Term
| What are the risk factors for getting an STD? |
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Definition
- # of sex partners
- Unprotected sex - anal sex increases risk
- Prostitution
- Illicit drug use
- Adolescence |
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Term
| How can STDs pass from mother to child? |
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Definition
- Congenital - passes through the womb
- Perinatal - at birth due to infected cervix or vagina |
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Term
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Definition
| Herpes simplex virus can infect oral or genital - settles in nerves of the spine where it can live latently. Virus can shed at any time. |
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Term
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Definition
- Clinical presentation most commonly used
- Tissue culture most specific |
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Term
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Definition
- First episode: Acyclovir 400 TID or 200 5x/day for 7-10 days. Valtrex 1g BID
- Suppression - Acyclovir 400 BID or Valtrex 500-1g QD
- Recurrent - Higher doses for shorter duration
**Topicals rarely work, ALWAYS shed virus. |
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Term
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Definition
| Caused by Treponema pallidum, transmitted through lesions |
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Term
| What are the stages of syphilis? |
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Definition
- Primary - Chancres are painless lesions that erode and heal
- Secondary - Rash, flu-like symptoms, swollen lymph nodes
**period of latency often between secondary and tertiary
- Tertiary - in 30%. Dementia, blindness, aortic insufficiency, gumma lesions |
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Term
| How is syphilis diagnosed? |
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Definition
- VDRL or RPR card test
- Treponemal tests specific for syphilis - detects antibodies for life |
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Term
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Definition
- Primary/Secondary/early latent - Benzathine PCN G 2.4 million units IM x1 dose
- Tertiary or late latent - Benzathine PCN G 2.4 million units IM weekly x3 doses
- Neurosyphilis - AQ crystal PCN G 3-4 mill units IV q4h or 9-12 mill units IV q12h x10-14 days
**Use Bicillin LA/Benzathine, NOT procaine. Alternative is Doxycycline |
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Term
| What must be monitored for in syphilis tx? |
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Definition
- Jarisch-Herxheimer rxn - SIRS like, give supportive care. From bacteria shedding toxins as they die
- Infection of sexual partner |
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Term
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Definition
Caused by Neisseria gonorrhoeae - transmitted through sexual contact
**Urethral infection in males, endocervical in females. Dysuria, urgency, discharge.
**Disseminated gonorrhea is 3x more common in women than men |
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Term
| How is gonorrhea diagnosed? |
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Definition
- Gram stain - see diplococci within PMNs
- Culture has good sensitivity
- Rapid diagnostic tests - EIA, NAATs. Expensive, does not provide sensitivity |
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Term
| How is gonorrhea treated and monitored? |
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Definition
- Cervix/urethra/rectum - Ceftriaxone IM x1 dose + Azith 1g x1 dose. May sub Cefixime.
- Pharynx - Ceftriaxone 250 mg + Azith 1 g x1 dose.
**Only need test of cure if using an alternate. Evaluate sex partners at 60 days. |
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Term
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Definition
Chlamydia trachomatis - often seen with gonorrhea unless ruled out.
**Often asymptomatic, especially in females. See discharge |
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Term
| How is chlamydia diagnosed? |
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Definition
- Cell culture is the standard. Can take 7 days, not used for diagnostics
- Enzyme assay - rapid but poor sensitivity
- NAAT - highly sensitive and fast - for diagnosis! |
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Term
| How is chlamydia treated and monitored? |
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Definition
Azith 1g x1 or Doxy 100 BID x7
Do not have to do test of cure, test sexual partners at 60 days |
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Term
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Definition
- Types 6 and 11 cause warts, 16 and 18 cause cervical cancer
- Diagnosis - pap smear only detects active. |
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Term
| How is HPV prevented/treated? |
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Definition
- Cervarix (genital warts) or Gardasil (cervical cancer)
- HPV is not curable. |
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Term
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Definition
| Pelvic Inflammatory disease - in the female genital tract, causes endometriosis, ovarian abscess, and pelvic peritonitis. Caused by GONORRHEA AND CHLAMYDIA |
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Term
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Definition
- Clinically, through vaginal fluids
- Biopsy of endometrium
- MRI
**Leads to infertility if not treated, ectopic pregnancy |
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Term
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Definition
- IV: Cefotetan 2g q12h or Cefoxitan + Doxy 100 mg q12h
- Oral: Ceftriaxone IM x1, then Doxy 100 BID x14 +/- flagyl 500 BID
**Hospitalize if no improvement in 3 days. Make sure to clear gonorrhea/chlamydia infections |
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Term
| What are diseases characterized by vaginal discharge? |
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Definition
- Bacterial Vaginosis - polymicrobial
- Trichomonasis - cause by trichomonas vaginalis, a protozoan
- Vulvovaginal Candidiasis |
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Term
| What is bacterial vaginalis? |
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Definition
Caused by anaerobes - see a thin discharge, clue cells, high pH, and fishy odor. Detected by gram stain
**Tx: Metronidazole oral or gel, clindamycin cream. No follow up |
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Term
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Definition
Asymptomatic, but can see a yellow-green discharge. Microscopy of vaginal secretions
**TX: Metronidazole/Tindazole 2g x1 dose. High rate of reinfection, rescreen in 3 months and treat sex partner |
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Term
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Definition
A fungal infection that causes itchiness, soreness, and dysuria. Gram stain and culture
**Tx: One dose of fluconazole |
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