STDS

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islandgirljane
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206063
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STDS
Updated:
2013-03-10 13:21:19
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STDs
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STD flash cards
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  1. What is the recommended treatment of Chlamydia?
    • Azithromycin  once OR
    • Doxycycline  BID for 7 days
  2. What is the alternative treatment : Chlamydia?
    • Ofloxacin  BID x 7 days
    • levofloxacin  once daily x 7 days
    • erythromycin QID x 7 days
    • erythromycin ethylsuccinate QID x 7days
  3. Recommended chlamydia tx in pregnancy
    • Azithromycin 1g once 
    • amoxicillin TID x 7 days
  4. alternative chlamydia tx in pregnancy
    • Erythromycin base QID x 7 days
    • erythromycin ethylsuccinate  QID x 7days
  5. What is the clinical presentation for chlamydia in men/women?
    • men: incubation 35 days, 50% asymptomatic, little to profuse mucoid to purulent discharge
    • women: incubation 7-35 days, 60% aysmptomatic, little to profuse mocoid to purulent discharge, uterine bleeding
  6. What are the complications of chlamydia?
    Epididymitis Reiter syndrome, also in women PID
  7. Chlamydia follow up for pregnant women, when?
    3 weeks after completion of therapy
  8. Sexual partner mgt. w/chlamydia
    • treat if sexual contact was during 60 days preceding onset of sx/diagnosis
    • abstinence for 7 days after single dose or after 7 treatment completed
  9. Which STDs cross the placenta ?
    • Chlamydia
    • Gonorrhea
    • syphilis after 12 wks gestation
  10. Most common cause of nongonococcal urethritis?
    Chlamydia
  11. Chlamydia and gonorrhea infects?
    • cervix
    • upper genital tract in women
    • urethra
    • rectum
    • conjuctiva
  12. What is the age group reporting most infections with STDs?
    • 15-24yrs
    • soo sad!!
  13. What is the most commonly reported infectious disease? What is the 2nd most commonly reported STD?
    • Chlamydia
    • N. gonorrhea
  14. 60% of gonorrhea infections is accompanied by?
    chlamydia
  15. Symptom onset for Chlamydia?
    for gonorrhea?
    • chlamydia 7-21 days male and female
    • gonorrhea: male 2-8 days, female 10 days
  16. What is gonorrhea incubation period?
    Men and women 1-14 days
  17. What are the symptoms of gonorrhea infection in men/women?
    • usually asymptomatic but both may experience dysuria and urinary frequency, rectal pain, pharyngitis
    • cervical: usually asymptomatic to mild
  18. What are the signs of infection for gonorrhea?
    • men: purulent rectal, urethral discharge
    • women: purulent rectal, urethral discharge,  uterine bleeding
  19. What are the diagnostic test for chlamydia?
    • patient history exam
    • edocervical or urethral cell scraping
    • NAAT (nuceic acid amplification test)
    • EIA (ezyme immunoassay)
    • DNA hybridization probe
    • DFA (direct fluorescent monoclonal antibody)
  20. Diagnostic test for gonorrhea
    • gram stain smears (low sensitivity in asymptomatic men
    • culture
    • nucleic acid hybridization test
    • NAAT
  21. Recommended Treatment for gonorrhea all routes of infxn, ie throat etc
    • ceftriaxone IM once + azithromycin once OR
    • doxycycline BID x 7 days 
    • azithromycin or doxycycline is added if chlamydia hasn't been ruled out
  22. Alternate regimen for gonorrhea
    • cefixime once + azithromycin once OR doxycycline BID x 7 days
    • azithromycin 2g once or ceftriaxone
  23. Gonorrhea treatment in pregnancy
    same as regular treatment except substitute amoxicillin TID x 7 days instead of doxycycline b/c we don't use tertracyclines or FQs in pregnancy
  24. What is the follow up treatment for Gonorrhea?
    same as chlamydia. no test for cure unless patient still has symptoms
  25. Transmission of Syphillis, how?
    • contact w/infected mucous membrane or lesions
    • mother to fetus after 12 weeks gestation
  26. Clinical presentation of primary syphilis
    appearance of a single sore or multiple sores
  27. Clinical presentation of 2ndary syphilis 
    • skin rash and mucous membrane lesions
    • develops in 2-8 wks
    • pruritic or nonpruritic rash, mucocutaneous lesions, flu-like symptoms, lymphadenopathy
    • disappear in 4-10 wks
    • lesions can recur anytime w/in 4 years
  28. Clinical presentation of latent syphilis
    • Asymptomatic -noninfectious stage
    • positive serologic test
    • 2 phases: early latency up to 1 yr after exposure (can still transmit); late latency > 1yr after exposure
    • ~25-30% progress to tertiary syphilis
  29. Clinical presentation/manifestations of tertiary syphilis
    • gummatous lesions
    • aortic insufficiency
    • neurosyphilis-meningitis, general paresis, dementia
  30. What is the most common site of infection in tertiary syphilis and when does it develop?
    • site of infxn: CNS, heart, eyes, bones, and joints
    • ~develops in 30% of untreated or inadequately treated its 10-30 years after initial infxn
  31. How is syphilis diagnosis by screening test, describe
    • Screening test (non-treponemal test):
    • Venereal disease research laboratory (VDRL) and rapid plasma reagin (RPR) -detect abs, high titer level correlates w/degree of the disease
  32. Confirmatory syphilis test (treponema test), what is it?
    • Fluorescent treponemal antibody absorption (FTA-ABS)
    • measures specific IgG abs
  33. Recommended:
    Primary -early latent treatment
    Late latent - tertiary treatment, unknown
    • Primary: Benzathine pcn G 2.4 million units IM once
    • Late: Benzathine pcn G 2.4 million units IM once weekly x 3
  34. Alternate:
    Primary - early latent treatment
    Late latent - unknown treatment
    • Primary: doxycycline BID x 14 days; Tetracycline QID x 14 days; ceftriaxone IM/IV once daily  x 10-14 days; azithromycin 2g once
    • Late latent: doxcycline BID x 28 days; tetracycline QID x 28 days
  35. Pregnancy syphilis tx
    Benzathine PCN G once then again 1 week later, depends on the provider
  36. SE of PCN treatment in pregnant patient being treated for syphilis
    Jarisch-Herxheimer -acute fever in 1st 24hrs, may induce labor or fetal distress

    **allergic pts should be desensitized**
  37. Syphilis follow up schedule:
    primary:
    late:
    sexual partners:
    • primary: non-treponemal test 6 & 12 months
    • late: non-treponemal test 6,12, & 24 months
    • sexual partners: contact if sex in previous 3 months; >3 months consider serologic test
  38. BV risk factors:
    • multiple sex partners
    • new sex partners
    • douching
    • lack of vaginal lactobacilli
  39. BV results from replacement of lactobacillus sp. by?
    • gardenella vaginalis
    • mycomplasma hominis
  40. BV is most prevalent cause of                 and         and is common among women of             .
    vaginal discharge and malodor, childbearing age
  41. BV clinical presentation S/Sx:
    • Thin white discharge
    • fishy odor
    • vulvar itching and irritation
  42. BV diagnosis by gram stain or clinical criteria, what are the clinical criteria?
    • Need at least :
    • Thin white discharge
    • fishy odor (positive whiff test)
    • presence of clue cells on microscopic exam
    • pH of vaginal fluid >4.5
  43. Which BV patients require treatment?
    All symptomatic patients
  44. A follow visit is necessary after patients are treated for BV? and sex partners must be treated?
    False and false only treat if symptoms are unresolved...duh men can't get BV they don't have a vagina
  45. BV treatment: 
    Recommended non-preggers:
    • metronidazole BID x 7 days
    • metronidazole vaginal gel once daily x 5 days
    • clindamycin cream QHS x 7 days
  46. BV non-preggers alternate treatment:
    • Clindamycin BID x 7 days
    • Clindamycin vaginal ovules QHS x 3 days
    • Tinidazole PO daily x 3 days
    • Tinidazole PO daily x 5 days
  47. BV preggers treatment:
    • metronidazole 25O mg TID or 500mg BID x 7 days
    • Clindamycin BID x 7 days
  48. Protozoal STD, trichomononas vaginalis only affects women
    False, men and women
  49. Trasmission method for trichomonas
    • sexual contact
    • direct exposure with contaminated surfaces (i.e. wet towels and toilet seats) SCARY!! don't sit hover like a UFO
    • mother to newborn during birth
  50. Incubation period for trichomoniasis:
    men:
    women:
    same for both, 3 - 28 days
  51. Trichomoniasis most common site of infection for:
    men?
    women?
    • men: urethra
    • women: endocervical canal
  52. Trichomoniasis s/sx:
    men?
    women?
    • men: usually asymptomatic or discharge
    • women: malodorous yellow green/foamy vaginal discharge, dysuria, dsypareunia, vulvar irritation and pruritus, "strawberry spots" (erosion of cervix 90% of women) 
    • Everything is harder on a woman that's why we are the stronger sex!!!
  53. Trichomoniasis diagnosis:
    • elevated vaginal ph >5
    • strawberry spots 
    • culture to confirm positive wet mount
    • EIA or DNA probe technique
  54. Trichomoniasis recommended treatment:
    men/women?
    pregnant?
    treatment failure?
    • men/women: metronidazole 1 dose or tinidazole 1 dose
    • pregnant: metronidazole 1 dose
    • treatment failure: metronidazole BID x 7 days
  55. Patients treated for trichomoniasis must follow-up with provider
    False
  56. Trichomoniasis mgt of sexual partners:
    • Treat partners
    • avoid sex until cured/ therapy completed
  57. Herpes is the most common cause of          and affects       ? Age grp? Women < men T/F?
    • genital ulceration
    • 1 in 6 americans
    • 14-49 years old
    • false, women affected more than men, 1 out of 5 women and 1 out 9 men
  58. What are the 5 lovely stages of Herpes?
    • primary mucocutaneous infection
    • infection of ganglia
    • establishment of latency
    • reactivation
    • recurrent infection
  59. What is the incubation period for genital herpes primary infection?
    2-14 days
  60. Primary HSV clinical presentation
    • painful small vesicular lesions on external genitalia
    • itching, dysuria, vaginal discharge, tender inguinal adenopathy
    • flu-like symptoms
  61. How long is viral shedding for HSV?
    11-12 days
  62. Recurrent infections for HSV1 are more severe than HSV2 T/F? How long is viral shedding for recurrent infection?
    • False
    • ~ 4 days
  63. HSV diagnosis
    • virologic test:
    • culture
    • PCR assay
    • specific serologic test
  64. Treatment for HSV for 1st episode with:
    Acyclovir
    famciclovir
    valacyclovir
    • Acyclovir TID 7- 10 days also has a 200 mg 5 x day dose
    • Famciclovir TID 7-10 days
    • Valcyclovir BID 7-10 days
  65. HSV recurrent episode treatment
    Acyclovir
    Famciclovir
    Valcyclovir
    see chart pg 11
  66. Daily suppressive treatment HSV
    • Acyclovir: BID
    • Famciclovir: BID
    • Valcyclovir: 500 mg QD (1g less effective if >10 episodes a year)
  67. What is the HSV rate of transmission to neonates? Pregnant women can be treated with which medication?
    • 30-50%
    • Acyclovir -limited prenatal exposure
  68. What is the HPV condylomata acuminata epidemiology (sounds fancy)
    • HPV 6 & 11 most common causes genital warts
    • associated with cancers of cervix, and oropharyngeal cancer in men
  69. HPV risk factors
    • multiple sex partners
    • < 25 years of age
    • sex at 16 or younger
    • having a slut or ex-slut for a partner
    • un-snipped man
  70. Clinical presentation for HPV
    • asymptomatic
    • genital warts, look like cauliflower or flat
    • painful /pruritic
    • may appear within weeks or months after sexual intercourse
  71. HPV health complications
    • cervical cancer in > 20 years after infection
    • vulvar malignancy
    • penile malignancy
  72. HPV diagnosis
    • pap smear
    • PCR detects HPV-DNA
  73. HPV Provider applied treatment
    • Cryotherapy
    • Podophyllin resin 10 - 25%
    • Trichoroacetic or bichloroacetic acid 80-90%
    • Surgical removal (for large area)
  74. HPV Patient applied treatment
    • Podofilox 0.5% sol or gel, wait 4 days in b/t 3 day treatment cycles
    • -BID x 3 days, can repeat for 4 cycles
    • Imiquimod 5% cream-leave on 6hrs
    • -3 times weekly for 6 weeks
    • Sinecatechins 15% ointment
    • -apply 0.5 cm strand to each wart TID (NTE 16wks)
  75. Vaginal spermicides can 
    Vaginal sponge protects against
    Diaphragm protects against cervical
    • spermicide: induce lesions, increase risk of infections
    • sponge: gonorrhea and chlamydia but increases risk of candidiasis
    • diaphragm: gonorrhea, chlamydia, & trich, increase risk of UTI
  76. Incubation period?
    Chlamydia
    Gonorrhea
    syphilis
    Trichomoniasis
    HSV
    • Chlamydia: men 35 days, women 7-35
    • Gonorrhea: men/women 1-14 days
    • syphilis: primary 10-90 days avg 21 days
    • Trichomoniasis: men/women 3-28 days
    • HSV: 2-14
  77. Onset of symptoms:
    Chlamydia
    Gonorrhea
    syphilis
    HSV
    • chlamydia: men/women 7-21 days
    • gonorrhea: men 2-8 days, women 10 days
    • syphilis: secondary 2-8 wks may take 4-10 wks to resolve
    • HSV: 2-14, viral shedding 11-12 days, for recurrent infxn viral shed is ~ 4 days

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