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STD's
Review of STD's
| Question | Description |
|---|---|
| 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
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