STIs Flashcards
Painless genital lesions
syphilis, LGV, Granuloma Inguinale
painful genital lesions
HSV, Haemophilus Ducreyi
describe appearance of HSV lesions
superficial, vesicular, erythematous base
Best diagnosis of HSV lesions
PCR
What to test if there is concern for HSV resistance
culture to get sensitivities
describe syphilis lesions
single, well circumscribed with heaped up borders and clean base
describe chancroid lesions
indurated, tender, suppurative inguinal LAD with kissing lesions n thigh
describe LGV lesions
ulcer, painful LAD, groove sign
proctitis can be seen with
LGV, HSV, MPOX
describe granuloma inguinale lesions
progressive serpiginous without LAD, beefy red lesions that bleed when biopsied
what is the drug of choice to treat syphilis in pregnancy
penicillin, no alternatives
features of primary syphilis
chancre, LAD
features of secondary syphilis
systemic symptoms, fever, malaise, sore throat, rash, LAD
features of syphilis hepatitis on labs
alk phos is very high compared to AST and ALT
what test to do if a patient is diagnosed with cardiovascular syphilis
need LP- they will have asymptomatic neurosyphilis
alternative therapy of early syphilis
doxycycline x 14 d
alternative therapy of late latent syphilis
doxycycline x 4 weeks
complication of J-H reaction in pregnancy
can induce early labor
alternative treatments for neurosyphilis
procaine penicillin IM plus probenecid for 10-14 d
Ceftriaxone IV or IM x 10-14 d
syphilis screening in pregnancy
during 1st trimester
screen high risk in 28 w and at the time of delivery
special circumstance for syphilis screening in pregnancy
if they have stillbirth after 20 weeks
indications for c/section with HSV
active lesions or prodromal symptoms
HSV suppressive therapy indicated in HIV
with CD4 < 200 if they have history of HSV and they are going to start ART- x 6 months
how to diagnose HSV in asymptomatic patients
Glycoprotein G EIA assays
Gg2 +
genital herpes
Gg1+
either oral or genital- can’t tell difference
when to use HSV IgM
never
how to diagnose chancroid
culture
treatment of chancroid
azithromycin 1g PO x 1 dose or CTX 250 mg IM x 1 dose
how to diagnose GI
biopsy
what stain to use for GI diagnosis
wright giemsa stain
feature of GI pathology
Donovan bodies within macrophages
treatment of GI
Doxycycline x 3 weeks or resolution of lesion
Azithromycin x 3 weeks
TMP-SMXw
who should be tested for m. genitalium
men with persistent urethritis or epididymitis
women with persistent cervicitis or PID
men or women with persistent proctitis symptoms
*anyone who doesn’t respond to initial therapy
treatment of choice for m. genitalium
moxifloxacin 400 mg qd 7-14 days
treatment of trich in women
metronidazole x 1 week or tinidazole 2g PO x 1
treatment of trich in men
metronidazole 2g x 1 dose or tinidazole 2g x 1
screening of trich in HIV women
annually
prefer treatment of trich in women
1 week of metronidazole
options for treatment failure trich with metronidazole
tinidazole 2g po x 1
metronidazole 2g PO x 5d
tinidazole 2g po qd x 5d
do partners of BV infection need to be treated?
no
pH in BV
> 4.5
positive whiff test in BV
amine odor with KOH
treatment of BV
metronidazole 500 mg BID x 7d
Clindamycin 300 mg PO TID x 7d
or topical metronidazole or clindamycin
screening of BV during pregnancy
only screen symptomatic patients
criteria for hospitalization in PID
pregnant
TOA
can’t rule out appendicitis
didn’t respond to PO therapy
N/V, fever/systemically ill
no reliable outpatient therapy
treatment of outpatient PID
CTX 500 mg x 1 IM
Doxy 100 mg BID.x 14d
Metronidazole 500 mg BID x 14d
Inpatient therapy of PID
Cefotetan 2g BID or Cefoxitin 2g q6h plus Doxycycline 100 mg BID
treatment of epididymitis in young people
CTX 500 mg x 1 and Doxy 100 mg BID x 10 d
who should be screened for chlamydia
sexually active women 25 years or younger and older women with risk factors (multiple sex partners)
post infectious complication of chlamydia
reactive/reiter’s arthritis
preferred test for chlamydia dx in women
vaginal swab NAAT
preferred test for chlamydia test in men
first catch urine NAAT
treatment of chlamydia in pregnancy
azithromycin
when to screen treated persons for chlamydia
3 months after treatment, rates of reinfection are high
treatment of choice in gonorrhea
ceftriaxone 500 mg IM x 1
treatment of pharyngeal GC
only CTX
follow up test for pharyngeal GC
need test of cure 7-14 d after therapy
treatment of GC conjunctivitis
1g CTX
complications of DGI
hepatitis
endocarditis
meningitis
risk factor for DGI
terminal complement deficiency
second line treatment for urogenital or rectal GC
cefixime 800 mg x 1
gentamicin 5 mg/kg x 1 IM + 2g azithromycin
Differential if person fails doxycycline for treatment of NGU
reinfection
mycoplasma genitalium
trichomonad vaginalis
HSV
trichomonas can be seen in what population? less common in what population
MSW
MSM
HPV vaccines during pregnancy?
don’t give, can just pick up where you left off after they deliver
molluscum treatment
curettage, cryotherapy, topical cidofovir
pediculosis pubis, if nits are on the upper shaft, treatment?
no, old infection, no need for pretreatment
treatment of pediculosis pubis
if treatment failure
permethrin cream or pyrethrins topical
malathion lotion or ivermectin if treatment failure
lindane in crabs?
don’t use
associated with seizures and aplastic anemia
treatment of scabies
permethrin cream
ivermectin and day 1 and 14
crusted scabies or Norwegian scabies seen in what population
HIV, immunocompromised
treatment of crusted/norwegian scabies
ivermectin on days 1 ,15, 19
