STIs Flashcards
Sexual history
(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
Special STI populations
Youth (15-24) Men who have sex w/ men (MSM) Pregnant women HIV-infected patients Individuals entering correctional facilities
Symptoms of vaginitis
d/c
odor
pruritus and/or discomfort
Most common causes of vaginitis
Candida vulvovaginitis
BV
Trichomoniasis
Cause of yeast infection
C. albicans (most common)
Presentation of vulvovaginal candidiasis
pruritus! external dysuria vulvar soreness dyspareunia abnormal vaginal d/c
PE for yeast infection
white, thick, curd-like d/c (adherent to vaginal walls)
may seem vulvar erythema, edema, fissures, excoriations
Risk factors for yeast infections
DM
Abx use
increased estrogen levels
Immunosuppressed
Dx of vulvovaginal candidiasis
Wet mount (10% KOH) - budding yeast, hyphae, pseudohyphae Normal pH (<4.5) Others: vaginal culture
uncomplicated candidiasis
mild-mod sx
sporadic/infrequent
caused by candida albicans
healthy, non-prego
Complicated candidiasis
severe
recurrent
nonalbicans species
prego, poorly controlled DM, immunosuppression
Tx for uncomplicated candidiasis
1-3 days of topical Clotrimazole (OTC)
oral fluconazole 150 mg po x 1
tx for complicated candidiasis
topical azole 7-14d
oral fluconazole 150 mg po q 72 hours x 2-3 doses (if nonalbicans, avoid fluconazole)
maintenance for recurrent
Tx of candida in pregos
topical clotrimazole x 7 days
Most common cause of d/c in women of chidlbearing age
BV
Etiology of BV
polymicrobial: gardnerella vaginalis, mobiluncus, prevotella
Presentation of BV
asymptomatic
Symptomatic: d/c & odor (thin, white gray d/c with fishy smell)
Risk factors for BV
sex (new/multiple partners) presence of other STIs African-American, Mexican-American Douching Smoking Lack of condom use
Dx of BV
Amsel’s diagnostic criteria
Gram stain
DNA probe
Amsel’s diagnostic criteria
- Thin, white homogenous discharge
- Clue cells on saline
- pH >4.5
- whiff test
Tx of BV
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
Complications of BV
increased risk of acquiring/transmitting HIV, and other STIs
more common in those w/ PID
Most common nonviral STI
trichomoniasis
Often coexist
BV and trich
Chlamydia + gonorrhea
Presentation of trich
vaginal d/c +/- vulvar irritation
Malodorous, frothy, yellow-green d/c
Burning/pruritus/dysuria/dyspareunia
Postcoital bleeding
PE for trich
punctate hemorrhages on vagina/cervix (“strawberry cervix”
pH >4.5
Strawberry cervix
trich
Dx of trich
Wet mount (motile organisms) NAAT - gold standard (vaginal, endocervical, urine)
Culture (rarely used)
Rapid antigen and DNA hybridization probes
Trich complications
urethritis/cystitis
PID (those w/ HIV)
Cervical neoplasia
infertility
increased risk of acquiring/transmitting HIV
Prego: premature rupture, preterm delivery, LBW
Tx for trich
symptomatic & asymptomatic
- treat sex partners (EPT)
- Metro (or Tinidazole) 2g (single dose)
- metro = pregnancy