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Foundations II Exam 6 (Jess) > STIs > Flashcards

STIs Flashcards

1
Q

What populations are at high risk for STIs?

A
  • Youth (15-24)
  • Racial/ethnic minorities
  • MSM
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2
Q

What population accounts for 85% of reported primary/secondary syphilis cases?

A

MSM

- 50% dx are also HIV +

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3
Q

What is the most prevalent non-viral STI in the US?

A

Trichomoniasis (T. vaginalis)

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4
Q

How does trichomoniasis present?

A
  • MC = asx

- Can have sx 1-4wks after

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5
Q

What are sx of trichomoniasis in men?

A

Only 10% have sx

  • Urethritis
  • Epididymitis
  • Prostatitis
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6
Q

How does trichomoniasis present in women?

A
  • ↑ vaginal ph > 4.5
  • vaginal irritation & malodorous frothy yellow-green discharge
  • petechiae on cervix or vagina (“strawberry cervix”)
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7
Q

How do you dx trichomoniasis?

A
  • Wet mount
  • Swab (culture or NAAT)
  • Pap (incidental finding)
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8
Q

What is a NAAT?

A
  • technique used to detect genetic material of an organism

- faster than culture, sensitive

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9
Q

How do you tx trichomoniasis? When do you retest?

A
  • Tx pt & sexual partners
  • Metronidazole oral
  • Abstain from sex until tx complete
  • Retest within 3 mos
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10
Q

What is a complication of trichomoniasis?

A

Increases risk of acquiring/transmitting HIV

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11
Q

Trich: What are pregnancy considerations?

A
  • Increases risk of premature rupture of membranes, preterm delivery, & low birth wt
  • Lactating women should hold breastfeeding 12-24 hrs after metronidazole dose
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12
Q

What is the MC BACTERIAL STI in the US?

A

Chlamydia (C. trachomatis)

Gram -

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13
Q

What are general demorgraphics/features of chlamydia?

A
  • Peaks in late teens (20s)
  • Women ≤ 25 should be screened (or older women w/ RFs)
  • Co-infection w/ gonorrhea is common
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14
Q

What are sx of chlamydia?

A
  • MC = asx
  • Sx may occur 1-3 wks after
  • W: Cervical discharge, vag bleeding, low abd pain, F/C, adnexal tenderness
  • M: Irritated urethra, penile discharge, dysuria
  • Oral/rectal infections
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15
Q

How do you dx chlamydia?

A
  • 1st catch urine specimen, endocervix or vagina (NAAT)

- Pharynx or rectal swab (NAAT)

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16
Q

How do you tx chlamydia? When do you retest?

A
  • Tx pt & sexual partners
  • Azithro or doxy for 7 days
  • Abstain from sex during tx
  • Consider tx for gonorrhea
  • Retest in 3-4 mos
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17
Q

How do you tx pregnant pts w/ chlamydia?

A
  • Avoid doxy (category D)

- Perform test-of-cure 3 wks after therapy completion

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18
Q

What are complications of chlamydia?

A
  • Increased risk of acquiring/transmitting HIV

- If untx –> PID

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19
Q

What are complications of chlamydia in pregnant pts?

A
  • Preterm delivery

- Can transmit to baby –> conjunctivitis or pneumo

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20
Q

What are characteristics of gonorrhea?

A
  • N. gonorrhea
  • Sx occur 1-14 days after
  • Annual screen women ≤ 25
  • Can cause oral/rectal infections
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21
Q

What is the clinical presentation of gonorrhea in women?

A
  • MC = asx

- Vag discharge, low abd pain, fever, cervical motion tenderness

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22
Q

What is the clinical presentation of gonorrhea in men?

A
  • Irritated urethra, white/yellow/green discharge, dysuria
23
Q

How do you dx gonorrhea/

A
  • Same as chlamydia
  • Tx failure –> culture & sensitivity
  • Gram stain: PMN leuks w/ gram - diplococci
24
Q

What are complications of gonorrhea?

A
  • Increased risk of acquiring/transmitting HIV
  • If untx –> PID
  • Conjuctivitis, meningitis, endocarditis, & disseminated disease
25
Q

What are pregnancy considerations in gonorrhea?

A

Transmittable to baby

  • Conjunctivitis –> perforation of the globe/blindness
  • Requires neonatal prophylaxis
  • In newborns w/ sx: ocular specimens should be tested
26
Q

What is PID? What organisms cause it?

A
  • Inflammatory disorders of upper genital tract
  • Chlamydia, gonorrhea
  • Anaerobes, H. influenzae
27
Q

What is the patho of PID?

A

Ascending infection from vagina/cervix to upper genital tract

28
Q

What are the RFs for PID?

A
  • < 25
  • AA race
  • Early sexual activity
  • Multiple partners
  • Douche
  • IUD
  • Prior hx of PID
29
Q

What is the clinical presentation of PID?

A
  • Subtle or mild sx

- Low abd/pelvic pain, cervical motion tenderness (chandelier sign), uterine or adnexal tenderness

30
Q

When does chronic infection occur in PID? What are the sx?

A
  • Insufficient tx

- Vague sx

31
Q

How do you dx PID?

A
  • HCG
  • Test for GC & chlamydia
  • WBCs on microscopy
  • CBC, ESR, CRP
  • U/S
  • Endometrial biopsy
  • Laparoscopy
32
Q

What is the tx for PID? When do you f/u?

A
  • Begin prior to results
  • Ceftriaxone (covers GC)
  • Doxy (covers chlamydia)
  • W/ or w/out metronidazole (covers trich)
  • Abstinence until tx complete
  • F/u in 48 hrs
33
Q

Hospitalize for PID if…

A
  • surgical emergencies cannot be r/o
  • pt is pregnant
  • pt is not responding to abx
  • pt has tuba-ovarian abscess
  • Pt is ill: fever (>102.2), N/V
34
Q

What are complications of PID?

A
  • Infertility
  • Ruptured tuba-ovarian abscess (emergency)
  • Chronic pelvic pain
  • Increased risk of ectopic pregnancy
  • Fitz-Hugh-Curtis syndrome (perihepatitis w/ RUQ pain)
35
Q

What are characteristics of herpes genitalis?

A
  • Minimal or no sx
  • 4 designations: primary, non-primary 1st episode, recurrent, asx viral shedding
  • Commonly acquired from asx partner
36
Q

What is the patho of genital herpes?

A
  • shedding can occur when lesions NOT present
  • virus remains latent in ganglion
  • virus reactivated by change in immune system
37
Q

What is the clinical presentation of genital herpes?

A
  • Prodrome: burning, tingling, pruritus
  • Painful vesicles on erythematous base
  • 1st outbreak = most severe
38
Q

How do you dx genital herpes?

A
  • Clinically! confirm w/ tests
  • Swab of active lesions (culture, NAAT)
  • Cytologic detection of cell changes = Tzanck prep
  • Serology
39
Q

How do you tx genital herpes? What is the duration?

A
  • Acyclovir, valacyclovir, famiciclovir
  • 1st outbreak: 7-10 days
  • recurrent: 1-5 days
40
Q

What are pregnancy considerations in herpes genitalis?

A
  • Vertical transmission before, during, & after delivery
  • During vag delivery = MC
  • Most infants w/ HSV are born to mother w/ no known hx of genital HSV
41
Q

What are 3 syndromes in neonates caused by genital herpes?

A
  • Localized skin, eye, mouth disease (SEM)
  • CNS disease (encephalitis)
  • Disseminated disease
42
Q

How do you prevent HSV in neonates?

A
  • Suppressive viral therapy at or beyond 36wks gestation

- Perform C-section

43
Q

What is the MC STI?

A

HPV

> 40 types

44
Q

What is the clinical presentation of HPV?

A
  • MC = asx
  • Genital warts (condyloma acuminata)
  • PreCA/CA changes
45
Q

How do you dx HPV?

A
  • Visualize warts
  • Abnormal pap
  • No test for men
46
Q

How do you tx HPV?

A
  • Destruction of warts (pt or provider applied)

- Tx preCA/CA changes

47
Q

What are complications of HPV?

A
  • 15 types –> cervical CA

- Type 16 & 18 account for 70% of cervical CA

48
Q

How do you prevent HPV?

A

9-valent HPV (Gardais 9)

  • < 15 = 2 doses at 0 & 6-12 mos
  • > 15 = 3 doses at 0, 1-2, & 6 mos
49
Q

What are pregnancy considerations in HPV?

A
  • Rarely transmitted to neonate

- Consider C-section if pelvic outlet obstructed or if vag delivery could result in excessive bleeding

50
Q

What are characteristics of syphilis?

A
  • T. pallidum “Great imitator”
  • Increasing prevalence
  • Direct contact w/ infected lesion
  • Enters skin in 10-90 days –> painless chancre
51
Q

What is the clinical presentation of primary syphilis?

A
  • Incubation: 21 days
  • Painless chancre
  • Raised indurated border
  • Persists 3-6 wks
52
Q

What is the clinical presentation of secondary syphilis?

A
  • Wks to pos after chancre
  • lymphadenopathy - epitrochlear
  • Rash (common)
  • Condyloma lata
  • Mucous patches
53
Q

What is the presentation of latent syphilis?

A
  • Asx
  • No longer transmittable
  • May persist for yrs
54
Q

What is the presentation of LATE syphilis?

A
  • May appear 10-20 yrs after
  • Develops in 15% of those untx
  • Causes neuro deficits & damage to internal organs

Foundations II Exam 6 (Jess) (4 decks)

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