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Terms in this set (90)
What are risk factors for STDs?
Sexually active (multiple partners, unprotected sex, serial monogamy), young (18-28 yo), MSM, IVDA, inmates
Why are young people at high risk for STDs?
Difference in cervical cell turnover makes them more susceptible along with social patterns
STDs classified by symptoms
What are the general principles regarding treatment of partners with STDs?
Current partners should be treated simultaneously and refrain from intercouse until both therapies are completed (refer partners in past 60 days for gonorrhea, chlamydia, NGU)
What are the top 3 causes of genital ulcers?
HSV (#1), Syphilis, Chancroid
What is the purpose of empiric treatment of genital ulcers?
Reduce transmission and increase treatment success
T/F: Herpes Simplex Virus is an incurable life long infection that has infected 50 million people in the US
What are the 2 types of HSV?
HSV-1 (15% of HSV genial ulcers) and HSV-2 (85% of HSV genial ulcers)
What is the "primary infection" of HSV?
Transmission from viral shedding host to mucosal surfaces leading to neuronal infection and ulceration of mucosa and skin
What are symptoms of HSV?
Multiple painful vesicles/ulcers on erythematous base and systemic flu-like symptoms are common, recurrent episodes are milder
How is HSV diagnosed?
Viral culture of cells from ulcer base OR HSV Ab serologic test and typing
Recommended oral treatment for genital HSV
What is buccal acyclovir (Sitavig) used for?
Recurrent HSV in immunocompetent patients
Sitavig is applied to the upper gum canine fossa region with 1 hr of prodromal onset and before lesions appear, and should be replaced if it falls of within _____
T/F: HSV topical therapy is not efficacious and antivirals do NOT cure or decrease the risk of recurrences after course is completed
What is the purpose of episodic HSV therapy?
Ameliorate/shorten duration of lesions, most efficacious if initiated in prodrome or within 24 hrs of lesions
What is the purpose of suppressive HSV therapy?
Decrease risk of transmission and reduce frequency of recurrences by 70-80%
Which antiviral is least effective as suppressive therapy for frequent outbreaks (>10/yr)?
HSV counseling points
What type of bacteria is Syphilis?
Treponema pallidum (spirochete)
How is Syphilis transmitted?
Mucocutaneous lesion contact
Syphilis can also cause systemic illness in which parts of the body?
CV, CNS, skin, musculoskeletal
Clinical presentation based on stage of syphilis
What is primary syphilis?
Painless, indurated single chancre that persists for 4-6 weeks also bilateral, non-tender lymphadenopathy
When does secondary syphilis occur?
6-8 weeks post infection characterized by maculopapular rash, lesions on palms and soles, constitutional symptoms (malaise, night sweats), oral mucosa involvement, meningitis
How is syphilis determined to be "early" or "late"?
<1 year after infection is early and >1 year is late
What is tertiary syphilis?
Slow progression to infection of virtually every organ system
How is syphilis diagnosed?
Serologic testing and Darkfield examination (rarely used)
What is the Darkfield examination?
Direct viewing of spirochetes from chancre which provides a definitive diagnosis
What are the serologic tests used for syphilis?
Nontreponemal (VDRL or RPR test) and Treponemal (FTA-ABS or TP-PA)
What type of test is the nontreponemal test?
Screening, marker of disease response, looking for a 4-fold titer change (# of dilutions until Ab cannot be detected)
What type of test is the treponemal test?
Confirmatory, no correlation with disease activity
What is required for positive diagnosis of syphilis?
BOTH serologic tests
Which abx are used to treat syphilis?
Pen G Benzathine (DOC) and Doxycycline (PCN allergy)
How does dosing frequency vary between stages of syphilis?
1 dose (primary, secondary, early latent) and 3 doses (tertiary, late latent, unknown duration)
What is the notorious AE with PCN treatment of syphilis?
Jarisch-Herxheimer reaction (resembles bacterial sepsis)
What type of response is typically observed with treatment of syphilis?
4 fold decrease in RPR or VDRL at 6 months
What are the pearls of treating syphilis in pregnant patients with PCN allergies?
Doxycycline is NOT an alternative and must use PCN de-sensitization
Neurosyphilis can occur at any stage of disease and should be treated with which abx?
PCN G IV 4 million units Q4H
H. ducreyi causes ______ which is found in discrete outbreaks and is a co-factor for HIV transmission
Chancroid is more prevalent in which gender?
What type of ulcer is caused by Chancroid?
Painful, non-indurated ulcer with ragged borders on deep base and is commonly associated with inguinal adenopathy
T/F: Syphilis and Chancroid are curable
How is Chancroid diagnosed?
Painful genital ulcer, regional lymphadenopathy, negative for T. pallidum and HSV
Which abx are used to treat Chancroid?
Azithromycin, Ceftriaxone, Ciprofloxacin, Erythromycin base
What is the presentation of urethritis and cervicitis?
Dysuria, purulent discharge, but NO ulcers/lesions
What is the 2nd most common STD in the US?
Gonorrhea (G- diplococci)
What are symptoms of gonorrhea in men?
Urethritis (dysuria) and purulent discharge
What is the clinical presentation of gonorrhea in women?
Asymptomatic (transmission w/o knowledge) and progresses to PID with infertility
Which class of abx is no longer recommended for treatment of gonorrhea due to developing resistance?
FQs (can be used if culture states sensitive, but not empirically)
How is Gonorrhea diagnosed?
Gram stain (best), culture, nucleic acid hybridization
What is the DOC for treatment of gonorrhea?
Ceftriaxone 250mg IM x1
What is second line treatment for gonorrhea?
Cefixime + Azithromycin/Doxycycline and return in 1 week to test for cure
What are complications of gonorrhea?
Pelvic Inflammatory Disease (PID), Disseminated Gonococcal Infection (DGI)
Which abx are used to treat DGI?
Ceftriaxone daily and Cefixime x7 days
What can occur post-treatment of gonorrhea?
Post-Gonococcal Urethritis which is recurrence of symptoms several days after treatment
How should dual urethral infection with NGU be treated?
Treat NGU empirically if gonorrhea diagnosis unless ruled out by diagnostic tests, and expedited partner therapy (EPT)
What is Expedited Partner Therapy (EPT)?
Treating sexual partners of patient without examination, CDC approved for gonorrhea, chlamydia, and heterosexuals
Patients infected with gonorrhea are frequently co-infected with _____
Which abx are used for co-treatment of gonorrhea and Chlamydia trachomatis?
Azithromycin or Doxycyline
What is the most common STD in the US?
What is the clinical presentation of chlamydia?
Majority are asymptomatic but men can have urethritis and mucopurulent discharge (<50%) and women are at risk of PID, ectopic pregnancy, and infertility
How is Chlamydia diagnosed?
Culture and NA hybridization
Which abx are the DOC for chlamydia and non-chlamydial NGU?
Azithromycin OR Doxycycline
Which abx can be used as alternatives for chlamydia and non-chlamydial NGU treatment?
Ofloxacin, Levofloxacin, Erythromycin
_____ is a clinical syndrome of inflammation from the cervix to endometrium and fallopian tubes (entire reproductive tract)
Pelvic Inflammatory Disease (PID)
What are known causes of PID?
Chlamydia, Gonorrhea, vaginal flora, anaerobes, GNRs
How is PID diagnosed?
Sexually active women, pelvic/abdominal pain, cervical motion tenderness, febrile, mucopurulent vaginal discharge, WBC on vaginal smear
PID risk is inversely proportional to ___
Vaginitis/Vaginal discharge is characterized by vaginal itching, irritation, odor and is commonly caused by _______
Bacterial Vaginosis (most), Trichomoniasis, Vulvovaginal Candidiasis
Bacterial vaginosis is a polymicrobial syndrome characterized by:
Replacement of lactobacilli (acidic) with anaerobes that raise the pH and lead to symptoms
T/F: Bacterial vaginosis does NOT require partner treatment
How is bacterial vaginosis diagnosed?
Gram stain of vaginal discharge or 3 out of 4 clinical signs (thin white vaginal discharge, clue cells on microscope, vaginal fluid pH >4.5, fishy odor of discharge after 10% KOH prep)
What is the recommended treatment for bacterial vaginosis?
Metronidazole (PO, gel) or Clindamycin cream
Which agent used to treat bacterial vaginosis will break down latex condoms?
When does bacterial vaginosis occur in pregnancy?
Premature rupture of membranes (PROM), preterm labor, and postpartum endometritis
When should bacterial vaginosis be treated during pregnancy?
Symptomatic or if asymptomatic and at high risk (previous preterm delivery)
Which agents are recommended for treatment of bacterial vaginosis in pregnancy?
Metronidazole (PO) or Clindamycin (PO)
Which microbe causes Trichomoniasis?
Protozoan Trichomoniasis vaginalis
What is the clinical presentation of Trichomoniasis?
Asymptomatic in men and 50% in women
How is Trichomoniasis diagnosed?
Microscopic examination of vaginal discharge and Point of Care rapid tests
What is the DOC for Trichomoniasis?
Which agents are used to treat genital warts?
Podofilox/Imiquimod (Patient) or Caustic agents/Cryotherapy/Laser surgery (Physician)
What is the treatment goal for HPV genital warts?
Remove warts (resolve within 3 months)
What can happen to genital warts without treatment?
Resolve spontaneously, remain unchanged, or increase in number
T/F: Treatment of genital warts doesn't eradicative HPV, reduce transmission, or cervical cancer risk
Why is partner testing and treatment not warranted in HPV infections?
Majority of infected adults will remain asymptomatic and infection will resolve without treatment
Which agents can be given to sexually assaulted victims?
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