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Nurp 501 > Week 3- STIs > Flashcards

Week 3- STIs Flashcards

1
Q

What symptom is specific to BV?

A

Malodorous discharge

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2
Q

Is BV sexually transmitted?

A

No, but it is associated with sex

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3
Q

What is the normal ph of the vagina?

A

3.5-4.5

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4
Q

What happens to vaginal ph with menstrual blood or introduction to semen?

A

It increases

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5
Q

What causes the odor of BV?

A

The lactobacilli are replaced with anaerobic bacteria like gardinella bc of the alkaline environment

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6
Q

Do we treat partners with BV?

A

No

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7
Q

What does adding KOH to slide with vagina secretions do?

A

Gives a positive whiff test
Dissolves epithelial cells so you can see abnormal cells easier
Let’s you see hyphae and yeast buds of a yeast infection

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8
Q

What does adding saline to vaginal secretions do?

A

Let’s you see clue cells
Epithelial cells
WBC
Trichamonasis

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9
Q

What would you see with saline slide if it were trich?

A

Moving flagella, tear drop shaped

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10
Q

Why is it important to do a nucleus acid amplification test? (NAAT)

A

Trichomoniasis can die before you get it under a microscope so you won’t see it moving making it harder to diagnose.

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11
Q

You suspect vulvovaginal candidiasis, what would you see under a microscope with the KOH slide?

A

Hyphae and buds

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12
Q

What would the vagina ph be with vulvovaginal candidiasis?

A

Less than 4.5

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13
Q

How do you treat uncomplicated vulvovaginal candidiasis?

A

Oral fluconazole 150mg single dose

Any azoles 7 nights

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14
Q

Can you give pregnant woman oral fluconazole for VVC?

A

Not in the first trimester, must give topical like miconazole

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15
Q

How do you treat complicated VVC?

A

Topical azole for 7-14 days OR
Fluconazole 150mg every 3rd day for 3 doses OR
Itraconazole 200mg BID for 3 days

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16
Q

What are some risks for VVC?

A 
Occlusive clothing
Diabetes 
Obesity 
COC- estrogen is the cause 
Steroids 
Recent antibiotics 
Pregnancy 
Hormone replacement therapy
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17
Q

Does being sexually active put you at a higher risk for BV?

A

Yes

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18
Q

Does being sexually active put you at a higher risk for a yeast infection?

A

No

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19
Q

Does having multiple sex partners put you at risk for VVC?

A

No

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20
Q

What could you give boric acid for?

A

Complicated VVC

600mg vaginally up to 14 days

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21
Q

What are the 3 strains that can cause VVC?

A

Albicans- most common
Glabrata
Tropicalis

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22
Q

Is trich sexually transmitted?

A

Yes

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23
Q

What do you see under saline in trich?

A

Trichomonads-protazoa

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24
Q

What happens with the vaginal ph with trich?

A

It rises greater than 4.5

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25
Q

What do you see on physical exam with trich when looking with a speculum?

A

Strawberry spots or tiny petechiae on the cervix

Cervix may bleed on contact

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26
Q

What would you expect the discharge to be like with trich?

A

Yellow-green, frothy, mucopurulent, copious, malodorous

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27
Q

How do you test for trich?

A

NAAT

28
Q

How can you collect a specimen to test for trich for the NAAT?

A

Men-urethra or urine

Women- cervical, vaginal, urine

29
Q

How do you treat trich?

A

Metronidazole 2gm PO single dose- If this causes stomach upset- tinidazole 2gm PO single dose- more expensive but less GI distress

30
Q

Can you use vaginal cream for trich?

A

No

31
Q

Does the cdc recommend to retest for trich? If so, when?

A

Yes

In 3 months bc partners that aren’t treated can reinfect

32
Q

What do you teach someone about sex after a diagnosis of trich?

A

Abstain from sex until all partners treated

Until 7 days after treatment has been completed

33
Q

What does KOH look for?

A

Hyphae and buds- kills all epithelial cells for yeast

Positive whiff test for BV

34
Q

What does a saline slide show?

A

Clue cells-BV
Protozoa, flagella- trich
WBC- cervicitis

35
Q

What is the antibiotic therapy for gonorrhea?

A

Ceftriaxone (recephin) 250mg IM once

Cefixime 400mg PO single dose

36
Q

What antibiotic do you give for chlamydia and gonorrhea?

A

Azithromycin 1gm or doxycycline 100mg BID for 7 days and ceftriaxone 250mg IM once

37
Q

What do you give for trich?

A

Metronidazole 2gm PO single dose

38
Q

Can you give metronidazole to someone who has had alcohol in the past 24 hours?

A

No

39
Q

What disease do you do a test of cure for, what population, and what time frame?

A

Chlamydia
Pregnancy
3-4 weeks

40
Q

The cdc recommends a retest of what disease in 3 months to make sure there is no reinfection?

A

Trich, gonorrhea, chlamydia

41
Q

What symptoms would a female have that presented with chlamydia?

A 
Could be asymptomatic 
Could mimic UTI
Vaginal spotting or postcoital bleeding 
Purulent cervical discharge 
Urinary frequency 
Lower abdominal pain 
Dyspareunia
42
Q

How can you test for chlamydia?

A

First catch urine

Swabs from endocervix or vagina

43
Q

How do you SCREEN?

A 
NAAT- preferred 
Cell culture 
Direct immunofluorescence 
Enzyme immunoassay (EIA)
Nucleic acid hybridization tests
44
Q

How do you test for syphilis?

A

Blood test- RPR

Confirmed with a treponemal test

45
Q

If a person has an STI what screenings should you also offer?

A

HIV

Syphilis

46
Q

If a person has sores or shankers, or men having sex with men, what should you screen them for?

A

HIV

47
Q

How long after treatment of chlamydia should patient use condoms?

A

7 days after treatment or until all partners are treated

48
Q

What is expedited partner therapy?

A

When someone tests positive for chlamydia or gonorrhea you can write a prescription for their partner without seeing them if your state allows

49
Q

How many days back do we treat partners for someone positive for chlamydia?

A

60 days 2 partners

50
Q

With EPT what do you need to give the partner besides the meds?

A

Handout on meds and disease

51
Q

What do you have to r/o with complaints of PID?

A 
Ectopic pregnancy 
Ovarian cysts with torsion 
Endometriosis 
Pelvic adhesions 
IBS 
Acute appendicitis
52
Q

Do you need to wait for cultures to come back to treat for PID?

A

No cdc recommends treating based on symptoms

53
Q

What complications of PID make you want to treat PID aggressively and quickly?

A 
Tubo- ovarian abscess 
Ectopic pregnancy 
Infertility 
Chronic pelvic and abdomen pain 
Dyspareunia 
Recurring PID
54
Q

What are the 2 symptoms a woman has to have in order to treat PID empirically?

A 
Lower abdominal/pelvic pain and r/o other issues 
And at a minimum: 
Cervical motion tenderness
Uterine tenderness 
Adnexal tenderness
55
Q

What are the common sti pathogens that cause PID?

A

Gonorrhea, chlamydia or BV, anaerobic bacteria that live in the vagina

56
Q

Doxycycline treats what sti?

A

Chlamydia

57
Q

What do you use to treat PID per CDC?

A

Ceftriaxone (Rocephin) 250mg IM once (gonorrhea) PLUS doxycycline 100mg PO BID x14 days (chlamydia) with or without metronidazole 500 mg PO BID x14 days (treats anaerobic)

58
Q

What STI is treated with ceftriaxone (rocephin)?

A

Gonorrhea

59
Q

How soon do you bring back patient with PID for reassessment to make sure symptoms are improving?

A

3 days

60
Q

What is after 3 days patient with PID is still having cervical motion tenderness and pelvic pain?

A

Admit to hospital- might have misdiagnosed or needs IV therapy

61
Q

What is the best way to diagnose HSV with a lesion?

A

Polymerase chain reaction (PCR)

62
Q

How do you diagnose HSV without lesions?

A

Serologic type- specific glycoprotein (IgG) based assays

63
Q

If patient has painless lesions, what would the diagnosis be?

A

Syphilis

HIV

64
Q

Primary syphilis presents with what?

A

Painless lesion called a chancre

65
Q

Secondary syphilis is characterized by?

A

Maculopapular rash over body

66
Q

What do you put women on in their 3rd trimester to prevent outbreak of HSV?

A

Acyclovir 400mg BID PO

67
Q

What is the Amsel criteria?

A 
Clinical diagnosis of BV based on the presence of 3/4 of the following:
White, thin, adherent vaginal discharge
Ph greater or equal to 4.5
Positive whiff/KOH test 
Clue cells (more than 20%)

Nurp 501 (8 decks)

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