Summarizing Cases STD's

Question 1

Give the most unique symptom and way to confirm dx of gonorrhea.

Answer 1

gonorrhea: PMNs with dipplococi (in men)

dx by gram stain and culture

tx (widespread ressitance to fluroquinolones), ceftriaxone + azithromycin; treat partners

Question 2

2. Describe the epidemiology of Chlamydia trachomatis and realize its is the most common cause of “nonspecific arthritis.”

Answer 2

Chlamydia trachomatis is the most common cause of nonspecific urethritis esp. in the absence of gonococci; culture

PCR/LCR/DFA for chlamydia

tx azithromycin, treat partners

Question 3

3. Identify and discuss non-STDs that can be acquired during sexual activity and several ways in which STDs can be acquired in the absence of sexual contact.

Answer 3

many diseases can be transmitted during close person-person contact

respiratory diseases
oral secretions
gastrointestinal disease
ectoparasites
skin disease
sexual contact- STDs

transmission can also include transfussion/ needle stick, kissing, maternal/ fetal transmission

Question 4

4. Describe the diagnostic and therapeutic problems posed by multiple STDs, occurring either simultaneously or sequentially.

Answer 4

evidence of past infection may be misleading even if culture is negative; can be particularly confusing with syphilis (VDRL remains positive for 9mo may cause misdiagnose soft chancre as syphilis)

Question 5

Give the most unique symptom and way to confirm dx of non-specific urethritis.

Answer 5

non-specific urethritis: PMNs without diplococci, dx by gram stain

empirical treatment: azithromycin 1 dose

Question 6

Give the most unique symptom and way to confirm dx of syphillis.

Answer 6

syphilis: solitary, non-tender ulcer

VDRL or RPR, confirm with FTA, more complicated after first infection

Question 7

Give the most unique symptom and way to confirm dx of chancroid.

Answer 7

chancroid: tender ulcer, associated with lymphadenopathy (more likely outside the US)

azithromycin

Question 8

Give the most unique symptom and way to confirm dx of herpes simplex.

Answer 8

herpes: groups of painful vesicular lesions that ulcerate, painful lymphadenopathy, photophobia and headache

cell culture or PCR; type specific serologies

tx. acyclovir, famciclovir/ valacyclovir

Question 9

Give the most unique symptom and way to confirm dx of bacterial vaginosis.

Answer 9

KOH “whiff test” +/- gram stain

tx. metronidazole PO/gel or clindamycin cream

Question 10

Give the most unique symptom and way to confirm dx of vulvovaginal candidiasis.

Answer 10

KOH prep +/- culture for Candida

tx with intravaginal cream

Question 11

Give the most unique symptom and way to confirm dx of trichomonas vaginalis.

Answer 11

wet mount for clue cells, whiff test

oral metronidazole or tinidazole; treat partners

Question 12

What STDs can be transmitted from mother to child?

Answer 12

syphilis, HIV, HSV, HBV, HPV, GC, chlamydia

CMV, toxoplasma, rubella and group B strep

Question 13

Give the most unique symptom and way to confirm dx of trichomonas vaginalis.

Answer 13

clinical appearance of warts, abnormal PAP

dx: commercial kits using PCR
tx: metronidazole

Question 14

Give the most unique symptom and way to confirm dx of HBV, HCV.

Answer 14

alteration in LFT,

dx: serologic tests

Question 15

Give the most unique symptom and way to confirm dx of HIV.

Answer 15

evidence of acute viral syndrome

dx: ELISA confirm with Western blot
tx: HAART