Sexually Transmitted Infections
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| Lifetime risk of acquiring an STD | 1 in 4
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| 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
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| 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
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| Complications of STIs | upper genital tract infections, infertility, cervical cancer, enhanced transmission and acquisition of HIV
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| 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
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| Same day STI lab tests | gram stain, wet mount, RPR (rapid plasma reagin), Darkfield Microscopy
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| Next day or Longer STI lab tests | Cultures (GC, HSV), PCR (LCX): GC, chlamydia, others, MHA-TP (microhemagglutination assay for Treponema pallidum): Syphilis
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| Genital ulcers in the US | Herpes Simplex Virus (HSV), Primary Syphilis, Chancroid
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| 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)
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| Extremely painful cluster of shallow vesicles with clear exudate on the shaft of the penis suggests | Primary Herpes
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| Nonpainful lesion that will heal without any scarring at all. no satellite lesions and is a deep ulcer. | Primary Syphilis-chancre.
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| Chancroid ulcer appearance | looks kind of wet and open
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| bacteria causing chancroid | H. ducreyi. Long chain of rods that stain blue/purple with gram stain
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| LGV | Lymphogranuloma venereum
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| 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
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| Diagnostic test for Lymphogranuloma venereum | Complement fixation test for C trachomatis serotypes L1, L2, L3 (L types are different than normal chlamydia)
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| Treatment for LGV | Abx, stricture dilation, surgery -->will scar
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| Donovan bodies on stained direct smear or biopsy of ulcer evaluates for | Granuloma inguinale
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| Chronic or recurrent ulcerative vulvitis caused by Calymmatobacterium granulomatis is | Granuloma inguinale
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| Tx for granuloma inguinale | ABX
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| Which HPV strains are the major cause of cancer? | 16 and 18
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| Which HPV strains cause genital conydloma? | 6 and 11
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| Appearance of Condylomata | Papillomatous, white, cauliflower-like
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| 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
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| Management of high risk HPV types | colonoscopy with biopsy
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| 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
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| Chancres (painless sores, raised oval ulcer with indurated edges) are found in which type of Syphilis? | Primary
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| Which forms of Syphilis are contagious? | Primary, Secondary
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| 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
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| lymphadenopathy is found in which forms of syphilis? | Primary, Secondary
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| 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)
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| Tertiary Syphilis | rarely infectious, CSF+, Multi-organ involvement, disease over 4 years duration, cardiovascular, late benign (gumma), neurosyphilis
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| serpiginous gummata of forearm and ulcerating gumma is suggestive of | late syphilis (tertiary?)
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| Spirochetes in the neural tissue is suggestive of | neurosyphilis
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| Titer >1:8 usually is indicative of what type of Syphilis? | Early
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| Diagnosing Primary Syphilis | Darkfield microscopy of chancre
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| 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
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| Epidemiology of HSV2 | high (25% in US), horizontal transmission rate: 9.7% over year, F>M
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| HSV transmission | Direct contact, autoinnoculation, herpetic whitlow, asymptomactic carrier, perinatal (vertical transmission)
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| Primary HSV | May be asx, primary infxn: 2-7 day course, systemic sx possible, local sx, painful, first outbreak is the worst!
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| HSV recurrences | milder, shorter, prodromal phase, non-systemic, precipitants (sun, wind, trauma, fever, menses, stress)
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| 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
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| Main management of HSV | Patient education: abstinence while lesions are present, condoms for all sexual exposures, neonatal risk, partner education, antivirals may reduce transmission
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| Which STI is an intracellular obligate bacteria? | Chlamydia Trachomatis. Highest prevalence in 15-24 yo females, not related to SES
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| #1 STI | HPV (but not reported to the health department). Chlamydia is the #1 reported STI
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| 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
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| 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
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| 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
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| 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
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| Chlamydia complications in a male | relatively uncommon, epididymitis, urethritis, may cause pain, fever, and rarely sterility
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| 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
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| Gram negative intracellular diplococcus STI | Neisseria gonorrhea
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| 2nd most commonly REPORTED infectious disease in the US | Gonorrhea. Underdiagnosed and undertreated
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| GC sx in women | vaginal discharge, abdominal pain (50% asx)
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| GC sx in men | purulent discharge/dysuria (only 3% asx) Milk the shaft of the penis for greenish, yellow discharge
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| GC infection increases the risk of contracting __ if exposed | HIV; risk is 3-5x greater
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| 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
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| GC lab diagnosis | Men: urethral gram stain 95% sensitive compared to culture. Women: culture is 85% sensitive. PCR IS OPTIMAL
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| initial Rapid testing for HIV | EIA. Confirm with supplemental. Test during window period (early infxn) with HIV RNA
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| Acute HIV sx | fever, mono-like illness, diarrhea
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| For which sexually transmitted Hepatitis types is there a vaccination? | A and B
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| When treating for gonorrhea, always treat for ____ as well | chlamydia; remember that quinolone resistance is a problem
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| 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)
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