CM/PHARM - STI & Vaginitis
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Which of the following is the most common causative agent of vulvovaginal candidiasis?

  • Candida tropicalis
  • Candida albicans (correct)
  • Candida krusei
  • Candida glabrata

    • Which of the following is NOT a risk factor for developing vulvovaginal candidiasis?

  • Diabetes
  • Recent antibiotic use
  • Immunocompromise
  • Hyperthyroidism (correct)

    • What is the typical presentation of a patient with vulvovaginal candidiasis?

  • Fever and chills
  • Pruritis and a thick, curd-like vaginal discharge (correct)
  • Abdominal pain and nausea
  • Dysuria and hematuria

    • Which of the following diagnostic methods is NOT mentioned in the text for vulvovaginal candidiasis?

    <p>Vaginal culture</p> Signup and view all the answers

    What is the recommended treatment for uncomplicated vulvovaginal candidiasis?

    <p>Single dose of fluconazole or 1-3 days of topical vaginal azole medication</p> Signup and view all the answers

    How should vulvovaginal candidiasis be treated in an immunocompromised patient?

    <p>7-14 days of topical azole or Fluconazole 150 mg every 72 hours taking 2-3 doses</p> Signup and view all the answers

    What is the recommended treatment for vulvovaginal candidiasis in a pregnant patient?

    <p>7 days of topical miconazole or clotrimazole</p> Signup and view all the answers

    What is the recommended treatment for recurrent vulvovaginal candidiasis?

    <p>Fluconazole 150 mg every 72 hours for 3 doses, then continued with one dose per week for 6 months</p> Signup and view all the answers

    What is the most common causative agent of Bacterial Vaginosis?

    <p>Gardnerella vaginalis</p> Signup and view all the answers

    Which of the following is a risk factor for developing Bacterial Vaginosis?

    <p>Smoking</p> Signup and view all the answers

    How is Bacterial Vaginosis diagnosed according to Amsel's Criteria?

    <p>Positive whiff/amine test</p> Signup and view all the answers

    What symptom is commonly seen in patients with Bacterial Vaginosis?

    <p>Fishy odor in the vaginal discharge</p> Signup and view all the answers

    Which treatment is recommended for all symptomatic patients with Bacterial Vaginosis?

    <p>Metronidazole or clindamycin cream</p> Signup and view all the answers

    Do male partners of women with Bacterial Vaginosis require treatment?

    <p>No, male partners do not need treatment</p> Signup and view all the answers

    Asymptomatic patients with Bacterial Vaginosis do not need treatment

    <p>True</p> Signup and view all the answers

    Trichomoniasis commonly presents with Bacterial Vaginosis.

    <p>True</p> Signup and view all the answers

    The gold standard for diagnosis of Trichomoniasis is a wet mount that shows motile, flagellated organisms.

    <p>False</p> Signup and view all the answers

    What is a key cervical finding in a patient with Trichomoniasis?

    <p>Punctate hemorrhages on vaginal and cervix</p> Signup and view all the answers

    What is the gold standard for diagnosis of Trichomoniasis?

    <p>Nucleic Acid Amplification Test using a Genprobe</p> Signup and view all the answers

    What is the initial test for Trichomoniasis?

    <p>Wet mount</p> Signup and view all the answers

    What is the recommended treatment for women with Trichomoniasis?

    <p>Metronidazole 500 mg twice a day for 7 days</p> Signup and view all the answers

    What is the recommended treatment for men with Trichomoniasis?

    <p>Metronidazole 2 g single dose</p> Signup and view all the answers

    What is a common symptom of chlamydia in women?

    <p>Cervicitis</p> Signup and view all the answers

    Which statement about chlamydia is false?

    <p>It can cause pelvic inflammatory disease in men</p> Signup and view all the answers

    What is the first line treatment for chlamydia in non-pregnant patients?

    <p>Doxycycline for 14 days</p> Signup and view all the answers

    What diagnostic method is considered the gold standard for chlamydia?

    <p>NATT Genprobe</p> Signup and view all the answers

    Which group should return for a test of cure 3 months post-treatment for chlamydia?

    <p>All patients, regardless of symptoms</p> Signup and view all the answers

    What is a possible consequence of untreated chlamydia in women?

    <p>Infertility</p> Signup and view all the answers

    In addition to genital infections, where else can chlamydia cause infections?

    <p>Rectal</p> Signup and view all the answers

    What is a common symptom of chlamydia in men?

    <p>'Burning' urination</p> Signup and view all the answers

    Which antibiotic can pregnant women with chlamydia safely take for treatment?

    <p>Azithromycin</p> Signup and view all the answers

    What is the purpose of a 'test of cure' after chlamydia treatment?

    <p>To confirm the infection has been cleared</p> Signup and view all the answers

    Patients on doxycycline are advised to avoid sunlight due to:

    <p>Sun sensitive reaction</p> Signup and view all the answers

    What is the recommended first-line treatment for Gonorrhea?

    <p>Ceftriaxone</p> Signup and view all the answers

    What is the diagnostic gold standard for Gonorrhea?

    <p>NAAT genprobe</p> Signup and view all the answers

    What is the common co-infection found with Gonorrhea?

    <p>Chlamydia</p> Signup and view all the answers

    What is the potential consequence of untreated Gonorrhea in women?

    <p>Pelvic Inflammatory Disease (PID)</p> Signup and view all the answers

    How often is routine screening recommended for Gonorrhea in patients 25 years of age and younger?

    <p>Annually</p> Signup and view all the answers

    What is the causative agent of Gonorrhea?

    <p>Neisseria Gonorrhea</p> Signup and view all the answers

    What is the recommended duration of abstinence from sex post-treatment for Gonorrhea?

    <p>2 weeks</p> Signup and view all the answers

    What is the hallmark symptom of Pelvic Inflammatory Disease (PID)?

    <p>Cervical motion tenderness (chandelier sign)</p> Signup and view all the answers

    Which of the following is NOT part of the outpatient treatment for PID?

    <p>Azithromycin 1 gram orally for one dose</p> Signup and view all the answers

    What is the most common age range for PID?

    <p>15 to 25 years</p> Signup and view all the answers

    Which of the following is a medical emergency that needs to be ruled out in a patient with suspected PID?

    <p>All of the above</p> Signup and view all the answers

    What is the recommended follow-up time frame for a patient with PID who is not sent to the emergency room?

    <p>48 hours</p> Signup and view all the answers

    What is the most common cause of PID?

    <p>Both Gonorrhea and Chlamydia</p> Signup and view all the answers

    Which of the following is NOT part of the inpatient treatment for PID?

    <p>Azithromycin 1 gram orally for one dose</p> Signup and view all the answers

    Which of the following is NOT a symptom of acute PID?

    <p>Headache</p> Signup and view all the answers

    How can a medical provider make a presumptive clinical diagnosis of PID?

    <p>Using history and physical exam findings alone</p> Signup and view all the answers

    What complication of PID is characterized by perihepatitis and right upper quadrant pain with "violin string" adhesions?

    <p>Fitz-Hugh-Curtis Syndrome</p> Signup and view all the answers

    A patient with suspected PID who has high fevers greater than 102.2F along with nausea and vomiting should be sent to the:

    <p>Emergency room</p> Signup and view all the answers

    Which of the following is a complication of untreated Pelvic Inflammatory Disease (PID)?

    <p>Increased risk of ectopic pregnancies</p> Signup and view all the answers

    A pregnant patient with suspected Pelvic Inflammatory Disease (PID) should be:

    <p>Sent to the emergency room</p> Signup and view all the answers

    PID is an _______ acute infection of the upper genital tract

    <p>ascending</p> Signup and view all the answers

    Which pathogen is most commonly responsible of cases of Non-Gonococcal Urethritis with no clear etiology?

    <p>Chlamydia or M. genitalium</p> Signup and view all the answers

    Which of the following antibiotics is recommended for the treatment of non-gonococcal urethritis?

    <p>Doxycycline</p> Signup and view all the answers

    What is the key diagnostic finding in herpes simplex virus on a Tzanck smear?

    <p>Multi nucleated giant cells</p> Signup and view all the answers

    What is the preferred mode of delivery for a pregnant woman with an active herpes simplex virus infection to prevent transmission to the infant?

    <p>Scheduled C-section</p> Signup and view all the answers

    How long should primary outbreaks of herpes simplex virus be treated with antivirals?

    <p>7 to 10 days</p> Signup and view all the answers

    Which virus can remain latent in the nerve root ganglion and be reactivated by changes in the immune system?

    <p>Herpes simplex virus</p> Signup and view all the answers

    What is considered the first episode of symptoms in a patient (such as genital warts, HSV-2) that is already diagnosed with herpes simplex virus infection (HSV-1)?

    <p>'Non-primary 1st episode'</p> Signup and view all the answers

    Which of the following is a common symptom that precedes an outbreak of painful vesicles in herpes simplex virus infections?

    <p>'Prodrome' of burning, tingling, and itching</p> Signup and view all the answers

    What term is used to describe a patient with a new strain of herpes simplex virus but already has antibodies to the other strain?

    <p>'Non-primary 1st episode'</p> Signup and view all the answers

    'SEM' is a complication seen in neonates exposed to which viral infection during delivery?

    <p>'SEM' can result from exposure to herpes simplex virus</p> Signup and view all the answers

    'Disseminated disease' is a potential consequence seen in neonates exposed to which viral infection?

    <p>'Disseminated disease' can result from neonatal exposure to herpes simplex virus</p> Signup and view all the answers

    What is the recommended duration of antiviral treatment for a recurrent outbreak of HSV?

    <p>1 to 5 days</p> Signup and view all the answers

    Which of the following antivirals is NOT mentioned in the text for the treatment of HSV?

    <p>Ganciclovir</p> Signup and view all the answers

    When is prophylaxis with antivirals recommended for pregnant patients with recurrent HSV infection?

    <p>At 36 weeks gestation</p> Signup and view all the answers

    How long do most outbreaks of HSV typically resolve spontaneously?

    <p>10-19 days</p> Signup and view all the answers

    What is the primary reason for starting antiviral prophylaxis in pregnant patients with recurrent HSV infection?

    <p>To prevent transmission to the infant</p> Signup and view all the answers

    What is the primary reason for vaccinating patients against HPV?

    <p>To prevent genital warts and cervical cancer</p> Signup and view all the answers

    How long does it typically take for most patients to clear an HPV infection?

    <p>2 years</p> Signup and view all the answers

    What is the appearance of visible anogenital warts caused by HPV?

    <p>Soft, flesh-colored, cauliflower-like lesions</p> Signup and view all the answers

    Which of the following statements about HPV testing is true?

    <p>There is no test to confirm that warts are due to HPV</p> Signup and view all the answers

    How is the HPV vaccine Gardasil 9 administered?

    <p>A 2-dose series, 6 months apart, if started between ages 9 to 14</p> Signup and view all the answers

    How soon after coming in contact with a syphilis lesion does it take to create a painless chancre?

    <p>10-90 days</p> Signup and view all the answers

    What is the first test ordered if a provider suspects syphilis?

    <p>Non-treponemal test</p> Signup and view all the answers

    How does secondary syphilis typically present?

    <p>With a maculopapular eruption involving the trunk and extremities</p> Signup and view all the answers

    What is the recommendation for the treatment of syphilis?

    <p>Penicillin (IM injection)</p> Signup and view all the answers

    What is the characteristic of a chancre in syphilis?

    <p>1-2 cm with raised indurated margins</p> Signup and view all the answers

    Why is a treponemal test ordered after a positive non-treponemal test?

    <p>To confirm the diagnosis by finding syphilis antibodies</p> Signup and view all the answers

    What can be visible under darkfield microscopy in syphilis?

    <p>Bacteria from the chancre</p> Signup and view all the answers

    When does late (tertiary) syphilis occur?

    <p>When treatment is delayed, with neurological deficits and internal organ damage</p> Signup and view all the answers

    If a patient with syphillis reports a penicillin allergy, what is recommended

    <p>Desensitize patient to be able to use PCN</p> Signup and view all the answers

    There is early screening for syphilis in pregnancy because it can cross the placental barrier and cause stillbirth on fetus

    <p>True</p> Signup and view all the answers

    What is the primary target of the Human Immunodeficiency Virus (HIV)?

    <p>CD4-positive T-cells and macrophages</p> Signup and view all the answers

    What is the highest risk mode of transmission for HIV?

    <p>Receptive anal sex</p> Signup and view all the answers

    A patient presents with a painful tender, genital ulcer that produces foul smelling discharge. The patient tests negative for HSV and Syphilis. What is likely?

    <p>Chancroid</p> Signup and view all the answers

    What is the primary stage of Lymphogranuloma Venereum (LGV) characterized by?

    <p>Genital ulcer or mucosal inflammation at the site of infection</p> Signup and view all the answers

    Which of the following is the recommended treatment for Lymphogranuloma Venereum (LGV)?

    <p>100 mg of doxycycline twice a day for 21 days</p> Signup and view all the answers

    What is the most accurate diagnostic test for Lymphogranuloma Venereum (LGV)?

    <p>Nucleic acid amplification test (NAAT)</p> Signup and view all the answers

    Which of the following is a characteristic of the secondary stage of Lymphogranuloma Venereum (LGV)?

    <p>Swollen lymph nodes called buboes with anal and rectal bleeding/discharge</p> Signup and view all the answers

    What is the late stage presentation of Lymphogranuloma Venereum (LGV)?

    <p>Fibrosis and strictures in the anogenital tract</p> Signup and view all the answers

    A patient presents with intense pubic itching with the presence of lice. What is the treatment?

    <p>Permethrin 1% cream</p> Signup and view all the answers

    Who should receive annual trichomonas, syphilis, gonorrhea, and chlamydia screening?

    <p>Patients with HIV</p> Signup and view all the answers

    Which STIs are considered reportable according to the text?

    <p>Syphilis, chancroid, LGV</p> Signup and view all the answers

    Which group of individuals need HIV screening at least once?

    <p>ALL Women and Men aged 13-64</p> Signup and view all the answers

    Who needs to be screened annually for Gonorrhea and Chlamydia?

    <p>Women under 25 years of age</p> Signup and view all the answers

    What are STATE reportable to partner conditions?

    <p>HIV and syphilis</p> Signup and view all the answers

    Study Notes

    Vulvovaginal Candidiasis (Yeast Infection)

    • Caused by candida albicans
    • Risk factors: recent antibiotic use, immunocompromise, diabetes, medications like SGLT2 and contraceptives, and pregnancy
    • Symptoms: pruritis, burning pain, thick, curd-like vaginal discharge
    • Diagnosis: clinical history, findings, and wet mount with KOH
    • Treatment: fluconazole (single dose or 150mg every 72 hours for 3 doses) or topical azole medication (short course of 1-3 days)

    Trichomoniasis

    • Caused by a single-celled flagellated protozoan
    • Often presents with bacterial vaginosis
    • Symptoms: vaginal irritation, malodorous, froth, yellow/green discharge
    • Key cervical finding: punctate hemorrhages on vaginal and cervix
    • Diagnosis: gold standard is Nucleic Acid Amplification Test (NAAT) using Genprobe, initial test is wet mount showing motile, flagellated organisms
    • Treatment: metronidazole (500mg twice a day for 7 days for women, 2g single dose for men)
    • Partner treatment and abstinence from sex for 2 weeks post-treatment are necessary

    Bacterial Vaginosis (BV)

    • Caused by Gardnerella vaginalis
    • Not a sexually transmitted infection (STI)
    • Risk factors: being sexually active with a new partner or multiple partners, women who have sex with women, douching, and smoking
    • Symptoms: thin white/gray vaginal discharge with a fishy odor
    • Diagnosis: Amsel's Criteria (at least 3 of the following: gray/white discharge, clue cells on wet mount, vaginal fluid pH > 4.5, positive whiff/amine test)
    • Treatment: metronidazole or clindamycin cream
    • Male partners do not need treatment
    • Asymptomatic patients do not need treatment

    Chlamydia

    • Highest reported STI in the United States
    • Risk factors: young age, new or multiple sex partners, history of STIs, and/or inconsistent condom use
    • Symptoms: cervicitis, cervical discharge, lower abdominal pain, fever, chills, and adnexal tenderness in women; urethritis, penile discharge, and dysuria in men
    • Diagnosis: gold standard is Nucleic Acid Amplification Test (NAAT) using Genprobe
    • Treatment: doxycycline (100mg twice a day for 7 days) or Azithromycin (1g single dose)
    • Partner treatment and testing for cure in 3 months are necessary

    Human Papillomavirus (HPV)

    • Group of nonenveloped, icosahedral viruses classified within the family Papillomaviridae
    • Composed of double-stranded DNA and divided into two major functional regions: early (E) and late (L) regions
    • Highly species-specific, infecting humans exclusively
    • Transmitted primarily through skin-to-skin contact
    • Can persist in the host for varying durations, cleared by the immune system in most cases
    • Clinical presentation varies depending on the affected site and type of virus
    • Associated with various forms of cancer (anal, cervical, vulvar, vaginal, and oropharyngeal)
    • Laboratory studies: detection using molecular techniques like polymerase chain reaction (PCR)
    • Prevention strategies: promoting safe sexual practices, improving hygiene, and encouraging vaccination

    Gonorrhea

    • Found with a co-infection of chlamydia in 50% of cases
    • Recommended routine screening annually for patients 25 years of age and younger
    • Caused by Neisseria Gonorrhea, a gram-negative diplococci
    • Presents exactly the same as Chlamydia
    • Diagnostic gold standard: NAAT Genprobe
    • Treatment: ceftriaxone (500mg IM injection single dose) or azithromycin (1g single dose)
    • Partner treatment and abstinence from sex for 2 weeks post-treatment are necessary

    Syphilis

    • Caused by Treponema pallidum
    • Transmitted through direct contact with an infected lesion
    • Symptoms: painless papules that ulcerate into a 1-2 cm chancre with raised indurated margins
    • Secondary syphilis: diffuse, symmetric maculopapular eruption involving the entire trunk and extremities
    • Diagnosis: non-treponemal test (first test to screen for the bacteria), treponemal test (to confirm the diagnosis by finding syphilis antibodies)
    • Treatment: penicillin (IM injection), even if an allergy is present
    • Late (tertiary) syphilis: patient often presents with neurological deficits, blindness, and dementia, and internal organ damage

    Human Immunodeficiency Virus (HIV)

    • Retrovirus that targets and infects key components of the human immune system
    • Three stages: asymptomatic HIV infection, clinical latency, and AIDS
    • Stages can progress from initial infection to advanced disease
    • Symptoms: may not experience any symptoms, may appear healthy, but can still transmit the virus
    • Diagnosis: NAAT Genprobe
    • Treatment: antiretroviral therapy (ART)

    Lymphogranuloma Venereum (LGV)

    • Subtype of Chlamydia trachomatis
    • Presents in three stages: primary, secondary, and late
    • Primary: genital ulcer or mucosal inflammation reaction at the site of inoculation
    • Secondary: local direct extension of the infection to the regional lymph nodes, called "buboes"
    • Late: fibrosis and strictures in the anogenital tract
    • Diagnosis: NAAT
    • Treatment: doxycycline (100mg twice a day for 21 days)

    Pelvic Inflammatory Disease (PID)

    • Ascending acute infection of the upper genital tract
    • Caused by untreated Gonorrhea and Chlamydia
    • Symptoms: lower abdominal pain, vaginal discharge, cervical discharge, fever, dyspareunia
    • Diagnosis: presumptive clinical diagnosis using history and physical exam findings
    • Treatment: ceftriaxone (500mg IM for one dose), doxycycline (100mg twice a day for 14 days), and metronidazole (500mg twice a day for 14 days)
    • Complications: infertility, increased risk of ectopic pregnancies, and Fitz-Hugh-Curtis Syndrome

    Non-Gonococcal Urethritis (NGU)

    • Inflammation of the urethra that is not caused by Neisseria gonorrhea

    • Diagnosis: urinalysis, microscopic examination of first-void urine sediment, urethral swabs, and culture testing

    • Causes: Chlamydia trachomatis, Mycoplasma genitalium, Trichomonas vaginalis, Ureaplasma urealyticum, Haemophilus vaginalis, and Herpes simplex virus

    • Treatment: azithromycin or doxycycline are commonly prescribed for Chlamydia trachomitis infections

    • CDC recommends considering M.genitalium infection in cases of persistent or recurrent urethritis### Genital Herpes (Herpes Simplex)

    • Caused by strains HSV1 and/or HSV2

    • Highly common disease that can present with latency

    • HSV can remain latent in the nerve root ganglion and be reactivated by changes in the immune system

    • Patients tend to report a prodrome of burning, tingling, and itching, followed by an outbreak of painful vesicles on an erythematous base

    • Most outbreaks resolve spontaneously after 10-19 days

    Diagnosis and Treatment

    • Diagnosed in the clinical setting with viral cultures or PCR swabs if the patient has active lesions
    • A Tzanck smear finding of “multi nucleated giant cells” is a key diagnostic finding in HSV
    • Primary outbreaks should be treated for 7-10 days with antivirals
    • Recurrent outbreaks should be treated for 1-5 days with antivirals
    • Antivirals used for HSV include Acyclovir, Valacyclovir, and Famicilovir
    • Patients with recurrent HSV infection or pregnant patients can take a daily dose of antivirals to suppress the virus and decrease the risk of spreading the disease to partners

    Transmission and Prevention

    • Can be transmitted from mother to infant before, during, and after delivery
    • Prophylaxis is recommended to be started at 36 weeks gestation in known cases of HSV
    • A c-section is preferred if a pregnant woman has an active infection of HSV at time of delivery
    • Neonatal HSV can cause localized skin, eye mouth disease (SEM), CNS disease, and/or disseminated disease

    Human Papilloma Virus (HPV)

    • Most prevalent STI, with at least 50% of sexually active people contracting the virus in their lifetime
    • Most patients will clear an HPV infection within 2 years
    • Can present as a cutaneous viral infection with flat, common, and plantar warts
    • Can present as a mucocutaneous viral infection with genital warts, squamous intraepithelial lesions, or carcinomas of the vagina, vulva, cervix, anus, or penis
    • Can impact the oral and respiratory mucosa
    • Most patients with HPV are asymptomatic
    • Visible anogenital warts present as “soft, flesh colored single or multiple flat, cauliflower-like lesions”
    • HPV 16 and 18 account for 70% of cervical cancers
    • Gardasil 9 vaccine can be given as a 2 dose series, 6 months apart, if started between ages 9 to 14

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    Explore the characteristics and risk factors associated with vulvovaginal candidiasis, commonly known as a yeast infection. Learn about the clinical presentation, diagnosis, and common causes of this condition.

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