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STI 3

Gynecology

QuestionAnswer
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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