STIs Flashcards
most common bacterial STI
chlamydia
chlamydia treatment
azithromycin 1g PO single dose
or
doxycyline 100 mg PO BID x 7d
gonorrhea treatment
cefixime 800mg PO + azithromycin 1g PO single dose of each
or
cetriaxone 250 mg IM + azithromycin 1g PO single dose of each
syphillis treatment
penicillin B 2.4 mu IM 1 dose
or
doxycycline 100 mg PO BID x 17 days
HSV treatment
acyclovir 200 mg PO 5x/day x5-10 days
or
valacyclovir 1g PO BID x 10 days
how to work up abnormal penile discharge
urethreal swab for microscopy and culture
how to manage abnormal penile discharge
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
treatment of genital warts
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
management of genital warts
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
what % of warts will undergo remission without treatment
20%
management of first presentation of PID
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
when would you refer a patient at risk of PID for specialist treatment
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
how does trichomonas usually present
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
what tests should you order when you suspect trichomonas
pap smear–> protozoan may be IDed on stained cytology prep
culture of vaginal exudates
PCR testing
how do you treat trichomonas
oral metronidazole 2g as single dose
or
oral tinidazole 2g as single dose
how do you manage trichomonas
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
treatment for BV
metronidazole 2g PO one dose
or
500mg PO BID 7d
what is abnormal vaginal discharge
any type of vaginal discharge associated with pruritis, odor or change in color
what is physiologic vaginal discharge
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
when should you investigate what looks like physiologic vaginal discharge
if increased peri-menopausally
investigate for other causes of excess estrogen like endometrial or ovarian ca
in pre pubertal girls, what are some causes of abnormal vaginal discharge that are infectious
shigella
GAS
what are some non infectious causes of vaginal discharge in a pre pubertal girl
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
what infections can cause abnormal vaginal discharge
yeast trichomonas vaginalis bacterial vaginosis chlamydia gonorrhea bartholinitis PID
what are some neoplastic causes of abnormal vaginal discharge
vaginal intraepithelial neoplasia
vaginal squamous cell ca
invasive cervical ca
fallopian tube ca
what are some things to ask about to assess for possible chemical vulvovaginitis
deodorants contraceptives bubble baths soaps frequend minipad use tight synthetic clothing
what to ask on history for abnormal vaginal discharge
- details of discharge–colour, consistency, presence or absence of odour, duration
- presence of noticeable lesion, pain, burning, pruritis
- sexual activity
- method of birth control, if any
- signs or symptoms of infection in partner
- past history of STDs
- presence of pelvic pain, dyspareunia, fevers, rigors
- use of vaginal douches, new soaps, bath oils, laundry products
- menstrual cycle history and details of discharge normally occurring
- history recent pregnancy
what to look for on exam for abnormal vaginal discharge
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
most common non STI causes of vulvovaginitis
candidiasis
bacterial vaginosis
trichomonas
what samples should be taken in order to evaluate abnormal vaginal discharge
culture swabs
wet slide preps for diagnostic use
endocervical cultures
in which patients is inpatient management suggests
PID with abscess, severe illness or poor patient compliance
what should increase your suspicion for a neoplastic cause of evaluate abnormal vaginal discharge
increasing age of patient
no obvious cause for the discharge
which women are at high risk for candidiasis
antibiotic use
pregnancy
immunosuppression
candidiasis discharge
white
cottage cheese
can be minimal
what test for candidiasis
KOH test reveals hyphae
pH is less than 4.5
treatment for candidiasis
fluconazole 150 mg PO
symptoms of BV
can be asymptomatic
fishy odour, increased discharge
discharge is grey/white, thin and diffuse
absence of vaginal irritation
test for BV
clue cells
positive whiff test
pH above 4.5
treatment for BV
metronidazole 500 mg PO BID 7 days
symptoms of gonorrhea
can be asymptomatic
burning irritation dysuria pelvic pain post coital bleed
friable cervix
discharge in gonorrhea
mucopurulent–grey, white, green or none
chlamydia symptoms
can be asymptomatic
burning irritation dysuria pelvic pain post coital bleed
friable cervix
discharge in chlamydia
none or mucopurulent yellow/white
symtpoms of trichomonas
purulent discharge, dysura, dyspareunia, post coital bleed
trichomonas on exam
erythema of vulva/vagna
petechiae
“strawberry cervix”
test for trichomonas
can do cultures or wet mounts to show the protozoa
shows mobile flagellated organism
pH above 4.5
incubation period for herpes
3-6 days can be longe
treatment for herpes
oral antivirals
oral analgesics
sitz baths
how long does the first herpes attack last
2 weeks
most common place for vesicles in the male with herpes
most commonly the shaft but can affect the glans and anus
suitable treatment for frequent herpes recurrences
continuous low dose therapy i.e valacyclovir
