STIs Flashcards
Which PID complication?
-RUQ pain and violin string adhesions of liver…
perihepatitis/Fitz-Hugh Curtis Syndrome
Patient presents with:
low abdominal pain during/shortly after menses
dyspareunia
cervical motion/adnexial tenderness
purulent discharge
acute symptomatic PID
workup for PID…
urine preg d/c microscopy for WBCs NAAT STI/HIV screens UA CBC ESR CRP Pelvic US
Tx for mild/moderate PID
ceftriaxone 250mg IM + Doxy 100mg BID x 14 days
When should f/u occur with PID Tx?
48-72 horus
The below are indications for what tx of PID?
Pregnancy Refractory noncompliance NPO/N/V high fever complications/abscess surg. emergency can't be excluded
hospitalize
What abx can be added to ceftriaxone and doxy for PID?
+/- metro 500mg PO BID x 14 days
What is an alternative to doxycycline for PID tx?
azithro 1gm q weekly x 14 days
This condition confers increased risk for ectopic pregnancy, infertility, hydrosalpinx and chronic pelvic pain
PID
When can PID patients resume sexual intercourse?
complete therapy, sxs resolved, partners treated
Who should have repeat testing in 3 mo after PID?
(+) for GC or chlamydia
MC STI worldwide transmitted thru infected skin/mucosa that can infect anogenital region
HPV
MC HPV types and oncogenic potential…
6 and 11, low oncogenic
Patient presents with:
soft, flesh colored plaque
cauliflower like lesions on anogenital region
HPV
If uncertain dx of an anogenital lesion, what diagnostic can be used?
bx
cyto destructive tx for HPV…
podofilox
Immune-mediated tx for HPV (2)
imiquimod, sinecatechins
Surgical tx for hpv (4)
cryo, laser, cautery, excision
how is HPV prevented?
vaccine
Patient presents with:
painful genital ulcer
inguinal LAD
can be asymptomatic
HSV/genital herpes
incubation for HSV after exposure is…
2-12 days
Which class of HSV tests is preferred?
virologic (cx, PCR)
Viral cx for HSV has highest dx yield when?
early stages
is PCR more or less sensative than viral cx for HSV?
more sensitive
presence of HSV-1 Abs can indicate what forms of disease?
anogenital or orolabial
is regular herpes screening indicated for general population?
no
first episode of HSV tx…
7-10 days antivirals
episodic tx of hsv outbreak
1-5 day regimen antivirals (acyclovir, etc.)
suppression tx for hsv
QD-BID dosing
Screening for which diseases would occur in sexually active women < 25 and older women w. risk factors?
GC chlamydia
Screening for _____ should be added to GC and chlamydia where prevalence is high.
trichomonas
repeat testing should occur with what diseases?
GC, chlamydia, trich
5 Ps of Sexual Hx
Partners (in last year, last sexual contact)
Practices (sites)
Preg Prevention
Protection (STI, condom use)
Past Hx STI (pt. and partners)
who accounts for 1/2 of all new STIs?
youth
This is a d/o of vagina caused by infx, inflammation, change in vaginal flora
vaginitis
3 MC causes of vaginitis
candida, BV, trich
Is candidiasis considered STI? Do partners need to be tx?
not STI, no partner tx
The below are RFs for…
DM, Abx, Increased Estrogen, Immunosuppression
candidiasis
Patient presents with:
Pruritis
curd-like adherent white thick d/c
vulvovaginal candidaisis
dx for candidiasis can be made via
10% KOH Wet Mount
uncomplicated vulvovaginal candidiasis can be tx by…
fluconazole 150mg PO x 1 dose
OR
clotramazle topical x 1-3 days
Complicated (4+ yearly or comorbidities) vulvovaginal candidiasis tx
fluconazole 150 mg PO q 72 hours x 2-3 doses
OR
topical azole x 7-14 days
Pregnant vulvovaginal candidiasis tx…
clotramazole or miconazole topical x 7 days
MC cause of vaginal d/c in women of childbearing age
BV
is BV an STI?
no
what percent of BV presents asymptomatically?
50-75%
Patient presents with…
thin, off-white vaginal d/c
fishy odor
this is suspicious for…
BV
Amsel’s criteria for BV requires 3 of what 4 signs?
thin, white homogenous d/c
clue cells wet mount
pH > 4.5
(+) whiff test
3 dx options for BV
Amsel’s criteria, gram stain, DNA probe
Tx for BV only needs to occur with patient, not partners. What are the tx options?
metro 500mg PO BID x 7 days
metro 0.75% gel intravaginally QD x 5 days
What can’t be ingested when taking metronidazole for fear of disulfiram like reaction?
etoh
What is a major complication of BV?
preterm delivery
This is the MC non-viral STI
trich
Patient presents with…
a. Purulent, malodorous, frothy, thin d/c
b. Burning, pruritus, dysuria, dyspareunia
c. Post-coital bleeding
Trich
What physical exam sign is often found with trich infx?
strawberry cervix: punctate hemorrhages on vagina/cervix
Gold Standard Dx for trich…
Vaginal/cervical/urine NAAT
trich wet mount may show…
motile organism
Tx for patient and partner with Trich…
metro 2g PO x 1 dose
no sex for 7 days after tx
Trich tx if N/V?
metro 500 mg BID x 5-7 days
The below are complications for…
a. PID, urethritis, cystitis
b. Cervical neoplasia
c. Infertility
d. Increased HIV risk
e. Pregnancy complications (preterm delivery)
trich
when should repeat trich testing take placE?
3 mo after tx
This is the MC reportable bacterial STI, it has high prevelance in 24 yo and younger
Chlamydia
Patient presents with…
a. Cervicitis: change in d/c, intermenstrual or post-coital bleeding
b. Urethritis: dysuria, frequency
a. Mucopurulent endocervical d/c
b. Cervix friability, erythema, edema
Chlamydia or GC
Gold standard Dx for chlamydia?
vaginal swab NAAT
Tx options for patient and partner for chlamydia
azithro 1g PO x 1
OR
doxy 100mg PO BID x 7 days
Tx for chlamydia if pregnant…
azithro
when can you have sex after chlamydia tx?
7 days after completed tx and no sxs
Preferred dx for GC?
vaginal/endocervical swab NAAT
If resistant GC is suspected, what diagnostic should be used?
Cx
Tx for partner and pt w. GC?
avoid sex, STI test
Ceftriaxone 250mg IM + Azithro 1g PO x 1 dose
