Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Gyn STIs
Sexually Transmitted Infections
| Question | Answer |
|---|---|
| Lifetime risk of acquiring an STD | 1 in 4 |
| Risk factors for STIs | New sex partner in last 60 days, multiple partners, unmarried, LSES, Past Hx of STI, Substance abuse, Early onset of sexual activity (before 16), lack of barrier contraception use |
| High risk populations | ages 15-24, Geographic (SouthEast urban and rural), AA, Commercial sex workers, incarcerated or in juvenile hall, meeting partners on the internet |
| Complications of STIs | upper genital tract infections, infertility, cervical cancer, enhanced transmission and acquisition of HIV |
| STD examination in women | Inguinal adenopathy, general skin exam including palms and soles, genital lesions (skin and mucosal), vaginal discharge, cervical mucopus/friability/pain, adnexal mass/tenderness, establish pregnancy status |
| Same day STI lab tests | gram stain, wet mount, RPR (rapid plasma reagin), Darkfield Microscopy |
| Next day or Longer STI lab tests | Cultures (GC, HSV), PCR (LCX): GC, chlamydia, others, MHA-TP (microhemagglutination assay for Treponema pallidum): Syphilis |
| Genital ulcers in the US | Herpes Simplex Virus (HSV), Primary Syphilis, Chancroid |
| What to look for in an ulcer exam | location and number, pain friability, induration, depth/diameter/base (shiny, purulent), borders (irregular or smooth), Adenopathy (bilateral, size, tender, consistency) |
| Extremely painful cluster of shallow vesicles with clear exudate on the shaft of the penis suggests | Primary Herpes |
| Nonpainful lesion that will heal without any scarring at all. no satellite lesions and is a deep ulcer. | Primary Syphilis-chancre. |
| Chancroid ulcer appearance | looks kind of wet and open |
| bacteria causing chancroid | H. ducreyi. Long chain of rods that stain blue/purple with gram stain |
| LGV | Lymphogranuloma venereum |
| Etiology of LGV | Chlamydia trachomatis. M>F, rare in US, more common in anal receptive patients, presents as rectal ulceration or strictures with inguinal LAD |
| Diagnostic test for Lymphogranuloma venereum | Complement fixation test for C trachomatis serotypes L1, L2, L3 (L types are different than normal chlamydia) |
| Treatment for LGV | Abx, stricture dilation, surgery -->will scar |
| Donovan bodies on stained direct smear or biopsy of ulcer evaluates for | Granuloma inguinale |
| Chronic or recurrent ulcerative vulvitis caused by Calymmatobacterium granulomatis is | Granuloma inguinale |
| Tx for granuloma inguinale | ABX |
| Which HPV strains are the major cause of cancer? | 16 and 18 |
| Which HPV strains cause genital conydloma? | 6 and 11 |
| Appearance of Condylomata | Papillomatous, white, cauliflower-like |
| 70-90% of __ infection will clear within 1 year | HPV; patient will remain immune from that strain for about 3 years. Reinfection with the same strain is possible after that |
| Management of high risk HPV types | colonoscopy with biopsy |
| Gardasil dosing | 3 vaccine series (0,2 & 6 months), offer to females 9-26 yo (full benefit if given prior to onset of sexual activity) even if hx of HPV |
| Chancres (painless sores, raised oval ulcer with indurated edges) are found in which type of Syphilis? | Primary |
| Which forms of Syphilis are contagious? | Primary, Secondary |
| Bilaterally symmetrical papulosquamous rash (check palms & soles!), condyloma, alopecia, denuded tongue, lymphadenopathy (firm, rubbery, non-tender) are symptoms of what type of Syphilis? | Secondary Syphilis. Sx usually have onset 6wks-6 months post infection and then last a few a weeks. Nonspecific sx include: fever, malaise, HA, arthralgias |
| lymphadenopathy is found in which forms of syphilis? | Primary, Secondary |
| Latent Syphilis is characterized by lack of clinical signs and | Usually you have a reactive serology (but CSF negative) (in the first year post secondary infection it is considered early latent; after that year, it is called late latent which may last 20 years to life) |
| Tertiary Syphilis | rarely infectious, CSF+, Multi-organ involvement, disease over 4 years duration, cardiovascular, late benign (gumma), neurosyphilis |
| serpiginous gummata of forearm and ulcerating gumma is suggestive of | late syphilis (tertiary?) |
| Spirochetes in the neural tissue is suggestive of | neurosyphilis |
| Titer >1:8 usually is indicative of what type of Syphilis? | Early |
| Diagnosing Primary Syphilis | Darkfield microscopy of chancre |
| Diagnosiing Syphilis | Serology: Nontreponemal (VDRL, RPR) confirmed by treponemal tests (FTA-ABS (fluorescent treponemal antibody absorption) and MHA-TP). Treponemal tests are lifetime positive. CSF examination recommended in sx, late-latenet, HIV co-infxn |
| Epidemiology of HSV2 | high (25% in US), horizontal transmission rate: 9.7% over year, F>M |
| HSV transmission | Direct contact, autoinnoculation, herpetic whitlow, asymptomactic carrier, perinatal (vertical transmission) |
| Primary HSV | May be asx, primary infxn: 2-7 day course, systemic sx possible, local sx, painful, first outbreak is the worst! |
| HSV recurrences | milder, shorter, prodromal phase, non-systemic, precipitants (sun, wind, trauma, fever, menses, stress) |
| The lesion with the greatest diagnostic testing accuracy for HSV is | 93% for vesicles, 72% for ulcers. 27% for crusted lesions. H & P is often enough to dx, PCR is over 95% sensitive and specific in any stage. Serology is controversial |
| Main management of HSV | Patient education: abstinence while lesions are present, condoms for all sexual exposures, neonatal risk, partner education, antivirals may reduce transmission |
| Which STI is an intracellular obligate bacteria? | Chlamydia Trachomatis. Highest prevalence in 15-24 yo females, not related to SES |
| #1 STI | HPV (but not reported to the health department). Chlamydia is the #1 reported STI |
| Who to test for Chlamydia | Women<26yo annually, new sex partner in last 60 days, >2 sex partners in past year. Based on exam: cervical mucopus, friability, ectopy |
| Clinical course of Chlamydia | Incubation is 7-10 days, Sx may be delayed up to 30 days, may be asx in both men and women, 15-305 concurrence with Gonorrhea |
| Clinical course of Chlamydia in Women | Asx or minor sx in majority of women (vaginal discharge, dysuria), muculopurulent cervicitis on clinical exam, acute urethral syndrome, pelvic pain, lower abdominal pain |
| Chlamydia complications in a female | PID (40% if untreated), infertility (20% of F with PID), Ectopic pregnancy, Perihepatitis (Fitz-Hugh-Curtis syndrome), Perinatal transmission (66%): Ophthalmia neonatorum - very serious, emergent tx. Pneumonia |
| Chlamydia complications in a male | relatively uncommon, epididymitis, urethritis, may cause pain, fever, and rarely sterility |
| Diagnosing Chlamydia | Enzyme Immune Assay (EIA) 75% (cheap), PCR (LCX) 95%, UA may increase detection, esp in men, CDC recommends re-testing for chlamydia 3 months post tx |
| Gram negative intracellular diplococcus STI | Neisseria gonorrhea |
| 2nd most commonly REPORTED infectious disease in the US | Gonorrhea. Underdiagnosed and undertreated |
| GC sx in women | vaginal discharge, abdominal pain (50% asx) |
| GC sx in men | purulent discharge/dysuria (only 3% asx) Milk the shaft of the penis for greenish, yellow discharge |
| GC infection increases the risk of contracting __ if exposed | HIV; risk is 3-5x greater |
| This is a complication of GC that is has higher likelihood in 15-19yo F and 20-25yo males | Dissemination. AA>W. Septic arthritis, vertical transmission, ophthalmia neonatorum |
| GC lab diagnosis | Men: urethral gram stain 95% sensitive compared to culture. Women: culture is 85% sensitive. PCR IS OPTIMAL |
| initial Rapid testing for HIV | EIA. Confirm with supplemental. Test during window period (early infxn) with HIV RNA |
| Acute HIV sx | fever, mono-like illness, diarrhea |
| For which sexually transmitted Hepatitis types is there a vaccination? | A and B |
| When treating for gonorrhea, always treat for ____ as well | chlamydia; remember that quinolone resistance is a problem |
| STI patient education | Patient needs to wait 7 days post completion of tx to have sex again (no, cannot have sex wiht a condom before then) |
Created by:
ltm12