STIs Flashcards
Early symptoms of HIV
fever, night sweats, weight loss
3 important monitoring tests for HIV/AIDS
CD4: normal >800, antivirals when ≤350; also Bactrim for prophylactic treatment of Pneumocystis jirovecii
CD4 percentage: risk of progression to AIDS when
Diagnosis of HIV
ELISA for screen
Western Blot to confirm
Diagnosis of AIDS
CD4 ≤ 200 AND/OR the presence of an opportunistic infection
How long does seroconversion from HIV negative to HIV positive take?
3 weeks to 6 months
Which two STI’s cause painful lesions?
herpes and chancroid
Chancroid: pathology, incidence
- Hemophilus ducreyi
- established as a co-factor for HIV transmission
- women usually asymptomatic, men with single (or multiple) superficial painful ulcer, surrounded by erythematous halo, unilateral swollen inguinal lymph node
How do you diagnose chancroid?
Diagnosis of exclusion, mae morphologically.
Painful genital ulcers in absence of Treponema and HSV with co-existing tender inguinal lymphadenopathy.
How do you treat chancroid?
Azithromycin 1gm by mouth x1 or
Ceftriaxone 250mg IM x1 or
Cipro 500mg PO BID x3 days
Chlamydia: pathology and incidence
- caused by Chlamydia trachomatis
- most common STI in the United States
What are the signs and symptoms of chlamydia?
- often asymptomatic
- dysuria
- dyspareunia and postcoital bleeding in women
- spotting in women
- vaginal or penile discharge
- testicular pain
What is the differential diagnosis for dyspareunia?
- chlamydia
- pelvic inflammatory disease
- menopause (dry)
- trichomonas
Diagnosis and treatment of chlamydia
- culture is most definitive, but enzyme immunoassay (EIA) is quicker so it is the preferred method
- azithromycin 1gm PO x1 or
- doxycycline 100mg PO BID x7 days
- report to the health department
Genital warts: cause and incidence
- caused by HPV
- most common VIRAL sexually transmitted disease in the US
Genital warts: sx, dx, tx
Sx: painless keratinized cauliflower growth
Dx: colposcopy for flat lesions; may need to biopsy if at risk
Tx: Keratolytic agents (Podophyllin, TCA, BCA), or refer for cryotherapy
Gonorrhea: pathology, incidence
- caused by Neisseria gonorrhea
- causes urethritis in men and cervicitis in women
- leading cause of infertility in women in United States
Signs and symptoms of gonorrhea
- Often asymptomatic
- Dysuria and urinary frequency
- Vaginal or penile discharge (green)
- Labial pain/swelling, pelvic pain in women
- testicular pain
- dysmenorrhea, abnormal periods
- nausea/vomiting in men
How do you diagnose and treat gonorrhea?
- Dx: gram stain of discharge, or cervical culture in Thayer-Martin
- Ceftriaxone 250mg IM x1, PLUS…
- Azithromycin or doxycycline to cover chlamydia (always co-treat)
- report to health department
What to do in case of hepatitis B exposure?
- HBIG within 14 days of exposure (the earlier the better)
What are the signs and symptoms of herpes?
Initial: Fever, malaise, dysuria, painful/pruritic ulcers for about 12 days
Recurrent: Less painful/pruritic ulcers for about 5 days
Diagnosis and treatment of herpes
Dx: viral culture
Tx: no cure; Valacyclovir is the standard for decreasing asymptomatic viral shedding of HSV2; Acyclovir also can be used for acute outbreak
Lymphogranuloma Vereneum (LGV): cause, symptoms
- caused by immunotypes L1, L2, or L3 of chlamydia trachomatis
- 2-3mm painless vesicle, bubo, or non-indurated ulcer
- stiffness and aching in groin f/b unilateral swelling of inguinal region
Diagnosis and treatment of lymphogranuloma vereneum (LGV)
Dx: may be confused with chancroid, requires isolating Chlamydia trachomatis from appropriate specimen
Tx: doxycycline 100mg PO BID x21 days, aspirate bubos to prevent ulcerations
Molloscum contagiosum: sx, dx, tx
Sx: 1-5mm smooth, rounded, firm, shiny flesh-colored to pearly white papules commonly seen on trunk and anogenital region
Dx: inspection and microscopic exam
Tx: cryoanesthesia with liquid nitrogen, but may scar (can also leave alone and they will go away)
Syphilis: cause and incidence
- caused by Treponema pallidum, a spirochete
- third most commonly reported infectious disease in the US
Clinical stages of syphilis
Primary- PAINLESS chancre, indurated ulcer
Secondary- flu-like symptoms, skin rash on palms/soles/mouth, lymphadenopathy, alopecia, arthralgias
Latent- seropositive but asymptomatic
Tertiary- leukoplakia, cardiac insufficiency, aortic aneurysm, meningitis, hemiparesis/hemiplegia
Diagnosis and treatment of syphilis
Dx: screen with VDRL/RPR, confirm with fluorescent treponemal antibody absorption (FTA-ABS)
Tx: Primary/secondary- Pen G 2.4m units IM x1
Tx: Latent/tertiary- Pen G 2.4m units IM weekly x3 weeks
Tx: For penicillin allergy: Doxy or EEC
- report to health department
