STIs + PID Flashcards
1
Q
Chlamydia
caused by which gram neg bacteria?
A
chlamydia trachomatis
2
Q
Chlamydia
mode of transmission
A
sex (anal or oral)
3
Q
Chlamydia
risk factors
A
- young age
- new partner/multiple partners
- inconsistent use of barrier methods
4
Q
Chlamydia
presentation of most patients male & female which allows for rapid spread?
A
asx
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
6
Q
Chlamydia
sx in men
3
A
- mucus or clear watery penile discharge (no odor)
- testicular pain/swelling
- burning with urination (dysuria)
7
Q
Chlamydia
rectal sx
5
A
- mucus like anal discharge
- anal bleeding, pain, pruritis
- painful bowel movements
8
Q
Chlamydia
Physical Exam Findings
Women
A
- can be unremarkable
- Cervicitis: mucupurulent discharge, cervical edema, cervical contact bleeding
- PID: cervical motion tenderness
9
Q
Chlamydia
Physical Exam Findings
Men
A
- can be unremarkable
- Urethral discharge
- scrotal swelling/pain
10
Q
Chlamydia
Dx
A
- NAAT (vaginal/cervical swab or urine)
11
Q
Chlamydia
Tx
firstline, second, and then 3 other options.
A
- Doxycycline (100mg PO, Q12 hrs, 7 days)
- Azithromycin (1gm PO x1 dose)
- Erythromycin, Ofloxacin, Levofloxacin
12
Q
Chlamydia
woh shuld be treated with Azithromycin?
A
pregnant women
13
Q
Chlamydia
which previous sexual partners should receive treatment?
A
anyone from three months
14
Q
Chlamydia
What follow up is done?
2 things
A
- test of cure within 3 wks
- test for reinfection after 3 mo (everyone)
15
Q
Chlamydia
which pts get test of cure withing 3 wks?
3 groups
A
- pregnant pts
- those with persistent sx
- Rx with erythromycin or amoxicillin because they are sub-optimal
16
Q
Chlamydia
Who is recommended for regular screening?
A
- under 25 years old
- pregnant
- new or multiple partners
- hx of chlamydia
17
Q
Chlamydia
Complications
2 overall, regardless of gender
A
- reactive arthritis
- conjunctivitis
18
Q
Chlamydia
Complications
non-pregnant females- 3 things
A
- increased risk for chronic pelvic pain
- infertility
- ectopic pregnancy
19
Q
Chlamydia
Complications
to fetus in preg females- 3 things
A
- preterm delivery
- neonatal blindness (conjunctivitis)
- neonatal pneumonia
20
Q
Chlamydia
Complications
Men
A
- reduced fertility
- epididymitis
21
Q
Gonorrhea
caused by which gram negative diplococci?
A
Neisseria gonorrhoeae
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
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
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
25
# Gonorrhea
Sx
| Rectal- 6ish
* anal discharge, pain, pruritis
* anal bleeding
* painful bowel movements
* possible: throat infection/pain
26
# Gonorrhea
Physical Exam Findings
| Women- 3
mucoprurulent discharge
friable cervix
cervical motion tenderness
27
# Gonorrhea
Physical Exam Findings
| Men- 1
mucopurulent urethral discharge
28
# Gonorrhea
Dx
NAAT
29
# Gonorrhea
Tx
| one med
1. Ceftriaxone (500-1000mg IM; wt dosed)
30
# Gonorrhea
why do we use high dose ceftriaxone?
* high dose because of increased MIC
* drug resistance is challenging rx
31
# Gonorrhea
which condition do we treat for simultaneously? which med?
* chlamydia
* Doxy or azithro
32
# Gonorrhea
who do we do test of cure on?
| inf. location
those with oropharyngeal infection
33
# Gonorrhea
Complications
| All populations- 1 category w/ 6 things in it
Disseminated Infection
* septic arthritis
* skin lesions
* pericarditis
* endocarditis
* meningitis
34
# Gonorrhea
Complications
| Females- 3
1. chronic pelvic pain
2. infertility
3. ectopic pregnancy
35
# Gonorrhea
Complications
| Men- 4
1. scars in urethra
2. inflammation of testicles
3. infertility
4. chronic prostate pain
36
# Gonorrhea
Complications
| Infants- 4
* ophthalmia neonatorum
* sepsis
* meningitis
* scalp abscesses
37
# Syphilis
caused by which spirochete?
*Treponema pallidum*
38
# Syphilis
who is disproportionately infected?
African American/Black individuals
39
# Syphilis
associated with ____ infection among ____ population.
1. HIV
2. MSM
40
# Syphilis
Transmission
* direct contact with lesion (kissing, touching, sex)
* crosses placenta
41
# Syphilis
what are the stages of syphilis?
| 4
1. primary
2. secondary
3. latent
4. tertiary (late)
42
# Syphilis
describe the primary stage
| onset/duration, sx
* 2-12 wks after exposure
* small, painless chancre (ulcers) develops and heals spontaneously
* stage may go unnoticed
43
# Syphilis
describe the secondary stage
| onset/duration, sx
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
# Syphilis
describe the latent stage
| when does it go here?
can go latent if left untreated and pt is without sx
45
# Syphilis
describe the tertiary (late) stage
| onset/duration, sx
1. moves here if untreated for 1 to 30 years after primary infection
2. CNS damage, cardiovascular lesions
46
# Syphilis
Dx- primary stage
| 2 signs/sx, 2 tests
* painless chancre (nontender, nonpurulent, indurated)
* nontender enlargement of regional lymp
* fluid from ulcer contacins *T. pallidum*
* serologic nontreponemal and treponemal tests
47
# Syphilis
Dx- secondary stage
| 3 groups of sx/signs, 2 tests
* generalized maculopapular rash on palms/soles
* mucous membrane lesions
* meningitis, hepatitis, osteitis, arthritis, iritis
* treponemes in moist lesions
* pos serologic test for syphilis
48
# Syphilis
Dx- latent stage
pos serologic tests for syphilis
(because no sx)
49
# Syphilis
Dx- tertiary stage
* Gummas
* CV damage
* CNS damage
50
# Syphilis
what are gummas
infiltrative tumors of skin/bones/liver
51
# Syphilis
what CV damage can occur in tert stage?
| 3 things
1. aortitis
2. aortic aneurysms
3. aortic regurgitation
52
# Syphilis
what CNS damange can occur?
| 5 things
1. meningovascular & degenerative changes
2. paresthesias
3. abnormal reflexes
4. dementia
5. psychosis
53
# Syphilis
when can neurosyphilis occur?
at any stage of disease
54
# Syphilis
characteristics of neurosyphilis
| 4 things
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
# Syphilis
Dx- neurosyphilis
1. perform neuro exam on all pts
2. consider CSF eval for atypical sx or no decrease in serology titers
56
# Syphilis
dx- congenital syphilis
* 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
# Syphilis
if a neonate is at risk for congenital syphilis what should they also be tested for?
HIV
58
# Syphilis
sx of congenital syphilis
| during preg- 3
miscarriage
stillborne
premature neonatla death
59
# Syphilis
sx of congenital syph
| seen after birth/later on- 6
desquamating maculopapular rash
serious rhinitis
saddle nose deformity
hutchinson's teeth
chorioretinopathy/optic neuritis
deafness
60
# Syphilis
describe the nontreponemal serologic test
* amoung of ab present (IgM & IgG) represents activity of infection
* not a definitive or specific test
61
# Syphilis
describe the treponemal serologic test
* 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
# Syphilis
Tx
| in primary/secondard/early latent stages & first/second/third trimesters
PCN G benzathine (2.4 mil units IM, x1)
| in third trimester, can repeat dose in 1 wk
63
# Syphilis
Tx
| late latent/tertiary stage
PCN G benzathine (2.4 mil units IM, wkly for 3 wks)
64
# Syphilis
Tx
| neurosphyilis
aqueous PCN G (18-24 mil units IV, QD, 10-14 days)
65
# Syphilis
what to use in PCN allergic, non-pregnant pts?
Doxy
66
# Syphilis
who do we reccomend PCN desensitation for?
pregnant pts with PCN hypersensitivity
67
# Syphilis
what is a Jarisch-Herxheimer rxn?
* acute worsening of sx and fever after tx begins
* occurs because toxins are released by spirchetes when they are skilled by the abx
68
# Syphilis
post tx monitoring
| early vs late syphilis
* early: RPR or VDRL at 6 and 12 mo intervals
* latent: RPR or VDRL at 6, 12, and 24 mo intervals
69
# Syphilis
when do we know tx failed?
return of signs/sx
titer of RPR or VDRL increases or does not change
70
# Trichomoniasis
caused by what protozoan
*Trichomonas vaginalis*
71
# Trichomoniasis
Sx
| males
* can be asx
* urethral discharge
72
# Trichomoniasis
sx
| females
* can be asx
* Frothy yellow/green discharge with fish odor
* pruritic (intensely sometimes- mistake for yeast)
* swelling, pain, redness in vulva
* dysuria
73
# Trichomoniasis
Dx
| exam findings, wet prep findings
* speculum exam finds "strawberry cervix"
* Wet prep: pH >4.5, amine/fish odor, many WBC (even if no trich isolated)
74
# Trichomoniasis
Tx
* Metronidazole (500 mg PO, BID, 7 days)
* Tinidazole (500mg PO, BID, 7 days)
75
# Trichomoniasis
prophylactic tx
* metronidazole (2g PO, x1)
* tinidazole (2g PO, x1)
76
# Vulvovaginal Candidiasis
caused by?
*Candida albicans*
77
# Vulvovaginal Candidiasis
this is not an ____
STI
78
# Vulvovaginal Candidiasis
Signs & Sx
| 5
1. pruritis
2. thick white curd-like discharge (no odor)
3. vulvular erythema, edema, excoriation
4. KOH prep= spores & hyphae
79
# Vulvovaginal Candidiasis
Tx in non-pregnant women
| topical vs oral
Topical
* 1-3 day regimen (miconazole or tioconazole)
Oral
* Fluconazole (150mg PO, x1)
80
# Vulvovaginal Candidiasis
tx in pregnant women
| topical only
longer course of miconazole or tioconazole
81
# Vulvovaginal Candidiasis
risk factors
| 7 things
1. DM
2. broad spectrum abx use
3. increased estrogen (OCPs)
4. pregnancy
5. corticosteroid use
6. immunosuppression
7. IUDs?
82
# Pelvic Inflammatory Disease (PID)
define
| what type of infection? associated with what?
polymicrobial infection of the upper genital tract- associated with STIs
83
# Pelvic Inflammatory Disease (PID)
what meets diagnostic criteria for PID?
| 3 things
1. cervical motion tenderness
2. uterine tenderness
3. adnexal tenderness
84
# Pelvic Inflammatory Disease (PID)
incidence
| related to, age, risk
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
# Pelvic Inflammatory Disease (PID)
OB/GYN differential dx
| 6
1. ovarian torsion
2. ectopic preg
3. ruptured ovarian cyst
4. endometriosis
5. cervicitis
6. ovarian neoplasm
86
# Pelvic Inflammatory Disease (PID)
GI differential dx
| 5
1. appendicitis
2. cholecystitis
3. diverticulitis
4. IBD
5. gastroenteritis
87
# Pelvic Inflammatory Disease (PID)
differential dx of GU system
| 4
1. urolithiasis
2. pyelonephritis
3. urethritis
4. cystitis
88
# Pelvic Inflammatory Disease (PID)
risk factors
| 7ish
1. age
2. hx of PID or chlam/gon
3. multiple partners
4. douching
5. insertion of IUD, use of OCPs
6. bacterial vaginosis
8. demographics (low SES/access to care)
89
# Pelvic Inflammatory Disease (PID)
Signs & Sx
| 6
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
# Pelvic Inflammatory Disease (PID)
Dx criteria
1. pelvic/abd pain
2. uterine or adnexal cervical motion tenderness
91
# Pelvic Inflammatory Disease (PID)
Dx criteria- may or may not have
| 5 things
1. fever
2. WBCs on saline wet prep
3. GC/CT hx
4. mucoprurulent discharge/friable cervix
5. elevated ESR/CRP
92
# Pelvic Inflammatory Disease (PID)
Testing to use to rule out other infections
| 7 tests
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
# Pelvic Inflammatory Disease (PID)
what radiolographic method can be used to confirm or ovarian abscess?
ultrasound
94
# Pelvic Inflammatory Disease (PID)
Tx
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
# Pelvic Inflammatory Disease (PID)
indicators for hospitalization
| 6 things
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
# Pelvic Inflammatory Disease (PID)
Complications
* tubo-ovarian abscess (TOA)
* Fitz-Hugh-Curtis Syndrome
* Ectopic pregnancy
* infertility
* chronic pelvic pain
97
# Pelvic Inflammatory Disease (PID)
describe TOA
* debris, septations, irregular thick walls
* often bilateral
98
# Pelvic Inflammatory Disease (PID)
describe Fitz-Hugh-Curtis Syndrome
liver capsule inflammation
99
# Pelvic Inflammatory Disease (PID)
Prevention
1. STI screening & treatment
2. condom use
