STIs Flashcards
probable dx of chancroid
Clinical findings compatible with the diagnosis plus negative darkfield microscopic examination for Treponema pallidum (chancre), negative serologic test for syphilis, and negative culture for herpes simplex virus (HSV) or a clinical presentation not typical for herpes.
Incubation period of chancroid
4-10 days
understanding dilution
**changes in titer- a titer should be obtained just before initiating therapy (ideally on 1st day of tx) since titers can increase dramatically over a few days between dx of syphilis and treatment initiation***
Incubation of chlamydia in women
7-14 days following infection
recurrent hsv
reactivation of genital hsv in which the hsv type recovered in the lesion isthe same as the antibodies in the serum
tx hsv2
acyclovir, valacylovir, famciclovir will decrease frequency and the duration of recurrences. Can do suppressive therapy of 500mg a day of Valtrex since 33% of the time you are pre-prodromal and begin viral shedding. Episodic is 1000mg Valtrex daily x 3 days.
treatment for syphilis
abx tx must be prolonged since T. pallidum divides slowly (average is 1 doubling vivo per day) tx in early and late stages- single dose of benzathine penicillin G (2.4 million units IM) this provides low but persistent serum levels of penicillin and is standard for therapy for primary, secondary, pr early latent syphilis
Chancre
Painless ulcer on the shaft of the penis or the labia dx with venereal syphilis. 1-2cm in diameter and raised, smooth, sharply defined borders. Chancre is concave in the center.
Symptoms of extensive condyloma acuminatum involving vulva
vaginal discharge, pruritis, bleeding, burning, tenderness, pain
s/s PID in women
abd pain, abnormal vaginal bleeding, dyspareunia. Nongonococcal salpingitis may be febrile and more ill. Bartholinitis. Complications w pregnancy
Advantages for azithromycin in tx chlamydia
intracellular and tissue penetration, single dose due to half life of 5-7 days, can be used in pregnant patients
Infection of H. ducreyi leads to
erythematous papule which rapidly evolves into a pustule that erodes into an ulcer
Women with gonorrhea
Can be isolated to the urethra in 90% of cases, may only have urinary s/s of dysuria, urgency, frequency. Worry about PID and Cervicitis.
Aldera
cream BID to penetrate lesions that are obvious. If lesions are inside rectum need colorectal surgery
Questioning and ROS
critical in syphilis. 12 months has massive meaning- be very accurate. be redundant in your questioning to get the correct information
Use of cephalosporins in gonn
used because of non cephalosporin resistance. Uncomplicated use ceftriaxone 250mg IM plus Azithromycin 1gram to cover for chlamydia or can do 100mg Doxy BID x 7 days instead which is for azithromycin intolerant patients and for cases of epididymtsis or proctitis
Treat chancroid
one dose Azithromycin 1g PO or Rochephin 250mg IM - less desirable, Cipro 500mg PO BID x 3 days
Tx Chancre
Heals 4-6 weeks even w out treatment. Primary syphillus tx is PCN G IM. PCN allergy use Doxy or Tetracycline.
diagnostic work up of primary syphilis
- diagnosis can be made by dark- field examination which has a high specificity for T. pallidum
(since this test is not readily available, dx is generally based on clinical suspicion and a positive RPR serology which occurs in 85% of primary cases)
Quinolones in tx Chlamydia
Ofloxacin and Levofloxacin are highly effective but need a full week of therapy and are more expensive, they CANT BE USED IN PREGNANT OR LACTATING WOMEN and can not be used in ADOLESCENTS YOUNGER THAN 18 D/T BONE ABNORMALITIES. Oflaxacin 300mg PO BID x 7 days. Levofloxacin 500mg PO once daily x 7 days. Only good for non pregnant and older who cannot tolerate first line therapy of doxycycline or azithromycin
false positive nontreponemal tests have been associated with?
pregnancy, IV drug use, TB, and rickettsial infection
Skin lesions in disseminated gonorrhea
Fever with painful joints, tender necrotic ulcers painful pustular gonn, painless is syphillus… hemorrhagic vesicopustule of the web space of the hand and sole of foot… fever with necrotic vesicles on arms and legs, tender purpuric papules on right leg with fever and joint pain
Cutaneous manifestations of gonorrhea
can have penile ulcers, purulent discharge of the urethra will also be present. Penile edema can be present painless swelling. More common in young boys. Skin lesions are in disseminated gonococcal infection with typical small pustular skin lesion
pregnant women can transmit T. Pallidum to their fetus (ie, congenital infection) for up to ?
for up to 4 years


