Transcript Document

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Condition:
Symptoms:
Treatment:
Reportable to the CDC?
Frenkle TL, P. J. (2011). Wein: Campbell-Walsh Urology, 10th. ed. E. Saunders. MD Consult.
Genital Herpes Simplex Virus Infection
Epidemiology: Prevalence - 50 million people in US
Cause: Virus, HSV-2 (85-90%) and HSV-1 (10-15%)
Clinical findings: Ulcer disease, recurrent, multiple, painful
vesicles
Test: Viral Culture
First Treatment: Valacyclovir 1g BID for 7-10 days
Recurrence: Valacyclovir 500mg BID for 3 days
Suppression: Valacyclovir 500mg SID
Reportable? No
Adapted from Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2010. MMWR
2010;59(RR-12):21–2.
Condition:
Symptoms:
Treatment:
Reportable to the CDC?
Frenkle TL, P. J. (2011). Wein: Campbell-Walsh Urology, 10th. ed. E. Saunders. MD Consult.
Lymphogranuloma Venereum
Epidemiology: Rare in US, most common in Africa,
Asia, South America, Carribbean
Cause: Bacteria, Chlamydia trachomatis L1,2,3
Clinical findings: Ulcer disease, painless vesicle then
ulcer, location penis, anus, vulvovaginal area
Test: Culture of lesion
Treatment: Doxycycline 100mg BID for 3 weeks
Reportable? No
Adapted from Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2010. MMWR
2010;59(RR-12):21–2.
Condition:
Symptoms:
Treatment:
Reportable to the CDC?
Frenkle TL, P. J. (2011). Wein: Campbell-Walsh Urology, 10th. ed. E. Saunders. MD Consult.
Primary Syphilis
Epidemiology: 7.8 cases per 100,000 in men; 1.4
cases per 100,000 in women
Cause: Spirochete, Treponema pallidum
Clinical findings: Ulcer disease, painless, indurated,
singular ulcer, bilateral lymphadenopathy
Test: Darkfield microscopy of specimens from lesion;
serumVDRL or RPR
Treatment: Benzathine penicillin G 2.4 mU IM x 1
Reportable? Yes
Adapted from Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2010. MMWR
2010;59(RR-12):21–2.
Condition:
Symptoms:
Treatment:
Reportable to the CDC?
Frenkle TL, P. J. (2011). Wein: Campbell-Walsh Urology, 10th. ed. E. Saunders. MD Consult.
DeCherney AH, Nathan L. Current Diagnosis and Treatment Obstetrics and Gynecology, 10th edition. McGraw Hill Companies.
Chancroid
Epidemiology: Incidence – 28 US cases in 2009, but
most common ulcer STI in the world
Cause: Bacteria, Haemophilus ducreyi
Clinical findings: Ulcer disease, painful ulcer,
involves penis or vulvovaginal area, unilateral
inguinal adenopathy
Lab: Difficult, but gram stain and culture lesion
Treatment: Azithromycin 1g PO x 1
Reportable? Yes
Adapted from Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2010. MMWR
2010;59(RR-12):21–2.
Vaginal
Discharge
pH
WBC
Microscopy
Symptoms
Normal
White, thick,
smooth
≤4.5
Absent
Lactobacilli
None
Candidiasis
White, thick,
curdlike
≥4.5
Absent
Mycelia
Vulvar pruritus, external or
superficial dysuria
Trichomoniasis
Frothy or
purulent
≥4.5
Present
Mobile trichomonads present; Amine
odor
Vulvar erythema and edema,
punctate strawberry lesions on
cervix
None or
mucopurulent
discharge from
cervicitis
≥4.5
Present
Gram-negative diplococci within or
adjacent to polymorphonuclear
leukocytes on Gram stain
Vaginal and pelvic discomfort,
dysuria, most often
asymptomatic
Chlamydia
trachomatis
infection
None or
mucopurulent
discharge from
cervicitis
≥4.5
Present
Organisms not visualized
Vaginal and pelvic discomfort,
dysuria, most often
asymptomatic
Bacterial
vaginosis
Thin, white
homogeneous
≥4.5
Absent
Absent Paucity of lactobacilli; Amine
odor; Clue cells
Fishy odor and increased vaginal
discharge
Neisseria
gonorrhoeae
infection
Condition:
Symptoms:
Treatment:
Reportable to the CDC?
Frenkle TL, P. J. (2011). Wein: Campbell-Walsh Urology, 10th. ed. E. Saunders. MD Consult.
Chlamydial urethritis/cervicitis
Epidemiology: Incidence – 1.2 million cases in 2009
Cause: Bacteria, Chlamydia trachomatis
Clinical findings: Asymptomatic. Lower urinary tract
symptoms in men. Mucopurulent discharge and PID
in women.
Screen: Yes, annually for sexually active women <26
Test: Urethral, endocervical culture or urine culture
Treatment: Azithromycin 1g PO x 1
Reportable? Yes
Adapted from Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2010. MMWR
2010;59(RR-12):21–2.
Vaginal
Discharge
pH
WBC
Microscopy
Symptoms
Normal
White, thick,
smooth
≤4.5
Absent
Lactobacilli
None
Candidiasis
White, thick,
curdlike
≥4.5
Absent
Mycelia
Vulvar pruritus, external or
superficial dysuria
Trichomoniasis
Frothy or
purulent
≥4.5
Present
Mobile trichomonads present; Amine
odor
Vulvar erythema and edema,
punctate strawberry lesions on
cervix
None or
mucopurulent
discharge from
cervicitis
≥4.5
Present
Gram-negative diplococci within or
adjacent to polymorphonuclear
leukocytes on Gram stain
Vaginal and pelvic discomfort,
dysuria, most often
asymptomatic
Chlamydia
trachomatis
infection
None or
mucopurulent
discharge from
cervicitis
≥4.5
Present
Organisms not visualized
Vaginal and pelvic discomfort,
dysuria, most often
asymptomatic
Bacterial
vaginosis
Thin, white
homogeneous
≥4.5
Absent
Absent Paucity of lactobacilli; Amine
odor; Clue cells
Fishy odor and increased vaginal
discharge
Neisseria
gonorrhoeae
infection
Condition:
Symptoms:
Treatment:
Reportable to the CDC?
Frenkle TL, P. J. (2011). Wein: Campbell-Walsh Urology, 10th. ed. E. Saunders. MD Consult.
Gonorrhea
Epidemiology: Prevalence - 50 million people in US
Cause: Bacteria, Neisseria gonorrhea
Clinical findings: Men- Lower urinary tract
symptoms, Women – mucopurlent endocervical
discharge
Test: Urethral, cervical swab for culture
Treatment: Ceftriaxone 250mg x 1 IM
Reportable? Yes
Adapted from Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2010. MMWR
2010;59(RR-12):21–2.
Vaginal
Discharge
pH
WBC
Microscopy
Symptoms
Normal
White, thick,
smooth
≤4.5
Absent
Lactobacilli
None
Candidiasis
White, thick,
curdlike
≥4.5
Absent
Mycelia
Vulvar pruritus, external or
superficial dysuria
Trichomoniasis
Frothy or
purulent
≥4.5
Present
Mobile trichomonads present;
Amine odor
Vulvar erythema and edema,
punctate strawberry lesions on
cervix
None or
mucopurulent
discharge from
cervicitis
≥4.5
Present
Gram-negative diplococci within or
adjacent to polymorphonuclear
leukocytes on Gram stain
Vaginal and pelvic discomfort,
dysuria, most often
asymptomatic
Chlamydia
trachomatis
infection
None or
mucopurulent
discharge from
cervicitis
≥4.5
Present
Organisms not visualized
Vaginal and pelvic discomfort,
dysuria, most often
asymptomatic
Bacterial
vaginosis
Thin, white
homogeneous
≥4.5
Absent
Absent Paucity of lactobacilli; Amine
odor; Clue cells
Fishy odor and increased
vaginal discharge
Neisseria
gonorrhoeae
infection
Condition:
Treatment:
Reportable to the CDC?
Frenkle TL, P. J. (2011). Wein: Campbell-Walsh Urology, 10th. ed. E. Saunders. MD Consult.
Trichomoniasis
Epidemiology: Prevalence – 174 million cases
worldwide in 1999
Cause: Protozoan, Trichomonas vaginalis
Clinical findings: Asymptomatic in men; frothy white
or green, malodorous discharge; strawberry cervix
Treatment: Metronidazole 2gm x1 PO
Reportable? No
Adapted from Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2010. MMWR
2010;59(RR-12):21–2.
Condition:
Symptoms:
Treatment:
Reportable to the CDC?
Frenkle TL, P. J. (2011). Wein: Campbell-Walsh Urology, 10th. ed. E. Saunders. MD Consult.
Habif (2009). Clinical Dermatology, 5th Edition. Elsevier. MD Consult.
Scabies
Epidemiology: Treat entire household, not just
sexual partners
Cause: Mite, Sarcoptes scabiei
Clinical findings: Wavy, elongated papules, eruption
with pruritis
Testing: Microscopic evidence of mite or eggs
Treatment: Permethrin cream (5%) all over, wash off
after 8-14 hours
Reportable? No
Adapted from Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2010. MMWR
2010;59(RR-12):21–2.
Condition:
Symptoms:
Treatment:
Reportable to the CDC?
Frenkle TL, P. J. (2011). Wein: Campbell-Walsh Urology, 10th. ed. E. Saunders. MD Consult.
HPV, Genital Warts
Epidemiology: Prevalence – 20 million, 80% of
women by age 50 will have had the infection
Cause: Human Papilloma Virus, various subtypes
HPV 6 & 11 - warts
HPV 16 & 18 – 99% of cervical cancers
Clinical findings: recurrent vesicular lesions
Treatment: Podofilox 0.5% gel q12h application x 3
days
Reportable? No
Adapted from Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2010. MMWR
2010;59(RR-12):21–2.