Module 5: STIs
Herpes Simplex Virus - HSV diagnosis
-Numerous painful lesions Sx: -Headache -Fever -Muscle aches -Swollen lymph nodes -Difficulty with urination HSV-2: causes most genital infections HSV-1: causes oral infections and genital infections Testing: IgG, swab of lesion
trichomonas vaginalis diagnosis
-Trichomonads on wet mount; -"strawberry cervix" - vaginal pH >4.5 -frothy discharge (yellow-green) -malodorous (fishy smell) discharge -vulvar pruritis -dysuria
Herpes Simplex (HSV) Treatment
Acyclovir 400 mg TID for 7-10 days or Acyclovir 200 mg 5x/day for 7-10 days or Valacyclovir 1g BID 7-10 days or Famciclovir 250 mg TID 7-10 days
Cervicitis treatment
Azithromycin Doxycycline
chlamydia treatment
Azithromycin 1 g PO (single dose) or Doxycycline 100 mg PO BID for 7 days
syphilis treatment
Benzathine penicillin 2.4 million units IM
pelvic inflammatory disease (PID) treatment
Ceftriaxone (250 mg IM) + Doxycycline (100 mg PO 14 days)
gonorrhea treatment
Ceftriaxone 250 mg IM single dose + Azithromycin 1g PO single dose
Chlamydia (CT) diagnosis
Chlamydia trachomatis Typically asymptomatic (7-21 day incubation) Later sx: -dysuria -pain with sex -lower abdominal pain -vaginal discharge (yellow, white) -bleeding between periods
syphilis diagnosis
Diagnosis: Treponema pallidum Primary: painless sore (chancre) located on genitals, lips, anus, area of contact Lasts 1-5 weeks, heals without tx Secondary: skin rashes 2-6 weeks on palms of hands, bottoms of feet, fever, swollen lymph nodes, headache, hair loss, muscle ache Testing: Rapid Plasma Reagin (RPR) Retest in 6 weeks, 3 months, 6 months
Bacterial Vaginosis (BV) diagnosis
Malodorous (fishy) smell Discharge: homogenous, white, gray, smoothly coats vagina Positive KOH Whiff test Wet mount: Clue cells, few WBCs
Bacterial Vaginosis (BV)Treatment
Metronidazole (Flagyl) 500 mg PO BID for 7 days
Trichomonas vaginalis treatment
Metronidazole 2g PO (single dose) or Tinidazole 2g PO (single dose) or Metronidazole 500 mg PO BID for 7 days
Amsel Criteria for BV
Must have at LEAST 3 of the following: -pH >4.5 -Presence of >20% per HPF of clue cells on wet prep -Positive amine or whiff test -Homogeneous, non viscous milky white discharge adherent to vaginal walls
clue cells
Seen in bacterial vaginosis
gonorrhea (GC) diagnosis
Sx (women): -abnormal vaginal discharge -intermenstural bleeding -dysuria -lower abdominal pain -dyspareunia -Mucopurulent or purulent cervical discharge -easily induced cervical bleeding testing: urinalysis or swab of cervix
Cervicitis diagnosis:
Sx: vaginal discharge, pruritis, pain with discourse, abnormal bleeding Can be caused by STD - chlamydia and gonorrhea most common Testing: pap, test for gonrrhea/chlamydia
Molluscum contagiosum treatment
Virus causes small pink benign wartlike tumors and is associated with HIV-positive patients physical removal oral therapy - cimetidine topical therapy - podophyllotoxin cream
Colposcopy
a procedure to look more closely at cervix to see if there are precancerous cells
Cryotherapy
a treatment to freeze and remove precancerous cells from the cervix
1. A "positive" whiff test or amine test is suggestive of: a. Bacterial Vaginosis b. Atrophic Vaginitis c. Candidiasis d. Lichen Sclerosis
a. Bacterial Vaginosis
3. What is the recommended treatment for uncomplicated gonorrhea infections? a. Ceftriaxone 250 mg IM single dose PLUS azithromycin 1g orally single dose b. Azithromycin 1 gram orally single dose c. Ceftriaxone 250 mg IM single dose PLUS Doxycycline 100 mg orally in single dose d. Cefixime 400 mg orally in single dose
a. Ceftriaxone 250 mg IM single dose PLUS azithromycin 1g orally single dose
4. A sexually active 18 year old presents with post coital spotting, dysuria and a yellow discharge. On exam you find her cervix is erythematous and bleeds with contact. The most likely diagnosis is: a. Chlamydia b. Cervical cancer c. Primary syphilis d. Tampon injury
a. Chlamydia
5. Upon examination, you see the following discharge when doing a speculum exam. What is your diagnosis of the cause of this discharge? (looks like cottage cheese) a. Bacterial Vaginosis b. Candidiasis c. Chlamydia d. Herpes
b. Candidiasis
2. A 28 year old female presents with the complaint of vaginal itching. She complains of a bad smell, especially after intercourse. Pelvic examination reveals a pattern of petechiae on the surface of the cervix along with frothy discharge. What would you suspect is her primary diagnosis? a. Gonorrhea b. Bacterial Vaginosis c. Trichomoniasis d. Candida
c. Trichomoniasis
Condyloma (genital warts) diagnosis
caused by HPV (types 6 & 11 most common) -skin-colored or whitish bumps on genitals testing: visual inspection, HPV test/swab?
HPV diagnosis
genital warts by inspection, may be asymptomatic -> routine pap tests and typing by PCR or NA hybridization assay.
pelvic inflammatory disease (PID)
inflammation and infection of organs in the pelvic region; salpingitis, oophoritis, endometritis, endocervicitis
LEEP
loop electrosurgical excision procedure
HPV treatment
no cure, infection usually goes away on its own Colposcopy: a procedure to look more closely at cervix to see if there are precancerous cells Cryotherapy: a treatment to freeze and remove precancerous cells from the cervix LEEP: or Loop Electrosurgical Excision Procedure, a treatment to remove precancerous cells from the cervix with an electrical current There are vaccines that can prevent high-risk HPV types and types that cause genital warts
condyloma (genital warts) treatment
physical removal of warts: -chemicals -cryotherapy -LEEP -creams
chlamydia testing
urinalysis and/or swab
