Review of STD's
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| Major presenting symptom: Vaginal discharge in: | Candidiasis, Bacterial vaginosis, Trichomoniasis + 30% no infection
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| Major presenting symptom: Urthritis/Cervicitis by: | Chlamydia (Serotypes D-K); Gonorrhea; always together; them most common STI in North America
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| Major presenting symptom: genital lesions in: | LGV; Herpes; Warts; Syphilis; Granuloma inguinale; Soft chancre; Molluscum Contagiosum
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| STI epidemiology? | HSV 70-80; 1° syphilis 5% (on the rise); chancroid <1%
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| Candidiasis symptoms? | itching, irritation, dyspareunia, white discharge with pseudohyphae in KOH preparation
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| 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
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| 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,
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| Bacterial vaginosis treatment? | Metronidazole (500 mg po bid X7d); in pregnancy: clindamycin (300 mg po bid) or amoxicillin
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| Trichomoniasis symptoms? | Copious grayish white discharge, itching strawberry cervix, saline preparation shows motile trichomonas
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| 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)
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| Chlamydia symptoms? | 70% asymptomatic; The most common STD in Canada; servars: D to K; may have vaginal discharge (foul smelling)
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| 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
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| Gonorrhea Symptoms? | May have vaginal discharge (foul smelling)
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| 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
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| LGV symptoms? | Painless ulcers (heals quickly) + lymphadenitis (unilateral); chlamydia trachomatis (L1-L3)
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| LGV treatment? | Doxycycline or erythromycin
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| Herpes etiology? | herpesvirus hominis type 2 (genital, 90%) and 1 (oral)
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| 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
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| 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)
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| Ano-genital warts other names and etiology? | Condylomata acuminata; HPV;
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| Ano-genital warts symptoms? | cauliflower appearance
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| 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
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| Syphilis etiology? | Treponema Pallidum
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| 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)
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| Secondary Syphilis symptoms and duration? | in 1-6 months; Systemic infection symptoms + macules &papules, Symmetric on flexor sides, condylomata lata (extremely infectious), mucosal patches
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| Latent Syphilis symptoms and duration? | Asymptomatic (positive serology) early and late (> 1 year)
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| 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)
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| 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
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| Granuloma inguinale etiology? | Calymmatobacterium, donovania
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| Granuloma inguinale symptoms? | painless, malodorous lesions
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| Granuloma inguinale treatment? | doxycycline and ceftriaxone or SMX/TMP
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| Soft chancre (chandroid) etiology and symptoms? | haemophilus ducreyi; painful multiple ulcers
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| 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
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| Molluscum contagiosum etiology and symptoms? | Poxvirus; Skin-colored, waxy, umbilicated small papules small papules that appear anywhere on the skin
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| Painful lesions: | Herpes; soft chancre;
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| Painless lesions: | Syphilis; LGV; ano-genital warts; granuloma inguinale; Molluscum contagiosum
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| Geimsa stain for | chlamydia; granuloma inguinale (Donovan bodies); Molluscum contagiosum (large cells with inclusion bodies)
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| Complications of Chlamydia cervicitis and trichomoniasis: | PROM and preterm labor, neonatal conjunctivitis
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| Complications of gonorrhea: | PID, infertility, Reiter’s Sx (urethritis, conjunctivitis, arthritis, male, HLA-B27); ectopic pregnancy, perinatal infection(conjunctivitis and pneumonia)
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| 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
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| "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
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| 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)
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Bijan39
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