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Women's health > Week 4 STIs > Flashcards

Week 4 STIs Flashcards

1
Q

The FNP is examining a patient suspected of having pelvic inflammatory disease (PID). Which risk factor is most associated with this diagnosis?

A

Recent abortion, pelvic surgery, childbirth or IUD (within last month) are risk factors for PID.

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2
Q

Which of these infections is caused by Treponema pallidum?

A

Syphilis

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3
Q

Which of these conditions is treated with benzathine penicillin G?

A

Syphilis

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4
Q

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?

A

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).

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5
Q

Which priority teaching point should the FNP include when prescribing metronidazole to treat trichomoniasis?

A

Correct Answer Do not drink alcohol while taking this medication and 24 hours after the last dose.

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6
Q

What does a normal saline wet prep help look for?

A

Clue Cells in BV WBC Trcihomonads

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7
Q

What does KOH look for?

A

hyphae and beds for VVC Whiff test

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8
Q

What are the sti screening recommendations for people <24

A

• Annual GC, CT • Routine screen in pregnancy • As needed based on at-risk behaviors

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9
Q

what are the STI screening recommendations for people >25

A

• 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

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10
Q

What are the screening recommendations for MSM?

A

Annually

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11
Q

What are the 5Ps for taking a sexual history?

A

Partners practices Past history of STIs Pregnancy plans Prevention of STIs

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12
Q

What does a NAAT test? How do you collect for women? Men?

A

CT NG Trich Women -urine (dirty am) -vaginal swab (more accurate; self collect) -Cervical swab Men -urethral swab

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13
Q

For people with NG, CT, or trich…what partners do you treat?

A

all partners within 60 days are treated

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14
Q

How do you treat NG in pregnancy? CT? Trich?

A

NG = ceftriaxone CT = Azithromycin Trich = Metronidazole

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15
Q

If you are suspicious for Syphillus…what other STI are you testing for?

A

HSV

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16
Q

Risk factors for screening for STI for people over 25

A
  • • 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
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17
Q

What are some of the bacterial causes of BV? What are other causes of BV?

A
  • Gardenerella,
  • Haemophilus,
  • cornyobactum
  • IUD Douching
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18
Q

What are BV risk factors

A

• Smoking • Douching • Menstruation • Sexual contact without condom • Low education • Oral/anal sex

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19
Q

What is BV associated with?

A

• Preterm birth • Premature membrane rupture in pregnancy • Low birth weight • Post-op infection • Endometriosis • STIs

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20
Q

What are the AMSEL criteria for BV diagnosis?

A

Homogenous discharge Clue cells pH >4.5 + whiff test need 3 for BV diagnosis

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21
Q

What is first line treatment for BV? What are other options and their side effects?

A

Metronidazole – Antabuse effect for 1-3 days after medication Clindamycin – Weakens latex condoms & diaphragms; metallic taste; N/V Tinidazole – less gi upset

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22
Q

What would you prescribe for someone who has “other type” of candida?

A

Terazol

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23
Q

What would a douche for Candida comprise of?

A

Cranberries, garlic, hydrogen peroxide

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24
Q

Who should be screened for chlamydia?

A

• All sexually active women <25 years • 21-29 if new partner • 2+ partners in preceding 2 months

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25
Q

complications of chlamydia

A
  • Salpingitis
  • PID
  • Rupture fallopian tube
  • Fetal/neonatal conjunctivitis & pneumonia
  • Increases risk ectopic pregnancy
  • Infertility
  • ALSO CAUSES: conjunctivitis, PNA, arthritis
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26
Q

Chlamydia exam findings

A
  • 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**

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27
Q

Chlamydia treatment

A

Treatment: • All partners within 60 days • 1st line: Doxycycline 100 mg BID x7 days • 2nd line: Azithromycin 1g PO x1 (if pregnant) OR Levofloxacin 500mg PO daily x7days

28
Q

How do you treat gonorrhea?

A

• 1st line: Ceftriaxone (gonorrhea) 500mg IM <150kg or 1G IM >150kg AND Doxycycline (Chlamydia) 100mg PO BID x7 days • 2nd line (PCN allergy): Gentamycin 240mg IM x1 AND Azithromycin 2g PO x1

29
Q

Treatment for non gonoccoccal urethritis

A

• Non-Gonococcal Urethritis: Doxycycline 100mg BID x7 days OR Azithromycin 1gm PO x1

30
Q

When do you do a test of cure?

A

2 weeks after treatment if they are pregnant or symptoms persist

31
Q

When do you repeat gonorrhea infection testing?

A

3 months to check for reinfection

32
Q

What would be seen on a microscopic exam with someone with PID?

A

WBC that are too numerous to count

33
Q

What labs would you check for someone that was suspicious for PID?

A

ESR & CRP culture for NG and CT

34
Q

How would you treat someone with PID

A

ceftriaxone & doxycycline & metronidazole -bed rest -pain kills -pelvic rest -HIV testing Not better within 3 days = hospitalization

35
Q

When would you hospitalize someone with PID?

A

• Cannot take oral meds • Does not respond to oral meds after 3 days • Has abdominal emergency like appendectomy • Uncertain diagnosis • Severe initial presentation • <18 years • Pregnant

36
Q

Describe Primary Syphilis

  • time after exposure
  • infectious routes
  • clinical symptoms
A

3-90 days (usually 21)

  • Sexual
  • Verticle
  • Chancre

Symptoms:

  • -Chancre -
  • Regional lymphadenopathy
  • Flu-like symptoms
37
Q

Describe a Syphilitic Chancre

A

painless papule that erodes to form non tender, shallow, indurated, clean ulcer. port of entry for other STIs Heals spontaneously in 2-8 weeks and may go unnoticed Contains spirochaete & highly infectious

38
Q

Describe secondary syphilis

Time after exposure

infectious routes

clinical symptoms

A

4-10 weeks after exposure

Routes:

  • -sexual
  • -vertical

Symptoms:

  • -Chancre may still be present -
  • Maculopapular nonpruritic rash on soles & palms
  • -Patchy alopecia -
  • Condylomata lata -
  • Symptoms of systemic illness
    • Fever, malaise, weight loss, myalgia
  • Generalized Lymphadenopathy
39
Q

Describe Early Latent Syphilis

Time after exposure

infectious routes

clinical symptoms

A

Time after exposure

​<1 year

Infectious routes

  • Sexual
  • Vertical

clinical symptoms

Usually asymptomatic

*if remains untreated 1/3 patients will develop tertiary syphilis

40
Q

Describe Late Latent Syphilis

time after exposure

infectious routes

clinical symptoms

A

time after exposure

>1 year

infectious routes

Vertical

clinical symptoms

Asymptomatic

41
Q

Describe Tertiary Syphilis

time after exposure

infectious routes

clinical symptoms

A

time after exposure

Years (15-30)

infectious routes

None

clinical symptoms

  • Cardiovascular syphilis (aortitis)
  • Gummuatous lesions
  • Granulomas throughout body
  • Neurosyphilis (happens at any stage and irreversible)
    • CN dysfunction
    • meningitis
    • stroke
    • ams
    • auditory or ophthalmic abnormalities
42
Q

What would you use for a presumptive syphillis diagnosis?

A
  • Non treponemal test: VDRL or RPR
    • sensitive but not specific (presumptive diagnosis)
    • Used to make sure numbers are trending down
43
Q

What would you order for a definitive Syphilis diagnosis?

A
  • Treponemal Test fluorescent treponemal antibody absorption test (FTA-ABS) (remains positive for life) or passive particle agglutination assay (TP-PA) (confirmatory diagnosis)
44
Q

What do you prescribe for primary, secondary and early latent syphilis?

What is 2nd line?

A
  1. Pen G
  2. Doxcycline
45
Q

What do you prescribe for latent syphilis or syphilis of unknown duration?

How do you treat tertiary syphilis?

A
  1. Pen G 1x/week for 3 doses
  2. Tetracycline

Tertiary:

Refer to ID specialist

46
Q

What is a Jarisch-Herxheimer reaction?

A

Reaction that occurs with penicillin and spirochete organisms

Sudden fever within 24 hours of beginning treatment

systemic symptoms: HA, myalgia

47
Q

If a patient has syphilis, which partners get treated?

A

all partners within 90 days

48
Q

What is the bacteria that causes syphilis?

A

Treponema Pallidum

49
Q

How would follow up someone with early syphilis?

A
  • VDRL or RPR at 1, 3, & 6 moths after treatment or until negative
50
Q

how would you follow up someone with latent syphilis?

A

VDRL or RPR at 1, 2, and 3 months and then at 3 months intervals until negative…then yearly

51
Q

What is a Chancroid?

Cause

Symptoms 4

Treatment Plan

A

Cause: Haemophilus ducreyi (Anaerobic bacillus bacteria)

Symptom:

  • Soft, ext painful irregularly/ill defined borders “punched out” shaped lesion NOT INDURATED
  • inguinal lymphadenopathy
  • >>progresses to Superative large lesion
  • >>>ulcerates & becomes necrotic then scars over (buboes)

Treatment

  • Rule out Syphilis & HSV
  • Localized infection & Curative: Azithromycin, Ceftriaxone, Ciprofloxacin, or Erythromycin
  • No long term effects
52
Q

Who is HSV more common in?

53
Q

Describe the initial or primary HSV infection characteristics

A

Usually starts 2 weeks after virus has been transmitted

  1. Flu-like 1 week after exposure
  2. Genital lesions tender/painful vesicles with possibly prodromal symptoms.

Also develop

  • bilateral tender inguinal lymphadenopathy
  • vulvar edema
  • vaginal discharge
  • severe dysuria
  • cervicitis
54
Q

Diagnose HSV

A
  • Can confirm clinically without lab confirmation
  • Labs
    • PCR (low sensitivity if lesions crusted over) can take 2 to 3 months to grow
    • IgG type-specific glycoprotein G to confirm diagnosis and reveal subtype (tells you if you’ve ever been exposed)
    • IgA shows current infection (does not mean you got it from partner just means current outbreak)
55
Q

When do you retest for Trich

A

Retest in 3 months d/t concern for reinfection

56
Q

what are the 5 Ps of sexual health assessment

A

5 P’s

Partners

Practices

Past history STIs

Protection

Pregnancy plans

57
Q

How do you diagnose trich?

58
Q

What are the signs of disseminated gonococcal infection?

A

2 stages…

Stage 1

  • Fever, chills, skin lesions

Stage 2

  • Acute septic arthritis w effusions usually in wrists, knees, and ankles
59
Q

what does unilateral labial pain and swelling indicate?

A

Bartholin gland infection

60
Q

what does periurethral pain and swelling indicate?

A

infected skenes gland

61
Q

What are symptoms of PID?

A
  • abrupt onset of acute lower abdominal pain following menses (classic presenting symptom)
  • lower back pain
  • intermenstrual bleeding
  • fever, N/V
  • urinary frequency
  • pain exacerbated by Valsalva maneuver/intercourse/movement
  • Bilateral pelvic tenderness
    *
62
Q

How to diagnose PID according to the CDC

A

1 or more:

  • cervical motion tenderness
  • Uterine tenderness
  • Adnexal tenderness

1 or more:

  • >101 degrees
  • discharge
  • WBC in vaginal fluid
  • Elevated ESR/CRP
  • Lab documentation of CT or NG
63
Q

When would someone with PID need hospitalization? #7

A
  1. need to r/o surgical emergencies EX appendicitis
  2. pregnancy
  3. no response to oral antibiotics
  4. cannot follow or tolerate the outpatient regimen (not better in 3 days)
  5. severe illness
  6. n/v/high fever
  7. tubo-ovarian abscess
64
Q

What is the treatment regimen for PID?

A

Ceftriaxone

Doxycycline

Metronidazole

65
Q

What is the difference between vaginitis and vaginosis?

A

Vaginitis = inflamed vagina with numerous WBC

Vaginosis = no increase in WBC

66
Q

how would you diagnose candida?

Women's health (10 decks)

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