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MSII Microbiology > Unit 1 - Diabnosing STIs > Flashcards

Unit 1 - Diabnosing STIs Flashcards

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1
Q

what percentage of female teenagers have an STI?

A

1 in 4, so 25%

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2
Q

what percentage of new STI cases are in people 15 to 24 yo?

A

1/2

-most asymptomatic and undiagnosed

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3
Q

what about parental consent?

A

all states must uphold confidentiality; must not tell parents

  • in all states, the child must first consent to STI services
  • 18 states allow doctors to tell parents IF child gives consent, or if doctor deems it in child’s best interests (NY is not among them)
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4
Q

that are three differential diagnoses for dysuria?

A
  1. UTI
  2. genital tract infection (cervicitis, vaginitis)
  3. skin related abnormalities/mucosal perineal (herpes, trauma)
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5
Q

what is important to get in history if one has dysuria?

A
  1. onset and duration of symptoms
  2. description of symptoms
  3. associated symptoms
    - nausea/vomiting
    - fever/chills
    - back pain
    - abdominal pain
    - sores, lumps, bumps
    - dysparenunia
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6
Q

what must one obtain from the sexual history?

A

5 P’s

  1. partners (number, amount of time, gender)
  2. prevention of pregnancy (contraception, emergency contraception)
  3. protection from STIs (condom use)
  4. practices (type of sex: anal, vaginal, oral, giving/receiving)
  5. past history of STIs
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7
Q

would frequent urination happen with an STI or a UTI?

A

frequent urination would happen with a UTI

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8
Q

what are the most common causes of vaginitis?

A
  1. Candida
  2. Trichomonas
  3. Bacterial vaginosis
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9
Q

what does trichomonas infection look like in females?

A

50% are asymptomatic

  • foul-smelling, frothy discharge
  • vaginal itching or redness
  • dyspareunia
  • urge to urinate and dysuria
  • post-coital bleeding
  • excessive or prolonged menses
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10
Q

what does trichomonas infection look like in males?

A

most are asymptomatic and often missed

  • if symptoms occur, can present as NGU (non-gonococcal urethritis)
  • consider trichomonas in males with recurrent urethritis post adequate treatment
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11
Q

if a female’s period is prolonged, what is the possible cause?

A

Trichomonas infection

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12
Q

what does bacterial vaginosis look like in females?

A

symptoms are odorous discharge and itching

  • found in 24 - 47% of STi clinic patients
  • sequelae are pregnancy complications (get tested ASAP) and possible increase in PID
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13
Q

what does candidas infection look like in females?

A
  • genital itching or burning
  • cottage cheese like discharge
  • fire-red tissue
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14
Q

what does Candidas infection look like in males?

A

itchy penile rash

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15
Q

what to symptoms/presentation look like in:

  • bacterial vaginosis
  • candidiasis
  • trichomoniasis
A

BV: odor, discharge, itch
C: itch, discomfort, dysuria, thick discharge
T: itch, discharge, 50% asymptomatic

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16
Q

what does vaginal discharge look like in

  • bacterial vaginosis
  • candidiasis
  • trichomoniasis
A

BV: homogenous, adherent, thin, milky-white, malodorous, “foul fishy”
C: thick, clumpy, white “cottage cheese”
T: frothy, gray, or yellow-green; malodorous

17
Q

what are clinical findings in:

  • bacterial vaginosis
  • candidiasis
  • trichomoniasis
A

BV: N/A
C: inflammation and erythema
T: cervical petechia (“strawberry cervix”)

18
Q

what is the vaginal pH in

  • bacterial vaginosis
  • candidiasis
  • trichomoniasis

(normal is 3.8 to 4.2)

A

BV: >4.5
C: usually <4.5
T: 4.5

19
Q

what is the KOH “whiff test” results in:

  • bacterial vaginosis
  • candidiasis
  • trichomoniasis
A

BV: positive
C: negative
T: often positive

20
Q

what does the NaCl wet mount look like in

  • bacterial vaginosis
  • candidiasis
  • trichomoniasis
A

BV: “clue cells” >20% (unique to BV), no/few WBC
C: few WBC
T: motile flagellated protozoa, many WBC

21
Q

what does the KOH wet mount look like in:

  • bacterial vaginosis
  • candidiasis
  • trichomoniasis
A

BV: N/A
C: pseudohyphae or spores if non-albicans species
T: N/A

22
Q

diagnosing trichomonas in males and females

A
  • culture (not used very much now)
  • antigen detection (use OSOM rapid teset)
  • DNA probe (Affirm VP III; used most often)
  • wet mount (not used very much now)

no good test for males, so often not tested

23
Q

candida diagnosis in males/females

A

largely a clinical diagnosis

  • women take themselves to any pharmacy and generally self-treat
  • otherwise use DNA probe or wet mount
24
Q

bacterial vaginitis diagnosis in females

A

Amsel’s criteria - requires presence of at least three of following four:

  1. whiff test positive for fishy/mushy odor when alkaline KOH solution added to smear
  2. “Clue” cells (bacteria attached to borders of epithelial cells) on >20% –> Gram Stain Gold Standard
  3. vaginal pH > 4.5
  4. homogenous non-inflammatory discharge
25
Q

how could we diagnose vaginitis using laboratory tests?

A
  1. nucleic acid probe that tests for T. vaginalis, G. vaginalis, and C. albicans
    - performed on vaginal secretions, and results in 45 minutes
  2. wet mount (takes a long time and skill)
26
Q

how do you treat bacterial vaginitis and trichomonas?

A

metronidazole, but in diferent doses

-for trichomonas, also must test partner

27
Q

what are the most common causes of cervicitis?

A

chlamydia and gonorrhea

28
Q

what are chlamydia symptoms (with regards to cervicitis) in females?

A

up to 75% females are asymptomatic

  • heavy or prolonged menses
  • spotting
  • dysmenorhea
  • dyspareunia
  • vaginal discharge
29
Q

what are chlamydia symptoms (with regards to cervicitis) in males?

A

up to 50% are asymptomatic

-itchy penile rash

30
Q

what are gonorrhea symptoms (with regards to cervicitis) in females?

A

50% are asymptomatic

  • yellow or bloody vaginal discharge
  • painful urination
  • dysmenorrhea
31
Q

what are gonorrhea symptoms (with regards to cervicitis) in males?

A

50% are asymptomatic

  • discharge from penis, with pain
  • burning during urination
  • swollen testicles
32
Q

what diagnostic test do you order for cervicitis?

A
  1. nucleic acid amplification test - NAAT (Gold standard)

2. culture (only for medical legal purposes, and even then not used much)

33
Q

what is a NAAT?

A

nucleic acid amplified tests

  • self-collected vaginal swabs
  • provider can obtain specimen if already performing an exam
  • can also use first 10-15 cc of urine specimens from men and women (must be >2h since last void)

MSII Microbiology (23 decks)

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