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STI 3
Gynecology
| Question | Answer |
|---|---|
| Chancroid: cofactor in contracting: | HIV |
| yellow creamy discharge | chlamydia |
| PID includes: | acute salpingitis (gono or non), IUD pelvic cellulitis, TOA, pelvic abscess |
| Tabes dorsalis = | in tertiary syphilis: loss of proprioception & vibratory sense, Argyll Robertson pupil (accommodation with near object but does not react to light) |
| Condyloma lata = | In secondary syphilis: smooth, moist, flat lesions |
| trichomonas vaginitis Sx/Sx | Severe pruritus, malodorous (musky) discharge, dysuria, dyspareunia, may be asymptomatic, greenish-yellow/frothy discharge, petechiae or “strawberry markings on cervix |
| Herpes ulcers description: | Painful, small, shallow, may have a clear exudate; secondary ulcers are smaller / less dramatic than primary lesions |
| Primary syphilis description: | Solitary, painless, indurated, large/deep ulcer; local painless rubbery LAD |
| Clinical presentation of lymphogranuloma venereum (LGV) | Rectal ulceration or stricture, inguinal LAD |
| Etiology of LGV | Chlamydia trachomatis |
| Clinical presentation of granuloma inguinale | Chronic or recurrent ulcerative vulvitis. Donovan bodies on stained direct smear or biopsy of ulcer. |
| etiologic agent of granuloma inguinale | Klebsiella granulomatis (formerly Calymmatobacterium granulomatis) |
| Etiologic agent of condyloma acuminata | HPV 6 & 11 |
| Clinical appearance of condyloma acuminata | Papillomatous, white, cauliflower like |
| Chancroid causative organism | Haemophilus ducreyi |
| HPV pathology | infect keratinized skin -> epithelial hyperplasia -> retained stratum corneum -> papules |
| HPV lesion types | Verruca vulgaris & plantaris (firm papules 1-10mm w/red-brown punctuations); verruca plana (flat papules 1-5mm on face, hands, shins) |
| Condyloma acuminata tx | Podofilex 0.5% solution BID; imiquimod cream 5%. if recalcitrant, possibly cryotherapy vs topical 5-FU |
| History of sexual intercourse with trauma increases the risk for what STD | Hep B , and Hep C |
| 3 causes of genital ulcers in US | Herpes simplex virus, primary syphilis, chancroid |
| Low risk HPV strains | HPV-6, and HPV-11 (cause genital warts) |
| High risk strains of HPV | HPV-16 & 18; 31, 33, 45 |
| Offer __ testing for all patients evaluated for STIs | HIV |
| Acute HIV symptoms | Fever, mono-like illness, diarrhea |
| Which hepatitides are commonly sexually transmitted | A, B, and C (especially B) |
| Characteristic of primary HSV outbreak | 2-7 day course, systemic symptoms possible, local symptoms (painful), first outbreak is the worst |
| Precipitants of HSV recurrent outbreaks | Sun, wind, trauma, fever, menses, stress |
| Multiple, vesicular, pruritic, painful, recurrent rash | Herpes simplex |
| Gonorrhea s/s | Vaginal discharge, abdominal pain, 50% asymptomatic |
| Female complications of gonorrhea | PID, infertility, ectopic pregnancy, tubo-ovarian abscess, perihepatitis (Fitz-Hugh-Curtis syndrome), septic arthritis, vertical transmission, ophthalmia neonatorum |
| Common co-infxn with Gonorrhea: | Chlamydia |
| Violin string adhesions between liver and parietal peritoneum, RUQ pain may be prominent symptom especially in young women, PID complication | Fitz-Hugh-Curtis syndrome |
| Secondary syphilis usual duration: | A few weeks |
| Clinical appearance of secondary syphilis | Bilaterally symmetrical papulosquamous rash, condyloma, alopecia, denuded tongue, lymphadenopathy (firm, rubbery, non-tender) |
| Secondary syphilis is contagious by: | Skin on skin contact (any portion of the body) |
| Latent syphilis = | period after secondary stage, no clinical manifestation |
| Tertiary syphilis is __ infectious | rarely |
| Etiology of syphilis (bug) | Treponema pallidum spirochete |
| How many stages of syphilis are there? | 4 |
| Acute syphilitic chancre develops on skin near infection site about __ after inoculation | 10-90 days |
| Characteristic of secondary syphilis | Maculopapular rash often on palms and soles, generalized LAD, typically lasts about 3 months |
| How long does the acute syphilitic chancre last | 1-5 weeks |
| How long may syphilis remain inactive? | Up to 5 years |
| tertiary syphilis = | End organ manifestation (CNS, cardiovascular, ocular); gummatous lesions of skin, bones, viscera |
| Indurated firm painless papule, heaped up or rolled edge = | Syphilitic chancre |
| Bilateral papulosquamous rash on palms and soles | Secondary syphilis |
| What type of bacterium is chlamydia trachomatis | Intracellular obligate bacteria |
| Clinical course of chlamydia | Asymptomatic or minor symptoms in majority, vaginal discharge, dysuria, mucopurulent cervicitis, acute urethral syndrome, pelvic pain, lower abdominal pain |
| Vaccine available for HPV | Gardasil (vs HPV 6,11,16,18) |
| Gardasil should be offered to: | Females 9-26 years old (full benefit if given prior to onset of sexual activity) even if history of hpv |
| Vaccinations are available for which hepatitides | A and B (no hep C vaccine available yet) |
| __ may reduce transmission of HSV | Antivirals |
| condyloma acuminata Tx | BCA/TCA; cryosurgery, electrosurgery, excision |
| Perinatal transmission of chlamydia can cause __ | Ophthalmia neonatorum, pneumonia |
| Female chlamydia complications | PID, infertility, ectopic pregnancy, perihepatitis, perinatal transmission |
| Treatment for trichomonas vaginitis | Flagyl 2g PO x1 or 250mg TID x7d. Teat partners, look for other STIs |
| gonorrhea tx | IM ceftriaxone or oral cefixime |
| chlamydia tx | zithro or doxy; Erythromycin in PG |
| Chancroid is often co-infection with: | HSV or syphilis |
| Jarisch-Herxheimer reaction = | Febrile reaction in 50-75% of pts treated with PCN. 2/2 massive (syphilis) spirochete destruction. Give antipyretics in 1st 24 hrs |
| Soft painful shallow genital ulcer with surrounding bright red zone of congestion (+/- painful inguinal adenitis) is seen with: | chancroid |
Created by:
Abarnard
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