Term
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Definition
Caused by:
-Chancroid
-HSV 1 & 2
-Syphilis
Characteristics:
-Painful, open lesions or sores within the genitalia
-Often infected with more than one organism and often assoc with HIV |
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Term
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Definition
Presentation:
-Causative organism: Haemophilus ducreyi
-Associated with regional lymphadenopathy
-Definative diagnosis requires isolation of H. ducreyi on special culture media (doesn't grow on agar)
Dx of exclusion:
-One or more painful genital lesions
-No evidence of Treponema pallidum by dark field microscopy
-Genital lesions + regional lymphadenopathy
-HSV PCR is negative
Treatment:
-Azithromycin 1g po x 1 dose
-Cefriaxone 250mg IM x 1 dose
-Ciprofloxacin 500mg po BID x 3 days
Follow-up: HIV testing, treat sex. partners, follow up in 3-7 days after initiation of tx |
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Term
| Genital Herpes Simplex: Presentation |
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Definition
-Multiple painful, vesicular or ulcerative lesions
-Flu-like symptoms
-Local discomfort/pruritis/discharge
Recurrent infections:
-Prodrome, fewer lesions, shorter duration, decresaed time of viral shedding
SHED EVEN WITHOUT SYMPTOMS! |
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Term
| Genital Herpes Simplex: Dianosis |
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Definition
-Viral culture
-PCR assay for HSV DNA
-HSV serologic assay for HSV antibodies (IgG) |
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Term
| Genital Herpes Simplex: Treatment |
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Definition
*No treatment will eradicate infection
-AV's reduce s/sx during episodes, shorten duration, and prophylaxis
First clinical outbreak
Episodic Treatment: initiate w/in 1 day of lesion onset. Pt uses on their own when episode occurs
Suppressive therapy: Reduced frequency of episodes and decreases rate of transmission |
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Term
| Syphilis: General info & Stages |
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Definition
Caused by: Treponema pallidum
Stages:
-Primary: ulcerative or chancre lesion
-Secondary: Non associated with genitalia, rash, mucocutaeous lesion, lymphadenopathy
-Latent: no symptoms (dx via routine lab test). Early, within 1 year of infection. Late, >1 year after infection
-Tertiary: manifestations in other organs (eyes, CNS, auditory changes) |
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Term
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Definition
DOC: Penicillin G (for all stages)
Primary, Secondary, & Early-latent: Benzathine penicillin G 2.4 million units IM x 1 dose
Late-latent & Tertiary: Benzathine penicillin G 2.4 million units IM once weekly for 3 weeks
Neurosyphilis: Aqueous crystalline penicillin G 18-24 million units per day, administered as 3-4 million units IV q4h x 10-14 days
True PCN allergy: Doxycycline 100mg po BID x 28 days (Cannot be used for neurosyphilis, must desensitize pt) |
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Term
| Jarisch-Herxheimer Reactions |
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Definition
Occurs with initial tx of syphilis: begins w/in 2-4 hours of initiation of tx, peaks at 8 hours and completes w/in 12-24 hours
Presentation: Acute febrile illness, with h/a & myalgia, aggravation of syphilitic lesions
NOT a PCN allergy/reaction
TX: antipyretics, analgesics, rest |
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Term
| Chlamydia: general info & presentation |
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Definition
Causative organism: Chlamydia trachomatis
Annual screening for all sexually active women <25 yrs (also for gonorrhea). Serious complications associated (PID, ectopic pregnancy, infertility)
-Usually no s/sx |
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Term
| Gonorrhea: general info & presentation |
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Definition
Causative organism: Neisseria gonorrhoeae
-Screening yearly <25 y/o
-Commonly no s/sx |
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Term
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Definition
-Inflammation of the urethra due to both infectious and non-infectious causes
Symptoms: mucopurulent or purulent discharge, dysuria, pruritis
-Gram stain (Gm (-) diplococci) and secretions with >5 WBC's
-Positive LE test with >10 WBC
-Caused by Neisseria gonorrhoeae and Chlamydia trachomatis |
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Term
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Definition
Signs: Visible purulent or mucopurulent exudate and/or sustained endocervical bleeding that can be induced by passage of a swab over the cervix
-Usually asymptomatic in women: maybe abnormal intermenstural bleeding or discharge. Sign of endometriosis or PID
Dx: Nucleic acid amplification tests for etiologic agents
Organisms: Neisseria gonorrhoeae and Chlamydia trachomatis |
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Term
| Urethritis and cervicitis: treatment |
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Definition
Non-gonococcal:
-Azithromycin 1gm po x 1 dose
-Doxycycline 100mg po BID x 7 days
Uncomplicated gonorrhea:
-Ceftriaxone 125mg IM x 1 dose
-Cefixime 400mg po x 1 dose
-Treat for chlamydia if not ruled out (golden rule to treat chlamydia)
Fluoroquinolones no longer recommended due to resistance issues with gonorrhea |
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Term
| Bacterial Vaginitis: presentation |
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Definition
Causative organisms: Gardnerella vaginalis, Mycoplasma hominis, Prevotella spp.
Risk factors: sex, douching, lack of lactobacillus
-Vaginal discharge (may be odorous)
-Itching or irritation
-Homogenous, thin, WHITE discharge coats the vaginal walls
-Presence of clue cells on microscopy
-pH >4.5 vaginal fluid |
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Term
| Bacterial vaginitis: Treatment |
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Definition
-Metronidazole gel 0.75% one applicatorful intravaginally daily x 5 days
-Clindamycin:
--2% cream, one applicatorful infravaginally HS x 5 days
--Suppository ovule 100mg intravaginally HS x 3 days
--systemic capsules 300mg po BID x 7 days |
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Term
| Trichomoniasis: , treatment, & general info |
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Definition
Causative organism: Trichomonas vaginalis
Clinical presentation: malodorous yellow-green vaginal discharge, urethral discharge in males, dysuria, dyspareunia, inflammation or the vulva, vagina, and/or cervix
Dx: microscopy, trichomonas rapid test, neucleic acid probe test
Tx:
-Metronidazole 2g PO x 1 dose OR 500mg po BID x 7 days
-Tindazole 2g po x 1 dose
(NO ALCOHOL for 24-72 hours after & during either of these) |
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Term
| Vulvovaginal candidiasis (VVC): Presentation & General information |
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Definition
Causative organism(s): Candida albicans, can be caused by other non-albicans Candida (ex. C. glabrata)
Presentation: thick, white (cottage cheese-like) vaginal discharge, pruritis, erythema, dysuria
-Peak incidence 30-40 years old
-Risk factors: sexually active women, spermicide, IUD, and sponge contraceptives, and antibiotic use |
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Term
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Definition
| Adding KOH to a wet prep or perfoming a Gram stain and looking for pseudohyphae or yeast |
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Term
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Definition
Uncomplicated: Topical or systemic therapy for 1-14 days
Complicated (uncontrolled DM, immunocompromised, pregnant, non-albicans VVC) Use extended duration of 10-14 days.
Recurrent infections (>4 episodes in 12 months): induction therapy x 14 days + maintenance tx for 6 months
OTC topicals: Clotrimazole cream or vaginal tablet, butconazole cream, miconazole cream or vaginal suppository or ovule, ticonazole cream
Prescription topicals: Nystatin vaginal tablet, ticonazole cream
Prescription orals: fluconazole, ketoconazole |
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Term
| Pelvic inflammatory disease (PID): General info & presentation |
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Definition
A variety of inflammatory disorders of the upper female genital tract (endometriosis, salpingitis, tubo-ovarian abscess)
Causative organisms: gonorrhea & chlamydia
Presentation (varies, difficult to diagnose): lower abdominal or pelvic pain plus one or more of the following- cervical motion tenderness, uterine tenderness, adnexal tenderness.
-Also: fever, discharge, WBC's in the discharge, increased ESR or CRP, organism identified |
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Term
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Definition
Regimen A:
-Cefotetan 2g IV q 12hrs OR Cefoxitin 2 g IV q6hrs
-PLUS Doxycycline 100mg po/IV q12h
Regimen B:
-Clindamycin 900mg IV q8h
-PLUS Gentamycin 2mg/kg IV or IM x 1 dose then 1.5mg/kg q 8hrs
Treat x 14 days. Convert to oral therapy rapidly. Oral may be initiated in pts with mild PID |
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Term
| Epididymitis: Presentation, general info, and treatment |
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Definition
Causative organisms: gonorrhea and chlamydia
Presentation: unilateral pain, swelling and inflammation of the epididymis. Acute <6 weeks, chronic >6 weeks
Treatment:
-Ceftriaxone 250mg IM x 1 dose
-PLUS Doxycycline 100mg po BID x 10 days
-OR levofloxacin 500mg po q 24 hours x 10 days (if rule out gonorrhea & organism is gm (-)) |
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Term
| HPV: Presentation & general information |
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Definition
Most common viral STD, >100 types of HPV
Presentation: may be asymptomatic, genital warts (type 6 or 11), cervical dysplasia or cancer
Dx: Cervical screening via Pap Smear to detect abnormal cervical cells. Yearly testing until 30 y/o then q 2-3 years |
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Term
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Definition
-Flat papular growth on the genital mucosa.
-Can infect the external genitalia as well as cervix, vagina, urethra, and anus
-Goal of therapy: Remove warts, treatment will reduce recurrence, but not eliminate infection |
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Term
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Definition
Guardasil
-Active against HPV types 6,11, 16, and 18
-Doesn't affect current infections
-Series of 3 injections @ 0, 2, and 6 months
-Recommended in children 11-12 yoa
-Prevention of genital warts in males
-Most effective if given prior to sexual contact |
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