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STIs Flashcards

1
Q

What is the vaginal flora?

A

lactobacilli predominate

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2
Q

What factors alter vaginal microflora?

A

abx, douching, sex

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3
Q

What does a fishy or amine odor indicated?

A

trich or BV

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4
Q

What does epithelial cells w/ irregular, granular edges suggest?

A

clumped bacteria on cell wall, highly suggests BV if in more than 20% of cells

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5
Q

What are 90% of vaginitis cases caused by?

A

Bacterial vaginosis (40-50%), vulvovaginal candidiasis, trich

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6
Q

What is mucopurulent cervicitis caused by?

A

chlamydia, neisseria gonorrhoea, mycoplasma, BV associated

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7
Q

What is the most common cause of bacterial discharge?

A

BV- gardnerella vaginalis

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8
Q

What are risk factors of getting BV?

A

new sexual partner, smoking, intrauterine device, and frequent douching

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9
Q

What are frequent features of BV discharge?

A

profuse, milky, nonadherent discharge that demonstrates an amine or fishy odor after alkalization with drop KOH, clue cells

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10
Q

What is the Amsel criteria?

A

characteristic vaginal discharge, elevated pH>4.5, clue cells, fishy odor

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11
Q

What is the gold standard for diagnosis using nugent or hal/ison criteria?

A

gram stain

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12
Q

What is not useful for diagnosing BV?

A

pap smear

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13
Q

What can happen if a pregnant woman gets BV?

A

preterm delivery

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14
Q

What is BV a risk factor for?

A

HIV and herpes simplex virus Type 2, gonorrhea, chlamydia, trich

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15
Q

What is the treatment for BV

A

resolves spontaneously in 1/3 of non pregnant, and 1/2 of pregnant women, otherwise, nonpreg- Flagyl 500mg bid x 7 days or clindamycin 2% cream dailyx7 days, if pregnant- clindamycin 300 mg BID 7 days, or flagyl 500mg BID 7 days

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16
Q

What are the common species for Vulvovaginal candidiasis?

A

candida albicans and candida glabrata

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17
Q

How many women acquire VVC in their life?

A

75%

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18
Q

What are risk factors for recurrent VVC?

A

high dose oral contraceptives, diaphragm, DM, ABX, pregnancy, immunocompromised, tight clothing

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19
Q

What is the classical presentation of VVC?

A

itching, burning, irritation, postvoiding dysuria, thick, curdy discharge with pH less than 4.7

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20
Q

Why would you get a fungal culture if you suspect VVC?

A

if the women has significant clinical findings but a normal wet-mount prep

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21
Q

What is the first line treatment of VVC?

A

azoles, diflucan oral, nystatin 100,000 units bid

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22
Q

What is the most common non viral STI?

A

trich

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23
Q

What is trich caused by?

A

protozoan T. vaginalis

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24
Q

How many people with trich infection are asymptomatic?

A

50%

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25
What is the classical sx of trich?
green-yellow, frothy vaginal discharge with a musty odor, sometimes dyspareunia, vulvovaginal irritation, dysuria, strawberry cervix
26
What is the treatment of Trich?
flagyl, 2 g dose or 500 mgx4, or 500 mg BID x7 days
27
When should you retest for trich?
2 weeks after treatment
28
What happens if trich goes untreated?
adverse reproductive outcomes, cervical neoplasm, posthysterectomy cuff cellulitis or abcess, PID and infertility
29
What if untreated in pregnant woman?
premature rupture of membranes, preterm delivery or delivery of LBW infant
30
What is the appearance of atrophic vaginitis?
pale in color, usually older women
31
What is the treatment of atrophic vaginitis
moisturizers and lubricants, topical estrogen, premarin cream
32
What can help improve atrophic vaginitis?
sex with lubricants, vaginal dilators, pelvic PT
33
How many people infected with herpes know they are infected?
10-20%
34
What is primary infection of HSV?
fever, malaise, HA, painful genital lesions, dysuria, sx can last 2-4 weeks, will reoccur ~4 times per year without treatment
35
What is the clinical presentation of HSV?
multiple, bilateral, painful anogenital vesicles or ulcers w/ erythematous base, heal without scarring in 2-3 weeks
36
What are lab tests to diagnose HSV?
viral culture of lesion, PCR, type-specific serologic test for HSV abs
37
What are goals of treating HSV?
symptoms relief, accelerated lesion healing, decrease frequency or recurrence
38
What are the treatment options for HSV?
acylclovir 400 mg TID or 200 mg 5/day for 7-10 days, Famciclovir 250 mg TID 7-10 days, valacyclovir 1000 mg BID 7-10 days
39
What are suppressive options for HSV?
acyclovir 400 mg BID, famciclovir 250 mg BID, valacyclovir 500 mg/1000 mg daily
40
What are pearls of early syphillis
occurs within 1 year, chancre at site of inoculation, then develop systemic illness, (rash, fever, HA, malaise, anorexia, diffuse lympadenopathy
41
At which stage of syphilis is it not transmissible?
the late latent, except pregnant women who can continue to transmit to fetus for four years
42
What are pearls of late syphilis?
can appear 1-30 years after primary infection, CNS involvement, CV, gummatous syphilis with nodular lesions skin and bones
43
Who should be screened for syphilis?
pt with suspected disease, high risk populations (inmates, multiple sexual partners), women attending antenatal or family planning clinics
44
What is the DOC for early/late syphilis?
penicillin G benzathine 2.4 million units once for early x21 days for late, or doxycycline 100 mg BID x 14 days for early, x4 weeks for late
45
What is the DOC for neuro syphilis?
penicillin G procaine 2.4 million units IM daily and probenacid 500 mg QID for 10-14 days
46
What is the cause of chancroids
haemophilus ducreyi bacterium, a gram negative rod the forms "school of fish" chains, co-infection with HIV is common
47
What is the appearance of chancroids?
open, red and painful sores, papule evolves into pustule then ulcer, it bleeds when scraped
48
How is chancroids diagnosed?
pt has one or more painful genital ulcers, with no evidence T. pallidum infection by dark field exam of ulcer exudate or by serologic testing, also negative test for HSV, identification of H. Ducreyi on special culture
49
Treatment of chancroids
treat for chancroids and syphilis, Ceftriaxone 250 mg, Azithromycin 1 g both once, erythromycin 500 mg QID x7 days, bactrim, cipro 500 mg PO BID x 3 days
50
about how many adults will be infected with HPV?
75%
51
Presentation of HPV
warty growths called condylomata acuminata on vulva, vagina, cervix, urethra or perianal area
52
What are the HPV vaccines?
gardasil (serotypes 6,8,16,18), and a high risk vaccine (serotypes 16,18,31,33 ,35, 39, 45....), the vaccine are 95% effective
53
What diagnostic test is done in women w/ HPV?
cervical cancer screening, after age 30 if have had normal pap smears, retest every 5 years
54
What is the treatment of HPV?
symptomatic and screenin, life style modifications, smoking cessation, wt lose, exss, eat well, vitamins
55
What infection has highest incidence of any bacterial STI in US?
chlamydia, 70% of infected females an d50% of males have no symptoms
56
What are the symptoms of chlamydia?
mucopurulent cervicitis, mucopus, yellow discharge coming from swollen, red, friable cervix that bleeds easily, acute urethritis w/ dysuria but minimal freq and urgency and neg urine culture
57
Diagnostic test for chlamydia?
swab female cervix, male urethra and sumbit for testing or collect urine, nucleic acid amplification, culture
58
What is the prognosis for females w/ chlamydia?
can lead to PID, perihepatitis, pregnancy complications, proctitis, infertility
59
What is the prognosis for males with chlamydia?
urethritis, epididymitis, prostatitis, proctitis, reactive arthritis
60
Treatment of chlamydia
azithromycin, 1g orally, or doxycycline 100 mg BIDx7 days, treat all sexual contacts w/in last 60 days, test for other STIs, abstain from sex x7 days
61
Treatment of gonorrhea?
ceftriaxone 250mg IM x1, treat chlamydia too, reat all sexual contacts, no sex during treatment, test for other STDs
62
How often will PID develop in inadequately treated gonorrhea or chlamydia?
15-30%
63
Women with PID are more likely to have what?
ectopic pregnancy and infertility
64
SX of PID
lower abd pain, esp w/ walking or coitus, abs vaginal discharge, fever, uterine and adnexal tenderness to palpation and motion, mucopurulent cervicitis, cervical motion tenderness

Clinical medicine (19 decks)

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