STIs Flashcards
What are the types of HSV infection?
Primary: infection in a patient without antibodies to HSV-1 or HSV-2. Nonprimary: first episode infection due to acquiring genital HSV-1 w/ preexisting antibodies to HSV-2 or vice versa. Recurrent: reactivation in which the HSV type recovered in the lesion is the same type as the antibodies in the serum
What are sx of HSV?
more severe in women, Systemic sx, local pain/itching, dysuria, lymphadenopathy
How is HSV diagnosed?
Viral culture if active lesions present.PCR is more sensitive. Direct fluorescent antibody. Serology: type-specific antibody testing of serum to determine if a patient has had a prior infection
What are treatment options for HSV?
Acyclovir (Zovirax), Famcilovir (Famvir), Valacyclovir (Valtrex). treated w/in 72hrs starting at first sign of prodromal sx
How is HSV treated in pregnancy?
Acyclovir can be used to treat a primary infection. Prophylactic C-section if active lesions in birth canal
What is the causative agent of syphilis and serologic tests available?
Treponema palidum (Cannot be cultured). Nontreponemal: VDRL, RPR, TRUST/Reported as titers. Treponemal: reported as “reactive” or “nonreactive”
Describe characteristics of primary syphilis
Incubation period of 2-3 wks, a papule forms and ulcerates to the painless chancre that will heal spontaneously w/in 3-6 wks. Usually there is bilateral lymphadenopathy
Describe characteristics of secondary syphilis
Weeks to a few months later. Rash pathognomically on palms/soles, condyloma lata, systemic sx, lymphadenopathy, alopecia, hepatitis, GI/musculoskeletal/renal abnormalities.
Describe characteristics of tertiary syphilis
1-25 years after secondary syphilis. SubQ (gumma)—granulomas. ascending thoracic aorta becomes dilated aortic valve regurgitation occurs. CNS (most common) Early: meningitis, meingiovascular disease. Late: general paresis, tabes dorsalis, ocular, otosyphilis
How is neurosyphilis diagnosed?
lumbar puncture will show Lymphocytic pleocytosis, Elevated protein, + CSF-VDRL and/or + FTA-ABS
What are treatment options for syphilis?
penicillin G IM. If allergic doxy 100mg BID for 14 days. for late syphilis treatment should last 3 wks. Penicillin is only therapy for neurosyphilis. Allergic patients must undergo PCN desensitization
How is syphilis response to treatment monitored?
reexamined clinically and serologically at 6 and 12 months. A fourfold reduction in titer of the nontreponemal antibody test is evidence of a response to therapy
What are clinical manifestations of HPV?
Genital warts (condyloma acuminatum), Bowenoid papules and Bowen’s disease, Giant condyloma (Buschke-Lowenstein tumors), Intraepithelial neoplasia and/or carcinoma of the vagina, vulva, cervix, anus or penis
What are the genotypes of HPV?
Carcinogenic types HPV16 & HPV18 account for most cervical cancers. HPV6 & HPV11 cause genital warts
What is the most common viral STI?
anogenital warts
What are sx of anogential warts?
Pruritis, burning, Bleeding, Tenderness, pain, Discharge (women), Large condylomata can interfere w/ defecation, intercourse and vaginal delivery, Lesions in the proximal anal canal may cause strictures
How are anogential warts diagnosed?
visual inspection. extent of involvement by PE, anoscopy, sigmoidoscopy, colposcopy, and/or vaginal speculum exam. 5% acetic acid causes lesions to turn white. Biopsy if unusual
What are treatment options for anogenital warts?
Ablative: Podophylliin (CI in pregnancy), Imiguimod (Aldara), Trichloroacetic acid, 5-fluoruracil, injected alpha interferon. Excisional: cryotherapy, laser therpy (require anesthesia, cause scars, risk of infections/hemorrhage)
What can cause urethritis in males?
gonorrhea, chlamydia, trichomonas vaginalis
What is trichomonas presentation in women?
Asymptomatic carrier state. Symptomatic cases:
Purulent, malodorous, thin discharge, Burning, pruritis, Dysuria, frequency, Dyspareunia, postcoital bleeding
How is trichomonas diagnosed in women?
Vaginal swab: wet mount can see motile trichomonads. green, frothy, foul-smelling discharge. Elevated pH (>4.5) & increased PMNs
What are treatment options for trichomoniasis?
Tinadazole or metronidazole (Flagyl): Single oral dose of 2 gms. Metronidazole 500 mg BID for 7 days. Metranidazole for symptomatic pregnant women. Male partners need to be treated too. No intercourse until all parties have been treated!
How does trichomoniasis present in men?
transient w/ spontaneous resolution and asymptomatic. Symptoms are typical for urethritis
No definitive diagnostic tests; low yield w/ swabs for motile organisms. Treatment is usually because of + female diagnosis
What are gonorrhea manifestations in women?
Any portion of the genital tract (PID), Most common site is the cervix, Urethritis, Anorectal infection/proctitis
What are gonorrhea manifestions in men?
Urethritis, Epididymitis, Proctitis (inflammation of rectal lining)
What are manifestations of disseminated gonococcal infection (DGI)?
triad: tenosynovitis, dermatitis, polyarthralgias. Purulent arthritis without skin lesions
How is gonorrhea diagnosed?
Nucleic acid amplification testing (NAAT): Amplifies N. gonorrhoeae DNA or RNA sequences using samples from: endocervix, vagina, urine, urethra in men. Culture nongenital sites
What are treatment options of gonorrhea?
Ceftriaxone 250mg IM single dose + Azithromycin (Zithromax) 1 gram single dose OR Doxycline 100 mg BID for 7 days except in pregnant women to cover chlamydia. Alternatives oare cefotaxime and cefoxitin
What are treatment options for epididymitis?
Ceftriaxone 250 mg IM + doxycycline 100 mg BID x 7 d. If intolerant to doxy can use azithromycin
What are chlamydial manifestations in women?
cervicitis, urethritis, PID if untreated. increased risk of premature rupture of membranes and low birth weight if pregnant. newborns can develop conjunctivitis/pneumonia
What are chlamydial manifestations in men?
urethritis, epididymitis, proctitis
How is chlamydia diagnosed?
NAAT: vaginal, urethral, urine specimens (“gold standard”). culture, genetic probe, antigen detection.
What are treatment options for chlamydia?
coexists w/gonorrhea so treat for both. Azithromycin (Zithromax) 1 gr single dose + Doxycyline 100 mg BID for 7 days. 2nd line ofloxacin/levofloxacin 7 days
What are routine screenings in pregnancy?
Chlamydia, Gonorrhea, Syphilis, Hepatitis B, Offered test for HIV, Take history for HSV, Pap done to assess for HPV
