11/28 STD Clinical Correlation – Flashcards
Unlock all answers in this set
Unlock answersquestion
| Name the STDs characterized by discharges. |
answer
| gonorrhea, chlamydia, nongonococcal urethritis, mucopurulent cervicitis, trichomonas vaginitis/urethritis, candidiasis |
question
| Name the STDs characterized by sores. |
answer
| syphilis, genital herpes uncommon in US= lymphogranuloma venereum, chancroid (Haemophilus ducreyi), granuloma inguinale |
question
| How do you treat a gonorrhea? |
answer
| cefixime 400 mg orally X 1 dose OR ceftriazone 125 mg IM x 1 dose PLUS Azithromycin 1 gram orally x 1 dose (for possible chlamydia coinfection) |
question
| What is the incubation period of gonorrhea in a male? |
answer
| 1-14 days (usually 2-5 days) |
question
| What are the symptoms of gonorrhea in a man? |
answer
| dysuria and urethral discharge (5% asymptomatic) |
question
| How do you diagnose gonorrhea? |
answer
| gram stain of urethral or cervical smear, NAAT |
question
| What are complications of gonorrhea? |
answer
| men= acute epididymitis, disseminated GC women= PID, disseminated GC |
question
| Where does gonorrhea infect females? |
answer
| endocervical canal is the primary site but 70-90% also colonize urethra |
question
| What is the incubation of gonorrhea in women? |
answer
| unclear, sx usually in 10 days |
question
| What are the symptoms of gonorrhea infection in women? |
answer
| majority asymptomatic; may have vaginal discharge, dysuria, labial pain/swelling, abdomenal pain |
question
| What causes nongonococcal urethritis? |
answer
| 20-40% chlamydia 15-25% mycoplasma genitalium 10-20% ureaplasma urealyticum 5-15% trichomonas vaginalis 1-4% adenovirus 1-2% herpes symplex virus |
question
| What are the symptoms of nongonococcal urethritis? |
answer
| mild dysuria and mucoid discharge |
question
| How do you diagnose nongonococcal urethritis? |
answer
| urethral smear= more than or equal to 5 PMNs (usually 15), or OI field urine microscopic= more than or equal to 10 PMNs Leukocyte esterase (+) |
question
| What are the symptoms of mucopurulent cervicitis? |
answer
| pelvic pain, vaginal d/c, dysparunia, post-coital bleeding |
question
| How do you diagnose cervicitis clinically? |
answer
| purulent or mucopurulent endocervical exudate visible in the endocervical canal OR yellow or green d/c visible on endocervical swab specimen OR easily induced cervical bleeding |
question
| What is empiric treatment for chlamydia? |
answer
| azithromycin 1 gram single dose OR doxycycline 100 mg twice daily for 7 days |
question
| What is the empiric treatment for GC? |
answer
| ceftriaxone 125 mg IM single dose OR cefixime 400 mg single dose |
question
| What are organisms other than chlamydia and gonorrhea associated with mucopurulent cervicitis? |
answer
| TV, BV, HSV, MG |
question
| What percent of C. trachomatis infections are asymptomatic? |
answer
| women= 80-90% men= 70-80% |
question
| What percent of N. gonorrhoeae infections in men and women are asymptomatic? |
answer
| 50-70% of women 20-30% of men |
question
| What percent of women with GC develop PID? |
answer
| 10-20 |
question
| What are the CDC minimal criteria for PID? |
answer
| uterine fundal tenderness, adnexal tenderness, or cervical motion tenderness |
question
| What are the symptoms of PID? |
answer
| endocervical d/c, fever, lower abdominal pain |
question
| What are the complications of PID? |
answer
| infertility (15-24% with 1 episode PID secondary to GC or chlamydia), 7x risk of ectopic pregnancy with 1 episode PID, chronic pelvic pain in 18% |
question
| What causes acute PID? |
answer
| 20-40% = N. gonorrhoeae 20% = C. trachomatis 40-60% = mixed aerobes and anaerobes including mycoplasma hominis + N. gonorrhoeae |
question
| Recomended outpatient treatment guidelines for PID= |
answer
| ceftriaxone 250 mg IM once OR other parenteral 2rd generation cephalosporin (ceftizoxime, cefotaxime) PLUS doxycycline 100 mg orally 2 times a day for 14 days, metronidazole is optional |
question
| What are you looking for on smear of pt with gonorrhea? |
answer
| gram negative intracellular diplococci (GNID) |
question
| What has replaced gram stain in clinic? |
answer
| one step methylene blue stain |
question
| What has the highest sensitivity and specificity for chlamydia endocervical specimens? |
answer
| amplification |
question
| T/F A negative culture, antigen detection, and gen-probe for chlamydia means the pt doesn't have chlamydia. |
answer
| false, those test have high specificity but relatively low sensitivity for chlamydia |
question
| What causes cervicitis? |
answer
| chlamydia, gonorrhea, genital herpes |
question
| What causes vaginitis? |
answer
| candidiasis, trichomoniasis, bacterial vaginosis |
question
| What are the microbial shifts that occur in bacterial vaginosis? |
answer
| decrease in lactobacillus 100-1000 increase in G. vaginalis, anaerobes, mycoplasmas |
question
| What physiologic changes are associated with bacterial vaginosis? |
answer
| elevation of vaginal pH above 4.5, production of high concentrations of amines, and thin homongenous skim-milk like discharge |
question
| What are possible complications of BV? |
answer
| abnormal pregnancy outcome, increased risk of post-hysterectomy wound infection, PID, endometritis following elective abortion, increased risk of HIV and other STD transmission |
question
| How do you diagnose bacterial vaginosis clinically? |
answer
| Amsel's critera= 3 out of 4 1) vaginal pH >4.5 2) positive "whiff" test 3) more than 20% of epithelial cells are clue cell 4) characteristic vaginal d/c (homogenous skim milk-like) |
question
| How do you treat bacterial vaginosis? |
answer
| metronidazole orally, clindamycin cream, metronidazole gel |
question
| How do you treat yeast vaginitis? |
answer
| topical antifungals, gluconazole single oral dose |
question
| How do you treat trichomoniasis? |
answer
| metronidozole single dose or tinidazole single dose |
question
| What causes painful genital ulcers? |
answer
| chancroid and genital herpes simplex |
question
| What causes painless genital ulcer diseases? |
answer
| syphilis, lymphogranuloma venereum, granuloma inguinale |
question
| How do you treat syphilis? |
answer
| benzathine penicillin 2.4 million units IM X 1 dose |
question
| What is the incubation period of primary syphilis? |
answer
| 10-90 days (average 3 weeks) |
question
| Describe the syphilitic chancre. |
answer
| early macule/papule erodes into clean based, painless, indurated ulcer with smooth firm borders. Unnoticed in 15-30% of patients. Resolves in 1-5 weeks and highly infectious |
question
| What stage of syphilis represents hematogenous dissemination of spirochetes? |
answer
| secondary |
question
| How long after the chancre does secondary syphilis appear? |
answer
| 2-8 weeks |
question
| What are the symptoms and duration of symptoms in secondary syphilis? |
answer
| rash-whole body (includes palms and soles), mucous patches, condylomata lata (highly infectious), constitutional symptoms, resolves in 2-10 weeks |
question
| T/F Primary infectious with genital HSV is commonly asymptomatic. |
answer
| true |
question
| Chancroid versus syphilitic chancre. |
answer
| syphilis= induration, painless, clean base chancroid= undetermined lesion border, painful lesion, purulent exudate |
question
| Classic characteristics of genital herpes to differentiate it from other ulcerative STDs. |
answer
| multiple ulcers, shallow lesions, painful lesions |
question
| How sensitive/specific are "classic" signs for the diagnosis of genital ulcer disease? |
answer
| low sensitivity but high specificity |
question
| What is characteristic physical exam finding of lymphogranuloma venereum? |
answer
| groove sign |
question
| Name the syphilis serologic assays. |
answer
| Reagin tests (VDRL, RPR, ART) treponemal tests (FTA-ABS, MHA-TP) |
question
| When is serologic testing for untreated syphilis most sensitive? |
answer
| secondary stage for both reagin and treponemal tests (treponemal test is also very sensitive during late syphilis) |
question
| How do you treat chancroid? |
answer
| azithromycin, ceftriaxone |
question
| How do you treat genital herpes? |
answer
| acyclovir, valcyclovir, famciclovir |
