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Chlamydia
- - causative organism is Choamydia Trachomatis
- - most common STD in US
- - causes non-Gonocoocal Urethrisitis (NGU) in men
- - initially asymptomatic in women but can result in Pelvic Inflammatory Disease (PID)
- - Ophthalmic infections and pneumonia in neonates
- - routine screening of sexually active women under 25 or with multiple partners
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Chlamydia Treatment
- - single dose of Azithromycin (Zithromax) 1 gram PO
- - Doxycycline 100mg PO BID X 7days
- - Confirmatory test DNA probe of cervix (female) or urethra (male)
- - offer concurrent treatment for gonorrhea
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Lymphogranuloma Venereum (LGV)
- - caused by a single strain of C. Trachomatis
- - common in tropical countries
- - some cases in southern US
- - begins as erosions in genital region
- - progresses to lymphatic swelling and obstruction
- - treatment with Doxycycline 100 mg PO BID X 21days
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Gonorrhea
- - causative organism is Neisseria Gonorrhoeae (Gonococcus)
- - male severe mucopurulent urethritis
- - females can be asymptomatic but progress to mucopurulent cervicitis and PID
- - can infect rectum, pharynx
- - treatment of choice is Ceftriaxone (Rocephin) IM 125 mg X 1
- - Alternative Cefixime (Suprax) 400 mg PO X 1
- - confirmatory testing DNA probe
- - co-treat for Chlamydia
- - can cause disseminated gonococcal infectoin: sepsis, petechiae, pustular skin lesions, septic arthritis
- - blindness in untreated infants
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Mycoplasma Genitalium
- - newly recognized STD
- - no commercially available test
- - causes urethritis or cervicitis
- - if urethritis does not respond consider
- - treat with 5 day course of Azithromycin (Zithromax)
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Pelvic Inflammatory Disease (PID)
- - syndrome involving endometritis, salpingitis, pelvic peritonitis, tubo-ovarian abscess
- - symptoms: pelvic pain, fever, vaginal discharge
- - pain worse with walking or intercourse
- - treatment of choice Cefoxitin (Mefoxin) IV with Doxycycline
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PID Treatment and Complications
- - may require hospitalization
- - may require surgery if abscesses fail to resolve
- Complications:
- - tubal scarring
- - infertility
- - ectopic pregnancy
- - chronic pelvic pain
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Epididymitis
- - infection of epididymis, a structure behind the testicle
- - can be STD or acquired non-sexually
- - Symptoms: fever, pain in posterior testicle
- - treat sexually acquired with Ceftriaxone (Rocephin) and Doxycycline
- - treat E coli with Ciprofloxacin (Cipro)
- - utilize analgesics, ice scrotal support, bedrest
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Syphilis
- - causative organism Treponema Pallidum, a spirochete
- - responsive to penicillin
- - if untreated, can progress to cardiac and neurological damage
- - congenital syphilis cause fetal death, blindness, mental retardation
- - 3 stages: primary, secondary, tertiary
- - diagnosis by blood test RPR or VDRL or culture of chancre
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Neurosyphilis
- - causes dementia, psychosis, peripheral neuropathy
- - must be treated with continuous IV Penicillin X 14 days
- - damage can be arrested but is irreversible
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Trichomoniasis
- causes by Trichomonas vaginalis a protozoal infection
- - causes a vaginal infection with itching and foul yellow-green discharge (diagnose smear of discharge)
- - men are asymptomatic
- - diagnosed by history, exam and microscopic examination of discharge
- - treatment is a single dose of Metronidazole (Flagyl) - cannot drink alcohol
- - must treat male partner
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Herpes Simplex
- - inoculation through direct contact with virus
- - symptoms begin about a week after exposure
- - may have prodrom of low grade fever, malaise, headache, aches, swollen lymph nodes
- - develop vesicles on area of exposure
- - vesicles evolve into painful ulcers
- - infection can occur on genitals, oral mucous, hands or cutaneous
- - lesions will resolve in several weeks, but infections persists for LIFE
- - initial outbreak is usually the worst
- - virus remains in nerve cells
- - virus can reactivate when host is stressed or immunocompromised
- - subsequent outbreaks may become less severe, less frequent or cease entirely
- - patient most contagious just before and during outbreak
- - viral shedding can occur when asymptomatic
- - refrain from sex during outbreak
- - use condoms
- - Valacyclovir (Valtrex) can reduce the risk of transmission
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Genital and Anal Warts
- - causative organism Human Papilloma Virus (HPV), multiple strains
- - causes fleshy lesions
- - certain strains promote cancer of the cervix or anus
- - no curative treatment
- - Gardasil: vaccine to prevent 4 strains of HPV
- - indicated for pre-adolescent girls
- - 3 shots over 6mo: $150/dose
- - can be removed with freezing, surgery, laser, topical applications
- - virus persists after removal and patient remains contagious
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