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STIs Flashcards

1
Q

clinical presentation

  • vaginal discharge
  • odor
  • pruritus
  • discomfort
A

vaginitis

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2
Q

what are the 3 most common causative agents of vaginitis

A
  • vulvovaginal candidiasis
  • bacterial vaginosis
  • trichomoniasis
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3
Q

is vulvovaginal candidiasis a STI

A

no, it is a common yeast infection

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4
Q

what is the most common causative agent of vulvovaginal candidiasis

A

candida albicans

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5
Q

clinical presentation

  • vulvar pruritus, external dysuria, burning, dyspareunia
  • thick, curd-like vaginal discharge
  • normal vaginal pH (4-4.5)
A

vulvovaginal candidiasis

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6
Q

what are the risk factors for getting vulvovaginal candidiasis

A
  • abx
  • immunosuppressed
  • pregnant
  • oral contraceptives
  • steroids
  • wearing tight clothes
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7
Q

how is vulvovaginal candidiasis diagnosed

A
  • wet prep (saline and 10% KOH)
    • visualize budding yeasts and hyphae
  • vaginal cultures for Candida
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8
Q

what characteristics classifies a vulvovaginal candidiasis infection as uncomplicated

  • symptom severity
  • frequency
  • organism
  • host
A
  • mild or moderate symptom severity
  • sporadic frequency, < or = 3 times per year
  • caused by candida albicans
  • healthy, non pregnant women
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9
Q

what characteristics classifies a vulvovaginal candidiasis infection as complicated

  • symptom severity
  • frequency
  • organism
  • host
A
  • severe
  • recurrent, > or = 4 x per year
  • nonalbicans species
  • pregnant, uncontrolled DM, immunosuppressed
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10
Q

tx for uncomplicated vulvovaginal candidiasis

A
  • topical azole 1-3 days
    • e.g. clotrimazole
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11
Q

tx for complicated vulvovaginal candidiasis

A
  • topical azole x 7-14 d or
  • oral fluconazole
    • if nonalbicans, avoid fluconazole
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12
Q

does male parterner need treatment if female partner is diagnosed with vulvovaginal candidiasis?

A
  • No, unless he has balanitis
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13
Q

Is bacterial vaginosis an STI

A
  • No
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14
Q

what is the most common cause of vaginal discharge in women of childbearing age

A
  • bacterial vaginosis
    • results from disruption of usual, healthy vaginal microflora (lactobacillus sp.)
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15
Q

causative agent of bacterial vaginosis

A
  • usually polymicrobial
    • ​often associated with Gardnerella vaginalis
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16
Q

clinical presentation

  • thin white or gray discharge
  • strong fishy odor
A

bacterial vaginosis

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17
Q

name risk factors for bacterial vaginosis

A
  • new or multiple sex partners
  • douching
  • can affect women that are not sexually active
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18
Q

how is bacterial vaginosis diagnosed

A
  • Amsel’s criteria- presence of at least 3
    1. ​think white homogenous discharge
    2. clue cells on microscopy
    3. vaginal fluid pH > 4.5
    4. fish odor of vaginal discharge before or after addition of 10% KOH
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19
Q

tx of bacterial vaginosis

A
  • treat symptomatic
  • metronidazole PO or metronidazole gel or clindamycin cream
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20
Q

does male partner need tx if female partner diagnosed with bacterial vaginosis

A

No

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21
Q

patients should not take when taking metronidazole

A
  • ETOH
    • cause Disulfiram-like reaction
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22
Q

complications of having bacterial vaginosis

A
  • increased risk of acquiring HIV, HSV-2, gonorrhea, and chlamydia
    • should be tested
  • increased risk of PID
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23
Q

is Trichomoniasis an STI

A
  • yes
  • most prevalent nonviral STI in the U.S.
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24
Q

causative organism of Trichomoniasis

A

trichomonas vaginalis

  • single celled protozoan parasite
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25
Q

most patients (70-85%) infected with Trichomoniasis have what symptoms

A
  • minimal or no symptoms
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26
Q

clinical presentation

  • vaginal pH > 4.5
  • vulvar irritation
  • malodorous, frothy, yellow-green vaginal discharge
  • may see petechiae on vagina and cervix (“strawberry cervix”)
A

Trichomoniasis

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27
Q

how do symptomatic men present with Trichomoniasis

A
  • urethritis
    • clear or mucopurulent urethral discharge and/or dysuria
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28
Q

how is Trichomoniasis diagnosed

A
  • wet mount: motile organisms
  • nucleic acid amplification tests (NAATs)
  • culture
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29
Q

how is Trichomoniasis treated

A

metronidazole

  • treat patient and partners
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30
Q

pregnancy considerations for Trichomoniasis

A
  • increased risk of premature rupture of membranes, preterm delivery, low birth
  • tx recommended for pt’s with symptoms
  • lactating women should withhold breastfeeding while taking metronidazole
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31
Q

Trichomoniasis retesting protocol

A
  • recommended for all sexually active women within 3 months following initial tx regardless of whether they believe their sex partners were treated
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32
Q

what pt population most commonly affected with chlamydia

A

< or = 24 yo

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33
Q

majority of pts affected with chlamydia have what symptoms

A

asymptomatic

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34
Q

most frequently reported infectious disease in the US

35
Q

causative organism of chlamydia

A

chlamydia trachomatis

  • gram -
36
Q

chlamydia and gonorrhea screening recommendations

A
  • women
    • yearly testing for sexually active women < 25 yrs old
    • older women with risk factors
  • men
    • consider in clinical settings with high prevalence or in high risk populations
      • correctional facilities
      • MSM
37
Q

risk factors for chlamydia

A
  • new sex partner
  • more than 1 sex partner
  • sex partner with concurrent partners
  • sex partners with an STI
38
Q

clinical presentation in women

  • cervicitis
    • purulent or mucopurulent vaginal discharge and or intermenstrual or postcoital bleeding
  • urethritis
    • dysuria, urinary frequency
  • PID
39
Q

clinical presentation in men

  • urethritis
    • penile dx (mucoid or watery), dysuria
  • epididymitis
  • prostatitis
40
Q

how is chlamydia and gonorrhea diagnosed

A

nucleic acid amplifciation testing (NAAT)

  • women: vaginal preferred
  • men: first-catch urine preferred
41
Q

tx chlamydia

A
  • azithromycin or doxycycline
    • treat patient and partner
42
Q

consequences of trichomoniasis

A
  • vaginitis
  • PID
  • infertility
  • HIV
43
Q

complications of chlamydia and gonorrhea

A
  • increased risk of HIV
  • if untreated, can cause PID, ectopic pregnancy, and infertility
44
Q

chlamydia pregnancy considerations

A
  • may lead to preterm delivery
  • transmittable to neonate during delivery
    • ophthalmia neonatorum
    • pna
  • avoid doxycycline (cat D)
45
Q

majority of patients with gonorrhea present with what symptoms

A

asymptomatic

46
Q

patients with chlamydia often have a co-infection with

A

gonorrhea (and vice versa)

47
Q

causative organism of gonorrhea

A
  • neisseria gonorrhoeae
48
Q

clinical presentation in women

  • cervicitis
  • urethritis
    • dysuria
  • cervical mucosa often friable
49
Q

clinical presentation in men

  • urethritis
    • purulent or mucopurulent penile dx
    • dysuria
  • epididymitis
50
Q

how is gonorrhea treated

A
  • dual therapy
    • ​ceftriaxone + azithromycin
  • treat patient and partner
51
Q

gonorrhea: pregnancy considerations

A
  • treat with dual therapy
  • transmittable to neonate during delivery
    • ophthalmia neonatorum
    • sepsis
      • arthritis
      • meningitis
52
Q

what are the two most common causes of nongonococcal urethritis (NGU)

A
  • Chlamydia trachomatis
  • Mycoplasma genitalium
53
Q

what is pelvic inflammatory disease

A
  • refers to a spectrum of inflammatory disorders of the upper female genital tract
    • ​endometriosis
    • salpingitis
    • tubo-ovarian abscess
    • pelvic peritonitis
54
Q

causative organisms of pelvic inflammatory disease

A
  • most common: chlamydia and gonorrhea
  • G. vaginalis, H. influenzae
55
Q

Cervical motion tenderness is commonly seen with acute pelvic inflammatory disease. what is this called

A

chandelier’s sign

56
Q

risk factors of pelvic inflammatory disease

A
  • age < 25
  • african american, black-caribbean ethnicity
  • early onset of sexual activity
  • multiple partners
  • IUD (within first 3 weeks)
  • prior STD
  • douching
57
Q

how is pelvic inflammatory disease diagnosed

A
  • clinical
    • sexually active women
    • pelvic or lower abd pain
    • chandelier’s sign
58
Q

complications of pelvic inflammatory disease

A
  • recurrent PID
  • infertility
  • chronic pelvic pain
  • ectopic pregnancy
  • Perihepatitis: Fitz-Hugh–Curtis syndrome (RUQ pain and adhesions)
59
Q

why is herpes simplex virus so common

A
  • many infected are asymptomatic but can still transmit infection
    • viral shedding can occur when lesions are not present
60
Q

how is genital herpes transmitted? average incubation period

A
  • skin to skin contact
  • average incubation: 4 days
61
Q

differentiate between primary, nonprimary first episode and recurrent genital herpes

A
  • primary: infection in a patient without preexisting antibodies to HSV 1 or 2; most severe
  • nonprimary first episode: acquisition of HSV 2 with preexisting antibodies to HSV 1 (and vice versa)
  • recurrent: reactivation of genital HSV
62
Q

clinical presentation

  • can be asymptomatic
  • multiple, extremely painful, genital vesicles/ulcers
  • local tingling, burning and or pruritis
  • dysuria
  • tender inguinal lympadenopathy
A

genital herpes: herpes simplex virus

63
Q

how is herpes simplex virus diagnosed

A

PCR preferred

64
Q

tx of herpes simplex virus: genital herpes

A
  • treat with cyclovir
    • ​must reduce dose in patients with renal insufficiency
65
Q

herpes simplex virus: genital herpes pregnancy considerations

A
  • transmission to neonate during labor and delivery
    • cesarean reduces risk
  • use antiviral meds during pregnancy (acyclovir) at 36 weeks gestation through delivery
  • 3 syndromes
    • localized skin, eye, mouth disease (SEM)
    • encephalitis
    • disseminated disease
66
Q

how is HPV transmitted

A
  • contact with infected genital skin, mucous membranes, body fluids
67
Q

patients with human papillomavirus typically have what symptoms

A

asymptomatic

68
Q

clinical presentation

  • visible genital warts condyloma acuminata
    • ​soft, flesh colored
    • single or multiple, flat, cauliflower-like
A

human papillomavirus

  • precancerous/cancerous **
69
Q

what types of HPV are strongly associated with anogenital dysplasia and carcinoma

A

16, 18, 31, 33, 35

70
Q

vaccines for human papillomavirus

A
  • cervarix
    • girls
    • HPV 16, 18
  • gardasil
    • girls and boys
    • 4vHPV: 16, 18, 6, 11
    • 9vHPV
  • routinely given at 11-12 yo
71
Q

causative organism of syphilis

A

bacterium treponema pallidum

72
Q

clinical presentation

  • painless chancre
    • ulcer with a raised, indurated margian
A

primary syphilis

73
Q

presentation of secondary symphilis

A
  • appears 2-6 months after primary infection
  • often starts with rash
    • ​non-pruritic
    • characteristically on palms and soles of feet
  • condyloma lata
    • ​large, raised, flat topped lesions in anogenital region and mouth
  • mucous patches
    • ​flat patches in oral cavity
74
Q

differentiate between early and late latent stage of syphilis

A
  • early latent: infection occured < 1 yr ago
  • late latent: infection occured > 1 yr ago
    • less contagious
75
Q

what signs are characteristic of tertiary syphilis

A
  • neurosyphilis
  • gummas
    • destructive, necrotic granulomatous lesions
76
Q

how is syphilis diagnosed

A
  • direct visualization of organism in clinical speciman
    • darkfield microscopy
  • serologic tests
    • nontreponemal test (screening)
      • RPR and VDRL (on CSF)
    • specific treponemal test (confirmatory)
      • fluorescent treponemal antibody absorption (FTA-ABS)
77
Q

a complication of syphilis is jarisch-herxheimer reaction. what is this

A
  • an acute febrile rxn with a HA and myalgias that occurs during PCN therapy
78
Q

pregnancy considerations for syphilis

A
  • transmission during gestation or intrapartum
  • treat with PCN
  • routine screening at 1st prenatal visit
  • residual stigmata
    • hutchinson teeth
79
Q

What is lymphogranuloma venereum

A
  • caused by chlamydia tranchomatis
  • self limited ulcer or papule at site of inoculation
  • causes systemic infection
    • bubo (unilateral, painful, inguinal lymph node)
80
Q

Chancroid

  • causative agent?
  • description
A
  • Haemophilus ducreyi
  • painful genital ulcer + tender suppurative inguinal adenopathy
81
Q

What are the five P’s: important questions to ask when patient presents with possible STI

A
  • partners
  • prevention of pregnancy
  • protection from STIs
  • practices
    • kind of sex you have had recently? vaginal, anal, oral
  • past h/o STIs
82
Q

retesting is recommended for what STIs

A
  • chlamydia
  • gonorrhea
  • trichomonas
83
Q

When should HIV be screened for

A
  • 13-64 yo
  • all persons who seek evaluation and tx for STIs

women's health (5 decks)

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