Sexually Transmitted Disease & Vaginitis Chart
| Disease | Pathogen & Transmission | Signs & Symptoms | Diagnosis | Treatment | Teaching |
|---|---|---|---|---|---|
| Herpes Simplex | Type 1 (HSV I) 5-10% of oral-labial lesions Type 2 (HSV II) 90-95% of all genital lesions | *PAINFUL GENITAL LESIONS Initial outbreak: painful urination, burning vulvar, scrotal, or penile pain, local swelling, erythema, fatigue, backache. Recurrent outbreak reactivation may have hours or days of genital pain, paresthesia or numbness; lesions tend to be unilateral; discomfort is generally less than with initial outbreak | Initial: Viral sheds for approx. 12 days Recurrent: Mean shedding time approx. 4 days | *Acyclovir 400mg PO TID for 7-10 days. Or *Famciclovir 250 mg PO TID for 7-10 days Or *Valacyclovir 1g PO BID for 7-10 days Anti-virals decrease the duration of lesions & viral shedding | activators: stress, illness, menstruation, pregnancy, trauma, heat, HIV No sex with outbreak & Can spread without outbreak to partner or baby |
| Syphilis-Primary (Most common stage) | Treponema pallidum | painless ulcer or chancre Non-tender chancre (sore) genitals, rectum or mouth May have swelling of the lymph in groin Chancre heals after 4 to 6 weeks, but patient still has syphilis | +VDRL or RPR treponemal test (FTA-ABS)= confirmation Tests reactive 14d after chancre appears ↑titer = primary syphilis | *Benzathine PCN G 2.4 mill units IM X 1 dose *Doxycycline 100 mg PO BID x 2 weeks id PCN allergic *Allergy test + give Benadryl w/ PCN | Once treated, you should see a decrease in titers Once reactive, the patient may remain so for life, even after treatment. |
| Syphilis-Secondary | Treponema pallidum | rash (macular, papular, or follicular in nature), adenopathy, fever, usually lasts 4 - 10 weeks The rash can last for a few weeks to months All S/S will disappear w/o TX in 3 weeks to 9 months., but infection still present | +VDRL or RPR treponemal test (FTA-ABS)= confirmation Tests reactive 14 days after chancre appears | *Benzathine 2.4 million units IM X 1 dose *Doxycycline 100mg PO BID x 2 weeks if PCN allergic | Do Penicillin Allergy Skin testing. Skin-test positive patients should be desensitized before initiating treatment (i.e. give monitored test doses) |
| Syphilis-Tertiary | Treponema pallidum | cardiac, Neuro, ophthalmic, eye & organ involvement Can affect 1/3 if not treated Common symptoms: fever; painful non-healing skin ulcers; bone pain, liver disease, and anemia. Tertiary syphilis can also affect the nervous system (resulting in the loss of mental functioning) and the aorta (resulting in heart disease). | +VDRL or RPR treponemal test (FTA-ABS)= confirmation Tests reactive 14 days after chancre appears | Benzathine PCN G 2.4 million units IM X 3 Doses *Consult Infectious Disease Specialist for management of PCN allergic patients | CDC= anyone in sexual contact with people that have syphilis within 90 days needs to be treated regardless of their test result. VDRL picks up approximately 76% of the cases. These individuals are more susceptible to getting HIV. Treat with Penicillin G 2.4 million units IM. |
| Chlamydia (Most frequently reported STD in US) | Chlamydia Trachomitis | Cervitis in women & urethritis in men. Conjunctivitis and/or pneumonia in newborn muculopurent discharge, post-coital bleeding, suprapubic tenderness, dysuria, hesitancy, frequency, often 7-10 days duration | Gen Probe + for Chlamydia | *Azithromycin 1 gm X 1 dose OR *Doxycycline 100 mg BID x 7 days SECOND-LINE: *Fluroquinolones or *Erythromycin IN PREGNANCY: *Azithromycin 1 g PO single dose, *Amoxicillin 500mg PO TID x 7 days. Repeat NAAT (nucleic acid amplification test) 3 weeks after treatment in pregnant women Treat sexual partner | 75% women and 50% men have no signs or symptoms 40% of women with untreated chlamydia will develop PID & may become infirtle Women infected are 3-5 times more likely to get HIV if exposed |
| Gonorrhea | Neisseria gonorrhea | urethral discharge (from scant to profuse, from clear to brown, yellow, white or green), dysuria, itching, and tenderness Males present with dysuria from inflammation of urethra | Gen Probe + for Gonorrhea Most frequent site of infection is cervix | FIRST-LINE: *Ceftriaxone (Rocephin) 250 mg IM X 1 dose + *Azithromycin 1g PO single dose OR *Doxycycline 100 mg PO BID x 7 days SECOND-LINE: *Cefixime 400mg PO + *Azithromycin (preffered)/Doxycycline if Ceftriaxone is not available Consult Infectious Disease Specialist for severe cephalosporin allergy Always treat for chlamydia when treating for gonorrhea Treat Gonnorrhea & Chlamydia in 1st trimester with Ceftriaxone + Azithromycin Treatment | Complications: -PID, infertile, ectopic pregnancy, epididymitis, urethral stricture -Gonococccal Conjunctivitis (if Neisseria gets in the eye) – this can lead to blindness. Studies have shown that gonorrhea can increase HIV transmission. |
| Trichomoniasis | Trichomoniasis vaginalis motile flagellated protozoa trichomonads (looks like little fish with tails on the end moving around | Foul-smelling (FISHY) yellow-green, white or gray, frothy vaginal discharge Dyspareunia & dysuria Vulvar erythema, petechial lesions on cervix (“strawberry cervix”) or friable cervix Men may have urethritis or prostatitis | Wet mount using saline See a ↑ number of WBCs on slide. | *Metronidazole (Flagyl) OR Tinidazole, each 2 g PO single dose Must treat sexual partners | Common form of vaginitis Women may or may not have symptoms Men are asymptomatic carriers Must report to public health |
| Sexual Assault Prophylaxis | *Rocephin 250 mg IM single dose + Doxycycline 100 mg PO BID x 7 days | ||||
| Bacterial Vaginosis (BV) NORMAL PH= 4.O | Overgrowth of normal vaginal flora w ↑ anaerobic organisms & gardnerella vaginalis Disruption of the lactobacilli flora in vagina | moderate white to gray d/c, possible fishy odor esp. after intercourse -May be asymptomatic -Can be sexually related or not | Physical Exam Ph > 4.5 Positive whiff test Clue cells on wet mount is a positive diagnosis. Clue cells are epithelial cells with bacteria adjacent to cell wall “black peppered egg” Cultures are not recommended | *Metronidazole (Flagyl) 500 mg PO BID X 7 days OR *Metronidazole 5 g gel intravaginally daily x 5 days *Clindamycin 5 g of 2% cream intravaginally at bedtime x 7 days IN PREGNANCY: *Metronidazole 500mg PO BID x 7 days OR 250mg PO TID x 7 days OR *Clindamycin 300 mg PO BID x 7 days *NO FLAGYL DURING 1ST TRIMESTER | Whiff Test: Mix vaginal secretions with 10% KOH (potassium hydroxide)= and has a fishy odor. Assess if patient has multiple sex partners, douching, IUD and OCP’s May enhance acquisition of HIV No ETOH during treatment & 3 days after treatment |
| Vulvovaginal Candidasis | Yeast Pseudohyphae and spores | Vaginal discharge (white, thick, curd-like), pruritus with excoriations, possible vaginal soreness, vulvar swelling, burning, dyspareunia | Hyphae or budding yeast | Intervaginal Miconazole, Terconazole, nystatin, Tioconazole, Butoconazole, Clotrimazole OR Fluconazole (Diflucan) 150mg x 1 dose | Recurrent episodes check patient for diabetes immunosupp, steroid or ABX use |
| Pelvic Inflammatory Disease (PID) | Gonorrhea & Chlamydia Repeated STD infections | Temp. > 101 Abnormal cervical or vaginal d/c Cervical motion tenderness | Fever >101 & vaginal discharge ↑ ESR Presence of either Gonorrhea or chlamydia | Out Patient Treatment: Rocephin 250mg IM + Doxycycline 100mg BID X 14d +/- Metronidazole 500 mg PO BID x 14 days | leads to tubal occlusion & tubal adhesion= infertility Infertility development by # of PID episodes: 1= 8% 2= 20% 3= 40% Overall 20% of women with PID will become infertile |
| Human Papilloma Virus (HPV) | HPV 6 or 11 (Warts) Cervical dysplasia (16, 18, 31, & 33) Over 150 types 40 are sexual transmitted | Papular lesions with warty granular surface; pinhead papules to cauliflower-like masses Usually skin-colored, soft & in clusters on vagina, anus, vulva, cervix, urethra, perineum. May be painful (most not), friable, or pruritic Males= warts on shaft of penis are painless | Pelvic exam and cultures | Goal is to remove warts Podofilox (apply to warts X 3 days none d 4-7 X 4 weeks TCA (trichloracetic acid) to lesion with cotton swab Cryotherapy (nitrous oxide to freeze lesions Laser surgery | Removal of warts does not insure a decrease in infectivity |
| Urethritis | Gonorrhea & chlamydia | Inflammation of the urethra. Discharge of mucopurulent or purulent material, dysuria. Chlamydia— can cause epididymitis and Reiter’s syndrome Can be asymptomatic | Gram stain of urethral secretions Chlamydia most common cause in older adults | Zithromax 1gm X1 or Doxycycline 100mg BID X 7days Recurrent Urethritis treat with: Flagyl 2gm X 1 and Emycin 500mg QID X 7d or EES 800mg QID X 7d | No sex for 7 days Refer all sex partners within the last 60 days |
| Non-Gonococccal NGU Urethritis | Coliform bacteria, Herpes Simplex, Trichomonads, fungal or viral infections | Urethral discharge scant to profuse clear to brown, yellow, white, or green, Dysuria Urethral itch and tender area. May be asymptomatic | NGU-no presence of gram negative organisms on gram stain | ||
| Cervicitis | mucopurulent or purulent endocervical exudate that is visible in vaginal canal Can be asymptomatic | Easily induced cervical bleeding | Treatment only recommended in areas where prevalence high or patient may not return for follow up |