STIs Flashcards
What is the number 1 cause of vaginal discharge
Bacterial vaginosis
What is the number 1 cause of symptomatic bacterial infection in reproductive age women
bacterial vaginosis
What symptoms may someone have with bacterial vaginosis
Discharge will be milky with a fishy odor (after KOH prep)
worse after unprotected intercourse
non-irritating
How is a diagnosis of bacterial vaginosis made
Amsels criteria
What will be present with amsels criteria with bacterial vaginosis
Clue cells on microscopy
alkalotic pH
+ whiff test
What is the first line treatment for bacterial vaginosis
Metronidazole PO for 7 days
or intravaginal metronidazole
or
intravaginal clindamycin gel
What do you have to warn a patient when prescribing metronidazole
n/v with ETOH
What is the risk if BV goes untreated
Increase risk of STI (including HIV)
increased preterm delivery
risk of candidiasis s/p tx
What is the second most common reported STI
Gonorrhea
What age group has the highest incidence of gonorrhea
15-24
*higher in black patients
If symptoms are present with Gonorrhea, what will they be
White/green/yellow purulent discharge
friable cervix
vaginal bleeding
dysuria
What are possible extra genital infections occur with gonorrhea
Conjunctivitis
arthritis
disseminated
How do you diagnose gonorrhea
NAAT
How do you treat gonorrhea
Ceftriaxone IM single dose
+
azithromycin or doxy
*no intercourse for 7 days
What are some complications with Gonorrhea
PID
epididymitis
mom-to-baby transmission
What is the most frequent reportable bacterial STI
Chlamydia
What symptoms will a patient have with chlamydia
pyuria
increased urinary frequency
purulent discharge
friable cervix
How do you treat chlamydia
Doxy 100mg PO BID x 7 days
What is the most prevalent non-bacterial STI
Trichomonas vaginitis
How is trichomoniasis prevented
condom use
What symptoms will females have with trichomoniasis
Profuse, malodorous, frothy vaginal discharge
strawberry cervix
How do you diagnose trichomoniasis
wet mount (must do immediately post sampling)
What is the treatment for trichomoniasis
metronidazole for 7 days for females
1 day for males
What are some associated risks for trichomonas
preterm labor
PROM
small gestational age
increased risk for cervical cancer
How is candidiasis diagnosed
presence of budding yeast and hyphae on KOH wet mount
*culture is gold standard
How do you treat candidiasis
OTC: clotrimazole/miconazole
RX: Fluconazole PO
What are some complications from syphilis
Neurosyphilis
ocular syphilis
auditory syphilis
How do you diagnose early syphilis
Darkfield microscopy
*ID spirochetes
What is the lab workup for later stages of syphilis
Non-treponemal test
treponema test (confirmatory)
When should syphilis screening be preformed
MSM every 6-12 months
High risk every 3 months
Pregnant at prenatal, 3rd tri, and delivery
What is the treatment for syphilis
Parenteral Pen G is first line
doxy is second line
* no intercourse 7-10 days
*ID and treat contacts within last 3 months
What is Jarisch-Herxheimer reaction
Fever and worsening clinical ssx
Starts within hours of tx
lysis of spirochetes
*associated with syphilis
What is chancroid
rare STI seen in younger men and sex workers
cause by Haemophilus ducreyi
What is the presentation for chancroid
Papule -> pustule -> ulcerations
- painful, soft, irregular borders, friable
- necrotic base with yellow/gray exudates
-swollen lymph nodes (unilateral) near the lesion
How do you diagnose chancroid
lesion culture is gold standard
How do you treat chancroid
Azithromycin 1g PO x1
or
ceftriaxone 250mg IM x1
What is the most common cause of genital ulcers
Herpes simplex
How will herpes simplex present
Tingling prodrome
macular/papular rash
vesicle on erythematous base
shallow painful ulcers
lesions are self limiting over 3 weeks
How do you diagnose herpes simplex
clinical if vesicles are present
tzank smear
HSV PCR
Urine culture
What is the first line treatment for herpes simplex
Acyclovir or valcyclovir
*lifelong disease
What strain of HPV is related to genital warts
6 or 11
What is the presentation of genital warts
flat pedunculated lesions near Introitus
What is the definitive diagnosis of genital warts
Biopsy of a lesion
What are the treatment options for genital warts
Cryotherapy
surgical excision
caustic agent
What are patient applied genital wart treatment
imiquimod cream
podofilox gel
sinecatechins ointment
What is PID
Inflammation of upper genital tract
*secondary to an ascending infection from lower genital tract
What is the most common cause of PID
chlamydia or gonorrhea
Who is at increased risk for PID
Multiple partners
age
previous PID
IUD
tubal ligation
How will PID present
Abdominal or lower pelvic pain
vaginal discharge
dyspareunia
AUB
How would you do an exam for suspected PID
Cervical discharge
cervical motion tenderness
uterine tenderness
adnexal tenderness
+/- pelvic mass
What clinical criteria needs to be present to have a high suspicion for PID
cervical motion tenderness
uterine tenderness
adnexal tenderness
How do you treat PID
IV or PO antibiotics
* should improve within 72 hours
What are the indications for admissions with PID
-need to rule out other surgical emergency
-presence of tubo-ovarian abscess
- severe infection (Temp over 101)
-no response to PO tx
What is the first line abx regimen for PID
Ceftriaxone 1g IM
+
Doxy 100mg PO
+
Metronidazole 500mg PO
*treat for 14 days
What are complications associated with PID
Tubo-ovarian abscess
pelvic abscess
ectopic pregnancy
infertility
chronic pelvic pain
