STIs and Vulvovaginal Infections Flashcards
Chlamydia big 5
Etiology: infectious agent = chlamydia trachomatis
Transmission: sexual
S/sx: asymptomatic MC, can see dysuria, fever, chills
Physical findings: thin/white mucus discharge
Diagnosis: NAAT
Treatment: 100 mg doxycycline BID x7 days (alternatives if allergic = azithromycin, levofloxacin, alternative if pregnant = azithromycin)
Chlamydia trachomatis morphology
Gram negative when it is able to pick up any stain, but can’t really survive outside of host –> needs to be tested with NAAT
Do you treat partners in chlamydia?
YES!
Chlamydia screening recommendations
Sexually active women should be screened for chlamydia (and gonorrhea) if 24 y/o or younger or 25+ and at increased risk
Gonorrhea big 5
Etiology: infectious agent = neisseria gonorrhoeae (shorter incubation period than chlamydia)
Transmission: sexual
S/sx: can be asymptomatic, can also see dysuria, urinary frequency
Physical exam: yellow-green purulent discharge
Diagnosis: NAAT is gold standard
Treatment: ceftriaxone 500 mg IM one time injection (1 g IM if pt weighs > 150 lbs), also treat for chlamydia
Gonorrhea morphology
Gram negative diplococci
Why do you cotreat for chlamydia in a pt who is positive for gonorrhea?
Chlamydia has a longer incubation time but is often cotransmitted with gonorrhea, so you treat for both because you assume that the chlamydia will develop later
HPV big 5
Etiology: infectious agents = HPV type 16 and 18 (oncogenic), types 6 and 11 (genital warts)
Transmission: primarily sexual, rare vertical transmission through birth
S/sx: “cauliflower lesions” on genitals, hands, mouth, throat, itching
Diagnosis: usually a clinical diagnosis, but NAAT is confirmatory (allows HPV typing), can also biopsy to confirm dx if lesions are atypical, bleeding, or ulcerated
Tx: removal of visible warts, topical agents (podofilox, imiquimod, aka Aldara), HPV vaccine as PREVENTION
Which types of HPV are associated with cancer? Which are associated with genital warts?
Cancer - types 16 and 18
Warts - types 6 and 11
Trichomoniasis big 5
Etiology: infectious agent = trichomonas vaginalis
Transmission: Sexual
S/sx: burning, dysuria, pruritus
Physical exam: yellow/green vaginal discharge, strawberry cervix, pelvic tenderness on palpation
Labs: flagellated protozoa on wet mount, (+) whiff test
Treatment: oral metronidazole (OK in pregnant patients)
T or F: Trich doesn’t survive well outside of the body
True (along with chlamydia, this is why they both have to be confirmed with NAAT rather than gram staining)
What is the vaginal pH with a trichomonas infection?
> 4.5
Bacterial vaginosis big 5
Etiology: infectious agent = gardnerella vaginalis
Transmission: can be transmitted sexually, but is NOT an STD bc it has other modes of transmission (IUD, vaginal douching, pregnancy)
Patho: lack of lactobacillus leads to elevated vaginal pH and growth of gardnerella vaginalis
S/sx: MC asymptomatic
Physical exam: milky discharge with fishy odor
Labs: (+) whiff/amine test, vaginal pH > 4.5, (+) clue cells on wet mount,(+) milky/gray vaginal discharge
Treatment: asx will resolve w/o tx, symptomatic = oral or intravaginal metronidazole
What is the Amsel criteria for BV?
BV diagnosis is confirmed when 3 out of 4 are met:
1) Vaginal pH > 4.5
2) Clue cells on wet mount
3) Positive amine/whiff test
4) Gray or yellow discharge on vaginal exam
Vulvovaginal candidiasis (yeast infection) big 5
Etiology: infectious agent = candida albicans
Transmission: not solely sexual
S/sx: white, crumbly, discharge (“cottage cheese”), ODORLESS, burning, itchy, dysuria, dyspareunia
Physical exam: erythema in vulva and vagina
Diagnosis: wet mount = pseudohyphae
Treatment: Non-pregnant = topical -azole or single dose of fluconazole; pregnant = topical -azole (clortimazole, miconoazole)
