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Infectious Disease > STIs > Flashcards

STIs Flashcards

1
Q

What are the types of HSV infection?

A

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

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2
Q

What are sx of HSV?

A

more severe in women, Systemic sx, local pain/itching, dysuria, lymphadenopathy

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3
Q

How is HSV diagnosed?

A

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

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4
Q

What are treatment options for HSV?

A

Acyclovir (Zovirax), Famcilovir (Famvir), Valacyclovir (Valtrex). treated w/in 72hrs starting at first sign of prodromal sx

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5
Q

How is HSV treated in pregnancy?

A

Acyclovir can be used to treat a primary infection. Prophylactic C-section if active lesions in birth canal

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6
Q

What is the causative agent of syphilis and serologic tests available?

A

Treponema palidum (Cannot be cultured). Nontreponemal: VDRL, RPR, TRUST/Reported as titers. Treponemal: reported as “reactive” or “nonreactive”

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7
Q

Describe characteristics of primary syphilis

A

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

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8
Q

Describe characteristics of secondary syphilis

A

Weeks to a few months later. Rash pathognomically on palms/soles, condyloma lata, systemic sx, lymphadenopathy, alopecia, hepatitis, GI/musculoskeletal/renal abnormalities.

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9
Q

Describe characteristics of tertiary syphilis

A

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

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10
Q

How is neurosyphilis diagnosed?

A

lumbar puncture will show Lymphocytic pleocytosis, Elevated protein, + CSF-VDRL and/or + FTA-ABS

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11
Q

What are treatment options for syphilis?

A

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

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12
Q

How is syphilis response to treatment monitored?

A

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

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13
Q

What are clinical manifestations of HPV?

A

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

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14
Q

What are the genotypes of HPV?

A

Carcinogenic types HPV16 & HPV18 account for most cervical cancers. HPV6 & HPV11 cause genital warts

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15
Q

What is the most common viral STI?

A

anogenital warts

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16
Q

What are sx of anogential warts?

A

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

17
Q

How are anogential warts diagnosed?

A

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

18
Q

What are treatment options for anogenital warts?

A

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)

19
Q

What can cause urethritis in males?

A

gonorrhea, chlamydia, trichomonas vaginalis

20
Q

What is trichomonas presentation in women?

A

Asymptomatic carrier state. Symptomatic cases:

Purulent, malodorous, thin discharge, Burning, pruritis, Dysuria, frequency, Dyspareunia, postcoital bleeding

21
Q

How is trichomonas diagnosed in women?

A

Vaginal swab: wet mount can see motile trichomonads. green, frothy, foul-smelling discharge. Elevated pH (>4.5) & increased PMNs

22
Q

What are treatment options for trichomoniasis?

A

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!

23
Q

How does trichomoniasis present in men?

A

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

24
Q

What are gonorrhea manifestations in women?

A

Any portion of the genital tract (PID), Most common site is the cervix, Urethritis, Anorectal infection/proctitis

25
Q

What are gonorrhea manifestions in men?

A

Urethritis, Epididymitis, Proctitis (inflammation of rectal lining)

26
Q

What are manifestations of disseminated gonococcal infection (DGI)?

A

triad: tenosynovitis, dermatitis, polyarthralgias. Purulent arthritis without skin lesions

27
Q

How is gonorrhea diagnosed?

A

Nucleic acid amplification testing (NAAT): Amplifies N. gonorrhoeae DNA or RNA sequences using samples from: endocervix, vagina, urine, urethra in men. Culture nongenital sites

28
Q

What are treatment options of gonorrhea?

A

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

29
Q

What are treatment options for epididymitis?

A

Ceftriaxone 250 mg IM + doxycycline 100 mg BID x 7 d. If intolerant to doxy can use azithromycin

30
Q

What are chlamydial manifestations in women?

A

cervicitis, urethritis, PID if untreated. increased risk of premature rupture of membranes and low birth weight if pregnant. newborns can develop conjunctivitis/pneumonia

31
Q

What are chlamydial manifestations in men?

A

urethritis, epididymitis, proctitis

32
Q

How is chlamydia diagnosed?

A

NAAT: vaginal, urethral, urine specimens (“gold standard”). culture, genetic probe, antigen detection.

33
Q

What are treatment options for chlamydia?

A

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

34
Q

What are routine screenings in pregnancy?

A

Chlamydia, Gonorrhea, Syphilis, Hepatitis B, Offered test for HIV, Take history for HSV, Pap done to assess for HPV

Infectious Disease (17 decks)

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