STI’s

STI Cause Presentation Symptoms Diagnostic Test Treatment Extra extra read all
about it
Cervicitis GC and Chlamydia *many asymptomatic vaginal discharge, dysuria, *treat for both GC and
cervical edema, erythema, abnormal vaginal bleeding chlamydia
friability, discharge
Urethritis *MC STI in males mucopurulent discharge, Dysuria, frequency, urgency, WBCs on gram stain, NGU: MC complication-
Chlamydia, Ureoplasm, test, pyuria penile discharge positive leukocyte Azithromycin 1g PO epididymitis
Mycoplasma, esterase single dose
trichomonas, HSV *look for presence of Or
gram(-) intracellular Doxy 100mg BID X 7d
diplococci
-determine gon vs non Recurrent/Persistent:
gon Metronidazole 2g PO
single dose

Resistant NGU (Myco):

N. Gonorrhoeae Gram (-) diplococcus Women: cervicitis, urethritis,
*humans only natural PID, acute pharyngitis
host Men: urethritis, prostatitis,
epididymitis
*40-60% of women develop
onset at end of
menstruation
Azithro 500mg day one
followed by 250 mg daily
for 4 days
Purulent cervical discharge Gram stain of cervical Co-existing chlamydial Other gon dz:
Lower abdominal pain, secretions (gram – infection should be -disseminated
anorexia, fever, dysuria, diplococci) treated as well! gonococcal arthritis,
urinary frequency, Thayer-Martin culture -follow up cultures and conjunctivitis/gon
asymptomatic! medium cultures exam 3-7 days after opthalmia neonatorum,
completion of therapy Fitz Hugh Curtis
syndrome
Ceftriaxone 250 mg IM
single dose plus *pts with acute PID
Azithromycin 1pg PO usually need
single dose hospitalization
OR
Doxy 100mg po BID 7d

Chancroid Small, non-motile gram PAIN Painful “soft chancres” Gram stain of chancre Azithromycin 1gm PO *young sexually active
(Hemophilus Ducreyi) (–) rod Adenopathy exudate, gram stain of single dose men involved with
Incubation 3-5 days aspirate Or Ceftriaxone 250 mg prostitutes
“school of fish” or IM
“chaining” of gram neg
rods
Granuloma Inguinale Pleomorphic gram (-) Raised, red lesions Initial lesion: indolent, irregular Gram stain of lesions Doxycycline 100mg PO
rods ulcer with pink to beefy red with inclusion cysts BID X 3 weeks
1 month incubation base called Donovan’’s
Secondary phase: beefy red bodies
granulation tissue with scar
formation
Advanced lesions:
hypertrophic, fistulas of
 vagina, bladder, and rectum
may occur!!
*elephantiasis of external
genitalia may occur
Syphilis Treponema pallidum Site of entry: vulva, vagina, Primary: Dark field examination Primary and Secondary:
(spirochete) cervix Initial lesion- PAINLESS, Benzathine PCN G
Other sites: anus, rectum, ulcerated, hard chancre, non- Serologic Test: 2.4million units IM single
Incubation 10-90 days pharynx, tongue, lips, fingers tender nodes Non Treponemal dose
Firm, punched out appearance -RPR, VDRL [PCN allergy=
Usually asymptomatic *rapid, easy, Tetracycline 500mg PO
Possible vaginal and cervical inexpensive QID x 14 days
lesions -VDRL will be positive
Resolve: 3-9 weeks in 3-6 weeks after Latent:
Secondary: infection -Benzathine PCN G 2.4
Left untreated  chancre million units IM each
followed in 6wks-6mo by Treponemal Tests: week X 3
secondary or bacteremic stage -FTA-ABS, MHA-TP
-low grade fever, HA, malaise, -specific Ab tests Neurosyphilis:
sore throat, anorexia, general -confirmatory or Aqueous crystalline PCN
lymphadenopathy, rash – diagnostic (NOT for G 18-24 million units
asymptomatic maculopapular routine screening) IV/day X 10-14 days
rash of palms and soles and -more sensitive and
mucus membranes specific than non trep
“Money Spots” tests
Generalized lymphadenopathy *remain positive
Resolve in 2-6 weeks despite therapy
Tertiary: 33% evolve
-transmission unlikely except
blood transfusion or placental
transfer
Damage to CNS, heart, lungs
Gummas
Chlamydial STIs
MC bacterial cause of STIs *C. trachomatis is resistance to PCN
 Lymphogranuloma Chlamydia that doesn’t Women- vulva lesion, Primary- lesions that are Complement fixation- Doxycycline 100mg PO
Venerum go away painless vesicular or popular papules or ulcers test of choice BID X 21 days,
4-21 days incubation lesion –resolves in 1 week Secondary: regional alternatively
lymphadenopathy, inguinal Erythromycin base
adenopathy, fever, myalgia’s, 500mg PO QID X 21 days
arthralgia’s

Tertiary: suppurative buboes

(draining fistulas and lymphatic
obstruction)
*elephantiasis in untreated
patients
 Chlamydia Most common bacterial In women may see Symptoms of urethritis, pyuria, Direct Azithromycin 1gm PO *Azithromycin
Trachomatis STI ! mucopurulent cervicitis negative urine culture immunofluorescence single dose recommended during
test *95% specificity OR pregnancy
*treat partners
 Doxycycline 100mg PO
BID X 7days *should do follow up
cultures
Genital Tuberculosis Almost always from Based on clinical Single or multi drug
miliary hematogenous or suspicion and therapy with INH,
lymphatic spread confirmed by cultures Rifampin, Streptomycin,
Ethambutol,
(TB skin test only Pyrazinamide
indicates exposure,
NOT location)
Bartholinitis Usually E.coli or Acute pain in region of gland Clinical symptoms Analgesics Can form abscess if not
staphylococci or after GC Vulvar pain, dyspareunia, Broad spectrum Ab treated properly !
infection tender, red swelling below [Bartholin’s cyst]
posterior part of labia majora Must I and D abscess
Viral Sexually Transmitted Disease
 Human Papilloma Genital warts Direct inspection Prevention: HPV 6 and 11 –low risk
Virus Associated with confirmed with biopsy Gardasil quadrivalent HPV 16 and 18 – high
increased risk of pre- Pap smears (halo cell) (covers types 6,11,16,18) risk  cancer of cervix!
invasive and invasive Colposcopy- turns Ceravix –bivalent (16,18)-
neoplastic lesions of lesions white not for prevention of Pre-cancerous lesions:
lower genital tract genital warts -cryotherapy, laser
Incubation 6wks-18mo vaporization, surgical
External excision
genital/perineal/vaginal
warts:
Podophyllin gel BID X3
days, off 4 days, repeat 4
cycles OR
Cryotherapy (many
options)

 Herpes Simplex Very common! Lesions on vulva, vagina,
Virus HSV-2 predominant cervix, perineal, perianal
genital pathogen
Dysuria, urinary retention,
Incubation 3-7 days mucopurulent discharge,
painful inguinal adenopathy,
generalized myalgia’s, low
grade fever
Anal Warts:
Cryotherapy with liquid
nitrogen
Prodromal Phase- mild Typically made by Primary Episode: If they have IgG’s, you
paresthesia and burning 2-5 lesion appearance and Acyclovir 400mg PO TID x can confirm they’ve had
days after infection, prior to clinical history 7-10 days or 200mg PO it for a while
vesicles breaking out -Nucleic acid 5x/d 7-10 days
Primary lesions- clear vesicles, amplification methods Or
then shallow coalescent PCR Famciclovir 250mg PO *menses and stress
painful ulcers with red border Viral culture TID 7-10 days associated with
3-7 days after exposure Antigen detection tests Or recurrent outbreaks
Last 2-3 weeks for HSV Valcyclovir 1g PO BID7-
Tzanck smear- rapid 10days Until all vesicles crusted
*will see Recurrent: over, lesions are highly
multinucleated giant Acyclovir 400 mg po TID x contagious and
cells 5 days intercourse should be
Severe: avoided
 Acyclovir 5-10mg/kg
body weight IV q 8h for
2-7 days until resolution
 Molluscum Mildly contagious Small (1-5mm) umbilicated Lesion is Local Excision, *think of sexual abuse in
Contagiosum Incubation- several papules in cutaneous genital pathognomonic of MC, cryotherapy, laser children in genital area
weeks region confirm histologically vaporization and Retin-A
-will see molluscum
bodies
 HIV Many infected Acute mono like syndrome Can progress to AIDs in 4-5 Elisa-screening NO effect prophylactic **She said not to go
individuals are (2-4 weeks), then night years – final stage, severe Western Blot- therapy to prevent into this “know it’s a
asymptomatic carriers sweats, diarrhea, weight alterations in cell mediated confirmatory infection thing, we screen for it,
loss, fatigue immunity (T4) Viral Load Treat with entry then we send it out –
-Kaposi’s sarcoma, P24 antigen inhibitors, fusion treatment very
opportunistic infections inhibitors, reverse specialized”
transcriptase inhibitors
Trichomonas Vaginalis Motile flagellated Profuse, yellow-grey frothy Vaginal pH 5-6 Metronidazole 2 gm PO
protozoan, most malodorous discharge of low Motile trichomonads single dose
common sexually viscosity on wet prep OR
transmitted protozoal Organisms twice the IV metronidazole for 10-
infection Vulvar pruritus size of WBCs 14 days in highly
Causes acute resistant cases
vulvovaginitis “strawberry cervix”
Ectoparasites Crab louse Intense vulvar pruritus See lice with hand lens 1% permethrin cream
(Pediculosis pubis) Confined to hair secondary to an allergic (NIX)
sensitization
Scabies (sarcoptes Quick, can be found Predominant symptom is See burrows with Disinfecting clothing,
scabiei) anywhere on skin ITCH hands lens bedding, home
Burrow long tunnels in Hands, wrists, breasts, Skin scrapings in 5% permethrin cream OR
skin to lay eggs buttock commonly effected mineral oil Ivermectin 200mcg/kg po
repeated in 2 weeks