Unit 1 - Diabnosing STIs Flashcards
what percentage of female teenagers have an STI?
1 in 4, so 25%
what percentage of new STI cases are in people 15 to 24 yo?
1/2
-most asymptomatic and undiagnosed
what about parental consent?
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)
that are three differential diagnoses for dysuria?
- UTI
- genital tract infection (cervicitis, vaginitis)
- skin related abnormalities/mucosal perineal (herpes, trauma)
what is important to get in history if one has dysuria?
- onset and duration of symptoms
- description of symptoms
- associated symptoms
- nausea/vomiting
- fever/chills
- back pain
- abdominal pain
- sores, lumps, bumps
- dysparenunia
what must one obtain from the sexual history?
5 P’s
- partners (number, amount of time, gender)
- prevention of pregnancy (contraception, emergency contraception)
- protection from STIs (condom use)
- practices (type of sex: anal, vaginal, oral, giving/receiving)
- past history of STIs
would frequent urination happen with an STI or a UTI?
frequent urination would happen with a UTI
what are the most common causes of vaginitis?
- Candida
- Trichomonas
- Bacterial vaginosis
what does trichomonas infection look like in females?
50% are asymptomatic
- foul-smelling, frothy discharge
- vaginal itching or redness
- dyspareunia
- urge to urinate and dysuria
- post-coital bleeding
- excessive or prolonged menses
what does trichomonas infection look like in males?
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
if a female’s period is prolonged, what is the possible cause?
Trichomonas infection
what does bacterial vaginosis look like in females?
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
what does candidas infection look like in females?
- genital itching or burning
- cottage cheese like discharge
- fire-red tissue
what does Candidas infection look like in males?
itchy penile rash
what to symptoms/presentation look like in:
- bacterial vaginosis
- candidiasis
- trichomoniasis
BV: odor, discharge, itch
C: itch, discomfort, dysuria, thick discharge
T: itch, discharge, 50% asymptomatic
what does vaginal discharge look like in
- bacterial vaginosis
- candidiasis
- trichomoniasis
BV: homogenous, adherent, thin, milky-white, malodorous, “foul fishy”
C: thick, clumpy, white “cottage cheese”
T: frothy, gray, or yellow-green; malodorous
what are clinical findings in:
- bacterial vaginosis
- candidiasis
- trichomoniasis
BV: N/A
C: inflammation and erythema
T: cervical petechia (“strawberry cervix”)
what is the vaginal pH in
- bacterial vaginosis
- candidiasis
- trichomoniasis
(normal is 3.8 to 4.2)
BV: >4.5
C: usually <4.5
T: 4.5
what is the KOH “whiff test” results in:
- bacterial vaginosis
- candidiasis
- trichomoniasis
BV: positive
C: negative
T: often positive
what does the NaCl wet mount look like in
- bacterial vaginosis
- candidiasis
- trichomoniasis
BV: “clue cells” >20% (unique to BV), no/few WBC
C: few WBC
T: motile flagellated protozoa, many WBC
what does the KOH wet mount look like in:
- bacterial vaginosis
- candidiasis
- trichomoniasis
BV: N/A
C: pseudohyphae or spores if non-albicans species
T: N/A
diagnosing trichomonas in males and females
- 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
candida diagnosis in males/females
largely a clinical diagnosis
- women take themselves to any pharmacy and generally self-treat
- otherwise use DNA probe or wet mount
bacterial vaginitis diagnosis in females
Amsel’s criteria - requires presence of at least three of following four:
- whiff test positive for fishy/mushy odor when alkaline KOH solution added to smear
- “Clue” cells (bacteria attached to borders of epithelial cells) on >20% –> Gram Stain Gold Standard
- vaginal pH > 4.5
- homogenous non-inflammatory discharge
how could we diagnose vaginitis using laboratory tests?
- nucleic acid probe that tests for T. vaginalis, G. vaginalis, and C. albicans
- performed on vaginal secretions, and results in 45 minutes - wet mount (takes a long time and skill)
how do you treat bacterial vaginitis and trichomonas?
metronidazole, but in diferent doses
-for trichomonas, also must test partner
what are the most common causes of cervicitis?
chlamydia and gonorrhea
what are chlamydia symptoms (with regards to cervicitis) in females?
up to 75% females are asymptomatic
- heavy or prolonged menses
- spotting
- dysmenorhea
- dyspareunia
- vaginal discharge
what are chlamydia symptoms (with regards to cervicitis) in males?
up to 50% are asymptomatic
-itchy penile rash
what are gonorrhea symptoms (with regards to cervicitis) in females?
50% are asymptomatic
- yellow or bloody vaginal discharge
- painful urination
- dysmenorrhea
what are gonorrhea symptoms (with regards to cervicitis) in males?
50% are asymptomatic
- discharge from penis, with pain
- burning during urination
- swollen testicles
what diagnostic test do you order for cervicitis?
- nucleic acid amplification test - NAAT (Gold standard)
2. culture (only for medical legal purposes, and even then not used much)
what is a NAAT?
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)
