Josh Johnson DO STD Board Review 2014

1. Board Review STD’s (+++)
Josh Johnson, PGY III

2. Judith says:
• Multiple STD’s frequently occur together
• When an STD is suspected treat for
gonorrhea and chlamydial infection

3. Chlamydia Trachomatis
• Signs and Symptoms:
– Urethritis and cervcitis, watery
• Females 80% asymptomatic
– Mucopurlent cervcitis
– PID
– Can lead to infertility
• Males 50% asymptomatic
– Watery discharge
– Treatment
• Azithromycin / Doxycycline
• Erythromycin in pregnancy
• Treat Partners

4. Reiters Syndrome
• Reactive arthritis associated with
immune response to Chlamydia
• Conjunctivitis
• Urethrrits
• Asymmetric polyarthrits
• Can’t see, Can’t pee and Can’t climb a
tree.

5. Lympogranuloma Venereum
• Sub type of Chlamydia (L1 and L3)
• Rare in the US
• Signs and Symptoms
– Primary
• Genital uclers
– Secondary
• 7-30 days after ulcers
• Buboes: Unilateral PAINFUL adenopathy
– Treatment
• Doxycyline or Erythromycin

6. Nisseria Gonorrhea (g- diplo)
• 2-8 days after sex
– Men: milky/yellow discharge and dysuria
– Females: asymptomatic , lower abdominal
pain, dysuria, PID
–Can get other places
•
•
•
•
•
•
Eyes
Epididymitis- Orchitis
Anus
Throat
Bartholonian Cyst
Disseminated
– Treatment
• Ceftriaxone (no FQ)

7. Disseminated Gonococcal Infection
• Rash
– Hemorrhagic pustules on erythematous
base
• Bactermemia
– Meningitis, endocarditits
• Oligoarticular arthritis
• Knees most common
• Tenosynovits
• ADMIT IV ABX
– And treat partner

8. Trichomoniasis
• Protozoan
• Female
– Itchy, foul odor, yellow green
(rarely)
– Vaginal pH>4.5
– Strawberry cervix
• Wetmount
• Avoid sex for 1 week after abx
• Metronidazole 2gm x 1

10. Syphylis (Treponema pallidum)
• Primary:
– Painless genital chancre
– Heals in 4-8 weeks
– VDRL not helpful yet…
• Secondary:
– 2-10 weeks later
– Rash (palms/soles), CNS, Liver… anything
• Tertiary
– Years later
– Granulomatous lesions, meningitis, dementia, tabes
dorsalis and thoracic aneurysm

11. – Tabes Dorsalis (syphilitic myelopathy
• Demylenation of dorsal columns of spinal cord
• Loss of vibration, 2 point touch and ataxia
• Diagnosis
• VDRL or RPR
• Confirm with a FTA-ABS
• Treatment
– PCN 2.4 million units
– Possibity Jarisch-Herxheimer reaction:
• Spirochetes die in mass quantities
• Fevers, rigors, hypotension

13. Chancroid
• Developing countries
• Haemophilus Ducreyi
• PAINFUL genital ulcers and PAINFUL
lymphadenitis
• Look for other STD’s (herpes and syphilis
• Treatment
– Azithro
– Ceftriaxone
– Ciprofloxacin
– Erythromycin

14. Pelvic Inflammatory Disease
• Polymicrobal
• Risk factors
• Signs/symptoms
– Lower abdominal pain
– Cervical motion tenderness
– Fever
• Complications
– Infertility
– Ectopic pregnancy

15. Fitz-Hugh-Curtis Syndrome
• Inflammation of the hepatic capsule and
diaphragm:

16. Herpes Simplex Virus
•
•
•
•
~25% have it
Transmitted via direct contact
Painful shallow ulcers or vesicles
Shedding can occur in asymptomatic patients
• Lives in your spinal cord for life
• Brought out by stress
• Dx clinical or by PCR
– Old school Tzanck smear
• Treat with Acyc- Famci- or
Valacyclovir

17. Botulism
• Botulinum toxin inhibits acetylcholine
release at neuromuscular
junction, causing paralysis
• Three main presentations of botulism:
– 1) foodborne (canned foods, honey)
– 2) infant (most common)
– 3) wound (IV drug user, dirty wounds)

18. • D's of botulism:
diplopia, droopy eyes
(ptosis) dilated pupils, dry
mouth, dysphonia, dysarth
ria
• Botulism treatment:
botulinum antitoxin from
CDC, consider early
intubation, supportive
care

19. Anthrax
•
•
•
•
Endospores (Gram + rods)
No Human-Human Spread
Weapons of mass destruction
3 types
– Intestinal and oropharyngeal
– Cutaneous
– Pulmonary

20. anthrax
• Cutaneous
– Puritic but not painful
– Animal hair/wool/hide
exposure
– tx Doxy, cipro
• Intestinal (rarest)
– Dysentery
– ~60% mortality
• Pulmonary
• Wide mediastium
• No infiltrates
• 100% mortality if not
treated in 24 hours
• Tx with Floroquinlones

21. Diptheria (Corynebacterium diptheriae)
• Humans via Respirations
• Diptheritic membrane
– Pseudomembrane
– Bleeds when scraped
– Smells like “wet mouse”
• Endotoxin
– Produces membrane
– Hemotogenous spread
• Myocarditis (2/3) and neuropathies (descending)
• TX: PCN or erythromycin
– Booster to all contacts