STD's

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1.

-Very painful, longer than recurrences *3-4 weeks "Floxy foxy doxy" 1. Outpatient (Ofloxacin + Doxycyclin) 2. Inpatient (Cefoxitin/Cefotetan + Doxycyclin) >6 outbreaks per year

Primary HSV infection Treatment for PID

12.

2.

Bacterial Vaginosis -Clue cell = bacteria-packed epithelial cell

3.

Normally treat with Valacycolvir -start within one day of prodrome When to consider prophylactic tx? Treatment for Chlamydia Diagnosis and Treatment for Gonorrhea

Positive whiff test (KOH)--fishy smell -Clue cells

13.

Bacterial Vaginosis -Gardnerella vaginalis Candidiasis Chancroid (H. ducreyi) Chandelier Sign Chlamydia

Basic pH -thin, gray discharge -not true STD, but problem with overgrowth of normal flora Acidic pH (<4.0) -thick white "cottage cheese" discharge Similar to HSV ulcers, but more redness and large local lymph nodes -Heal in 7 days Extreme tenderness on palpation seen in PID Very prevalent in Omaha -sterile pyuria -big risk for ascending infection and PID Risk for neonates if mom has Chlamydia and delivers vaginally Where does latent HSV hang out?

14.

4.

1. Azithromycin (1gm) 2. Doxycyclin (very cheap, good drug 2x for 7 days) 1. Culture, Gm stain 2. Treat IM Ceftriaxone *if GC, always treat for Chlamydia at same time (Azithro or Doxy) -inverse not true 1. CV (aortic dissection) 2. Gummas 1. Herpes (valacycolvir) 2. Chancroid (H. ducreyi, Azithro or Ceftriaxone) 1. PID (chandelier)--Chlamydia and GC, but POLYMICROBIAL! 2. Bacterial Vaginosis (Gardnerella, basic pH, whiff test and Clue cells) 3. Yeast (Candida, cottage cheese, acid pH) 4. Trichomonas (motile protozoan, smelly with green discharge, Frothy strawberry cervix) 5. Painful Lesions (HSV, Chancroid (Azithro or Ceftri) 6. Painless Lesions (Syphilis PenG, Donovanosis Doxy, and Lymphogranuloma Venereum Doxy) 1. Primary Syphilis (Pen G) 2. Lymphogranuloma venereum (chronic Chlamydia, Doxy) 3. Granuloma Inguinale (Donovanosis) 1. TCA (acid) 2. Freeze (liquid nitrogen) 3. Laser 7-14 days prior to outbreak (before prodrome)

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6.

Tertiary Syphilis
18.

7.

Painful lesions
19.

Conjunctivitis, blindness Dorsal Ganglia (sacral or trigeminal) Doxycyclin Fitz-HughCurtis syndrome Frothy discharge -basic pH

8.

Review
20.

Treatment for Donovanosis -hint Cheap drug also used for Chlamydia Adhesions seen as result of PID in abdominal cavity -fiddle strings

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9.

Painless lesions Characteristic for Trichomoniasis Treatments for Molluscum contagiosum Contagious period for HSV

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23.

Gonorrhea -intracellular Gmdiplococci

35.

Trichomoniasis

Usually asymptomatic in females, not in males -age 15-29

36. 24.

Granuloma Inguinale (Calymmatobacterium, Gm-) Lymphogranuloma Venereum *L1, L2, L3 Metronidazole (good for anaerobes) Molluscum Contagiosum Mucocutaneous lesions or Condyloma Lata Oral-HSV 1 Genital-HSV 2 Penicillin G Polymicrobial (but Chlamydia and GC top two single causes) Primary Syphilis *Treponema pallidum (spirochete) TRHA-TP Trichomoniasis

Donovan bodies -painless papular lesion ("beefy red ulcer") -pseudobuboes Chronic Chlamydia lymph infection -"groove sign" edema in inguinal canal -Serotypes: Treatment for Bacterial Vaginosis Benign pox virus (DNA) -multiple umbilicated papule -yellowish plug Secondary Syphilis

VDRL

Non-specific titer for Syphilis -false positive can be seen with Lupus

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29.

Usual strains of HSV and locations -but lots of crossover, not distinguished Absolute best treatment for Syphilis By far the most common cause of PID

30. 31.

32.

Long incubation period 10-90 days -painless, firm ulcer (chancre) -seen on Dark Field More specific test for syphilis Motile, flagellated on wet mount -protozoan -thick, yellow-green discharge

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