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STIs + PID Flashcards

1
Q

Chlamydia

caused by which gram neg bacteria?

A

chlamydia trachomatis

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2
Q

Chlamydia

mode of transmission

A

sex (anal or oral)

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3
Q

Chlamydia

risk factors

A
  • young age
  • new partner/multiple partners
  • inconsistent use of barrier methods
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4
Q

Chlamydia

presentation of most patients male & female which allows for rapid spread?

A

asx

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5
Q

Chlamydia

sx in women

8 things

A
  • white, yellow, gray vaginal discharge (no odor)
  • ithcing, burning, metrorrhagia
  • postcoital bleeding, painful intercourse
  • PID: pelvic pain, fever chills
  • UTI sx
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6
Q

Chlamydia

sx in men

3

A
  • mucus or clear watery penile discharge (no odor)
  • testicular pain/swelling
  • burning with urination (dysuria)
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7
Q

Chlamydia

rectal sx

5

A
  • mucus like anal discharge
  • anal bleeding, pain, pruritis
  • painful bowel movements
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8
Q

Chlamydia

Physical Exam Findings

Women

A
  • can be unremarkable
  • Cervicitis: mucupurulent discharge, cervical edema, cervical contact bleeding
  • PID: cervical motion tenderness
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9
Q

Chlamydia

Physical Exam Findings

Men

A
  • can be unremarkable
  • Urethral discharge
  • scrotal swelling/pain
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10
Q

Chlamydia

Dx

A
  1. NAAT (vaginal/cervical swab or urine)
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11
Q

Chlamydia

Tx

firstline, second, and then 3 other options.

A
  1. Doxycycline (100mg PO, Q12 hrs, 7 days)
  2. Azithromycin (1gm PO x1 dose)
  3. Erythromycin, Ofloxacin, Levofloxacin
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12
Q

Chlamydia

woh shuld be treated with Azithromycin?

A

pregnant women

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13
Q

Chlamydia

which previous sexual partners should receive treatment?

A

anyone from three months

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14
Q

Chlamydia

What follow up is done?

2 things

A
  1. test of cure within 3 wks
  2. test for reinfection after 3 mo (everyone)
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15
Q

Chlamydia

which pts get test of cure withing 3 wks?

3 groups

A
  1. pregnant pts
  2. those with persistent sx
  3. Rx with erythromycin or amoxicillin because they are sub-optimal
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16
Q

Chlamydia

Who is recommended for regular screening?

A
  1. under 25 years old
  2. pregnant
  3. new or multiple partners
  4. hx of chlamydia
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17
Q

Chlamydia

Complications

2 overall, regardless of gender

A
  1. reactive arthritis
  2. conjunctivitis
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18
Q

Chlamydia

Complications

non-pregnant females- 3 things

A
  1. increased risk for chronic pelvic pain
  2. infertility
  3. ectopic pregnancy
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19
Q

Chlamydia

Complications

to fetus in preg females- 3 things

A
  1. preterm delivery
  2. neonatal blindness (conjunctivitis)
  3. neonatal pneumonia
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20
Q

Chlamydia

Complications

Men

A
  1. reduced fertility
  2. epididymitis
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21
Q

Gonorrhea

caused by which gram negative diplococci?

A

Neisseria gonorrhoeae

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22
Q

Gonorrhea

Epi- relative rates, who infected most?

not a specific rate, just a generalized statement

A
  • second most common communicable disease in US
  • highest rates among sexually active teens & adults
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23
Q

Gonorrhea

Sx

Women- 7 sx, 1 general statement on commonality of sx

A
  • often asx
  • white/yellow discharge from vagine
  • metrorrhagia, postcoital bleeding
  • PID: pelvic pain, chills, fever
  • UTI sx
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24
Q

Gonorrhea

Sx

Men- 1 statement on commonality of sx, 4 sx

A
  • sx more common with gonorrhea than with chlamydia
  • white/yellow penile discharge
  • burning with urination
  • testicular/scrotal pain/swelling
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25
Q

Gonorrhea

Sx

Rectal- 6ish

A
  • anal discharge, pain, pruritis
  • anal bleeding
  • painful bowel movements
  • possible: throat infection/pain
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26
Q

Gonorrhea

Physical Exam Findings

Women- 3

A

mucoprurulent discharge
friable cervix
cervical motion tenderness

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27
Q

Gonorrhea

Physical Exam Findings

Men- 1

A

mucopurulent urethral discharge

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28
Q

Gonorrhea

Dx

A

NAAT

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29
Q

Gonorrhea

Tx

one med

A
  1. Ceftriaxone (500-1000mg IM; wt dosed)
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30
Q

Gonorrhea

why do we use high dose ceftriaxone?

A
  • high dose because of increased MIC
  • drug resistance is challenging rx
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31
Q

Gonorrhea

which condition do we treat for simultaneously? which med?

A
  • chlamydia
  • Doxy or azithro
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32
Q

Gonorrhea

who do we do test of cure on?

inf. location

A

those with oropharyngeal infection

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33
Q

Gonorrhea

Complications

All populations- 1 category w/ 6 things in it

A

Disseminated Infection
* septic arthritis
* skin lesions
* pericarditis
* endocarditis
* meningitis

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34
Q

Gonorrhea

Complications

Females- 3

A
  1. chronic pelvic pain
  2. infertility
  3. ectopic pregnancy
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35
Q

Gonorrhea

Complications

Men- 4

A
  1. scars in urethra
  2. inflammation of testicles
  3. infertility
  4. chronic prostate pain
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36
Q

Gonorrhea

Complications

Infants- 4

A
  • ophthalmia neonatorum
  • sepsis
  • meningitis
  • scalp abscesses
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37
Q

Syphilis

caused by which spirochete?

A

Treponema pallidum

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38
Q

Syphilis

who is disproportionately infected?

A

African American/Black individuals

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39
Q

Syphilis

associated with ____ infection among ____ population.

A
  1. HIV
  2. MSM
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40
Q

Syphilis

Transmission

A
  • direct contact with lesion (kissing, touching, sex)
  • crosses placenta
41
Q

Syphilis

what are the stages of syphilis?

4

A
  1. primary
  2. secondary
  3. latent
  4. tertiary (late)
42
Q

Syphilis

describe the primary stage

onset/duration, sx

A
  • 2-12 wks after exposure
  • small, painless chancre (ulcers) develops and heals spontaneously
  • stage may go unnoticed
43
Q

Syphilis

describe the secondary stage

onset/duration, sx

A
  1. 1 to 6 mo after chancre healing
  2. raised rash appears on palms/soles
  3. general sx: fever, adenopathy, fatigue, myalgia, sore throat, eye sx, GI sx
44
Q

Syphilis

describe the latent stage

when does it go here?

A

can go latent if left untreated and pt is without sx

45
Q

Syphilis

describe the tertiary (late) stage

onset/duration, sx

A
  1. moves here if untreated for 1 to 30 years after primary infection
  2. CNS damage, cardiovascular lesions
46
Q

Syphilis

Dx- primary stage

2 signs/sx, 2 tests

A
  • painless chancre (nontender, nonpurulent, indurated)
  • nontender enlargement of regional lymp
  • fluid from ulcer contacins T. pallidum
  • serologic nontreponemal and treponemal tests
47
Q

Syphilis

Dx- secondary stage

3 groups of sx/signs, 2 tests

A
  • generalized maculopapular rash on palms/soles
  • mucous membrane lesions
  • meningitis, hepatitis, osteitis, arthritis, iritis
  • treponemes in moist lesions
  • pos serologic test for syphilis
48
Q

Syphilis

Dx- latent stage

A

pos serologic tests for syphilis
(because no sx)

49
Q

Syphilis

Dx- tertiary stage

A
  • Gummas
  • CV damage
  • CNS damage
50
Q

Syphilis

what are gummas

A

infiltrative tumors of skin/bones/liver

51
Q

Syphilis

what CV damage can occur in tert stage?

3 things

A
  1. aortitis
  2. aortic aneurysms
  3. aortic regurgitation
52
Q

Syphilis

what CNS damange can occur?

5 things

A
  1. meningovascular & degenerative changes
  2. paresthesias
  3. abnormal reflexes
  4. dementia
  5. psychosis
53
Q

Syphilis

when can neurosyphilis occur?

A

at any stage of disease

54
Q

Syphilis

characteristics of neurosyphilis

4 things

A
  1. meningitis
  2. tabes dorsalis (damages posterior columns & dorsal roots of spinal cord)
  3. mental deterioration/psychiatric sx
  4. Argyll-Robertson pupil (accommodates, but no rxn to light)
55
Q

Syphilis

Dx- neurosyphilis

A
  1. perform neuro exam on all pts
  2. consider CSF eval for atypical sx or no decrease in serology titers
56
Q

Syphilis

dx- congenital syphilis

A
  • syphilis pos mother
  • presence of clinical, laboratory, or radiographic evidence of syph in neonate
  • comparison of maternal (at time of delivery) and fetal nontreponemal serologic titers
57
Q

Syphilis

if a neonate is at risk for congenital syphilis what should they also be tested for?

58
Q

Syphilis

sx of congenital syphilis

during preg- 3

A

miscarriage
stillborne
premature neonatla death

59
Q

Syphilis

sx of congenital syph

seen after birth/later on- 6

A

desquamating maculopapular rash
serious rhinitis
saddle nose deformity
hutchinson’s teeth
chorioretinopathy/optic neuritis
deafness

60
Q

Syphilis

describe the nontreponemal serologic test

A
  • amoung of ab present (IgM & IgG) represents activity of infection
  • not a definitive or specific test
61
Q

Syphilis

describe the treponemal serologic test

A
  • used as initial screening test
  • confirmatory test if nontreponemal test is reactive
  • not useful for confirming new dx of syphilis in pt’s with a hx of syphilis because they’ll be pos for life
62
Q

Syphilis

Tx

in primary/secondard/early latent stages & first/second/third trimesters

A

PCN G benzathine (2.4 mil units IM, x1)

in third trimester, can repeat dose in 1 wk

63
Q

Syphilis

Tx

late latent/tertiary stage

A

PCN G benzathine (2.4 mil units IM, wkly for 3 wks)

64
Q

Syphilis

Tx

neurosphyilis

A

aqueous PCN G (18-24 mil units IV, QD, 10-14 days)

65
Q

Syphilis

what to use in PCN allergic, non-pregnant pts?

66
Q

Syphilis

who do we reccomend PCN desensitation for?

A

pregnant pts with PCN hypersensitivity

67
Q

Syphilis

what is a Jarisch-Herxheimer rxn?

A
  • acute worsening of sx and fever after tx begins
  • occurs because toxins are released by spirchetes when they are skilled by the abx
68
Q

Syphilis

post tx monitoring

early vs late syphilis

A
  • early: RPR or VDRL at 6 and 12 mo intervals
  • latent: RPR or VDRL at 6, 12, and 24 mo intervals
69
Q

Syphilis

when do we know tx failed?

A

return of signs/sx
titer of RPR or VDRL increases or does not change

70
Q

Trichomoniasis

caused by what protozoan

A

Trichomonas vaginalis

71
Q

Trichomoniasis

Sx

males

A
  • can be asx
  • urethral discharge
72
Q

Trichomoniasis

sx

females

A
  • can be asx
  • Frothy yellow/green discharge with fish odor
  • pruritic (intensely sometimes- mistake for yeast)
  • swelling, pain, redness in vulva
  • dysuria
73
Q

Trichomoniasis

Dx

exam findings, wet prep findings

A
  • speculum exam finds “strawberry cervix”
  • Wet prep: pH >4.5, amine/fish odor, many WBC (even if no trich isolated)
74
Q

Trichomoniasis

Tx

A
  • Metronidazole (500 mg PO, BID, 7 days)
  • Tinidazole (500mg PO, BID, 7 days)
75
Q

Trichomoniasis

prophylactic tx

A
  • metronidazole (2g PO, x1)
  • tinidazole (2g PO, x1)
76
Q

Vulvovaginal Candidiasis

caused by?

A

Candida albicans

77
Q

Vulvovaginal Candidiasis

this is not an ____

78
Q

Vulvovaginal Candidiasis

Signs & Sx

5

A
  1. pruritis
  2. thick white curd-like discharge (no odor)
  3. vulvular erythema, edema, excoriation
  4. KOH prep= spores & hyphae
79
Q

Vulvovaginal Candidiasis

Tx in non-pregnant women

topical vs oral

A

Topical
* 1-3 day regimen (miconazole or tioconazole)

Oral
* Fluconazole (150mg PO, x1)

80
Q

Vulvovaginal Candidiasis

tx in pregnant women

topical only

A

longer course of miconazole or tioconazole

81
Q

Vulvovaginal Candidiasis

risk factors

7 things

A
  1. DM
  2. broad spectrum abx use
  3. increased estrogen (OCPs)
  4. pregnancy
  5. corticosteroid use
  6. immunosuppression
  7. IUDs?
82
Q

Pelvic Inflammatory Disease (PID)

define

what type of infection? associated with what?

A

polymicrobial infection of the upper genital tract- associated with STIs

83
Q

Pelvic Inflammatory Disease (PID)

what meets diagnostic criteria for PID?

3 things

A
  1. cervical motion tenderness
  2. uterine tenderness
  3. adnexal tenderness
84
Q

Pelvic Inflammatory Disease (PID)

incidence

related to, age, risk

A
  1. related to increased incidence of gonorrhea/chlamydia
  2. ages 15-25
  3. increased risk w/ multiple partners
  4. increased risk w/ failure to use condoms
85
Q

Pelvic Inflammatory Disease (PID)

OB/GYN differential dx

6

A
  1. ovarian torsion
  2. ectopic preg
  3. ruptured ovarian cyst
  4. endometriosis
  5. cervicitis
  6. ovarian neoplasm
86
Q

Pelvic Inflammatory Disease (PID)

GI differential dx

5

A
  1. appendicitis
  2. cholecystitis
  3. diverticulitis
  4. IBD
  5. gastroenteritis
87
Q

Pelvic Inflammatory Disease (PID)

differential dx of GU system

4

A
  1. urolithiasis
  2. pyelonephritis
  3. urethritis
  4. cystitis
88
Q

Pelvic Inflammatory Disease (PID)

risk factors

7ish

A
  1. age
  2. hx of PID or chlam/gon
  3. multiple partners
  4. douching
  5. insertion of IUD, use of OCPs
  6. bacterial vaginosis
  7. demographics (low SES/access to care)
89
Q

Pelvic Inflammatory Disease (PID)

Signs & Sx

6

A
  1. abnormal vag discharge
  2. abnormal bleeding
  3. pain in upper/lower abdomen
  4. fever/chills
  5. dysuria
  6. dyspareunia

can be variable/broad

90
Q

Pelvic Inflammatory Disease (PID)

Dx criteria

A
  1. pelvic/abd pain
  2. uterine or adnexal cervical motion tenderness
91
Q

Pelvic Inflammatory Disease (PID)

Dx criteria- may or may not have

5 things

A
  1. fever
  2. WBCs on saline wet prep
  3. GC/CT hx
  4. mucoprurulent discharge/friable cervix
  5. elevated ESR/CRP
92
Q

Pelvic Inflammatory Disease (PID)

Testing to use to rule out other infections

7 tests

A
  1. preg test
  2. CBC with diff
  3. gram stain of discharge
  4. microscopy of discharge
  5. NAAT GC and CT
  6. HIV test
  7. RPR
93
Q

Pelvic Inflammatory Disease (PID)

what radiolographic method can be used to confirm or ovarian abscess?

A

ultrasound

94
Q

Pelvic Inflammatory Disease (PID)

Tx

A

many different options based on severity of sx/location of tx
* inpatient: cefoxitin/cefotetan w/ doxy or clindamycin w/ gentamicin
* outpatient: ceftriaxone (IM x1) w/ doxy (14 days) w/ metronidazole (14 days)

95
Q

Pelvic Inflammatory Disease (PID)

indicators for hospitalization

6 things

A
  1. can’t exclude surgical emergency
  2. pregnant
  3. pelvic abscess suspected
  4. HIV infection w/ low CD4 count
  5. non-response to oral therapies or suspected non-compliance
  6. severe illness
96
Q

Pelvic Inflammatory Disease (PID)

Complications

A
  • tubo-ovarian abscess (TOA)
  • Fitz-Hugh-Curtis Syndrome
  • Ectopic pregnancy
  • infertility
  • chronic pelvic pain
97
Q

Pelvic Inflammatory Disease (PID)

describe TOA

A
  • debris, septations, irregular thick walls
  • often bilateral
98
Q

Pelvic Inflammatory Disease (PID)

describe Fitz-Hugh-Curtis Syndrome

A

liver capsule inflammation

99
Q

Pelvic Inflammatory Disease (PID)

Prevention

A
  1. STI screening & treatment
  2. condom use

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