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ObGyn Lecture > Lecture 9- STDs > Flashcards

Lecture 9- STDs Flashcards

1
Q

What STDs can you use expedited partner therapy for?

A

gonorrhea

chlamydia

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2
Q

What are the 2 immunizations to consider w/ STDs

A

Gardasil

Hep B

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3
Q

Who should be screened annually for STDs?

A

Sexually active women under 25 (book) 26 in CDC

older women with multiple sexual partners or a new partner

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4
Q

What is the most frequently reported infectious disease in the US?

A

Chlamydia trachomatis

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5
Q

What STD usually has less symptoms- chlamydia or gonorrhea?

A

gonorrhea

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6
Q

Is gonorrhea a reportable disease?

A

Yes, reportable disease in all states and sexual partners of infected individuals must be tested and treated

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7
Q

What are some screening diagnostics for discharge?

A

culture
microscopy
NAATs
EIA (immuno-assay)

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8
Q

What is NAATs?

A

nuclear acid amplification testing (can be rapid screens)

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9
Q

Name the condition: Recently on antibiotics, itchy white, curdy discharge, see hyphae and buds on microscope. Will have normal pH.

A

Candidasis albicans

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10
Q

What do you use to treat candidiasis albicans first line?

A

OTC intravaginal butoconazole (Femstat)
(any that end in “ole”)
use at bed time 3-5 nights

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11
Q

Name the condition: discharge, odor that is worse after intercourse. Thin homogenous, white, adherent discharge w/ fishy odor, positive whiff test. pH >4.5. On microscope there is clue cells

A

Bacterial vaginosis

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12
Q

How do you treat bacterial vaginosis?

A

Metronidazole (flagyl) 500 mg po BIDx 7

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13
Q

What are some precautions to take with metronidazole (flagyl) (treatment for BV, t. vaginalis) ?

A

Take with food
May have mild headache
No alcohol while taking it
May have a metallic taste

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14
Q

Name the condition: discharge, foul odor, dysuria, dyspareunia, vulvar itching and burning. Yellow-green discharge, frothy, “strawberry cervix” Will see protozoan on microscope.

A

Trich (T. vaginalis)

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15
Q

How do you treat t. vaginalis?

A

Metronidazole (flagyl) 2 grams po single dose

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16
Q

What is the progression with chlamydia trachomatis?

A

PID, ectopic, infertility

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17
Q

What does the cervix with chlamydia look like?

A

mucoprurulent cervicitis, friable cervix (bleed when touched)

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18
Q

What diagnostics do you do for chlamydia?

A

culture or liquid based cytology

urine based test (NAAT)

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19
Q

How do you treat chlamydia?

A

Azithromycin 1 gm po single dose

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20
Q

do partners needs to be treated with chlamydia?

A

yes

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21
Q

When do you do a test of cure with chlamydia?

A

Pregnant

Re-infection suspected

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22
Q

When should you do a test of cure?

A

Give at least 4 weeks after treatment

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23
Q

How far back do you have to treat partners of people who had chlamydia?

A

60 days

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24
Q

What is the sequelae with gonorrheae?

A

PID, ectopic, infertility

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25
Q

How do you treat gonorrhoeae?

A

Ceftriaxone (Rocephine) 250 mg IM single dose plus azithromycin (zithromax) 1 g PO (covers co-existant chlamydia)

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26
Q

Where can gonorrhoeae present?

A

Cervix
Rectum
Pharynx
Eye

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27
Q

What can cause PID?

A

N. gonorrhea, C. trachomatis, vaginal anaerobes

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28
Q

What is necessary for a diagnosis of PID?

A 
Uterine, cervical or adnexal tenderness plus at least one of the following:
T >101 F
Mucopurulent discharge
WBCs in vaginal fluid
elevated sed rate
elevated c-reactive protein
documented GC or chlamydia
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29
Q

How do you treat PID in the non vomiting, non spetic or pregnant, non surgical abdomen.

A

Ceftriaxone 250 mg IM plus azithromycin 1 g Po single dose or doxycycline 100 mg BID x 7 days

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30
Q

For inpatient treatment of PID (those who fail to response w/in 24-72 hours outpatient Rx, TOA, can’t do outpatient Rx) how do you treat it?

A

IV cephalosporin plus doxycycline

31
Q

What is caused by the pox virus. Presents as umbilicated papules.

A

Molluscum

32
Q

how do you treat molluscum?

A

Cryotherapy
Laser
Topicals

33
Q

What is caused by human itch mite, rash ad burrows in belt area, intertriginous spaces.

A

scabies

34
Q

How do you treat scabies?

A

Permethrin 5% (adult, egg)

Bedding, clothing and towels use hot water and hot dry cycle

35
Q

How do you treat pubic lice?

A

Permethrin 5% (adult, egg) bedding, clothing, and towels use hot water dry cycle

36
Q

What is the most common STD in the US?

A

HPV

37
Q

What are the high risk types of HPV?

A

16, 18

38
Q

How does HPV appear on a PE?

A

visible condyloma (flat, smooth, pedunculated): genitalia, anus, mouth

39
Q

How do you treat visible condyloma?

A

Liquid nitrogen/ cryotherapy
Patient applied imiquimod (Aldara) 5% cream
Sinecatechins 15% ointment (Veregen)
Podofilox

40
Q

What is used for prevention of HPV?

A

Gardasil (quadrivalent)

Cervarix (bilvalent)

41
Q

Where does HSV 1 occur?

A

Oral cold sores, fewer recurrences

42
Q

where does HSV 2 occur?

A

Genital area, recurrent but less severe

43
Q

With the first episode of HSV 2 what can happen?

A

Constitutional episode
pelvic adenopathy
lesions

44
Q

What is a prodrome?

A

Presents with HSV, feel tingling, symptoms on a outbreak coming on

45
Q

What are diagnostics for herpes?

A

Culture and PCR

type specific: HSV G1 and G2 (glycoprotein)

46
Q

What can you use to treat the 1st episode of herpes?

A

Ancyclovir (Zovirax) 400 mg TID 2-10 days

47
Q

To suppressive herpes what do you give?

A

Suppressive: Acyclovir 400 mg BID

48
Q

For an episode of herpes what can you give?

A

Acyclovir 400 mg TID x 5 days

49
Q

For discordant couples for herpes what do you give to treat?

A

Valacyclovir 500 mg qd (only to partner that is symptomatic)

50
Q

What organism causes syphilis?

A

Treponema pallidum (spirochete organism)

51
Q

What is the average time it takes for clinical signs for syphilis to occur?

A

3 weeks

52
Q

What is the sign of the primary stage of syphilis?

A

Chancre (10-60 days post infection)

painless, punched out ulcer gone in 3-6 weeks, regional adenopathy.

53
Q

When does secondary syphilis occur?

A

4-8 weeks after chancre, resolves spontaneously

54
Q

What are some symptoms of secondary syphillis?

A

Rash will also include palms and soles
fever, HA, malaise, sore throat
Rah is contagious

55
Q

What happens in the latent phase of syphilis?

A

No clinical S and S

56
Q

What happens in tertiary syphilis?

A

Have gumma= nodular, granulomatous lesions

can be external or internal

57
Q

What do you use to diagnose syphilis?

A

RPR (rapid plasma reagin) & FTA-ABS (fluorescent treponemal antibody absorption)
If FTA is positive then def syphilis
VDRL & HA-TP
Serum/CSF/ Tissue : dark field (microscopy)

58
Q

How do you treat syphilis?

A

Benzathine PCN G (Bicillin LA) 2.4 mu IM
Single dose for primary, secondary and early latent
Weekly X 3 weeks for late latent or unknown

59
Q

How often do you monitor people with syphilis?

A

Monitor 6, 12, 24 months

60
Q

What is considered treatment failure w/ syphilis?

A

Failure to decrease titer by 2 dilutions

61
Q

How do you know if someone has been re-infected w/ syphilis?

A

4 fold increase in titer

62
Q

What is the Jarisch - Herxheimer rxn?

A

HA, fever w/in 24 hours of injection

Due to die off of spirochete in blood

63
Q

What are 2 other conditions to consider in the ddx for syphilis?

A 
Lymphogranuloma venerum (LGV)
Donovanosis
64
Q

What condition has a break down of the lymph notes (bubos)?

A

Lymphogranuloma venerum (LGV)

65
Q

How do you treat lymphogranuloma venerum and donovanosis?

A

doxycycline 100 mg BID x 21 days

66
Q

What is a disorder often found in Australia, India, Africa with Painless, slow growing ulcerative lesions w/out LAD

A

Donovanosis

67
Q

What presents with painful genital ulcer w/ tender, suppurative inguinal LAD. Prevelant in Africa, Caribbean?

A

Chancroid

68
Q

How do you treat chancroid?

A

Azithromycin single 1 g dose

69
Q

What are symptoms of HIV?

A

Fever, pharyngitis, lymphadenopathy (inguinal, axillary) rash, arthralgias, myalgias, HA

70
Q

What are diagnostics for HIV/ AIDS?

A

Rapid screening confirmed with Western Blot

71
Q

If the WB blot is positive what other information do you want to get?

A

Viral lode, CD4 count, CBC< CMP, other STDs, hep, TB, CXR

72
Q

What is quantitative? RPR (rapid plasma reagin) or FTA-ABS (fluorescent treponemal antibody absorption)

A

RPR

73
Q

What is the name for lesions associated with genital warts caused by HPV?

A

Condyloma acuminata

74
Q

What is the name for white lesions associated w/ secondary syphillis?

A

Condylomata lata

ObGyn Lecture (21 decks)

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