STIs Flashcards
Trichomoniasis
clinical presentation
most often asymptomatic
if sxs present:
increase pH >4.5
vaginal irritation, malodorous, FROTHY, yellow green d/c
may see petechiae on cervix or vagina “strawberry cervix”
Trichomoniasis
pathogen and treatment
Trichomonas vaginalis - single celled protozoan parasite
Metronidazole (Flagyl) orally, single dose (or tinidazole)
Diagnostics for trichomoniasis
Nucleic Acid Amplification test (NAAT)** - faster than culture and very sensitive
Wet mount, +60% of time - may visualize motile organism
Culture - may take 7 days
M.C non-viral STI?
Trichomoniasis
M.C bacterial STI?
Chlamydia
Who should be screened for chlamydia?
Women < 25yo should be screened every yr (screen older women with risk factors) and also men with risk factors
Chlamydia pathogen and treatment
Chlamydia trachomatis - gram neg bacterium
Azithromycin (Zithromax) SINGLE dose
or Doxycycline orally for 7 days
(avoid doxycycline in pregnancy - Category D)
Chlamydia clinical presentation
most often asymptomatic
if sxs present
Women: cervical d/c, vaginal bleeding, low abd pain, fever, chills, adnexal tenderness
Men: irritated urethra, penile d/c, dysuria
can cause oral and rectal infections
Complication of all STIs?
Increases risk of acquiring & transmitting HIV
Gonorrhea pathogen and treatment
Neisseria gonorrhea - gram neg diplococci bacterium
Ceftriaxone (Rocephin) 250 mg IM
PLUS
azithromycin 1 gram PO (single dose) or doxycycline
(this regimen covers chlamydia too)
Complications of gonorrhea
HIV risk
PID and complicated pregnancy
in males epididymitis
can cause conjunctivitis, meningitis, endocarditis, and disseminated diseases
Clinical presentation gonorrhea
same as chlamydia but often more severe
can cause oral and rectal infections
What is Fitz-Hugh-Curtis syndrome?
PID complication
Perihepatitis characterized by RUQ pain & adhesions (adhesions that develop bw the liver and diaphragm)
Complications of PID
- infertility
- ruptured tubo-ovarian abscess - surgical emergency
- chronic pelvic pain (esp if untreated)
- increased risk of ectopic pregnancy
- Fitz-Hugh Curtis syndrome
Clinical presentation of genital herpes
prodrome - burning, tingling, and/or pruritis followed by outbreak of painful versicles on erythematous base “dew drops on a red base”
can be very different however - not classical description
initial outbreak tends to be most severe
Tx of genital herpes
Acyclovir, or other “virs”
initial outbreak - tx for 7-10 days
recurrent outbreak tx 1-5 days (shorter course)
Neonatal HSV, 3 syndromes possible ..
- localized skin, eye, mouth (SEM) dz
- CNS dz (encephalitis, long term morbidity, metal retardation)
- Disseminated dz (organ involvement, mortality common)
Prevention of neonatal HSV considerations
offer women with active recurrent genital herpes suppressive viral therapy (Acyclovir) at or beyond 36 wks gestation
perform c-section delivery in women w active genital lesions or prodromal sxs
avoid intercourse/receptive oral sex w partners suspected of HSV during 3rd trimester
Most common STI
HPV
Human Papillomavirus
HPV clinical presentation
most asymptomatic
visible genital warts (condyloma acuminata)
precancerous/cancerous changes (anywhere infected) - persistent HPV main cause of cervical cancer (Types 16 & 18 =70%)
Tx options for HPV warts
Topical Imiquimod (Aldara) Topical podofilox
Provider applied options
Cryotherapy
Surgical therapy (excison, electrocautery, CO2 laser, curettage)
Trichloroacetic acid (TCA)
HPV pregnancy considerations
HPV rarely transmitted to neonated during delivery
cesarean if pelvic outlet obstructed or vaginal delivery would result in excessive bleeding - what’s best for mom’s health per ACOG
