1
Q
- 85% of primary & secondary syphilis
- 51% also w/ HIV
A
MSM
2
Q
- Most prevalent NON-VIRAL STI in United States?
- MC presentation?
- When do sxs occur?
A
Trichomoniasis
- Asymptomatic
- 1-4 weeks after exposure
3
Q
- urethritis
- epididymitis
- prostatitis
A
3 sxs of Trichomoniasis in men
(but men are usually asymptomatic)
4
Q
- Increased vag pH >4.5
- Vag irritation, malodorous, frothy, yellow/green discharge
- LOTS of discharge
- Petechiae on cervix or vagina (what’s this called)?
- Organism?
A
Trichomoniasis
- Strawberry Cervix
- Trichomonas vaginalis
5
Q
Dx of Trichomoniasis
- 60% accurate?
- Most accurate?
A
- 60% - wet mount w/ flagellated organisms
- Swab –> culture (takes 7 days)
- NAAT = fast and most accurate
6
Q
Tx of what?
- Metronidazole (oral)
- Tinidazole (single dose)
- Retest in __
- Test of cure in ___ (for pregnant pts)
A
Trichomoniasis
7
Q
Increases risk of premature rupture of membranes, preterm deliv, low birth weight
(but tx does NOT reduce risk)
A
Trich
(can tx pregnant women w/ Metronidazole)
(Lactating women should not breast feed 12-24 hrs after Metron single dose)
8
Q
- MC bacterial STI in United States
- Organism?
- Peaks in late teens/early 20s
- Screening?
A
Chlamydia
- Chlamydia trachomatis (gram -)
- Women 25 or younger screened yearly
9
Q
- cervical dsch
- vag bleeding
- low abd pain
- F/chills
- adnexal tenderness
- burning
- SMALL amt discharge
A
Chlamydia sxs of women
10
Q
- Oral & Rectal infections are more common in Trich or Chlamydia??***
- Possible in which other infection?
A
Chlamydia
- Gonorrhea
11
Q
- 1st catch urine
- NAAT
- Pharynx/Rectal swab
- Tx: Azithromycin single dose or Doxy x7 days
- Don’t use which med in pregnant pts?? Cat D
A
- Chlamydia
- Doxy is Class D Preg
12
Q
- Increased risk of HIV
- Untreated –> PID
- Males –> epididymitis
A
Chlamydia & Gonorrhea
13
Q
- May lead to preterm delivery
- Leading cause of MILD conjunctivitis and PNA in newborns (ophthalmia neonatorum)
A
Chlamydia
14
Q
- Severe conjunctivitis in newborns
A
Gonorrhea
15
Q
- sxs 1-14 days after exposure
- Screen sexually act women under 25
- NO recommendations for men or women over 25
A
Gonorrhea
(Neisseria gonorrhea = gram -)
16
Q
- Women:
- Usually asymptomatic
- cervical motion tenderness
- Men:
- urethritis, dysuria
- white/yellow/green discharge
A
Gonorrhea
17
Q
- 1st catch urine
- NAAT
- Gram stain: PMN leuks w/ intracellular Gram-negative diploccoci**
(On exam)
A
Dx of Gonorrhea
18
Q
- IM Ceftriaxone + Azithromycin PO
- or DOxy
A
Tx of Gonorrhea
19
Q
Newborns: perforation of globe & blindness
A
Gonorrhea
20
Q
MC cause of PID
A
- STI organisms
- Chlamydia & Gonorrhea
21
Q
IUD within ___ of insertion can be cause of PID
A
3 weeks
22
Q
- Lower abd/pelvic pain
- Cervical Motion Tenderness (Chandelier sign)
- Uterine or adnexal tenderness
- Cervical friability
A
PID
23
Q
- Get serum quant HCG
- US to r/o ectopic
A
PID
24
Q
Outpatient regimen:
- Cef
- Doxy x 14 days
- +/- Metronidazole x 14 days
Inpatient: IV
**FU in 48 hrs**
A
PID
25
**Hospitalize pts w/ ___ if:\*\***
* cannot r/o ectopic, appy, torsion
* pregnant
* Unresponsive to oral abx (48-72 hrs)
* Tubo-ovarian abscess
* Pt is VERY ill w/ 102.2F, N/V, looks sick
PID
26
Main compliation of PID?
Infertility
27
**Fitz-Hugh -Curtis syndrome**
* What is it? / Which disease?
* WHat 2 sxs?
**PID**
* _Perihepatitis_
* RUQ pain & Adhesions
* Adhesions between liver & diaphragm
28
* Acyclovir
* Valacyclovir
* Famciclovir
* Reduce dose if renal insufficiency
* Initial outbreak: ___ days
* Recurrent outbreak ___ days
**Tx of Genital Herpes**
* initial: 7-10 days
* recurrent: 1-5 days
29
Transmission during vaginal delivery MC
C-section to reduce transmission
Genital Herpes
30
MC syndrome of Neonate HSV from genital herpes
Localized Skin, Eye, Mouth (SEM disease) 4 weeks after birth
31
MC STI overall?\*\*\*
on exam
**HPV**
6&11 are sexually transmitted
32
* Most asymptomatic
* Condyloma acuminata
* flesh colored / soft
* cauliflower
* Persistence of this infection is MCC of \_\_\_\_
**HPV**
* Cervical Cancer
33
**Pt applied therapy:**
* Imiquimod
* Podofilox
**Provider applied:**
* Cryotherapy
* Surgical therapy
* Trichloroacetic Acid (TCA)
(NO CURE of this)
HPV
34
Vaccine for HPV?
9-valent HPV (Gardasil 9)
35
* Treponema pallidum
* painless chancre
Syphilis
36
Primary Syphilis
Painless Chancre
37
Secondary Syphilis
* **Rash**
* diffuse, symmetric, macular/papular, NON-pruritic
* Palms and soles of feet
* Salmon colored lesions
38
When is syphilis no longer sexually transmittable?
Latent
| (asymptomatic)
39
Late syphilis
* 10-20 yrs after infection
* Neuro deficits: blindness, dementia, damage to internal organs
40
What type of syphilis can happen at ANY stage?
Neurosyphilis
41
Dx of syphilis
* Non-treponemal serological assays
* RPR (MC used) = rapid plasma reagin
42
* Benzathine PCN G (IM)
* If PCN allergy: oral doxy
* retreatment: weekly Benzathine PCN G (IM x 3 weeks)
Tx of Syphilis
43
**Early Congenital Syphilis**
* Manifests prior to __ yrs
**Late Congenital Syphilis**
* Manifests after __ yrs
* 2
* 2
44
* CNS syphilis
* Long bone abnorm
* PNA
* Severe anemia
Early COngenital Syphilis
45
* Gumma Formation (granulomatous lesion)
* Hutchinson Triad\*\*\*??
## Footnote
**(On exam)**
Late Congential Syphilis
* Hutchinson teeth
* Interstitial keratitis
* Sensorineural hearing loss
46
Tertiary Syphilis
* Multi-organ involvement
* Gummatous syphilis (skeletal, spinal, mucosal)
* CV syphilis: aortic regurg, CAS, aortitis
47
* Haemophilus ducreyi
* Sporadic outbreak in US
* Painful ulcer
* fould discharge
* buboes
* Contact County Health Dept
Chancroid
48
* Chlamydia trachomatis
* "groove sign"
* rectal bleeding
* Contact County Health Dept
Lymphogranuloma venereum (LGV)
49
* Pthirus pubis
* Crab louse
* Tx: Permethrin cream rinse
Pediculosis Pubis
50
All pregnant women should be screened for what 3 things?
* HIV
* Syphilis
* HBsAg
51
Annual screenings for which 2?
* Chlamydia
* Gonorrhea
52
Screen MSM annually for what 2?
* HIV
* Syphilis
53
Screen 13-64 y/o
HIV
54
55
9-Valent HPV (Gardasil 9) vaccine for \<15 y/o
**2 doses**
* 0 months
* 6-12 months
56
9-Valent HPV (Gardasil 9) vaccine for 15+ y/o
**3 doses**
* 0 months
* 1-2 months
* 6 months
