STI's Schoenwald Flashcards
Who is the Hep B vaccine recommended for?
recommended for all sexually active persons
Who is the Hep A vaccine recommended for?
recommended for MSM
Who is the HPV vaccine recommended for?
recommendation ages 9-26 (males & females)
What should be included in the MSM annual screening?
- HPV screening-anal pap smear
- HBsAg testing (for active infection)
- Hep C Ab testing (annually)
What are two painful genital ulcer diseases?
Chancroid, genital herpes simplex
A patient complaints of 7-10 days of painful vesicles on erythematour base. Would could the pt have?
HSV 2
What is the best way to test for herpes? What about if the patient has meningoencephalitis?
Viral studies-culture and PCR of CSF for meningitis
Primary, recurrent or prodrome herpes sxs?
Associated with fever and bilateral adenopathy,
Primary (first occurrence)
Primary, recurrent or prodrome herpes sxs?
no fever or adenopathy
Recurrent
Primary, recurrent or prodrome herpes sxs?
tingling or burning 18- 36 hours prior lesion
Prodrome
Best way to dx herpes?
Tzank smear
Presence of multinucleated giant cells on Tzank smear is indicative of what?
HSV
What is the duration of tx for herpes?
7-10 days
What is the tx for a first episode of herpes?
Acyclovir 400 mg TID or 200 mg 5x/day or valacyclovir 1000 mg BID
Episodic tx of herpes?
Acyclovir
Tx for daily suppression of herpes?
Acyclovir, famcyclovir, valacyclovir
Can you tx herpes in pregnancy?
Limited data but yes with acyclovir- C section recommended though if have to deliver baby and have sores present. Otherwise, can safely vag deliver
How do you define early latent syphilis?
Reactive testing within 1 year of
infection-no symptoms (infection acquired within one year)
How do you define late latent syphilis?
Reactive testing greater than 1 year after onset of infection or timing cannot be determined
-no sxs
Treponema pallidum
Syphilis
What is the GS test for syphilis?
Darkfield examination of exudate/tissue (gold standard)
WHat is RPR
One of the blood tests for syphilis
What is VDRL?
One of the CSF tests for syphilis
Once + syphilis does it ever go back to normal?
NO
How do you confirm syphilis?
RPR ran and + then confirm with antibody test
What stage of syphilis is this (chancre)?
Macule/papule that erodes?
Early
What is the syphilis incubation period?
10-90 days (avg 3 wks)
What stage of syphilis is this (chancre)?
clean based, painless, indurated ulcer with smooth firm borders
Late
Is a chancre painful?
Yes
What is secondary syphilis?
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)
Anorectal syphilis that looks like warts is called?
Condylomata lata
Treatment of tertiary syphilis (gumma and cardiovascular syphilis)
Penicillin G 2.4 million units IM q week x 3 weeks
Tx for tertiary neurosyphilis?
Treat with Aqueous Penicillin G 18-24 million units/day for 10-14 days (24 hr infusion)
What is a Jarisch-Herxheimer Rxn?
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
Tx for Jarisch-Herxheimer Rxn
NSAID or APAP and anti-asthmatic (because anaphylaxis-like rxn)
Tx for primary, secondary, early latent syphilis?
Benzathine Penicillin G, 2.4 million units IM
Tx for syphilis with PCN allergy?
Doxycycline 100 mg twice daily x 14 days
What partners should be treated for syphilis?
ALL PARTNERS tx everyone even if no sxs
Tx for syphilis in pregnancy?
Benzathine penicillin 2.4 mu IM after the initial dose for primary, secondary, or early latent syphilis
Should you test for HIV in a newly diagnosed syphilis patient?
Yes I think they go hand in hand and if testing for HIV also test for syphilis
Painless chancre-papule that ulcerates
syphilis
Non-indurated painful vesicle or papule to pustule or ulcer that is soft
chancroid
Haemophilus ducreyi
chancroid
Combo of painful ulcer with tender inguinal adenopathy suggests chancroid
chancroid
Tx for chancroid?
Azithromycin 1 gm orally OR Ceftriaxone 250 mg IM
SHould you re-examine the pt after chancroid tx?
Re-examine 3-7 days after tx
Should you treat the partner if someone has a chancroid?
YES-> Examine and tx partner whether symptomatic or not if partner contact <10 days prior to onset