STIs

Question 1

Primary Syph- SX

Answer 1

Painless chancer- 4-6 weeks

Question 2

Secondary Syph- Sx

Answer 2

Rash- hands & feet, noncontageous, not pruitic
Condoloma lata- flat, moist, heaped, papilomas- contageous
Mucous patch- flat, painless- oral, pharynx, infectious
Malaise & lymphadenopathy

Question 3

Tertiart Syph- Sx

Answer 3

Up to 10-30 years post infection

• Cardiovascular
• Gummatous lesions anywhere on body
• Neuro syptoms- DX with spinal tap

Question 4

Syph- Dx

Answer 4

Dark field microscopy
RPR or VDRL
Confirm with FTA-ABS

Question 5

Syph- Tx

Answer 5

Parental Penicillin G- Increase dose if infected >1yr
Doxycycline if allergic
Confirm decrease with RPR 3, 6, 12 & 24 mo.

Question 6

Gonorrhea- SX

Answer 6

1-14 days post exposure
Females: Profuse vaginal discharge, abd pain, fever, cervical motion tenderness,
Males: urethritis, white-yellow-green profuse discharge, dysuria

Question 7

Gonorrhea- Dx

Answer 7

Swab or urine sample

Question 8

Gonorrhea- Tx

Answer 8

Treat everyone:

Cetriaxone IM 250 mg plus azithromycin or doxycycline due to common chlam. coinfection

Question 9

Gonorrhea- Complications

Answer 9

Increased risk of HIV, PID if left untreated, conjunctivitis, meningitis, endocarditis, disseminated diseases

Question 10

Herpes- Sx

Answer 10

Primary- following first exposure- painful and most severe outbreak
Recurrent- recurrence of genital lesions, viral shedding in asymptomatic- lies dormant in nerve root. Prodromal sx- tingling, pruitis, vesicles.

Question 11

Herpes- Dx

Answer 11

Viral culture swab- requires active lesion

Serology- specifies HSV1 or 2, can have false +, antibodies may not be present in primary infection

Question 12

Herpes- Tx

Answer 12

Primary- 7-10 days acyclovir, valcyclovir or famcyclovir
Recurrent- 1-5 days
Suppression through daily dose to decrease risk of spreading infection- well tolerated

Question 13

Chancroid- Sx

Answer 13

Painful, tender ulcer with foul smell, discharge and painful inguinal adenitis (buboes)

Question 14

Chancroid- Dx

Answer 14

Rule out syphallis, HIV- Use special culture media to ID Haemophilus Ducreyi

Question 15

Chancroid- Tx

Answer 15

1 g Azithromycin- single dose or Cipro 500 mg BID x 3 days

Question 16

Granuloma Inguinale- Kliebsiella granulatomatis- Sx

Answer 16

Fleshy lesions, pruluent, foul smelling, spread & do not resolve on own, beefy red, bleed easily

Question 17

GI- Dx

Answer 17

Culture- growth of K granulatomiatis and presence of Donovan bodies

Question 18

GI- Tx

Answer 18

Azithromycin 1g injection weekly- 3 weeks or until lesions resolve

Question 19

Lymphogranuloma vernereum- Sx

Answer 19

Systemic infection with unilateral buebo. Self limiting ulcer or papule at site of infection, anal discharge/ bleeding

Question 20

LGV- DX

Answer 20

Rule out syphallis- lymphadeopathy, groove sign

Question 21

LGV- Tx

Answer 21

Doxycycline 100 mg BID x 21 days

Question 22

Chlamydia- Sx

Answer 22

Often asymptomatic
Females- Cervical discharge, lower abd pain, adnexal tenderness
Males- urethritis, penile discharge, dysuria

Question 23

Chlamydia- Dx

Answer 23

Swab, Urine NAAT test, pharynx or rectal swab

Question 24

Chlamydia- Tx

Answer 24

100 mg Doxycycline BID x 7 days or 1 mg azithromycin. Abstain for 7 days, retest 3 mo.

Question 25

HPV- Sx

Answer 25

None to visible warts. Soft, flesh colored califlour like papules. Dysplasia- precancerous

Question 26

HPV- Dx

Answer 26

Visualize warts- vinegar turns white. biopsy or abn pap

Question 27

HPV- Tx

Answer 27

Liquid nitrogen, trichloracetic acid, podofilox ointment or topical imiquimod

Question 28

HPV- Complications

Answer 28

Cervical cancer- cause of 70% of cancers. Vaccine covers!