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Women's Health > STIs > Flashcards

STIs Flashcards

1
Q

5 Ps of taking sexual history

A

Partners: men, women, both; how many in past year; last time you had sex?

Practices: anatomic sites of exposure

Prevention: desire to be pregnant? what are they doing to prevent?

Protection from STIs: frequency of condom use

Past hx of STI: pt and partners

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2
Q

special populations: youth

why do we take extra time with these populations

A

15-24

account for half of all new STIs

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3
Q

other special populations

A

men who have sex with men

pregnant women

HIV-infected pts

individuals entering correctional facilities

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4
Q

symptoms of vaginitis

A

discharge

odor

pruritus/discomfort

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5
Q

3 most common causes of vaginitis

A

candida vulvovaginitis

bacterial vaginosis

trichomoniasis

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6
Q

pt comes in with vaginal discharge. how do you approach it?

A

differentials

important hx

important components of physical exam

testing

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7
Q

is vulvovaginal candidiasis an STI

A

no

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8
Q

causative organ of vulvovaginal candidiasis

A

c. albicans

c. glabrata

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9
Q

clinical presentation of vulvovaginal candidiasis

A

pruritis

external dysuria

vulvar soreness

dysparaunia (painful sex)

abnormal vaginal discharge

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10
Q

physical exam vulvovaginal candidiasis

A

white, thick curd like vaginal discharge adherent to vaginal walls

maybe edema, fissures, excoriations, erythema

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11
Q

risk factors of vulvovaginal candidiasis (VVC)

A

DM

antibiotic use

increased estrogen levels

immunosuppressed

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12
Q

dx of vulvovaginal candidiasis

A

clinical + (definitive) wet mount (10% KOH) - looking for budding yeast, hyphae, or pseudohyphage; normal vaginal pH (less than 4.5) which supports dx of VVC or rules out trich!

culture - if we want to figure out what species it is

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13
Q

VVC tx is for what: to eradicate candida OR for tx of symptoms

A

ONLY FOR RELIEF OF SYMPTOMS!!!!

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14
Q

uncomplicated of complicated VVC

sporadic or infrequent

mild to moderate symptoms

candida albicans

healthy, nonpregnant women

A

uncomplicated

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15
Q

uncomplicated or complicated VVC

severe symptoms

recurrent yeast infections

nonalbicans species

pregnancy, poorly controlled DM, immunosuppression

A

complicated

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16
Q

tx regiment for uncomplicated VVC

A

short course (1-3 days) of topical azole (OTC)

or

oral fluconazole (diflucan) 150 mg PO - one dose

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17
Q

tx regimen complicated for VVC

what happens if nonalbicans?

A

treat for longer duration (7-17 days) of topical azole (OTC)

or

oral fluconazole (150mg q 72 hours for 2-3 doses)

IF NONALBICANS, do not use fluconazole

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18
Q

what tx is preferred for pregnancy

A

topical tx for 7 days

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19
Q

do we tx sex partners for VVC?

A

nope

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20
Q

is bacterial vaginosis classified as STI

A

no

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21
Q

most common cause of vaginal discharge in women of childbearing age

A

bacterial vaginosis

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22
Q

causative organism of bacterial vaginosis

A

polymicrobial

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23
Q

clinical presentation of bacterial vaginosis

A

asymptomatic (50-75%)

symptomatic: vaginal discharge and/or vaginal odor: thin, white, or grey discharge with a strong “fishy smell”

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24
Q

risk factors for bacterial vaginosis

A

sexual activity - new or multiple

presence of other STIs

Race/ethnicity (AA, MA)

Douching (regularly)

Smoking

Lack of condom use

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25
Q

Dx considerations for bacterial vaginosis

A

clinical by Amsel’s dx criteral

can do gram stain

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26
Q

what is Amsel’s criteria for bacterial vaginosis?

A

presence of at least three:

thin, white, homogenous discharge

clue cells on saline wet mount

vaginal fluid over 4.5

positive whiff test - presence of fishy odor when drop of 10% KOH is added to sample of vaginal discharge

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27
Q

clue cells - indicate what

A

bacterial vaginosis

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28
Q

tx pts with or without symptoms

A

ONLY WITH SYMPTOMS

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29
Q

a woman comes in with NO symptoms for her pap smear and bacterial vaginosis, what do you do

A

NOT TX. THERE ARE NO SYMPTOMS

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30
Q

most commonly used tx for bacterial vaginosis (3)

A

metro (500 mg PO BID x 7 days)

metro gel (.75% intravaginally QD times 5 days)

clindamycin cream 2% intravaginally QHS times 7 days

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31
Q

what do you avoid when taking metro?

A

ETOH

tell your pts NOT to drink with metro~

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32
Q

FDA approved in 2017 for tx of bacterial vaginosis

A

secnidazole - single 2 gram oral dose

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33
Q

complications of bacterial vaginosis

A

increases risk of acquiring and transmitting HIV

increases risk of acquiring HSV-2, N. gonorrhea, C. trach, T. vaginalis

Bacterial vaginosis is more common among women with PID

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34
Q

causative organism of trichomoniasis

A

t. vaginalis (flagellated protozoan)

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35
Q

most common nonviral STI wordwide

A

trichomoniasis

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36
Q

coexistence of ___ and ___ pathogens are common

A

t. vaginalis and bacterial vaginosis

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37
Q

clinical presentation of trichomoniasis

A

asymptomatic

vaginal discharge +/- vulvar irritation: malodorous, frothy, yellow-green vaginal discharge; burning, pruritus, dysuria, dyspareunia

postcoital bleeding!!!!

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38
Q

physical exam of trichomoniasis

A

punctuate hemorrhages on vagina and cervix - strawberry cervix

vaginal pH over 4.5

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39
Q

strawberry cervix

A

trichomoniasis

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40
Q

highly sensitive and specific trichomoniaiss dx tool - GOLD STANDARD

A

nucleic acid amplification test - do on vaginal, endocervical, or urine speciments

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41
Q

if trichomoniasis goes untreated, what can happen (complications)

A

urethritis or cystitis

PID (those with HIV)

cervical neoplasia

infertility

increased risk of acquireing and trasnmitting HIV

increased risk of premature rupture of membranes; preterm delivery; low birth weight

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42
Q

tx of trichomoniasis: symptomatic, asymptomatic, or both

A

BOTH

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43
Q

do we treat sexual partners with trichomoniasis

A

YES - expedited partner tx

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44
Q

tx regimen for trichomoniasis

A

metro 2 grams single dose

tinidazole 2 grams single dose

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45
Q

tx of trichomoniasis in pregnancy

A

metro 2g single dose

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46
Q

for how long do you suggest abstainance from sex

A

7 days after tx of BOTH self and partner

must be asymptomatic

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47
Q

what must you test for with trichomoniasis

A

other STIs

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48
Q

repeat testing with what dx

A

trichomoniasis

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49
Q

when do you repeat test for trich and why

A

within 3 months following initial tx

reinfection rates up to 17% have been reported in women tx for trichomoniasis

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50
Q

CDC recommends screening for t. vaginalis in ____

A

all HIV infected women - annually and at prenatal visits

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51
Q

what are high prevalance settings in which you should consider trich screening

A

STI clinics

correctional facilities

52
Q

most frequently reported infectious disease in US

A

chlamydia

53
Q

majority of women present how with chlamydia

A

asymptomatic (85%)

54
Q

causative agent of chlyamida

A

chlamydia trachomatis

55
Q

most common site involved with clamydia

A

cervix

56
Q

symptoms related to chlamydia with cervicitis

A

change in vaginal discharge

+/- intermenstrual or postcoital bleeding

THESE ARE IF THEY ARE SYMPTOMATIC. Most often asymptomatic.

57
Q

symptoms related to chlamydia with urethritis

A

frequency and dysuria

58
Q

physical exam of chlamydia

A

cervix: mucopurulent, endocervical discharge

friability, erythmea, edema

59
Q

dx of chlamydia

A

NAAT: dx test of choice

vaginal swab preferred: endocervical swab or urine

60
Q

complications of chlamydia

A

PID, ectopic preg, infertilty, chronic pelvic pain

pregnancy complications - increased risk of premature rupture of membranes, preterm delivery, transmittable to neonate during delivery

61
Q

tx chlamydia

regular population and pregnancy

A

regular: tx pt and sex partners:

azithromycin 1 gm PO single dose

doxy 100mg PO BID for 7 days

Pregnancy: tx with azithrymycin; test for cure

62
Q

avoid what with chlamydia

A

intercourse until tx is complete and resolution of sx - 7 days after single dose or after 7-day tx course is done

63
Q

what else must you test for with chlamydia

A

other STIs

64
Q

do you repeat testing for chlamydia

A

YES

65
Q

annual screening for whom with chlamydia

A

all sexually active women less than 25 y/o

66
Q

screen older women for chlamydia with what risk factors

A

new or multple sex partners

sex partner recently tx for STI (or has STI)

no or inconsistent condom use outside a mutually monogamous relationship

Hx of prior STI

exchange sex for drugs or money

67
Q

2nd most commonly reported communicable disease in US

A

gonorrhea

68
Q

most common clinical presentation of gonorrhea

A

asymptomatic

69
Q

what is of increasing concern with gonorrhea

A

antimicrobial resistance!

70
Q

causative agent with gonorrhea

A

n. gonorrhea

71
Q

if people present with gonorrhea and symptoms, clinical presentation is

A

change in vaginal discharge

+/- intermenstrual or postcoital bleeding

frequency and dysuria

mucopurulent endocervical discharge

friable, erythema, and edema cervix

72
Q

dx of gonorrhea

A

NAAT - vaginal swab perferred (can do endocervical swab or urine)

cultre when antibiotic resistance suspected

73
Q

gonorrhea complications

A

PID, ectopic preg, infertility, chronic pelvic pain

Disseminated gonococcal infection

complications: risk of preterm birh, low birth weight,
ifnection; transmissable to neonate

74
Q

gonorrhea tx for regular people and pregnant people

A

regular: tx pt and sex partner:

ceftriaxone 250 mg IM AND azithromycin 1 gram PO single dose

SAME FOR PREGNANCY

75
Q

avoid what with gonorrhea tx

A

sexual intercourse for 7 days after tx + resolution of symptoms

76
Q

screening for gonorrhea:

A

same as chlamydia

ALL sexually active women ages less than 25

older women with risk factors

77
Q

initiated by sexually transmitted agent which ascends into upper genital tract

A

PID

78
Q

what two organisms cause PID

A

n. gonorrhea
c. trachomatis
others: BV assoc pathogens and emerging: mycoplasms genitalium

79
Q

PID represents a ____ of infection

A

spectrum - combo of endometritis, salpingitis, tubo-ovarian abscess, pelvic peritonitis

1 in 8 women with hx of PID have trouble getting preg

80
Q

PID pts at risk?

what population at highest risk

A

highest risk: women with multiple partners

younger age (less than 25)

hx of prior PID or STI

IUD - 3 weeks after insertion

disruption of normal vaginal flora - certain types of BV

81
Q

PID symptoms

A

lower abdominal pain - onset during or shortly after menses

abnormal vaginal discharge

abnormal uterine bleeding

dyspareunia

fever

82
Q

physical exam of PID

A

Abdominal or uterine tenderness

cervical motion tenderness - chandelier sign

purulent endocervical discahrge and/or vaginal discharge

83
Q

chandelier sign

A

PID

84
Q

PID: what must you get

A

pregnancy test

85
Q

PID: what dx

A

microscopy vaginal discharge (wet mount) - check for WBCs (leukorrhea, greater than 10 WBC hpf)

86
Q

leukorrhea

A

PID

87
Q

when unsure, what additional test can be done for PID dx

A

pelvic ultrasound

88
Q

dx of PID

A

difficult – can be clinical with sexually active young women + pelvic or lower abdominal pain + evidence of cervical motion, uterine, or adnexal tenderness on exam

89
Q

additional findings that can aid in dx of PID

A

over 101F temp

abnormal cervical or vaginal mucopurlent discharge or cervical friability

presence of abundant numbers of WVS on saline microscopy

elevated EST or CRP

documented cervical infection with c. trach or n. gonnorhea

90
Q

PID tx: outpatient

A

ceftriaxone 250 mg IM single dose AND doxy 100 mg BID for 14 days

with or without metro (500mg PO BID for 14 days)

close follow up is essential - 48-72 hours

91
Q

When to hospitalize with PID

A

preg

lack of response to oral meds (within 72 hours)

concern for nonadherence

inability to take oral meds due to N/V

severe clinical illness - high fever, N/V

complicated PID with pelvic abscess

surgical emergencies are not excluded (may be appendicitis)

92
Q

PID complications

A

infertility

chronic pelvic pain

risk of ectopic preg

perihepatitis (fitx-hugh curtis syndrome): RUQ pain and adhesions!! BOARDS!

93
Q

abstain from sexual intercourse with PID tx until

A

therapy is completed

symptoms have resolved

partners tx

repeat testing for those with positive chlyamydial or gonococcal PID in 3 months

94
Q

if PID is positive, do you treat for both chylamida and gonorrhea

A

YEP

95
Q

most common STI in the US

A

HPV

96
Q

how is HPV transmitted

A

through contact with infected skin or mucosa (JUST NEED SKIN TO SKIN CONTACT - DO NOT NEED TO HAVE WARTS)

97
Q

40 types of HPV can be transmitted how

A

through sexual contact and infect the anogenital region

98
Q

aka anogential warts

A

condyloma acuminata

99
Q

risk factors for anogenital warts

A

sexual activity (main one)

smoking

immunosuppression (assoc with more treatment-resistant disease, higher rates of recurrence, malignant transformation of anogenital warts)

100
Q

6 or 11 - oncogenic or not

A

not - low oncogenic activity

101
Q

what types are most commonly detected with HPV

A

6 and 11

102
Q

are co-infections with HPV 6 and 11 common with malignant HPV types

A

yep

103
Q

what are the two types of HPV with high oncogenic activity

A

16/18

104
Q

clinical presentation with anogenital warts

A

usually asymptomatic but may be pruritic

soft, flesh colored smooth or plaque like (cauliflower like)

105
Q

where are anogenital warts found

A

vulva

penis

groin

vagina

perianal skin

suprapubic skin

106
Q

dx for anogenital warts

A

clinical ususally

can do anoscopy

107
Q

tx for anogenital warts

A

cyto-destructive (podofilox, trichloracetic acid, bichloracetic acid)

immune mediated (imiquimod, sinecatechins)

surgical (cryotherapy, laser, electrcautery, excision)

108
Q

prevention of HPV

A

vaccine!!!!!!!

condoms used consistently and correctly

limiting number of sex partners

genital warts can be tx but no cure

109
Q

can the body clear itself of HPV

A

yes - sometimes

110
Q

can you tx HPV with vaccine

A

nope - prevention only

111
Q

genital herpes subtypes

A

genital - subtype 2

oral - subtype 1

112
Q

how is HSV transmitted

A

mucosal surfaces, genital, oral secretions - contact with HSV

many have minimal or no symptoms - 70% of transmission occurs during times of asymptomatic HSV shedding

avg incubation: 4 days

113
Q

primary infection: HSV

A

infection without preexisting antibodies to either HSV-1 or 2

longer duration, increased viral shedding, and systemic symptoms

may last 2-4 weeks if left untreated

114
Q

non-primary first episode genital herpes

A

acquisition of genital HSV 2 in pt with preexisting antibodies to HSV 1 (or vice versa)

symptoms usually milder than primary infection

115
Q

recurrent infection genital herpes

A

reactivation of genital HSV

disease usually less severe and shorter in duration

116
Q

clinical presentation of genital herpes - primary infection

A

painful genital ulcers, dysuria, fever, tender local inguinal lymphadenopathy, headache

some may be mild or even asymptomatic

117
Q

recurrent infection genital herpes clinical presentation

A

prodromal symptoms BEFORE eruption (tingling)

less severe than primary infection

118
Q

viral culture for genital herpes dx

more or less sensitive than PCR

A

dx yield is highest in early stages of disease

less sensitive than PCR

119
Q

PCR: more sensitive or less sensitive than culture

A

more sensitive

120
Q

Serologic tests - how do they work and what are their limitations

A

detect antibodies

false-negatives might be frequent in early stages of infection

121
Q

what does genital herpes testing mean?

HSV-2 antibodies

HSV-1 antobodies

do you screen for both?

A

2 - anogenital infection

1 - can be either anogenital or orolabial infection

do not need to screen both in general population - not indicated

122
Q

tx of genital herpes: first clinical episode

A

valtrex or zoviraz or famiciclovir for 7-10 days; START WITHIN 72 HOURS

123
Q

tx of genital herpes:

episodic tx for recurrent outbreaks

A

same meds; 1-5 day regimen

124
Q

suppression of genital herpes:

A

once a day or BID dosing

reduces frequency of recurrences and risk of transmission to partner

periodically reassess as needed

125
Q

why should you counsel your genital herpes pt?

A

prevention of sexual transmission

disclose HSV status to sexual partners

use condoms

identify concerns or miconceptions

126
Q

describe vertical transmission with HSV

A

transmitting to infants before during and after delivery

Women's Health (2 decks)

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