STIs

Question 1

most common bacterial STI

Answer 1

chlamydia

Question 2

chlamydia treatment

Answer 2

azithromycin 1g PO single dose

or

doxycyline 100 mg PO BID x 7d

Question 3

gonorrhea treatment

Answer 3

cefixime 800mg PO + azithromycin 1g PO single dose of each

or

cetriaxone 250 mg IM + azithromycin 1g PO single dose of each

Question 4

syphillis treatment

Answer 4

penicillin B 2.4 mu IM 1 dose

or

doxycycline 100 mg PO BID x 17 days

Question 5

HSV treatment

Answer 5

acyclovir 200 mg PO 5x/day x5-10 days

or

valacyclovir 1g PO BID x 10 days

Question 6

how to work up abnormal penile discharge

Answer 6

urethreal swab for microscopy and culture

Question 7

how to manage abnormal penile discharge

Answer 7

treat partners

advise sexual abstinence until eradication of infection

encourage use of condoms

advise patient the symptoms can occur weeks after intercourse

counsel on importance of safe sex

Question 8

treatment of genital warts

Answer 8

Podofilox 0.5% solution topically BID x 3 days, then 4 days off–> repeat this for 4 weeks

and/or

Imiquimod 5% cream topically 3/week for max 16 weeks

Question 9

management of genital warts

Answer 9

topical treatment as above

bring partner in for treatment as well

counsel around safe sex and use of condoms

test for other STIs including chlamydia, gonorrhea, HIV, hep B

provide takeaway information for patient and partner

Question 10

what % of warts will undergo remission without treatment

Answer 10

20%

Question 11

management of first presentation of PID

Answer 11

pregnancy test

microscopic exam of vaginal discharge in saline

CBC

nucleic acid amplification tests for chlamydia and gonorrhea

UA

CRP

HIV testing

Hep B serologies

syphilis testing

Transvaginal U/S should be considered

Question 12

when would you refer a patient at risk of PID for specialist treatment

Answer 12

cases of unexplained infertility

all teenagers with dysmenorrhea sufficient to interfere with normal activities and not responding to prostaglandin inhibitors

patients with dysmenorrhea that reaches a crescendo mid menses

unexplained bowel or bladder symptoms

patients with positional dyspareunia

patients with cyclic pain or bleeding in unusual sites

Question 13

how does trichomonas usually present

Answer 13

profuse vaginal discharge that has unpleasant odour–frothy, greenish gray

vulval soreness, dyspareunia, erythema of vaginal walls and cervix with red punctate appearance of the cervix

Question 14

what tests should you order when you suspect trichomonas

Answer 14

pap smear–> protozoan may be IDed on stained cytology prep

culture of vaginal exudates

PCR testing

Question 15

how do you treat trichomonas

Answer 15

oral metronidazole 2g as single dose

or

oral tinidazole 2g as single dose

Question 16

how do you manage trichomonas

Answer 16

metronidazole

treat patient and sexual contacts with oral meds

regular sex partner must be treated simultaneously

attention must be paid to vaginal hygiene

patient should refrain from intercourse while infected

vaginal meds can be used if necessary –> clindamycin cream 2% for 7d or clotrimazole 100mg vaginal tablets for 7d

Question 17

treatment for BV

Answer 17

metronidazole 2g PO one dose

or

500mg PO BID 7d

Question 18

what is abnormal vaginal discharge

Answer 18

any type of vaginal discharge associated with pruritis, odor or change in color

Question 19

what is physiologic vaginal discharge

Answer 19

usually clear to white and non odorous

not accompanied by pain, pruritis, burning or erythema

seen post pubertal, predominantly mid cycle and in states of increased estrogen including pregnancy, OCP, PCOS

Question 20

when should you investigate what looks like physiologic vaginal discharge

Answer 20

if increased peri-menopausally

investigate for other causes of excess estrogen like endometrial or ovarian ca

Question 21

in pre pubertal girls, what are some causes of abnormal vaginal discharge that are infectious

Answer 21

shigella

GAS

Question 22

what are some non infectious causes of vaginal discharge in a pre pubertal girl

Answer 22

blood dyscrasia
foreign object
child abuse
trauma
poor hygiene
candida (if diapers)
psychosomatic 
*if infection in a child, think child abuse, through infection can be seen at any age

Question 23

what infections can cause abnormal vaginal discharge

Answer 23

yeast
trichomonas vaginalis
bacterial vaginosis
chlamydia
gonorrhea
bartholinitis
PID

Question 24

what are some neoplastic causes of abnormal vaginal discharge

Answer 24

vaginal intraepithelial neoplasia
vaginal squamous cell ca
invasive cervical ca
fallopian tube ca

Question 25

what are some things to ask about to assess for possible chemical vulvovaginitis

Answer 25

``` deodorants contraceptives bubble baths soaps frequend minipad use tight synthetic clothing ```

Question 26

what to ask on history for abnormal vaginal discharge

Answer 26

1. details of discharge--colour, consistency, presence or absence of odour, duration 2. presence of noticeable lesion, pain, burning, pruritis 3. sexual activity 4. method of birth control, if any 5. signs or symptoms of infection in partner 6. past history of STDs 7. presence of pelvic pain, dyspareunia, fevers, rigors 8. use of vaginal douches, new soaps, bath oils, laundry products 9. menstrual cycle history and details of discharge normally occurring 10. history recent pregnancy

Question 27

what to look for on exam for abnormal vaginal discharge

Answer 27

examine vulva, external genitalia for erythema, edema, excoriation and abnormal lesions palpation of grain and femoral chains for LAD vaginal speculum and bimanual exams for suspected cervicitis, adnexal disease, screening for presence of masses

Question 28

most common non STI causes of vulvovaginitis

Answer 28

candidiasis bacterial vaginosis trichomonas

Question 29

what samples should be taken in order to evaluate abnormal vaginal discharge

Answer 29

culture swabs wet slide preps for diagnostic use endocervical cultures

Question 30

in which patients is inpatient management suggests

Answer 30

PID with abscess, severe illness or poor patient compliance

Question 31

what should increase your suspicion for a neoplastic cause of evaluate abnormal vaginal discharge

Answer 31

increasing age of patient no obvious cause for the discharge

Question 32

which women are at high risk for candidiasis

Answer 32

antibiotic use pregnancy immunosuppression

Question 33

candidiasis discharge

Answer 33

white cottage cheese can be minimal

Question 34

what test for candidiasis

Answer 34

KOH test reveals hyphae pH is less than 4.5

Question 35

treatment for candidiasis

Answer 35

fluconazole 150 mg PO

Question 36

symptoms of BV

Answer 36

can be asymptomatic fishy odour, increased discharge discharge is grey/white, thin and diffuse absence of vaginal irritation

Question 37

test for BV

Answer 37

clue cells positive whiff test pH above 4.5

Question 38

treatment for BV

Answer 38

metronidazole 500 mg PO BID 7 days

Question 39

symptoms of gonorrhea

Answer 39

can be asymptomatic ``` burning irritation dysuria pelvic pain post coital bleed ``` friable cervix

Question 40

discharge in gonorrhea

Answer 40

mucopurulent--grey, white, green or none

Question 41

chlamydia symptoms

Answer 41

can be asymptomatic ``` burning irritation dysuria pelvic pain post coital bleed ``` friable cervix

Question 42

discharge in chlamydia

Answer 42

none or mucopurulent yellow/white

Question 43

symtpoms of trichomonas

Answer 43

purulent discharge, dysura, dyspareunia, post coital bleed

Question 44

trichomonas on exam

Answer 44

erythema of vulva/vagna petechiae "strawberry cervix"

Question 45

test for trichomonas

Answer 45

can do cultures or wet mounts to show the protozoa shows mobile flagellated organism pH above 4.5

Question 46

incubation period for herpes

Answer 46

3-6 days can be longe

Question 47

treatment for herpes

Answer 47

oral antivirals oral analgesics sitz baths

Question 48

how long does the first herpes attack last

Answer 48

2 weeks

Question 49

most common place for vesicles in the male with herpes

Answer 49

most commonly the shaft but can affect the glans and anus

Question 50

suitable treatment for frequent herpes recurrences

Answer 50

continuous low dose therapy i.e valacyclovir