Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Dec 31 2021

Sexually Transmitted Infections (STIs)

  • Overview
    • STD's are one of the most common gynecologic ER presentations
    • All sexually active partners should be screened for STDs
    • Risk factors incude
      • multiple sexual partners
      • unprotected sexual intercourse
      • young age at first intercourse
      • men who have sex with men
    • Common presentations are
      • ulcerations of the vulvovaginal region
      • abnormal vaginal discharge
      • inguinal rashes
      • inguinal lyphadenopathy
      • abdominal pain
    • 25-50% have multiple genital tract infections
      • Disease
      • Introduction
      • Presentation
      • Evaluation
      • Treatment
      • Primary syphilis
      •   Caused by Treponema pallidum (spirochetes)
      • Appears in 2-10 weeks
      • Painless genital ulceration (chancre)
      • Dark field microscopy, VDRL/RPR (a rapid but nonspecific screening test), and/or a FTA-ABS (specific and diagnostic, the gold standard)
      • Penicillin
      • Secondary syphilis
      • Caused by Treponema pallidum (spirochetes)
      • Appears 1-3 months after primary infection
      • Maculopapular rash on palms and soles, fever, headache, and generalized lyphadenopathy
      •   Condylomata lata (moist lesions on the genitals which are highly infectious)
      •  -
      • Penicillin
      • Tertiary syphilis
      • Caused by Treponema pallidum (spirochetes)
      • Aortic aneurysm and aortic regurgitation
      •   Granulomatous gummas of the CNS, heart and great vessels
      •  -
      • Penicillin
      • Gonorrhea
      • Caused by Neisseriae gonorrhoeae
      • Dysuria, urinary frequency, and purulent yellow-green discharge
      • May progress to PID, high rate of coinfection with with chlamydia
      •   Can cause proctitis in the setting of anal intercourse 
      • Evaluation should include cervical and urethral cultures for chlamydia and gonorrhea
      • Clean catch urine culture to rule out UTI
      • Saline/KOH/Gram stain of vaginal discharge
      • All sexually-active women 24 years of age or younger should be screened 
      • Ceftriaxone, also treat for presumed chlamydia infection
      • If urethritis is refractory to azithromycin, consider Trichomonas and treat with metronidazole 
      • Chlamydia
      • Caused by Chlamydia trachomatis serotypes D-K
      • Often asymptomatic, but may cause dysuria, cervicitis, PID, lymphogranuloma venereum, or infertility
      • Chlamydia antigen test
      • All sexually-active women 24 years of age or younger should be screened 
      • Tetracycline/doxycycline, azithromycin for cervicitis
      • Use erythromycin base or amoxicillin in pregnancy
      • Do not need to routinely treat for presumed gonorrhea infection, but should in patients with confirmed gonorrhea or high risk patients
      • Venereal warts (condylomata acuminata)
      • External lesions associated with HPV 6,11, endocervical warts caused by HPV 16, 18, 31, 33. Transmitted sexually and have a incubation period of 1 to 6 months
      • Painless, soft, fleshy, "cauliflower like lesion"
      •   Lesion can be on the vulva, vaginal wall, the cervix, and the perineum
      • Biopsy lesion with 5% acetic acid to detect condylomata acuminata
      • No treatment is satisfactory. Relapse is frequent and requires retreatment
      • Treatment modalities include podofilox (an antimiotic), cryotherapy, laser surgery, or electrocauterizations, and biopsy, imiquimod (interferon inducer) are widely used but require multiple applications and frequently fail
      • Presence during pregnancy does not require cesarian section
      • Herpes
      • Caused by HSV-2
      • Parasthesias and burning followed by painful vesicles and ulcerations
      •   In primary infections patients may present with fever, malaise, and adenopathy
      • Tzanck smear for lesions suspicious of HSV
      • Topical acyclovir ointment during flare-up, oral acyclovir to decrease rate and severity of recurrence
1 of 0
1 of 2
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options