STIs Flashcards
what is the most common STI?
chlamydia (1 in 4 people)
what aged people are the highest rates of gonorrhea and chlamydia?
females aged 15-19
5 P’s of Sexual hx to ask a pt
partners, prevention of pregnancy, protection from STDs, practices, and past hx of STDs
USPSTF and CDC recommend _________ sexual risk assessment to determine which patients are most likely to benefit from _______ _______
periodic; STD screening
what is the 2015 screening recommendation of USPSTF for chlamydia and gonorrhea? (females)
annually screen sexually active women aged 24 and younger for chlamydia (AND older women at an increased risk of infection for BOTH)
how do we define STD
“screening”
people at risk who DON’T have symptoms
what is the CDC’s recommendation for gonorrhea and chlamydia screening? (females)
screen sexually active females 25 years and younger every year for both diseases
what is the CDC’s and USPSTF’s screening guidelines for HIV? (females mostly)
CDC: everyone 13-64 yr should be tested once (male and female)
USPSTF: screen adolescents and adults at risk for infection
what is the ACOG’s and USPSTF’s screening guidelines for HPV? (females)
start cervical screening with Pap tests at age 21; every 3 yrs after (HPV/Pap every 5 years for people 30 yrs or older)
CDC and USPSTF don’t recommend screening for what 5 diseases? (females)
syphilis, trich, HSV, HCV, and HBV
should you screen for GC/chlamydia in asymptomatic MSM?
yes, some recommendations are for it
what is CDC and USPSTF chlamydia screening guidelines for men?
CDC: consider screening in clinical settings with high prevalence
USPSTF: insufficient evidence to recommend screening
Is gonorrhea screening recommended for men?
no (only asymptomatic MSM)
what are HIV screening guidelines for men?
screen those at a higher risk, including all persons who seek evaluation and tx for STDs
Is HPV infection common with WSW?
yes, especially if one woman has had sex with men previously
are there reliable resources of sexual health info for WSW?
no, few comprehensive and reliable resources on how to screen for STDs in WSW
if diagnosed with gonorrhea, when is the next screening interval?
re-test in 3 months after meds (test for cure)
what are screening guidelines for patients “at risk” with negative screen?
screen again in 12 months
for high risk pts, how often should they get an HIV screen?
annually
general STD symptoms for males?
often asymptomatic (penile discharge, itch, burning vesicles, painless chancres)
general STD symptoms for females?
most common compliant- vaginal discharge BUT often ASYMPTOMATIC (can have itch, burning vesicles, pelvic pain)
what are some general non-genital STD symptoms? (male and female)
skin rashes, arthritis, rectal/oropharyngeal infections
what is expedited partner therapy?
the clinical practice of treating the sex partners of pts diagnosed with chlamydia or gonorrhea by providing prescriptions or meds for the pt to take to his/her partner (carilion doesn’t support this but state of virginia does)
incubation time of chlamydia? are most cases diagnosed?
5-7 days; no because most are asymptomatic
men and women symptoms of chlamydia
men: common to be asymptomatic (clear discharge, normal urine)
women: common to be asymptomatic (70%), mild discharge is most common complaint (usually no odor), dysuria, maybe bleeding after sex
what happens in untreated chlamydia for females and males?
females: increase in PID, with scarring of the uterus which can lead to ectopic preg, premature rupture of membranes, miscarriage
males: non-gonococcal urethritis, inflammation of epididymis and prostate
gold standard of chlamydia dx
NAATS- nucleic acid amplification tests (urine-best for male/endocervical-best for women)
**same as PCR
self collected vaginal swabs for chlamydia have _____ S&S as provider collected
SAME
tx of chlamydia
azithromycin 1 gm (doxycycline less effective, azithro ESP for pregnant women)
is retesting after chlamydia tx recommended?
no
CDC says to test for ____, ____, and _____ in pts with chlamydia dx
GC, HIV, and syphilis
what is the 2nd most reported STI in the US
gonorrhea
symptoms of gonorrhea for men; what part of the GU tract can it affect?
mainly symptomatic (appears 2-5 days post contact): purulent drainage, burns when urinating, hurts like razor blades; any part of the GU tract
female symptoms of gonorrhea
copious cervical discharge, dysuria, frequency, moderate inflamed cervix (more symptomatic during menses)
** consider this in rape victims
gonorrhea in women can affect what part of the GU tract? it may progress to what disease?
affect any part; may progress to PID
gonorrhea dx gold standard and what’s normally done in clinical practice
GS: culture (99% specific) Practice: PCR/NAAT test (men: first void urine, females: cervical swab)
tx of uncomplicated GC
ceftriaxone (250 mg in US, 500 mg in Europe) plus azithromycin OR doxycycline (covers tx of chlamydia as well)
disseminated dz clinical manifestations
“hot joint”, fever, rash, mostly seems like an asymptomatic local infection
gold standard dx for disseminated dz
culture (must tap the joint for stain and culture)
tx for disseminated dz
hospital protocol: usually ceftriazone 1 g every 24 hrs for 1-2 days PLUS azithromycin 1 gm (oral agent then for 7 day total)
____% of GC and chlamydia will develop PID; what is this usually do to?
10%; untreated or improper tx of GC/chlamydia
three major signs of PID on physical exam
1) . shuffling gait: due to inflammation of infected organ
2) . cervical motion tenderness
3) . chandelier sign on pelvic exam
what is dangerous about PID?
these pts can become septic if not tx asap (less life threatening: scarring leading to infertility/chronic pelvic pain)
PID is an ___________ infection
ascending
which pts should be treated outpatient for PID? (6)
temp, 101.5; WBC <11,000, minimal evidence of peritonitis, active bowel sounds, can take oral nourishment, RELIABLE
which pts should be treated inpatient for PID? (6)
pregnant, non compliant, temp > 101.5, WBC > 11,000, dx uncertain, suspected abscess
outpatient tx of PID
ceftriaxone IM plus doxycycline for 14 days (maybe metronidazole for 2 weeks too)
what STD is the most common cause of genital ulcers?
HSV
HSV I vs II
I: oral
II: genital
can you transmit HSV when not having an outbreak?
yes
2 main methods of transmission of HSV
sexual/oral contact & childbirth transmission
70% of HSV transmission is when?
during asymptomatic shedding (hence epidemics)
when is primary outbreak of HSV usually?
2-12 days after exposure
are males or females at a greater risk of HSV?
females because they have increased mucosal surfaces
what are the three types of HSV infection?
primary, non primary first episode, and recurrent
what is primary HSV? what is the classic initial presentation?
primary refers to pts without previous infection; 1st episode is most painful BUT many people are asymptomatic (highly variable first presentation)
Recurrent HSV: ________ symptoms, ______ and ________ prodromal symptoms, most people are _____________
fewer symptoms, tingling and pain are prodromal, most are asymptomatic
usually see ________, __________ lesions in herpes infection, compared to syphilis where you have ________, ________ lesion,
multiple, painful lesions- herpes
syphilis- non-painful solitary lesion
testing for herpes
overall, difficult and time consuming (nothing is great)
tx of primary, recurrent, chronic suppression of herpes
primary: acyclovir 3x/day for 10 days
recurrent: acyclovir or famciclovir 5 days
chronic: acyclovir or famciclovir 2x for one day
what is bad about herpes and pregnancy?
both HSV 1 and 2 can infect the fetus and induce congenital malformations (more likely to spread when mom is symptomatic)
male and female symptoms for trich
males- typically asymptomatic
females- pruritic, copious discharge (“YELLOW, GREEN, FROTHY”), strawberry cervix, urethral and bladder colonization (topical tx doesn’t work)
how to dx trich?
wet mount “wet prep”: see MOTILE organisms with flagellae
tx of trich
tx both partners at the same time
oral metronidazole for a week (if tx fails, re-treat for another week)
what is not a true STD but upset of normal vaginal flora? because of this, it can’t lead to _____
bacterial vaginosis (BV); can’t lead to PID
what type of vaginal discharge does a pt with BV have?
malodorus: thin and gray/white
dx of BV
wet prep (one slide with saline and one with KOH)- see clue cells and “whiff test”
what is a positive whiff test?
ammonia smell with KOH
what % of clue cells do you need for dx of BV?
need 20% or more for diagnosis
tx of BV
oral metronidazole for 7 days OR metro gel for 5 days OR clindamycin cream for 7 days
Chancroids are _________: _______ ulcers and is a differential for _______
uncommon, painful ulcers, herpes
initial lesion of chancroid is at the site of _______
inoculation
dx of chancroid
obtain culture (always test for syphilis and herpes as well)
LGV is ___________: caused by types of __________, travel hx of ________, often characterized with __________ _________________, malaise, fever, chills, HA
uncommon; chlamydia; travel hx of tropics, painful lymphadenopathy
symptoms for males and females for LGV
males: PAINLESS lesion, then lymphadenopathy
females: perirectal lymphadenopathy, bloody purulent discharge
3 clinical phases of LGV
1) . shallow painless ulcer (extremely transient)
2) . painful adenopathy (1-4 weeks later)
3) . Buboes: greatly swollen lymph glands (*bubonic plague)
tx of LGV
doxycycline for 3 weeks (except pregnancy then use erythromycin)
genital warts are caused by _______. they are ____ and ______-________ in appearance. _________ contagious
HPV; soft and flesh-colored; highly contagious
HPV is associated with _______ ___________ and ______
cervical dysplasia and cancer
what do you use to prevent genital warts? tx of genital warts
prevention- condoms
tx- aldara/imiquimod
pearly penile papules are a ________ _________ and therefore are NOT supposed to be treated
normal variant
what STD is caused by treponema pallidum?
syphilis
what are the four stages of syphilis?
1) . primary: local, sharply demarcated eruption where bug enters the skin (one, INDURATED & PAINLESS ulcer)
2) . secondary: skin rash (PALMS AND SOLES), “condyloma lata”
3) . Latent period: NO physical signs (can last years)
4) . tertiary: NEUROSYPHILIS
nearly all cases of syphilis are spread by _______ _________. what are the three largest risk groups?
sexual contact; young urban black and Hispanic males, MSM
what group of people are most likely to have primary and secondary syphilis?
MSM (54%)
without tx of primary syphilis, does it resolve?
yes, resolves in 3-9 weeks
tx of primary syphilis
benzathine penicillin IM (95-100% cure rate)
when can you get latent syphilis?
hx of syphilis with inadequate tx
________ of pts with untreated secondary syphilis will go on to develop tertiary
1/3
what are two clinical syndromes of tertiary syphilis?
1) . tabes dorsalis: steppage gait, lightning pains, dec peripheral reflexes
2) . general paresis
what three cardio problems can you have with tertiary syphilis?
dilated aorta, aortic valve regurg, non-atherosclerotic CAD
what is the most common nontreponemal test of syphilis?
RPR: tests for antibodies (good for SCREENING)
what two autoimmune disorders can give false positives on nontreponemal tests? how about one NOT autoimmune disease?
lupus and RA (up to 20% of cases); diabetes
what is the confirmatory test of syphilis? what prototype is used?
treponemal: measures antibodies to T pallidum bacteria; FTA-ABS
what are two other treponemals that can give false positive results?
lyme disease and heroin use
what is lyme disease caused by?
spirochete but resembles syphilis (has primary, secondary, and tertiary stages too)
in what female population are all screened for syphilis?
pregnancy (congenital syphilis can cause severe birth defects)
what happened in the Tuskegee Study?
poor black sharecroppers with and without syphilis were studied how their disease progressed without tx
