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