Human Papillomavirus Most common STD in females HPV 6 and 11 – warts HPV 16, 18, 31, 33, 35 – cervical cancer Treatment Podofilox, Imiquimod cream Cryotherapy Surgical removal
Syphilis Does this hurt???
Syphilis Treponema Pallidum Primary Painless chancre Know testing 1 st : nontreponemal test VDRL RPR 2 nd : treponemal test FTA-ABS TP-PA These may be + for life regardless of treatment
Syphilis Secondary Palmar rash Mucocutaneous lesions Lyphadenopathy PALMS and SOLES – nickel and dime Tertiary Cardia Opthalmic and auditory Gummatous lesions Latent + test with no clinical symptoms Early – within past year Late – after 1 st year of infection Treatment PCN G IM x 1
Neurosyphilis Adolescent with hearing loss Cognitive dysfunction, motor or sensory deficits CSF VDRL is diagnostic Very specific Usually diagnose based on: Clinical suspecion Elevate WBC, protein Treatment Peniciliin G IV for 2 weeks
Genital Herpes Wright-Giemsa stain – multi nucleated giant cells
Genital Herpes – usually Type 2 Clusters of vesicular ulcers, erythematous base Tender Inguinal Adenopathy, fever, myalgia Diagnosis: Physical exam Wright-Giemsa stain Treatment: Acyclovir 7 days (oral)
Gardnerella Vaginalis - BV Caused by disruption of vaginal flora Test: Whiff test – fishy amine odor Clue cells Treatment Metronidazole
Gonorrhea Bartholin Gland Abscess
Gonorrhea Commonly assymptomatic Males Dysuria and discharge Can progress to epididymitis (unilateral pain and swelling of scrotum) Females Urethritis and cerivicitis Dysuria and malodorous discharge Fitz-Hugh-Curtis – perihepatitis *normal LFTs RUQ pain
GC Con’t THINK GC for any arthritis in adolescents GC pharyngitis Patchy, erythematous, pustular lesions on palate Diagnosis – throat culture Disseminated GC Usually don’t have local symptoms anymore Most common arthritis and rash Can develop meningitis and endocarditis Diagnosis: culture – GRAM - DIPLOCOCCI *DON’T FORGET, TREAT ALL GC CASES FOR CHLAMYDIA
Chlamydia Most common treatable STD Symptoms: Men – urethritis Women - cervicitis Diagnosis: Nucleic acid amplification test Treatment: Azithromycin 1 gm x 1 Doxycyclin 100 mg BID x 7 days or Erythromycin 500mg BID x 7 days Don’t forget – You need a TOC in pregnancy
PID Complication of lower genital tract infection Risk Factors: Adolescent, multiple sexual partners, previous PID Symptoms: Ill apperaing fever, shaking chills, lower abdominal pain Cervical motion tenderness Diagnosis: Culture, U/S (fluid in cul-de-sac) Treatment: Can try outpt but need to reexamine within 24 hours Hospitalization Ceftriaxone and Doxycycline Complications: Ectopic pregnancy
Pregnancy ½ of all pregnancies occur with 6 mos of first intercourse 1/5 in first month Testing All pregnant women have to be tested for HIV 1 st visit labs: syphillis, Chlamydia, GC, Hep B, Hep C, Pap
How about a few Pictures??
Mom complains of constant scratching of bottom!!! Scotch tape Test!!!
Urethral Prolapse Common Presentation: Vaginal bleeding
Irriatant Vulvovaginitis **Think if they mention “bubble baths”
Strep Vulvovaginitis Usually very painful!! Sharp demarcation