Week 4 STIs Flashcards
The FNP is examining a patient suspected of having pelvic inflammatory disease (PID). Which risk factor is most associated with this diagnosis?
Recent abortion, pelvic surgery, childbirth or IUD (within last month) are risk factors for PID.
Which of these infections is caused by Treponema pallidum?
Syphilis
Which of these conditions is treated with benzathine penicillin G?
Syphilis
A patient presents to the clinic with reports of a “greenish” vaginal discharge and vaginal itching. Upon examination, the FNP notes green, frothy vaginal discharge and inflammation of the vulva and vagina. Which diagnosis best supports these findings?
While some patients are asymptomatic, others with trichomoniasis will present with yellow/green, frothy discharge, dyspareunia, dysuria, inflammation of the vulva and vagina, and a “strawberry” cervix (Schuiling & Likis; Module 3).
Which priority teaching point should the FNP include when prescribing metronidazole to treat trichomoniasis?
Correct Answer Do not drink alcohol while taking this medication and 24 hours after the last dose.
What does a normal saline wet prep help look for?
Clue Cells in BV WBC Trcihomonads
What does KOH look for?
hyphae and beds for VVC Whiff test
What are the sti screening recommendations for people <24
• Annual GC, CT • Routine screen in pregnancy • As needed based on at-risk behaviors
what are the STI screening recommendations for people >25
• Current STI, previous STI, new or multiple partners • Partner with concurrent partners • Inconsistent use of condoms when not in monogamous relationship • Exchanging sex for drugs/money
What are the screening recommendations for MSM?
Annually
What are the 5Ps for taking a sexual history?
Partners practices Past history of STIs Pregnancy plans Prevention of STIs
What does a NAAT test? How do you collect for women? Men?
CT NG Trich Women -urine (dirty am) -vaginal swab (more accurate; self collect) -Cervical swab Men -urethral swab
For people with NG, CT, or trich…what partners do you treat?
all partners within 60 days are treated
How do you treat NG in pregnancy? CT? Trich?
NG = ceftriaxone CT = Azithromycin Trich = Metronidazole
If you are suspicious for Syphillus…what other STI are you testing for?
HSV
Risk factors for screening for STI for people over 25
- • History of GC or PID within 2 years
- • >1 partner in past year
- • New partner last 90 days
- • Yes to “Do you have any reason to believe that your partner is having sex with another person?”
- • If patient concerned regarding STI exposure:
- o Offer testing based on prevalence rates
- o Inform her of all tests
- • If has 1 STI should be screened for HIV and all other STIs
What are some of the bacterial causes of BV? What are other causes of BV?
- Gardenerella,
- Haemophilus,
- cornyobactum
- IUD Douching
What are BV risk factors
• Smoking • Douching • Menstruation • Sexual contact without condom • Low education • Oral/anal sex
What is BV associated with?
• Preterm birth • Premature membrane rupture in pregnancy • Low birth weight • Post-op infection • Endometriosis • STIs
What are the AMSEL criteria for BV diagnosis?
Homogenous discharge Clue cells pH >4.5 + whiff test need 3 for BV diagnosis
What is first line treatment for BV? What are other options and their side effects?
Metronidazole – Antabuse effect for 1-3 days after medication Clindamycin – Weakens latex condoms & diaphragms; metallic taste; N/V Tinidazole – less gi upset
What would you prescribe for someone who has “other type” of candida?
Terazol
What would a douche for Candida comprise of?
Cranberries, garlic, hydrogen peroxide
Who should be screened for chlamydia?
• All sexually active women <25 years • 21-29 if new partner • 2+ partners in preceding 2 months
complications of chlamydia
- Salpingitis
- PID
- Rupture fallopian tube
- Fetal/neonatal conjunctivitis & pneumonia
- Increases risk ectopic pregnancy
- Infertility
- ALSO CAUSES: conjunctivitis, PNA, arthritis
Chlamydia exam findings
- Cervicitis “rawness”
- Post coital bleeding
- Mucoid/Purulent discharge
- Lower Abdominal tenderness
- Cervical motion tenderness
- Adnexal fullness
(chlamydia infections mimic UTI)
**PID is the most serious complication**