Sti's I

Front 1

Chlamydia Trachomatis
biology and transmission

Back 1

obligate intracellular parasite
grows in columnar epithilium
most often sexually transmission

Front 2

Chlamydia Trachomatis
life span

Back 2

6-14 incubation
can live indefinitely

Front 3

Chlamydia Trachomatis
clinical manifestations females

Back 3

80% asymptomatic
dysuria
vaginal DC
nonspecific abdominal pain
dyspareunia
post-coital bleeding
cervicitis
uretrhitis
PID
Bartholin's cyst
Protocolitis

Front 4

Chlamydia Trachomatis
clinical manifestations males

Back 4

25% asymptomatic
scant clear or cloudy DC
dysuria
urethral pruritis
urethritis
Epidymitis
Protocolitis

Front 5

Chlamydia Trachomatis
complications

Back 5

PID
Salgingits/Endometritis
Infertility
Ectopic pregnancy
Fitz-Hugh-Curtis Syndrome (perihepatitis associated with PID)
protocolitis (rectal pain)
Reiter's syndrome (urethritis, arthritis, conjunctivitis)

Front 6

Chlamydia Trachomatis in pregnancy

Back 6

^risk of PROM and prematurity
^low birth weight
risk of pp endometritis
risk of infection in exposed infant (conjunctivitis or pneumonitis)

Front 7

Chlamydia Trachomatis
diagnositis testing

Back 7

Nucleic Acid Amplification testing
80-95% sensitivity >98% specificity
Tissue culture: >99% specifity, 50-85% sensitivity b/c inadequate specimin
gram stain for WBCs

Front 8

Chlamydia Trachomatis
treatment in NON PREGNANT WOMEN
first line

Back 8

Azithromycin 1gm POx1 or Doxycline 100mg PO BID x7days

Front 9

Chlamydia Trachomatis
treatment in PREGNANT WOMEN
first line

Back 9

Azithromycin 1gm POx1
Amoxicilin 500mg PO TIDx7days

Front 10

Chlamydia Trachomatis
Patient Education

Back 10

Acquisition, implications
safe sex,
no sexual intercourse for 7 days after both partners are treatment

Front 11

Chlamydia Trachomatis
follow up

Back 11

Test all sexual contacts within 60days or last partner if >60days
TOC not recommended except pregnant women (3-4 weeks)
TOC for pt's treated with erythromycin
ALL WOMEN need retesting in 3 months (b/c high reinfection rate)

Front 12

Gonorrhea "the Clap"
pathology

Back 12

Neisseria gonorrhea
gram negative intracellular diplococcus ("GNIC diplo")

Front 13

Gonorrhea
life cycle

Back 13

incubation 2-8 days
transmission by sexual contact
infection limited to mucosal surfaces-columnar epithilium
dervic, urethra, rectum pharynx, conjunctiva

Front 14

Gonorrhea
clinical manifestations
females

Back 14

cervicitis
urethritis
salpingitis/endmetriis
Bartholin's Gland cyst
Proctocolitis
Disseminated GC (associated with asymtomatic,infection of pharynx, urethra, or cervix)

Front 15

Gonorrhea in pregnancy

Back 15

controversial
may ^risk of PROM/prematurity
may ^risk of chorio
^of pp endometritis

Front 16

Gonorrhea diagnostic testing

Back 16

gram stain can be used for presumptive testing in males,
only for women if see intracellular diplo.
NAAT less sensitive in urine than cervical samples (women)

Front 17

Gonorrhea
treatment non-pregnant women and pregnant
first line

Back 17

ceftriazone 125 IMx1
cefixime,me 400mg POx1
cefpodoxime 400mg POx1
+presumptively treat for CT unless NAAT culture negative

Front 18

Gonorrhea
follow up

Back 18

treat all partners within 60days
no TOC of cure needed unless pregnant
re-test ALL WOMEN in 3 mo.

Front 19

Trichomonas

Back 19

pathogenic protozoan
flagellated parasite of GU tract

Front 20

Trichomonas
transmission and incubation

Back 20

usually sexually,
fomite transmission possible
incubation period 5-28days

Front 21

Trichomonas vaginalis
in Pregnancy

Back 21

^PROM+premature delivery
exposed infants may develop vaginal d/c

Front 22

Trichomonas vaginalis
clinical manifestations

Back 22

malodorous DC
yellow, whitish yello, green FROTHY
urethritis,dysuria, frequency, urethral DC
vaginitis
may be asymptomatic
Strawberry cervix

Front 23

Trichomonas vaginalis
Diagnosis

Back 23

motile trichomonads on NaCl wetmount
+PMNs
KOH may have amine odor
pH elevated >4.5
culture-Diamond's medium
DNA probes
ADD: GC/CT/HIV/RPR

Front 24

Trichomonas vaginalis
Treatment

Back 24

Metronidazole 2gm PO x1 (ok pregnancy)
or Tinidazole 2gm PO x1

Front 25

Trichomonas vaginalis
Patient education

Back 25

no Etoh 24hrs after metronidazole or 72hrs after tinidazole
avoid sex until both partners complete treatment

Front 26

Herpes Simplex Virus
transmission

Back 26

humans are sole reservoir
readily inactivated by room temp and drying
transmitted via mucosal contact
incubation 1-45days, 4 day average

Front 27

Primary Herpes
Clinical manifestations

Back 27

systemic involvement (fever, HA, malaise, myalgia)
tender inginal lymphadenopathy;
viarlsehding during primary episode lasts 11-14days

Front 28

Non-primary first episode herpes

Back 28

initial outbreak in person with antibodies to either HSV1 or HSV2
-only way to distinguish a non-primary first oubreak is by seologic testing

Front 29

Recurrent Herpes outbreak

Back 29

usually 4x/year, then decrease
average 5-10 days,
viral shedding average 4 days
TRIGGERS: stress, menses, illness, trauma, sunlight, sexual activity (friction)

Front 30

Asymptomatic Herpes

Back 30

viral shedding 2-27% of time
is usually labia, not cervical

Front 31

HSV diagnostic testing

Back 31

tissue culture gold standard,
best samplef from intact vesicle within 48 hrs after symptoms (up to 40% falsely negative)
Additional: RPR and HIV

Front 32

HSV treatment goal

Back 32

decrease symptoms,
shoren duration of outbreak,
suppress recurrent outbreak,decrease asymptomatic shedding
Acyclovir 400mg TID 7-10days

Front 33

HSV suppression

Back 33

safe up to 6 years
offer if >or=6 outbreaks per year,
benefitis usually evident after 3-6mo
Acycolvir 400mg BID
reduces outbreaks 70-80%