STIs Flashcards
3 most common types of vaginitis
- Bacterial vaginosis
- Vulvovaginal candidiasis
- Trichomoniasis
Vaginitis usually involves these sx’s, regardless of etiology
Itch & discharge
Bacterial vaginosis is mostly due to ________
Gardnerella vaginalis
Vulvovaginal candidiasis is mostly due to _______
Candidiasis albicans
Sx’s associated with bacterial vaginosis
- Asymptomatic
- Malodorous, fishy smell
- Pruritic discharge
- Thin, milky-white/grey discharge
Discharge esp. after sex or menses
Sx’s associated with Candidiasis
- Dysuria
- Thick, cottage cheese-like discharge
Sx’s associated with trichomoniasis
- Mostly asx
- Frothy, malodorous discharge
- Strawberry cervix (cervical petechiae)
Identify etiology of vaginitis by vaginal pH
≤4.5 = Normal or candidiasis >4.5 = Bacterial vaginosis or trichomoniasis
Dx bacterial vaginosis
Amsel criteria → 3+ of the following:
- Vaginal pH >4.5
- > 20% “clue cells” per high-power field on wet mount
- Positive amine or “whiff” test
- Homogenous, non-viscous milky discharge adherent to vaginal walls
+Affirm VPIII for G. vaginalis DNA
Vaginal sialidase activity test (OSOM PV test)
Dx candidiasis
Mostly clinical (cottage cheese discharge)
- Pseuodohyphae & budding yeast on KOH prep
- Few to many WBCs on wet mount
If both negative or recurrent → culture
Dx trichomoniasis
- Nucleic acid amplification test (Aptima) via urine/genital swab
- Rapid antigen test (Affirm VPIII) or nucleic acid probe test (DNA hybridization)
- Wet mount: Motile flagellated protozoa, many WBCs
- Vaginal Cx
Tx gonorrhea
ceftriaxone 250mg IM x1 PLUS azithromycin 1g PO x1
Tx chlamydia
azithromycin 1g PO x1 OR doxycycline 100mg PO bid x7d
Treat GC/chlamydia w/ epididymitis (i.e. complicated)
ceftriaxone 250mg IM x1 PLUS doxy 100mg bid x10-21d
Tx GC/chlamydia with proctitis (i.e. complicated)
ceftriaxone 250mg IM x1 PLUS doxy 100mg bid x7-21d
Repeat testing after tx for GC/chlamydia in pregnant pt
NAAT re-test in 3wks
Repeat testing after tx for GC/chlamydia in nonpregnant pt
In 3-4 months AND screen at next health care visit
No test of cure unless compliance is in question, sx’s persist, or re-infection
Counseling for GC/chlamydia pt
- Avoid sex until pt and partners are cured (asx for 7 days)
- Tx partners within last 60 days
Sx’s of GC/chlamydia in women
Dysuria, mucopurulent discharge, CMT, pruritic/tender uterus, PID sx’s, bleeding, cervicitis (red/friable)
Sx’s of gonorrhea in men
- White, yellow, or green discharge +/- penile edema
Sx’s of chlamydia in men
Clear mucoid or watery urethral discharge, maybe only w/ milking
Most cases of PID are ______
Polymicrobial - N. gonorrhoaea & C. trachomatis
Risk factors of PID
- Adolescence
- Low socioeconomic status
- Multiple partners
- Hx of GC/chlamydia
- Bacterial vaginosis
- Current douching
- IUD
- OCP (some cases)
Si/Sx’s of HPV infection
Most cases have are transient, with no manifestations
- Dyspareunia, pruritus, burning, bleeding
- Genital warts → condylomata acuminata, smooth/flat papules, keratotic
- Pap abnormalities
Tx HPV
Pt-applied → podofilox gel/solution, imiquimod, or sinecatachins ointment (not in HIV pts)
Provider-applied → cryotherapy, podophyllin resin in benzoin, trichloracetic acid, bichloracetic acid, surgical removal
**Thearpies reduce but don’t eliminate infectivity
When do HPV sx’s clear?
Many recur within 6-12 wks of tx but clear by 6 months
HSV-1 vs. HSV-2
HSV-2 more common in women and more prone to recur
T or F: antiviral therapy dramatically reduces HSV shedding in asx pt but doesn’t completely eliminate it
True
HSV tx
Valacyclovir → partially controls sx’s but does NOT eradicate latent virus; does NOT affect recurrence
- 1st ep → 1g PO bid x7-10d
- Suppressive → 1g PO qd
- Episodic → 500mg PO bid x3days OR 1g PO qd x5days
Patient education/counseling for HSV
- Natural hx of infection, tx options, transmission, neonatal prevention
- Prodromal sx’s for episodic tx
- Emphasize potential for recurrence, asx viral shedding/transmission
- Inform all sex partners
- Abstinence when lesions/prodrome present
Stages of syphilis
Primary vs. Secondary vs. Latent vs. Tertiary (Late)
High-risk population of syphilis
MSM, esp. blacks
Sx’s associated w/ primary syphilis
Chancre - painless indurated lesion w/ non-exudative clean base; heal spontaneously in 3-6wks
Serology may not be positive during early phase
Sx’s associated w/ secondary syphilis
Palmar/plantar rash, may last for months
Serology highest in this stage
Sx’s associated w/ latent syphilis
No lesions, only positive serology
Early latent → <1 yr duration
Late latent → ≥1 yr duration or unknown
Sx’s associated w/ late/tertiary syphilis
Gummatous lesions, CV syphilis - may occur at any point up to 30 yrs after primary infection
Dx syphilis
Serology - must use more than one test
- Darkfield microscopy
- Non-treponemal (Reagin Ab) → can measure tx efficacy
- Treponemal (antibody) → more specific but can’t measure tx efficacy
When should you screen for syphilis?
1st prenatal visit of pregnant women, esp. if hx stillborn after 20wks
Anyone else suspicious
