Clin med sem 2 > STD > Flashcards

STD Flashcards

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1
Q

Herpes Virus- pathophysiology

A

Most common infectious etiology of genital ulceration - 32-50% of adults infected

Often transmitted unknowingly – asymptomatic viral shedding

  • Have the virus w/out any symptoms and still pass it
  • Majority of cases undiagnosed
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2
Q

Herpes Virus- cause

A

HSV1/HSV2

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3
Q

Herpes Virus- S/S & PE

A

Multiple painful vesicles on erythematous base, persist - 7-10 days
- red halo

Primary – fever, bilateral adenopathy
- flu like symptoms
Recurrent – no fever

Prodrome – tingling or burning 18-36 hours prior lesion

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4
Q

Herpes Virus- labs & imaging

A

Serological testing high rate of false negative
Viral studies – TOC
- PCR - CSF
- Culture
Tzank smear – gold standard
- Pos = presence of multinucleated giant cells
- scrape base of wet lesion

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5
Q

Herpes Virus- treatment

A

First episode - 7-10 days

  • Acyclovir – 400mg TID OR
  • Acyclovir – 200mg 5x daily OR
  • Famciclovir 250mg TID OR
  • Valacyclovir 1000mg BID

Episodic therapy –

  • Acyclovir – 400mg BID x 5days
  • Acyclovir 800mg BID x 5 days
  • Acyclovir 800mg TID x 2 days
  • Famciclovir 125mg BID x 5 days
  • Famciclovir 1000mg BID x 1day
  • Valacyclovir 500mg BID x 3days
  • Valacyclovir 1gm PO QD x 5days

Suppression – Daily

  • Acyclovir – 400mg BID
  • Famciclovir – 250mg BID
  • Valacyclovir – 500-1000mg QD
  • > > For those w/ >6outbreaks a year - Reduces frequency by 70-80%

Pregnancy

  • No indicated risk that treatment will hurt fetus
  • Acyclovir – used w/ 1st episode or severe recurrent disease
  • Risk of transmission – 30-50% among women who acquire HSV near delivery
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6
Q

Herpes Virus- prognosis

A

Chronic, lifelong infection

Lesions will spontaneously heal and then reoccur

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7
Q

Herpes Virus- counseling

A
  • Natural hx or infection, recurrence, asymptomatic shedding, transmission risk
  • Use of episodic vs suppressive therapy
  • Abstain from sexual activity when lesions or prodromal symptoms start
  • Inform partners
    Risk of neonatal infection
  • women w/out symptoms can deliver vaginally
  • Ulcer present – c section
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8
Q

Syphilis- pathophysiology

A

Incidence inc - HIV + men and MSM, IV drug usage

  • 71% inc
  • Test for if HIV +
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9
Q

Syphilis- cause

A

Treponema pallidum - spirochete

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10
Q

Syphilis- S/S & PE

A 
Primary:
Incubation - 10-90d
Chancre 
- early - macule/papule -> erodes
- Late - clean based, painless, indurated ulcer w/ smooth firm borders
- unnoticed in 15-30% of pts
- Resolves in 1-5w
- HIGHLY INFECTIOUS
Secondary:
- Hematogenous dissemination of spirochetes
- Usually 2-8w after chancre appears
- Rash - whole body - palms/soles
- Mucous patches 
- condylomata lata - wart like presentation - HIGHLY Infection 
- Constitutional symptoms
- Resolve in 2-10w
Tertiary:
- Gumma - soft, tumor like growth tissues
- CV
- neuro - eye - uveitis, optic neuritis
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11
Q

Syphilis- diagnosis

A

Early latent – reactive testing w/in 1 year of infection
- no symptoms
Late latent – reactive testing >1 year after onset of infection or timing can’t be determined
- No symptoms

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12
Q

Syphilis- labs & imaging

A

Darkfield examination of exudate/tissue – gold standard

Serologic testing:
Nontreponemal – RPR, VDRL
- Reactivity fades over time – can treat them down
Treponemal – fluorescent treponemal ab (FTA-ab)
- Once positive – stays positive -> can’t treat it down

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13
Q

Syphilis- treatment

A

Primary, secondary, early latent:
1st line – Benzathine Penicillin G 2.4mill units IM one dose
Allergy
- Doxy 100mg BID x 14days
- Ceftriaxone 1gm IM/IV QD x 8-10days
- Azithromycin 2gm single dose
Tertiary – Pen G 2.4mill units IM Qweek x 3 weeks – Bicillin LA
Pregnancy
- Screen at 1st prenatal visit – repeat 3rd trimester
- Treat for appropriate stage
- Additional? – benzathine penicillin 2.4mu IM after initial dose for prim, sec, early latent
- U/S 2nd half – eval congenital syphilis
—> Congenital syphilis – 40% die or stillborn
—–> Nerve damage – vision and hearing

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14
Q

Syphilis- prognosis

A

Jarish-Herxheimerr

  • occurs w/in 24hr of treatment
  • acture febrile rxn - HA, myalgia, fever
  • antipyretics
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15
Q

Syphilis- management of sex partners

A

Management of sex partners:

  • Exposure to primary, secondary, early latent w/in 90days – treat presumptively - PenG
  • Exposure to primary, secondary, early latent >90days – treat presumptively if serology not available – Pen G
  • Exposure to latent w/ high nontreponemal titers >1:32 – treat presumptively for early
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16
Q

Chancroid- pathophysiology

A

Declining

Risk for transmitting HIV

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17
Q

Chancroid- cause

A

Hemophilus ducreyi

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18
Q

Chancroid- S/S & PE

A

vesicle, papule, pustule, ulcer
– soft, not indurated, very painful

Classic - painful ulcer w/ tender inguinal adenopathy

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19
Q

Chancroid- diagnosis

A

Diff to diagnose – hard to culture

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20
Q

Chancroid- labs & imaging

A

Culture

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21
Q

Chancroid- treatment

A

Azithromycin 1gm PO
Ceftriaxone 250mg IM single dose
Ciprofloxacin 500mg BID x 3days – contra in Prego
Erythromycin base 500mg TID x 7days

Sex partners
- Exam and treat symptomatic or not if <10 to contact from onset

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22
Q

Chancroid- prognosis

A

Manage

  • Reexam in 3-7days post treatment
  • Time for healing – related to ulcer size
  • Lack of improvement – incorrect diagnosis, coinfection, noncompliance, antimicrobial resistance
  • Lymphadenopathy -> drainage
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23
Q

Lymphogranuloma Venereum- cause

A

Chlamydia trachomatis

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24
Q

Lymphogranuloma Venereum- S/S & PE

A

5–21-day incubation

painless papule, vesicle, ulcer
Tender regional lymphadenopathy – unilateral

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25
Lymphogranuloma Venereum- treatment
1st line – Doxy 100mg BID x 21days | 2nd – Erythromycin
26
Granuloma inguinale- pathophysiology
Rare in US
27
Granuloma inguinale0 cause
Klebsiella granulomatis | - Calymmatobacterium
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Granuloma inguinale- S/S & PE
9–50-day incubation Painless papule -> ulcerations No regional lymph nodes Donovanosis
29
Granuloma inguinale- labs & imaging
Culture - donovan bodies
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Granuloma inguinale- treatment
1st line - Doxy 100mg QD x 3w Azithromycin 1gm once w x 3w Cipro 750mg BID x 3w Trimethoprim-sulfa - 800mg/160mg BID
31
Gonorrhea- pathophysiology
2nd most common reported infection yearly
32
Gonorrhea- cause
Neisseia gonorrhea
33
Gonorrhea- S/S & PE
Urethritis - Male - urethral inflammation - incubation - 1-14days - S/S - dysuria, urethral discharge Urogenital infection - female - Endocervical canal - primary site - urethra also - 70-90% - Incubation - unclear, 10d? - S/S - asymptomatic, vaingal discharge, dysuria, urination, labial pain/swelling, abd pain - Bartholin's abscess - masupilation -> I&D and sew it back up Skin lesion, arthritis - disseminate gonorrhea PID
34
Gonorrhea- labs & imaging
NAAT - urine - TOC Gram stain - Gold - gram negative diplococi intracellular Culture
35
Gonorrhea- treatment
Cervix, urethra, rectum, pharynx: Ceftriaxone 250mg IM single dose + Azithromycin 1g PO single dose Disseminated Gonococcal - 1st line - Ceftriaxone 1gm IM or IV Q 24hr - 2nd - Cefotaxime orr Ceftizoxime 1gm IV Q8hr
36
Gonorrhea- prognosis
Resistance - penicillin and tetracycline - geographic - non to ceftriaxone - Fluoroquinolone worldwide - Surveillance crucial for therapy
37
Nongonococcal Urethritis- cause
``` C. Trachomatis - 20-40% Genital mycoplasmas - 20-30% - Ureaplasma urealyticum - Mycoplasma genitalium Trichomonas vaginalis HSV Unkown - 50% ```
38
Nongonococcal Urethritis- S/S & PE
Mild dysuria | Mucoid discharge
39
Nongonococcal Urethritis- diagnosis
Urethral smear - >5PMN Urine microscopic - >10PMN Pos Leukocyte esterase
40
Nongonococcal Urethritis- labs & imaging
Urethral smear | Urine
41
Nongonococcal Urethritis- treatment
Azithromycin 1gm single dose OR Doxy 100mg BID x 7days
42
Chlamydia trachomatis- pathophysiology
Most reported STD in US Screen women <25yo
43
Chlamydia trachomatis- cause
Chlamydia trachomatis
44
Chlamydia trachomatis- epidemiology
<24yo
45
Chlamydia trachomatis- S/S & PE
Asymptomatic Complications: - cervicitis, uretisis, proctiis - lymphogranuloma venereum - PID - more likely than GC Cervix - mucopurluant discharge, red base
46
Chlamydia trachomatis- labs & imaging
``` NAAT - urine Cervical/urethral swab Enzyme Immunassay - EIA - Chlamydiazyme - 85% sense - 97% - spec - high volume screening - false positives Nucleic Acid Hybridization - NA probe - Gen-Probe Pace-2 - 75-100% sensitive - 95% spec - Detects RNA - can detect GC and CT ``` DAN amplification assays - urine - PCR - 95% sen - LCR - 85% sen
47
Chlamydia trachomatis- treatment
Azithromycin 1gm PO single dose OR Doxy 100mg BID x 7days Pregnant - Azithromycin 1gm PO OR - Amoxicillin 50mmg TID x 7days
48
Chlamydia trachomatis- prognosis
Can transmit during delivery - conjuncitivis, PNA Screening: - sexually active + <25yr - yearly - sexually active + >25yr w/ risk - yearly - Rescren 3-4m post treatment -> high prevalence of repeat infection
49
Pelvic Inflammatory Disease (PID)- pathophysiology
10-20% w/ GC progress to PID Higher in CT Inflammatory disorder of upper genital tract
50
Pelvic Inflammatory Disease (PID)- epidemiology
``` <25 Previous PID Untreated STI Multiple sex partners Douche IUD ```
51
Pelvic Inflammatory Disease (PID)- S/S & PE
CDC criteria - Uterine Adnexal tenderness - Cervical motion tenderness S/S - endocervical discharge, fever, lower abdominal pain, dysuria, pain/bleeding w/ intercourse, irregular vaginal bleeding Complications - infertility - 15-24% w/ 1 episode sec to GC or CT - 7x risk of ectopic pregnancy w/ 1 episode - Chronic pelvic pain -18%
52
Pelvic Inflammatory Disease (PID)- diagnosis
Minimal - Uterine/adnexal tenderness OR - Cervical motion tenderness Additional - Temp >101F - Inc ESR - Inc CRP - Cervical CT or GC - WBC/saline microscopy - Cx discharge
53
Pelvic Inflammatory Disease (PID)- labs & imaging
Wet prep - white cells CBC ESR/CRP Swabs/urine - GC/CT Transvaginal US or MRI - thickening or fluid filled tubes Laparoscopy - diagnostic All tests can be normal
54
Pelvic Inflammatory Disease (PID)- treatment
No data on PO vs IV - should cover anaerobic Parenteral regimen A - Cefotetan 2g IV Q12hr OR - Cefoxitin 2g IV Q 6hr And - Doxycyline 100mg PO/IV Q12hr Parrenteral Regimen B - Clindamycin 900mg IV Q8hr + Gentamicin loading dose IV/IM 2mg/kg -> maintance dose 1.5mg/kg Q8hr PO Regimen - Ceftriaxone 250mg IM single dose + Doxycycline 100mg BID x 14days w/ or w/out -> Metronidazole 500mg BID x 14days Sex partner - Male partners of women w/ PID - examined and treated w/in 60days - Treated empirically for CT and GC
55
Pelvic Inflammatory Disease (PID)- prognosis
Hospitalization - surgica emergencies - pregnancy - Clinical fialure of PO anitmicrobials - Inablity to follow/tolerate PO regimen - Severe illness, nausea/vomiting, high fever - Tubo-ovarian abscess
56
Epididymitis- pathophysiology
Sexually active men - GC or CT | otherwise eColi
57
Epididymitis- S/S & PE
Pain, swelling, inflammation of epididymis <6wees Chronic - >3m unilateral testicular pain
58
Epididymitis- treatment
GC/CT - Ceftriaxone 250mg IM single dose + Doxy 100mg BID x 10days Enteric - eColi - Levofloxacin 500mg PO QD x 10days
59
Bacterial Vaginosis- pathophysiology
Not an STD? Alteration in vaginal flora - Lactobacillus - decrease
60
Bacterial Vaginosis- cause
Gardnerella vaginosis
61
Bacterial Vaginosis- epidemiology
``` New sex partner Douching Dec nl flora No barrier methods IUDs ```
62
Bacterial Vaginosis- S/S & PE
Thin gray -white-yellow discharge - fishy odor - mildly adherent to vaginal wall Mild vulvar irritation
63
Bacterial Vaginosis- diagnosis
Diagnosis - Amsel Criteria - 3 or 4: - Abnormal gray discharge - pH >4.5 - whiff test - pos - Wet prep - clue cells
64
Bacterial Vaginosis- labs & imaging
Wet Prep - clue cells - epithelial cells eaten away whiff test
65
Bacterial Vaginosis- treatment
Metronidazole - 500mg BID x 7day Metronidazole gel 0.75% 5g intravainally QD x 5days Clindamycin cream 5% 5g intravaginally Qhr x 7day ``` Prego - Symptomatic - treat due to AE - don’t use topical - screen and treat asymp if high risk for preterm delivery - at first prenatal visit Metronidazole 500mg PO BID x 7days Metronidazole 250mg TID x 7days Clindamycin 300mg BID x 7days ``` Sex partners - response to therapy and relapse not related to tx of sex partner
66
Vulvovaginal Candidiasis- pathophysiology
Recurrent - >4 symptomatic episodes/year Don’t usually coexist w/ STD
67
Vulvovaginal Candidiasis- cause
Candida albicans - 90%
68
Vulvovaginal Candidiasis- epidemiology
``` Pregnant DM Obese Immun Meds - corticosteroids, OCPs, abx Tight clothing Panty liners ```
69
Vulvovaginal Candidiasis- S/S & PE
``` Itching White vaginal discharge - thick, curd like Vulvar erythema Asymptomatic Burning w/ urination ``` PE: Vulva/vaginal tissue bright red Excoriated external vaginal tissue
70
Vulvovaginal Candidiasis- labs & imaging
``` Vaginal culture - gold standard pH - >4.5 Whiff test - neg, odorless KOH - spores - spaghetti/meatballs Wet prep - Hyphae ```
71
Vulvovaginal Candidiasis- treatment
Topical therapy - 7-14day Fluconazole - 150mg PO x 1 dose Maintenance - clotrimazole, ketoconazole, fluconazole, itraconazole Non-albicans - longer duration of therapy w/ non-azole regimen Sex partner - tx not recommended - doesn't reduce freq of partner - Male w/ balanitis - treat Pregnancy - ONLY topical intravaginal regimens recommended - 7days Keep vaginal area dry
72
Trichomonas- pathophysiology
2x risk of HIV Most common non-vaginal STD Flagellate protozoan - vagina, skene ducts, male/female urethra Coexists w/ other STDs
73
Trichomonas- cause
Trichomonas vaginalis
74
Trichomonas- S/S & PE
Vulvar itching, burning, erythema Thin, ""frothy"" yellow/green discharge - foul smelling Dysuria Dyspareunia Strawberry cervix - petechiae
75
Trichomonas- labs & imaging
``` Wet prep - gold - polymorpho-nuclear cells - motile flagellates pH - >5 NAATT - more sensitive and recommended ```
76
Trichomonas- treatment
Metronidazole - 2g PO single dose Tindiazole - 2g PO single dose Treatment failure - retreat - metronnidazole 500mg BID x 7days - Repeat failure - mettronidazole 2mg x 7days - metronidazole susceptibility testing via CDC Sex Partners - should be tx - avoid intercourse until therapy is completed and both are asymptomatic
77
Trichomonas- prognosis
Metro SE - N/V w/ alcohol
78
Trichomonas- prenatal complications
preterm birth
79
Human Papillomavirus (HPV)- pathophysiology
100 diff strains - 40 infect genital area Routine pap - early detection
80
Human Papillomavirus (HPV)- cause
Type 16 & 18 - high risk - oncogenic | Type 6 &11 - low risk
81
Human Papillomavirus (HPV)- S/S & PE
associated w/ cervical cancer - probs other cancer too - 99% of cervical cancer w/ HPV DNA Anogenital Warts - HPV type 6 or 11 - Asymptomatic - if large can cause obstructive issues - Large - have a risk of causing cancer Condyloma acuminata
82
Human Papillomavirus (HPV)- diagnosis
HPV DNA
83
Human Papillomavirus (HPV)- treatment
Removal of symptomatic warts - obstructive issues Difficult to determine if treatment reduces transmission No evidence any regimen is superior Patient applied - Podofilox - 0.5% solution or gel - Imiquimod - 5% cream - Sinecathechins - 15% ointment Provider administered - Cryotherapy - Tricholoroacetic or Bichloroacetic acid - 80-90% - Surgical removal Pregnancy - DO NOT use topical - imiquimod, podophyllin, podofilox, sinecatechins - DO NOT USE - support removal due to proliferation and friability - Types 6 & 11 cause resp papillomatosis in infants and children - C section?
84
Human Papillomavirus (HPV)- prognosis
Vaccines - 9-26yo - now approve for 45, don’t do it though - Gardisil quadravalent - 6, 11, 16, 18 - Gardisil 9 valent - 6, 11, 16, 18, 31, 33, 45, 52, 58 Cervical Cancer Screening - STD hx inc risk - HPV testing for SCUS pap testing
85
Scabies- pathophysiology
Parasitic skin infection
86
Scabies- cause
Sarcoptes scabiei
87
Scabies- S/S & PE
Intense itching Contagious Look for tracking
88
Scabies- treatment
Permethrin 5% cream - all areas of body - leave it on overnight and shower off Ivermectin 200ug/kg PO - repeat in 2w Persistent Symptoms - Rash and pruritis lasts >2w - > tx failure, resistance, reinfection, druge aller gy, cross reactivity w/ Houshold mites - pay attention to fingernails - Treat close contacts empirically - Wash - linens, bedding, clothing
89
Scabies- prognosis
Norwegain Scabies - aggressive infestation in immunodeficient, debilitated or malnourished - greater transmissibility - Substantial treatment failure w/topical scabicide or oral ivermectin - Treat - combo topical scabicie w/ ivermectin OR repeat treatments w/ ivermectin
90
Pediculosis Pubis- pathophysiology
In pubic hair Spread via sexual contact or shared infected bedding/clothes Eggs laid at base of hair shafter - hatch in 7-9d
91
Pediculosis Pubis- cause
Crab louse - Phthirus pubis Pruritus Lice Nits
92
Pediculosis Pubis- S/S & PE
Itching - pubic and anogenital Pale brown insects or ova seen on hair shafts
93
Pediculosis Pubis- treatment
Wash bedding/clothing Permethrin 1% Lindance 1% shampoo Pyrethrins w/ piperonly butoxide Retreat - if sx persist Sex partners - tx if w/in last month
94
Molluscum Contagiosum- pathophysiology
Benign epithelial
95
Molluscum Contagiosum- cause
Poxvirus
96
Molluscum Contagiosum- epidemiology
Young children | Adults - sexually transmitted
97
Molluscum Contagiosum- S/S & PE
``` Pearly dome shaped papules w/ umbilicus genital Lower abdomen Butt Inner thigh ```
98
Molluscum Contagiosum- diagnosis
Skin scraping or biopsy | -> Microscope - numerous inclusion bodies in cytoplasm
99
Molluscum Contagiosum- treatment
Self-limiting Cryotherapy Curettage Topical therapy - imiquimod
Clin med sem 2
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