STIs Flashcards

1
Q

Sexual history

A

(5 P’s)
Partners: men/women, #, last time u had sex
Practices: anatomic sites of exposure
Prevention of pregnancy: desired? contraception?
Protection from STI’s: frequency of condom use
Past hx of STIs: patient and their partners

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2
Q

Special STI populations

A
Youth (15-24)
Men who have sex w/ men (MSM)
Pregnant women
HIV-infected patients
Individuals entering correctional facilities
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3
Q

Symptoms of vaginitis

A

d/c
odor
pruritus and/or discomfort

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4
Q

Most common causes of vaginitis

A

Candida vulvovaginitis
BV
Trichomoniasis

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5
Q

Cause of yeast infection

A

C. albicans (most common)

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6
Q

Presentation of vulvovaginal candidiasis

A
pruritus!
external dysuria
vulvar soreness
dyspareunia
abnormal vaginal d/c
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7
Q

PE for yeast infection

A

white, thick, curd-like d/c (adherent to vaginal walls)

may seem vulvar erythema, edema, fissures, excoriations

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8
Q

Risk factors for yeast infections

A

DM
Abx use
increased estrogen levels
Immunosuppressed

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9
Q

Dx of vulvovaginal candidiasis

A
Wet mount (10% KOH) - budding yeast, hyphae, pseudohyphae
Normal pH (<4.5)
Others: vaginal culture
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10
Q

uncomplicated candidiasis

A

mild-mod sx
sporadic/infrequent
caused by candida albicans
healthy, non-prego

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11
Q

Complicated candidiasis

A

severe
recurrent
nonalbicans species
prego, poorly controlled DM, immunosuppression

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12
Q

Tx for uncomplicated candidiasis

A

1-3 days of topical Clotrimazole (OTC)

oral fluconazole 150 mg po x 1

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13
Q

tx for complicated candidiasis

A

topical azole 7-14d

oral fluconazole 150 mg po q 72 hours x 2-3 doses (if nonalbicans, avoid fluconazole)

maintenance for recurrent

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14
Q

Tx of candida in pregos

A

topical clotrimazole x 7 days

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15
Q

Most common cause of d/c in women of chidlbearing age

A

BV

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16
Q

Etiology of BV

A

polymicrobial: gardnerella vaginalis, mobiluncus, prevotella

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17
Q

Presentation of BV

A

asymptomatic

Symptomatic: d/c & odor (thin, white gray d/c with fishy smell)

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18
Q

Risk factors for BV

A
sex (new/multiple partners)
presence of other STIs
African-American, Mexican-American
Douching
Smoking
Lack of condom use
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19
Q

Dx of BV

A

Amsel’s diagnostic criteria
Gram stain
DNA probe

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20
Q

Amsel’s diagnostic criteria

A
  1. Thin, white homogenous discharge
  2. Clue cells on saline
  3. pH >4.5
    • whiff test
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21
Q

Tx of BV

A

Only treat symptomatic

  • Metro 500 mg PO BID x 7 days
  • Metro gel 0.75% vaginally QD x 5 days
  • Clinda cream 2% intravaginally QHS x 7 d
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22
Q

Complications of BV

A

increased risk of acquiring/transmitting HIV, and other STIs

more common in those w/ PID

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23
Q

Most common nonviral STI

A

trichomoniasis

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24
Q

Often coexist

A

BV and trich

Chlamydia + gonorrhea

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25
Q

Presentation of trich

A

vaginal d/c +/- vulvar irritation
Malodorous, frothy, yellow-green d/c
Burning/pruritus/dysuria/dyspareunia
Postcoital bleeding

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26
Q

PE for trich

A

punctate hemorrhages on vagina/cervix (“strawberry cervix”

pH >4.5

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27
Q

Strawberry cervix

A

trich

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28
Q

Dx of trich

A
Wet mount (motile organisms)
NAAT - gold standard (vaginal, endocervical, urine)

Culture (rarely used)
Rapid antigen and DNA hybridization probes

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29
Q

Trich complications

A

urethritis/cystitis
PID (those w/ HIV)
Cervical neoplasia
infertility
increased risk of acquiring/transmitting HIV
Prego: premature rupture, preterm delivery, LBW

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30
Q

Tx for trich

A

symptomatic & asymptomatic

  • treat sex partners (EPT)
  • Metro (or Tinidazole) 2g (single dose)
  • metro = pregnancy
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31
Q

education for trich tx

A

wait 7 days after treatment for sex
Test for other STIs
Repeat testing in 3 months (reinfection high)

32
Q

Repeat testing

A

Trich
Chlamydia
Gonorrhea

33
Q

Screening for trich

A

HIV infected
High prevalence settings (STI clinics, correctional facilities)
Asymptomatic @ high risk of infection

34
Q

Most frequently reported STI

A

chlamydia

35
Q

Age group for chlamydia

A

<24 hours

36
Q

sx of chlamydia

A

cervicitis (d/c, intermenstrual/postcoital bleeding)

Sx of urethritis (frequency & dysuria)

37
Q

PE for chlamydia

A

mucopurulent endocervical d/c

friability, erythema, edema

38
Q

Dx of chlamydia

A

NAAT (test of choice)

- Vaginal swab (preferred), endocervical swab, urine

39
Q

Complications of chlamydia

A
PID
ectopic pregnancy
infertility
chronic pelvic pain
Prego: premature rupture, preterm deliver, conjunctivitis in newborn
40
Q

Tx for chlamydia

A

pt + sex partner

Azithro 1 gm PO single dose
OR
Doxy 100 mg PO BID x 7 days

Prego: only azithro

41
Q

Screening for chlamydia

A
annually <25 YO
Older w/ risk factors:
- new/multiple sex partners
- sex partner recently treated for STI
no or inconsistent condom use outside of monogamous relationship
- hx of prior STI
- exchange for drugs/money
42
Q

Presentation of gonorrhea

A

Cervicitis sx

urethritis

43
Q

PE for gonorrhea

A

mucopurpulent cervcal d/c

friability, erythema, edema

44
Q

Dx of Gonorrhea

A

NAAT (vaginal swab preferred)

Culture (abx resistance)

45
Q

Complications of gonorrhea

A

PID, ectopic preg, infertility, chronic pelvic pain
Disseminated gonococcal infection (DGI)

Preg: LBW, preterm, infection (chorioamnionitis), transmit to neonate (opthalmia neonatorum)

46
Q

Tx for gonorrhea

A

Ceftriaxone 250 mg IM + azithro 1 gm PO single dose

47
Q

Screening for gonorrhea

A

same as chlamydia

48
Q

PID spectrum

A

endometritis
salpingitis
tubo-ovarian abscess
pelvic peritonitis

49
Q

Risk of PID

A
sexually active (multiple partners)
Younger <25 
Partner w/ STI
Hx of prior PID or STI
IUD (1st 3 weeks after insertion)
Disruption of normal vaginal flora (BV)
50
Q

Sx of PID

A
lower abdominal pain (during or shortly after menses)
Abnormal vaginal d/c
abnormal uterine bleeding
dyspareunia
fever
51
Q

PE for PID

A

ab/uterine/adnexal tenderness
Cervical motion tenderness (chandelier sign)
Purulent endocervcal d/c and/or vaginal d/c

52
Q

Eval for PID

A
Pregnancy test
Microscopy of d/c (wet mount) - WBC (leukorrhea >10 WBC)
NAAT for chlamydia/gonorrhea
NAAT for mycoplasma genitalium
HIV screen, syphilis
CBC, ESR, CRP
UA
Pelvic US, CT/MRI
53
Q

Dx PID

A

presumptive: sexually active, pelvic/lower ab pain, cervical motion, uterine OR adnexal tenderness on exam

54
Q

Findings supporting clinical dx of PID

A

temp >10
abnormal cervical/vaginal d/c or friability
WBC on wet mount
elevated ESR/CRP
Documented infection of chlamydia/gonorrhea

55
Q

Tx of PID

A

ceftriaxone 250 mg IMI + doxy 100 mg BID x 14 d

Outpatient: w/wo metronidazole (500mg PO BID x 14 days)

F/u 48-72 hours

56
Q

Hospitalize for PID

A

pregnancy
lack of response to oral (w/i 72 hours)
concern for nonadherence
inability to take PO due to N/V
severe illness (high fever, n/v/, ab pain)
Complicated w/ abscess
Surgical emergencies (appendicitis ) cannot be excluded

57
Q

Complications of PID

A

infertility
chronic pelvic pain
risk of ectopic
perihepatitis (Fitz-Hugh-Curtis syndrome)

58
Q

Perihepatitis

A

RUQ pain & adhesions

59
Q

Condyloma Acuminata

A

HPV (anogenital warts)

60
Q

Most common STI in US

A

HPV

61
Q

Most common types of HPV

A

6 and/or 11

62
Q

Risk factors of HPV

A

sex
smoking
immunosuppression (more severe/malignant)

63
Q

Types of HPV associated w/ malignancy

A

6 or 11

64
Q

Presentation of HPV

A

asymptomatic, may be pruritic
flesh colored, plaque-like
single or multiple, flat cauliflower like

65
Q

Dx for HPV

A

visualize warts on PE (anoscopy, speculum exam)

bx if uncertain

66
Q

Tx for HPV

A

Cyto-destructive (pdofilox, trichloracetic acid or bicloracetic acid)
Immune-mediated (imiquimoid, sinecatechins)
Surgical (cryo, laser, electrocautery, excision)

67
Q

Vaccine

A

HPV

68
Q

Genital herpes caused by

A

HSV-2

69
Q

Primary HSV infection

A

no preexisting antibodies
longer duration, increased viral shedding & systemic sx
sx last 2-4 weeks if left untreated

70
Q

Non-primary first episode

A

acquisition of HSV-2 in patient w/ preexisting antibodies to HSV-1
Milder sx

71
Q

Recurrent HSV

A

reactivation of HSV

less severe/shorter

72
Q

Sx of primary infection

A

painful genital ulcers!
dysuria, fever, tender local inguinal LAD, h/a
some mild/asymptomatic

73
Q

Sx of recurrent infection

A

prodrome before eruption (tingling)

less severe sx

74
Q

Dx of herpes

A
Viral culture (good early)
PCR (more sensitive than culture)

Serologic tests - HSV1/2 antibodies

75
Q

Limitations to serologic tests for herpes

A

false negative frequent in early stages of infection

76
Q

Tx for herpes

A

1st episode: Valacyclovir, famciclovir, or acyclovir 7-10 d (start w/i 72 hours)

Recurrent outbreak: 1-5 day regiment

Suppression: QD or BID dosing