Week 3- STIs Flashcards
What symptom is specific to BV?
Malodorous discharge
Is BV sexually transmitted?
No, but it is associated with sex
What is the normal ph of the vagina?
3.5-4.5
What happens to vaginal ph with menstrual blood or introduction to semen?
It increases
What causes the odor of BV?
The lactobacilli are replaced with anaerobic bacteria like gardinella bc of the alkaline environment
Do we treat partners with BV?
No
What does adding KOH to slide with vagina secretions do?
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
What does adding saline to vaginal secretions do?
Let’s you see clue cells
Epithelial cells
WBC
Trichamonasis
What would you see with saline slide if it were trich?
Moving flagella, tear drop shaped
Why is it important to do a nucleus acid amplification test? (NAAT)
Trichomoniasis can die before you get it under a microscope so you won’t see it moving making it harder to diagnose.
You suspect vulvovaginal candidiasis, what would you see under a microscope with the KOH slide?
Hyphae and buds
What would the vagina ph be with vulvovaginal candidiasis?
Less than 4.5
How do you treat uncomplicated vulvovaginal candidiasis?
Oral fluconazole 150mg single dose
Any azoles 7 nights
Can you give pregnant woman oral fluconazole for VVC?
Not in the first trimester, must give topical like miconazole
How do you treat complicated VVC?
Topical azole for 7-14 days OR
Fluconazole 150mg every 3rd day for 3 doses OR
Itraconazole 200mg BID for 3 days
What are some risks for VVC?
Occlusive clothing Diabetes Obesity COC- estrogen is the cause Steroids Recent antibiotics Pregnancy Hormone replacement therapy
Does being sexually active put you at a higher risk for BV?
Yes
Does being sexually active put you at a higher risk for a yeast infection?
No
Does having multiple sex partners put you at risk for VVC?
No
What could you give boric acid for?
Complicated VVC
600mg vaginally up to 14 days
What are the 3 strains that can cause VVC?
Albicans- most common
Glabrata
Tropicalis
Is trich sexually transmitted?
Yes
What do you see under saline in trich?
Trichomonads-protazoa
What happens with the vaginal ph with trich?
It rises greater than 4.5
What do you see on physical exam with trich when looking with a speculum?
Strawberry spots or tiny petechiae on the cervix
Cervix may bleed on contact
What would you expect the discharge to be like with trich?
Yellow-green, frothy, mucopurulent, copious, malodorous
How do you test for trich?
NAAT
How can you collect a specimen to test for trich for the NAAT?
Men-urethra or urine
Women- cervical, vaginal, urine
How do you treat trich?
Metronidazole 2gm PO single dose- If this causes stomach upset- tinidazole 2gm PO single dose- more expensive but less GI distress
Can you use vaginal cream for trich?
No
Does the cdc recommend to retest for trich? If so, when?
Yes
In 3 months bc partners that aren’t treated can reinfect
What do you teach someone about sex after a diagnosis of trich?
Abstain from sex until all partners treated
Until 7 days after treatment has been completed
What does KOH look for?
Hyphae and buds- kills all epithelial cells for yeast
Positive whiff test for BV
What does a saline slide show?
Clue cells-BV
Protozoa, flagella- trich
WBC- cervicitis
What is the antibiotic therapy for gonorrhea?
Ceftriaxone (recephin) 250mg IM once
Cefixime 400mg PO single dose
What antibiotic do you give for chlamydia and gonorrhea?
Azithromycin 1gm or doxycycline 100mg BID for 7 days and ceftriaxone 250mg IM once
What do you give for trich?
Metronidazole 2gm PO single dose
Can you give metronidazole to someone who has had alcohol in the past 24 hours?
No
What disease do you do a test of cure for, what population, and what time frame?
Chlamydia
Pregnancy
3-4 weeks
The cdc recommends a retest of what disease in 3 months to make sure there is no reinfection?
Trich, gonorrhea, chlamydia
What symptoms would a female have that presented with chlamydia?
Could be asymptomatic Could mimic UTI Vaginal spotting or postcoital bleeding Purulent cervical discharge Urinary frequency Lower abdominal pain Dyspareunia
How can you test for chlamydia?
First catch urine
Swabs from endocervix or vagina
How do you SCREEN?
NAAT- preferred Cell culture Direct immunofluorescence Enzyme immunoassay (EIA) Nucleic acid hybridization tests
How do you test for syphilis?
Blood test- RPR
Confirmed with a treponemal test
If a person has an STI what screenings should you also offer?
HIV
Syphilis
If a person has sores or shankers, or men having sex with men, what should you screen them for?
HIV
How long after treatment of chlamydia should patient use condoms?
7 days after treatment or until all partners are treated
What is expedited partner therapy?
When someone tests positive for chlamydia or gonorrhea you can write a prescription for their partner without seeing them if your state allows
How many days back do we treat partners for someone positive for chlamydia?
60 days 2 partners
With EPT what do you need to give the partner besides the meds?
Handout on meds and disease
What do you have to r/o with complaints of PID?
Ectopic pregnancy Ovarian cysts with torsion Endometriosis Pelvic adhesions IBS Acute appendicitis
Do you need to wait for cultures to come back to treat for PID?
No cdc recommends treating based on symptoms
What complications of PID make you want to treat PID aggressively and quickly?
Tubo- ovarian abscess Ectopic pregnancy Infertility Chronic pelvic and abdomen pain Dyspareunia Recurring PID
What are the 2 symptoms a woman has to have in order to treat PID empirically?
Lower abdominal/pelvic pain and r/o other issues And at a minimum: Cervical motion tenderness Uterine tenderness Adnexal tenderness
What are the common sti pathogens that cause PID?
Gonorrhea, chlamydia or BV, anaerobic bacteria that live in the vagina
Doxycycline treats what sti?
Chlamydia
What do you use to treat PID per CDC?
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)
What STI is treated with ceftriaxone (rocephin)?
Gonorrhea
How soon do you bring back patient with PID for reassessment to make sure symptoms are improving?
3 days
What is after 3 days patient with PID is still having cervical motion tenderness and pelvic pain?
Admit to hospital- might have misdiagnosed or needs IV therapy
What is the best way to diagnose HSV with a lesion?
Polymerase chain reaction (PCR)
How do you diagnose HSV without lesions?
Serologic type- specific glycoprotein (IgG) based assays
If patient has painless lesions, what would the diagnosis be?
Syphilis
HIV
Primary syphilis presents with what?
Painless lesion called a chancre
Secondary syphilis is characterized by?
Maculopapular rash over body
What do you put women on in their 3rd trimester to prevent outbreak of HSV?
Acyclovir 400mg BID PO
What is the Amsel criteria?
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%)
