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LMCC Part II > STIs > Flashcards

STIs Flashcards

1
Q

most common bacterial STI

A

chlamydia

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2
Q

chlamydia treatment

A

azithromycin 1g PO single dose

or

doxycyline 100 mg PO BID x 7d

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3
Q

gonorrhea treatment

A

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

or

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

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4
Q

syphillis treatment

A

penicillin B 2.4 mu IM 1 dose

or

doxycycline 100 mg PO BID x 17 days

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5
Q

HSV treatment

A

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

or

valacyclovir 1g PO BID x 10 days

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6
Q

how to work up abnormal penile discharge

A

urethreal swab for microscopy and culture

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7
Q

how to manage abnormal penile discharge

A

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

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8
Q

treatment of genital warts

A

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

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9
Q

management of genital warts

A

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

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10
Q

what % of warts will undergo remission without treatment

A

20%

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11
Q

management of first presentation of PID

A

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

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12
Q

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

A

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

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13
Q

how does trichomonas usually present

A

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

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14
Q

what tests should you order when you suspect trichomonas

A

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

culture of vaginal exudates

PCR testing

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15
Q

how do you treat trichomonas

A

oral metronidazole 2g as single dose

or

oral tinidazole 2g as single dose

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16
Q

how do you manage trichomonas

A

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

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17
Q

treatment for BV

A

metronidazole 2g PO one dose

or

500mg PO BID 7d

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18
Q

what is abnormal vaginal discharge

A

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

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19
Q

what is physiologic vaginal discharge

A

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

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20
Q

when should you investigate what looks like physiologic vaginal discharge

A

if increased peri-menopausally

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

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21
Q

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

A

shigella

GAS

22
Q

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

A 
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
23
Q

what infections can cause abnormal vaginal discharge

A 
yeast
trichomonas vaginalis
bacterial vaginosis
chlamydia
gonorrhea
bartholinitis
PID
24
Q

what are some neoplastic causes of abnormal vaginal discharge

A

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

25
Q

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

A 
deodorants
contraceptives
bubble baths
soaps
frequend minipad use
tight synthetic clothing
26
Q

what to ask on history for abnormal vaginal discharge

A
  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
27
Q

what to look for on exam for abnormal vaginal discharge

A

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

28
Q

most common non STI causes of vulvovaginitis

A

candidiasis
bacterial vaginosis
trichomonas

29
Q

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

A

culture swabs

wet slide preps for diagnostic use

endocervical cultures

30
Q

in which patients is inpatient management suggests

A

PID with abscess, severe illness or poor patient compliance

31
Q

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

A

increasing age of patient

no obvious cause for the discharge

32
Q

which women are at high risk for candidiasis

A

antibiotic use
pregnancy
immunosuppression

33
Q

candidiasis discharge

A

white
cottage cheese

can be minimal

34
Q

what test for candidiasis

A

KOH test reveals hyphae

pH is less than 4.5

35
Q

treatment for candidiasis

A

fluconazole 150 mg PO

36
Q

symptoms of BV

A

can be asymptomatic

fishy odour, increased discharge

discharge is grey/white, thin and diffuse

absence of vaginal irritation

37
Q

test for BV

A

clue cells

positive whiff test

pH above 4.5

38
Q

treatment for BV

A

metronidazole 500 mg PO BID 7 days

39
Q

symptoms of gonorrhea

A

can be asymptomatic

burning
irritation
dysuria
pelvic pain
post coital bleed

friable cervix

40
Q

discharge in gonorrhea

A

mucopurulent–grey, white, green or none

41
Q

chlamydia symptoms

A

can be asymptomatic

burning
irritation
dysuria
pelvic pain
post coital bleed

friable cervix

42
Q

discharge in chlamydia

A

none or mucopurulent yellow/white

43
Q

symtpoms of trichomonas

A

purulent discharge, dysura, dyspareunia, post coital bleed

44
Q

trichomonas on exam

A

erythema of vulva/vagna

petechiae

“strawberry cervix”

45
Q

test for trichomonas

A

can do cultures or wet mounts to show the protozoa

shows mobile flagellated organism

pH above 4.5

46
Q

incubation period for herpes

A

3-6 days can be longe

47
Q

treatment for herpes

A

oral antivirals
oral analgesics
sitz baths

48
Q

how long does the first herpes attack last

A

2 weeks

49
Q

most common place for vesicles in the male with herpes

A

most commonly the shaft but can affect the glans and anus

50
Q

suitable treatment for frequent herpes recurrences

A

continuous low dose therapy i.e valacyclovir

LMCC Part II (52 decks)

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