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Review of STD's

Major presenting symptom: Vaginal discharge in: Candidiasis, Bacterial vaginosis, Trichomoniasis + 30% no infection
Major presenting symptom: Urthritis/Cervicitis by: Chlamydia (Serotypes D-K); Gonorrhea; always together; them most common STI in North America
Major presenting symptom: genital lesions in: LGV; Herpes; Warts; Syphilis; Granuloma inguinale; Soft chancre; Molluscum Contagiosum
STI epidemiology? HSV 70-80; 1° syphilis 5% (on the rise); chancroid <1%
Candidiasis symptoms? itching, irritation, dyspareunia, white discharge with pseudohyphae in KOH preparation
Candidiasis treatment? Oral azoles (fluconazole: 150 mg po single dose; recurrence X3d then once weekly) or Topical azoles (clotrimazole: 200 mg tablet pv od X3d or 1 applicator of 1% cream X6d) or Nystatin 1 g pv X14d
Bacterial vaginosis symptoms? excessive discharge, fishy or musty odor (when treated with KOH, whiff test), grayish white greenish homogenous discharge, no edema or erythema of vulva and vagina, clue cells,
Bacterial vaginosis treatment? Metronidazole (500 mg po bid X7d); in pregnancy: clindamycin (300 mg po bid) or amoxicillin
Trichomoniasis symptoms? Copious grayish white discharge, itching strawberry cervix, saline preparation shows motile trichomonas
Trichomoniasis treatment? Metronidazole (2 g po single dose or 500 mg po bid X7d), partner should also be treated, test of cure is not necessary; can be used in pregnancy (benefits overweights possible risks)
Chlamydia symptoms? 70% asymptomatic; The most common STD in Canada; servars: D to K; may have vaginal discharge (foul smelling)
Chlamydia treatment? Cefixime 400 mg po single dose (or ceftriaxone 125 mg im single dose in pregnancy and nursing) + Azithromycin: 1 g po single dose
Gonorrhea Symptoms? May have vaginal discharge (foul smelling)
Gonorrhea Treatment? Cefixime 400 mg po single dose (or ceftriaxone 125 mg im single dose in pregnancy and nursing) + Azithromycin: 1 g po single dose
LGV symptoms? Painless ulcers (heals quickly) + lymphadenitis (unilateral); chlamydia trachomatis (L1-L3)
LGV treatment? Doxycycline or erythromycin
Herpes etiology? herpesvirus hominis type 2 (genital, 90%) and 1 (oral)
Herpes symptoms? Asymptomatic or just tingling and burning followed by vesicles (highly infectious), inguinal lymphadenopathy, may be with urethritis; recurrence: less severe; Chronic pattern with high rates of recurrence and asymptomatic virus shedding
Herpes treatment? Acyclovir: 200 mg X5/d po for 5-10 days (or 400 mg tid) may need to repeat on recurrence (or valacyclovir: 1000 mg bid for 10 days; famciclovir: 250 mg tid for 5 days)
Ano-genital warts other names and etiology? Condylomata acuminata; HPV;
Ano-genital warts symptoms? cauliflower appearance
Ano-genital warts treatment? cryotherapy, electrocautery, podophyllotoxin; for dysplasia: colposcopy and possible excision; • Podofilox 0.5% solution or gel bid x 3 days in a row (4 days off) then repeat x 4 weeks
Syphilis etiology? Treponema Pallidum
Primary Syphilis symptoms and duration? Single red indurated painless chancre with raised borders after 3 weeks; negative serology (repeat q 1-2 wks for 1 month)
Secondary Syphilis symptoms and duration? in 1-6 months; Systemic infection symptoms + macules &papules, Symmetric on flexor sides, condylomata lata (extremely infectious), mucosal patches
Latent Syphilis symptoms and duration? Asymptomatic (positive serology) early and late (> 1 year)
Tertiary Syphilis symptoms and duration? 10-30 years later with cardiac (aneurysm, valvular dis), neurologic (stroke, dementia, personality changes, Argyll Robertson pupil (small pupils, reactive on near focus but not to light), tabes dorsalis (Charcot joint: neuropathic osteoarthropathy)
Syphilis treatment? 1° and 2°: Benz. PCN 2.4 mU IM SD; 3° syphilis: PCN 10-20 mU/day IV for 10 days; if PCN-allergic: doxycycline 100 mg po bid for 1° and 2°; Note: 3° and pregnant women must be desensitized; Neuro-syph.: IV PCN G 3-4 mU q4h for 10-14 days
Granuloma inguinale etiology? Calymmatobacterium, donovania
Granuloma inguinale symptoms? painless, malodorous lesions
Granuloma inguinale treatment? doxycycline and ceftriaxone or SMX/TMP
Soft chancre (chandroid) etiology and symptoms? haemophilus ducreyi; painful multiple ulcers
Soft chancre (chandroid) treatment? like urethra-cervicitis; Azithromycin single dose or ceftriaxone intramuscularly (single dose). Erythromycin for 7 days or cipro for 3 days are alternatives
Molluscum contagiosum etiology and symptoms? Poxvirus; Skin-colored, waxy, umbilicated small papules small papules that appear anywhere on the skin
Painful lesions: Herpes; soft chancre;
Painless lesions: Syphilis; LGV; ano-genital warts; granuloma inguinale; Molluscum contagiosum
Geimsa stain for chlamydia; granuloma inguinale (Donovan bodies); Molluscum contagiosum (large cells with inclusion bodies)
Complications of Chlamydia cervicitis and trichomoniasis: PROM and preterm labor, neonatal conjunctivitis
Complications of gonorrhea: PID, infertility, Reiter’s Sx (urethritis, conjunctivitis, arthritis, male, HLA-B27); ectopic pregnancy, perinatal infection(conjunctivitis and pneumonia)
PID inpatient Rx if … High risk: atypical, mass or abscess, moderate to severe illness, unable to tolerate oral AB, poor compliance, immunocompromised, pregnant, adolescent, secondary to instrumentation, surgical situation cannot be excluded
"PID inpatient Rx: Cefoxitin 2 g iv q6h + doxycycline 100 mg iv q12h, or Clindamycin 900 mg iv q8h + gentamicin 2 mg/kg IV loading dose then 1.5 mg/kg q8h
PID outpatient Rx choices Ofloxacin 400 mg PO bid x 14d (or levofloxacin 500 mg PO bid X 14d) ± metronidazole 500 mg PO bid X 14d (if suspect abscess)
Created by: Bijan39