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DU PA GYN infections

Duke PA Gyn Infections

What is the lifetime risk of contracting an STD 1 in 4
What age group is the highest at risk population 15-24
What geographic regions are at highest risk for STD’s southeast and urban
History of sexual intercourse with trauma increases the risk for what STD Hep B , and Hep C
Why would you check the palms of a patient when concerned about STD’s you are looking for secondary syphilis
3 causes of genital ulcers in US Herpes simplex virus, primary syphilis, chancroid
Herpes ulcers are __ Painful, small, shallow, may have a clear exudate
Secondary herpes ulcers are __ Smaller, and less dramatic looking than the primary lesions
Primary syphilis is a __ Solitary, painless, indurated, large/deep ulcer
Agent responsible for chancroid H. ducreyi
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.
What is the etiologic agent of granuloma inguinale Calymmatobacterium granulomatous
What is the etiologic agent of condyloma acuminata HPV
What is the clinical appearance of condyloma acuminata Papillomatous, white, cauliflower like
Vaccine available for HPV Gardasil
Who should Gardasil be offered to Females 9-26 years old (full benefit if given prior to onset of sexual activity) even if history of hpv
Secondary syphilis usually only lasts for __ 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
Primary diagnosis of syphilis Darkfield microscopy of chancre
Diagnosis of neurosyphilis CSF examination recommended in symptomatic, late-latent, HIV co-infection (lumbar puncture)
What is herpetic whitlow Herpes on the fingers (especially around the nail bed)
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
__ may reduce transmission of HSV Antivirals
What type of bacterium is chlamydia trachomatis Intracellular obligate bacteria
What is the most commonly reported STI in the US, >1 million infections in 2006 Chlamydia
Who should be tested for chlamydia Women<26 yo annually, new sex partner in past 60 days, >2 sex partners in past year, exam findings of cervical mucopus/friability/ectopy
If you are treating a patient for gonorrhea what else should you treat for Chlamydia
If you are treating a patient for chlamydia do you need to also treat for gonorrhea Not necessarily
Clinical course of chlamydia Asymptomatic or minor symptoms in majority, vaginal discharge, dysuria, mucopurulent cervicitis, acute urethral syndrome, pelvic pain, lower abdominal pain
Perinatal transmission of chlamydia can cause __ Ophthalmia neonatorum, pneumonia
Female chlamydia complications PID, infertility, ectopic pregnancy, perihepatitis, perinatal transmission
What type of bacterium is Neisseria gonorrhea Gram negative intracellular diplococcus
What is the 2nd most commonly reported infectious disease in the US Gonorrhea
Symptoms of gonorrhea 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
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)
Vaccinations are available for which hepatitides A and B (no hep C vaccine available yet)
Males voiding within __ before urethral culture washes secretions away 1-2 hours
Best source of HSV for testing Unroofing the vesicle
Gold standard for HSV testing Culture
__% of US population have positive herpes antibodies on serological testing 50
Etiology of syphilis Treponema pallidum spirochete
How many stages of syphilis are there 4
Characteristic of acute syphilis. Chancre develops on skin near infection site about __ after inoculation 3-6 weeks
Characteristic of secondary syphilis Maculopapular rash often on palms and soles, generalized lymphadenopathy, typically lasts about 3 months
How long does the acute syphilitic chancre last 5-6 weeks
How long may syphilis remain inactive Up to 5 years
About how many patients with latent syphilis progress to tertiary phase 2/3
What is tertiary syphilis End organ manifestation, including CNS, cardiovascular and ocular
VDRL becomes positive __ after inoculation with Syhpilis About 2 weeks
What will gram stain show for positive Gonorrhea infection Gram negative intracellular diplococci
If a patient is infected with Gonorrhea they are probably also infected with __ Chlamydia
What is the etiology of Chancroid Haemophilus ducreyi
Chancroid is most often a co-infection with what Herpes and or syphilis
Gram stain with a “school of fish” appearance is probably what Chancroid (Haemophilus ducreyi)
What is the most frequently occurring STD in developed countries Chlamydia
Chlamydia is most prevalent in what population <20 yr olds, nulliparous, users of non-barrier contraceptive methods
What are the 4 methods for diagnosis of HIV Detect antibodies to the virus, detect viral p24 antigen, detect viral nucleic acid, culture HIV virus
What is the most widely used method to diagnose HIV Detection of antibody to HIV
What is the most common cause of false positive tests for HIV in low risk patients Recent immunization
What is the initial screening for HIV EIA enzyme immunoassay (EILISA)
What is the confirmatory test for HIV (done after the screening test) Western blot or IFA (Immunofluorescence Assay)
Multiple, vesicular, pruritic, painful, recurrent rash Herpes simplex
Single, heaped up or rolled edge, textbook case never painful Syphilitic chancre
Most appropriate way to test for herpes Culture (not serological)
Trichomonas is tested for by use of what Wet prep
Treatment for contact dermatitis 1% hydrocortisone cream and removal of offending agent
What causes the fishy odor in bacterial vaginosis Anaerobes
What do you look for on microscopic examination to show the presence of bacterial vaginosis Clue cells (epithelial cells with irregular borders in clusters, very shiny)
Bacterial vaginosis requires 3 of 4 criteria. What are the 4 criteria Typical discharge, alkaline pH(5.0-5.5), positive “whiff” test, clue cells on wet prep
Bacterial vaginosis is not considered an __ STD
Treatment for bacterial vaginosis Metronidazole or clindamycin, topical or orally
Should you treat male partners of women with bacterial vaginosis No
Signs and Symptoms of trichomonas vaginitis Severe pruritus, malodorous (musky) discharge, dysuria, dyspareunia, may be asymptomatic, greenish-yellow/frothy discharge, petechiae or “strawberry markings on cervix
Treatment for trichomonas vaginitis 2gm metronidazole stat, treat partners, look for other STDs
Treatment for yeast vaginitis Over the counter imidazoles, oral fluconazole 150mg stat
Atrophic vaginitis often masquerades as what Infection
Signs and symptoms of atrophic vaginitis Pruritis/burning, vaginal dryness, dyspareunia, possibly spotting, pale/thin vaginal mucosa, loss of vaginal rugation
Bilateral Bartholin’s abscess said to be associated with what Gonorrhea
Treatments for Bartholin’s gland abscess if not pointing Antibiotic treatment may be successful
Treatment for Bartholin’s gland abscess I&D and placement of Word catheter (left in for 1-2 weeks), marsupialization, needs to remain open to avoid recurrence
What organism is associated with toxic shock syndrome S. aureus/endotoxins
Woman with flu like symptoms, on her period think Toxic shock syndrome
CDC case definition of __ ; fever >38.9 C, hypotension, diffuse erythroderma, desquamation, involvement of at least 3 organ systems Toxic shock syndrome
Treatment for toxic shock syndrome Supportive, look for foreign body in vagina and remove, clindamycin and oxacillin/nafcillin, MRSA: clindamycin and vancomycin/linezolid
Common condition in which microorganisms spreads from the lower genital tract infect and inflame upper genital tract structures including the endometrium, tubes, ovaries and peritoneum Pelvic inflammatory disease
Symptoms of PID Abdominal pain, dyspareunia, possibly fever/chills, possibly RUQ pain
Start empiric treatment for these 3 CDC minimum criteria for PID Lower abdominal tenderness, adnexal tenderness, cervical motion tenderness
In addition to the 3 CDC minimum criteria what are the additional criteria for PID Elevate oral temp (>101), abnormal cervical or vaginal discharge, elevated ESR, Elevated C-reactive protein, positive GC or chlamydia, increased WBC
Which PID patients need hospitalization Nulliparous/adolescents/non compliant, pregnant, treatment failure, HIV/immunosuppression, unable to tolerate oral regimen, Tubal ovaria cyst, severe peritonitis/uncertain diagnosis
Violin string adhesions between liver and parietal peritoneum, RUQ pain may be prominent symptom especially in young women, PID complication Fitz-Hugh-Curtis syndrome
What cancer is a sexually transmitted infection caused by HPV Cervical cancer
Risk factors for cervical cancer Smoker, hormones, multiple sexual partners, sex before 18, HIV, poor SES, age, multiple pregnancies, chlamydia infection, diet low in fruit and vegetables
Effective methods to prevent cervical cancer Routine pap tests, avoid smoking, condom use, limit partners, HPV vaccine
Low risk HPV strains HPV-6, and HPV-11 (cause genital warts)
High risk strain HPV-16 and HPV-18
What is the HPV vaccine Gardasil (HPV 6,11,16,18)
Bilateral papulosquamous rash on palms and soles Secondary syphilis
Created by: bwyche