Term
| why are STDs called STIs now? |
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Definition
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Term
| what are the 3 concerns that will bring a pt to a dr w/concern about an STI? |
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Definition
| discharge, lesion on genitalia, and hx of (possible) exposure |
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Term
| what is the WHO definition for sexual health? |
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Definition
| a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity |
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Term
| what is the presentation of trichomoniasis? |
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Definition
| foul smelling, grayish, frothy vaginal discharge, strawberry cervix (punctuate hemorrhages), and dyspareunia (pain w/intercourse) |
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Term
| what is in the ddx for trichomoniasis? |
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Definition
| candida, bacterial vaginosis |
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Term
| how can trichomoniasis be diagnosed w/a microscope? |
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Definition
| *motile trichomonad on a saline wet mount (collected from a woman presenting w/vaginal discharge). must be from a fresh specimen. |
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Term
| why does the CDC recommend treating male pts for trichomoniasis if it is asymptomatic in males? |
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Definition
| b/c trichomoniasis can be transmitted to other females by infected males, even though they are asymptomatic |
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Term
| how is trichomoniasis treated? |
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Definition
| metronidazole. remember disulfiram reaction w/alcohol, so pt needs to refrain from that and sex during therapy. |
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Term
| how does candidiasis present? |
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Definition
| cottage cheese-like discharge, vulvar/vaginal pruritus, and dyspareunia |
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Term
| how can candida be diagnosed via microscopy? |
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Definition
| visible pseudohyphae on a wet mount |
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Term
| what needs to be considered w/recurrent candidiasis? |
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Definition
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Term
| how is candidiasis treated? |
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Definition
| clotrimazole, miconazole, or oral fluconazole |
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Term
| how does bacterial vaginosis present? |
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Definition
| homogeneous, milky vaginal discharge |
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Term
| what is bacterial vaginosis? how would it appear w/microscopy? |
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Definition
| a disturbance in normal flora, where protective lactobacilli (gram negative rods) are decreased and other flora: gardnerella vaginalis, mobiluncus, mycoplasma hominis, prevotella bacteroides, atopobium vaginae, anaerobes are increased. this is an imbalance in bacterial population, not an infection. under a microscope, the *clue cell* is squamous epithelium w/heavily stippled granular appearance (gram neg cocci) with raggedy borders due to the above microorganisms (and a lack of gram neg rods). |
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Term
| how is bacterial vaginosis treated? |
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Definition
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Term
| what are the 4 criteria for a positive bacterial vaginosis test? |
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Definition
| alkaline vaginal pH (>4.5), more discharge than normal, presence of clue cells, and a positive whiff test |
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Term
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Definition
| trichomoniasis and bacterial vaginosis cause the vaginal pH to become more alkaline, which can be confirmed by adding KOH to a preparation. if the preparation is alkaline, KOH will liberate amines = fishy odor = positive whiff test |
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Term
| what disease does chlamydia trachomatis cause? how does it present? |
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Definition
| nongonococcal urethritis. pts will present with serous/muco-purulent discharge, highly inflamed cervix in females, lack of pain, and a gram stain showing *no organisms but many PMNs |
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Term
| who does the CDC recommend screening for chlamydia in? |
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Definition
| all females under 25, and females over 25 who have unprotected sex/have more than one sexual partner. |
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Term
| what is the triad for reactive (reiter's syndrome) arthritis? |
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Definition
| non-gonococcal urethritis (mostly chlamydia or some enterobacteriaceae), conjunctivitis, arthritis. can't pee, can't see, can't climb a tree. reactive arthritis is associated with *circinate balanitis on the penis, *keratoderma blennorrhagicum (scaly rash) on the feet, and dactylitis (inflamed fingers). |
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Term
| what is lymhgranuloma venereum? |
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Definition
| an infection due to chlamydia trachomatis which presents as tender femoral/inguina lymphadenopathy - mostly unilateral (*groove sign). |
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Term
| how does infection w/neisseria gonorrhea present? |
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Definition
| mucopurulent vaginal/urethral discharge, dysuria, urinary frequency, vaginal/rectal bleeding, anal pain, pruritus, and tenesmus |
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Term
| how is a neisseria gonorrhea infection diagnosed? how does this dx change in males vs females? |
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Definition
| gram stain showing gram negative diplococci (selective media such as thayer-martin, martin-lewis, or NYC should be used). in men, this is pretty much a definitive dx, in women, this is presumptive (b/c of other neisseria which are part of normal flora) - but *need to f/u w/a cx (for DNA ID). |
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Term
| what are other presentations of neisseria gonorrhea are possible if it becomes a systemic infection? what are risk factors for gonorrhea becoming systemic? |
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Definition
| arthralgias, purulent arthritis, asymmetric polyarthritis, dermatitis, and tenosynovitis. risk factors for dissemination: asymptomatic infection, menstruation, IUD, pelvic sx, pregnancy, and complement deficiency. |
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Term
| what is tx for a neisseria gonorrhea infection? |
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Definition
| uncomplicated neisseria gonorrhea infection: 125 mg ceftriaxone IM (becoming resistant to quinolones) |
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Term
| what disease is a risk for females if chlamydia or gonorrhea infections go untreated? what signs are associated with this? |
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Definition
| pelvic inflammatory disease (PID) which is associated with the fitz-hugh curtis/chandelier sign = *RUQ pain due to perihepatic adhesions. PID can lead to tubal infertility, ectopic pregnancy, and chronic pelvic pain. |
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Term
| what are the painful genital ulcers? |
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Definition
| chancroid or genital herpes |
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Term
| what are the painless genital ulcers? |
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Definition
| syphilis, lymphogranuloma venereum, and granuloma inguinale |
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Term
| how does genital herpes present? |
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Definition
| when symptomatic: painful vesicular lesions (sometimes grouped together on erythematous base), fever, and dysuria. there is also an association with erythema multiforme |
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Term
| does HSV-2 facilitate HIV? |
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Definition
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Term
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Definition
| positive tzanck smear (non-specific - positive for HSV 1,2 and VZV) or cx for PCR |
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Term
| what is the most prevalent STI? |
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Definition
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Term
| what is herpetic whitlow? |
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Definition
| lesions on fingers due to contact w/HSV-2 |
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Term
| what is herpes treated with? when is optimal treatment? |
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Definition
| acyclovir, valacyclovir, famciclovir - which are best administered during the prodrome phase (malaise/fever/tingling/burning) and eruption can then be controlled. tx is then recommended up to 48 hrs after the eruption occurs. |
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Term
| should IgM be used to test for HSV? |
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Definition
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Term
| what is the DOC for syphilis? |
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Definition
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Term
| what is the organism responsible for syphilis? |
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Definition
| treponema pallidum, a spirochete - doesn't show up on gram stain |
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Term
| what characterizes chancres associated with syphilis? |
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Definition
| they are painless and self-resolve |
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Term
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Definition
| moist plaques containing spirochetes - due to secondary syphilis. these do not itch and may appear all over the pt's body, including their palms |
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Term
| how can treponema pallidum be visualized? |
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Definition
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Term
| what is argyll robertson pupil? |
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Definition
| a sign of neurosyphilis, pts can accommodate, but not react to light. |
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Term
| which subtype of HPV causes the most cervical CA? |
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Definition
| 16 (SCC), followed by 18 (adenocarcinoma) |
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Term
| what are the warts due to HPV 6 and 11 called? |
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Definition
| condyloma acuminata (painless, benign) |
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Term
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Definition
| recurrent respiratory papillomatosis - breathing obstruction due to laryngeal HPV |
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Term
| what is molluscum contagiosum? |
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Definition
| a pox virus which can cause umbilicated lesions and may be sexually transmitted |
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Term
| what is the number 1 cause of genital ulcer disease in africa? |
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Definition
| chancroid, due to haemophilus ducreyi (school of fish), a gram negative coccobacillus. infection is very painful and presents as ragged undermined edges, gray/yellow necrotic exudate, friable base, and painful lymphadenitis. associated signs: railroad track, watering can, and kissing lesions. tx: asithromycin |
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Term
| what is lymphogranuloma inguinale? |
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Definition
| infection of klebsiella granulomatis (gram neg), associated with donovan bodies (bipolar safety pin bodies in cytoplasm of macrophages) |
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