer Rxn?

A

Basically a toxic reaction from the die off of bacteria in syphilis that occurs within 24 hrs of tx
• Acute febrile rxn
• Headache, myalgia, fever

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35
Q

Tx for Jarisch-Herxheimer Rxn

A

NSAID or APAP and anti-asthmatic (because anaphylaxis-like rxn)

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36
Q

Tx for primary, secondary, early latent syphilis?

A

Benzathine Penicillin G, 2.4 million units IM

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37
Q

Tx for syphilis with PCN allergy?

A

Doxycycline 100 mg twice daily x 14 days

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38
Q

What partners should be treated for syphilis?

A

ALL PARTNERS tx everyone even if no sxs

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39
Q

Tx for syphilis in pregnancy?

A

Benzathine penicillin 2.4 mu IM after the initial dose for primary, secondary, or early latent syphilis

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40
Q

Should you test for HIV in a newly diagnosed syphilis patient?

A

Yes I think they go hand in hand and if testing for HIV also test for syphilis

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41
Q

Painless chancre-papule that ulcerates

A

syphilis

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42
Q

Non-indurated painful vesicle or papule to pustule or ulcer that is soft

A

chancroid

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43
Q

Haemophilus ducreyi

A

chancroid

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44
Q

Combo of painful ulcer with tender inguinal adenopathy suggests chancroid

A

chancroid

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45
Q

Tx for chancroid?

A

Azithromycin 1 gm orally OR Ceftriaxone 250 mg IM

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46
Q

SHould you re-examine the pt after chancroid tx?

A

Re-examine 3-7 days after tx

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47
Q

Should you treat the partner if someone has a chancroid?

A

YES-> Examine and tx partner whether symptomatic or not if partner contact <10 days prior to onset

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48
Q

A patient presents with Unilateral painless papule, vesicle or ulcer with tender regional LAD that is unilateral what is the most likely dx?

A

Lymphogranuloma Venerum

49
Q

What is the mc bug that causes Lymphogranuloma Venerum?

A

Chlamydia Trachomatis

50
Q

What is the treatment for Lymphogranuloma Venerum? Name an alternative tx too?

A

TX: Doxycycline 100 mg BID x 21 days OR Erythromycin base 500 mg QID x 21 days

51
Q

Painless papule that eventually ulcerates WITHOUT lymph node involvement

A

Granuloma Inguinale

52
Q

Granuloma Inguinale is caused by what bug?

A

Klebsiella

53
Q

Donovan bodies

A

Granuloma Inguinale

54
Q

Tx for Granuloma Inguinale? And name an alternate tx?

A

Doxycycline 100 mg BID x 3 weeks OR Azithromyxin 1 gram qday x 3 weeks

55
Q

What is the difference between Condyloma Acuminatum and condylomata lata?

A

Condyloma Acuminatum= anal warts

Condylomata Lata= Anorectal syphilis

56
Q

These are symptoms of what in a male? Dysuria and urethral discharge (5% asymptomatic)

A

Urethritis

57
Q

These are symptoms of what in a female?

A

Majority asymptomatic; may have vaginal discharge, dysuria, urination, labial pain/swelling, abd. pain

58
Q

What is the TOC for gonorrhea?

A

NAAT on urine

59
Q

What is the GS test for gonorrhea?

A

Gram stain

60
Q

Gram stain-gram negative diplococci intracellular

61
Q

Disseminated gonorrhea causes ______

A

joint pain and skin lesions

62
Q

What is the tx for cervix, urethra, rectum and pharynx gonorrhea?

A

Ceftriaxone 250 mg IM single dose PLUS

Azithromycin 1 gram po single dose

63
Q

What is the new updated guideline tx for gonorrhea?

A

Ceftriaxone 500 mg IM x a single dose NO COMBO

64
Q

WHat is the tx for pharyngeal gonorrhea?

A

Ceftriaxone 250 mg IM in a single dose PLUS

Azithromycin 1 gram po single dose

65
Q

What is the treatment for gonorrhea plus concurrent chlamydia tx?

A

Doxycycline x 7 days

66
Q

Tx for disseminated gonococcal infection?

A

Ceftriaxone 1 gm IM or IV q 24 hr

67
Q

What bug mostly is responsible for nongonoccal urethritis?

A

C. trachomatis

68
Q

A patient presents with Mild dysuria, mucoid discharge. Urethral smear shows >5 PNMs. What is the most likely dx?

A

Nongonococcal urethritis

69
Q

Tx for Nongonococcal urethritis?

A

Azithromycin 1 gm in a single dose

70
Q

How do you test for chlamydia?

A

NAAT or cervical/urethral swab

71
Q

Who should be screened for chlamydia?

A
  • Annual screening of sexually active women <25

- Annual screening of sexually active women >25 with risk factors

72
Q

Treatment for Chlamydia?

A

Azithromycin 1 gm single dose or
Doxycycline 100 mg bid x 7d

(weighted more towards doxy)

73
Q

Follow up for tx of chlamydia?

A

Rescreen women 3-4 months after treatment due to high prevalence of repeat infection

74
Q

Treatment for Chlamydia in pregnant women?

A

Azithromycin 1 gram orally OR

Amoxicillin 500 mg three times daily for 7 days

75
Q

What is the minimum diagnostic criteria for PID?

A

Uterine/adnexal tenderness or cervical motion tenderness

76
Q

Maximum diagnostic criteria for PID?

A

Oral temperature >101 F(38.3 C) Elevated ESR
Cervical CT or GC Elevated CRP
WBCs/saline microscopy Cx discharge

77
Q

Parenteral tx A for PID?

A

Cefotetan 2 g IV q 12 hours

78
Q

Parenteral tx B for PID?

A

Clindamycin PLUS Gentamycin

79
Q

Oral regimen for PID?

A

Ceftriaxone PLUS Doxy with or without metronidazole

80
Q

Should a patient’s sex partner be treated for PID?

A

Male sex partners of women with PID should be examined and treated for sexual contact 60 days preceding pt’s onset of symptoms

81
Q

Acute or chronic epididymitis?

Pain, swelling and unilateral inflammation of epidydimis <6 weeks

82
Q

How long does it have to be for epididymitis to be chronic?

A

> 3 months

83
Q

Sexually active men <35, most

likely what organism(s)?

A

gonorrhoeae or chlamydia

84
Q

Age >35, most

likely what organism(s)?

A

Enteric-e. coli

85
Q

Tx for epididymitits caused by GC/Chlamydia?

A

Ceftriaxone PLUS doxy

86
Q

Tx for epididymitits caused by E. Coli?

A

Levofloxacin

87
Q

Acute swelling and inflammation of the

prostate gland usually due to infection

A

Prostatitis

88
Q

How do you diagnose prostatitis?

A

Diagnose with UA/culture pre and post prostate exam

-Pre will likely be - until you massage the prostate and release bacteria then it will be +

89
Q

Treatment for prostatitis?

A

Same as epididymitis
Gc/C= Ceftriaxone PLUS doxy
E.Coli= levofloxacin

90
Q

Wet prep-clue cells, positive whiff test

91
Q

BV treatment?

A

Metronidazole PO or cream

92
Q

BV treatment in pregnancy?

A

Metronidazole PO NO TOPICAL

93
Q

What is the tx for BV in pregnant woman in the 1st trimester?

A

Clindamycin

94
Q

Is treatment of sex partner recommended for BV?

95
Q

Is treatment of sex partner recommended for candidiasis?

A

No unless male has balanitis

96
Q

What is the definition of Vulvovaginal Candidiasis?

A

Four or more symptomatic episodes/year

97
Q

Treatment of Vulvovaginal Candidiasis?

A

Initial regimen of 7-14 days topical therapy or fluconazole 150 mg (repeat 72 hr)

98
Q

Candidiasis treatment in pregnancy?

A

Only topical intravaginal regimens recommended x 7 days

99
Q

Diffuse, malodorous yellow to green discharge

A

Trichomonas

100
Q

What is the gold standard test for diagnosis for trichomonas?

101
Q

Flagella on wet prep

A

Trichomonas

102
Q

Strawberry cervix

A

Trichomonas

103
Q

What is the tx for trichomoniasis?

104
Q

If you don’t get better after the course of metronidazole for Trichomonas what should you do?

A

Re-treat with metronidazole 500 mg twice daily for 7 days

105
Q

Do partners of an infected person with trichomoniasis need to be treated?

106
Q

What are the high risk HPV strains?

107
Q

What are the low risk types that cause warts?

108
Q

How do you test for HPV?

109
Q

What is the treatment goal for HPV?

A

Primary goal of treatment is to remove the visible warts with topicals or surgery but this might not eradicate the HPV obviously

110
Q

How do you treat the warts?

A

Imiquimod or can do cryo or surgery

111
Q

The HPV vaccine is recommended for what ages?

A

9-26 and approved up to age 45

112
Q

Parasitic skin infection by the mite Sarcoptes scabiei that causes intense itching and pruritis >2 weeks

113
Q

Treatment for scabies?

A

Permethrin 5% cream to all areas of body or Ivermectin PO

*Also check the fingernails of these patients

114
Q

Who else should be treated for scabies?

A

Close contacts!!!

115
Q

What are norwegian scabies?

A

Basically a more aggressive form of regular scabies that infects immunosupporessed patients and is resistant to monotherapy of scabicide or ivermectin

116
Q

Treatment for norwegian scabies?

A

combination topical scabicide with ivermectin or repeated treatments with ivermectin

117
Q

Pruritus or lice or nits on pubic hair

A

Pediculosis Pubis

118
Q

Treatment for Pediculosis Pubis?

A
  • Permethrin 1%

* Lindane 1% shampoo

Clin Med Final Material 5 (18 decks)

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