Sexually Transmitted Disease & Vaginitis Chart

Sexually Transmitted Disease & Vaginitis Chart

Disease Pathogen &
Signs & Symptoms Diagnosis Treatment Teaching
Herpes SimplexType 1 (HSV I) 5-10% of oral-labial lesions

Type 2 (HSV II) 90-95% of all 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 pallidumpainless 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-SecondaryTreponema pallidumrash (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-TertiaryTreponema pallidumcardiac, 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.

(Most frequently reported STD in US)
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
*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
GonorrheaNeisseria gonorrheaurethral 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
*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

-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.
TrichomoniasisTrichomoniasis 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
*Rocephin 250 mg IM single dose + Doxycycline 100 mg PO BID x 7 days
Bacterial Vaginosis (BV)

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
*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
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

Pseudohyphae and spores
Vaginal discharge (white, thick, curd-like), pruritus with excoriations, possible vaginal soreness, vulvar swelling, burning, dyspareuniaHyphae or budding yeastIntervaginal 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
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
UrethritisGonorrhea & chlamydiaInflammation 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
NGU Urethritis
Coliform bacteria, Herpes Simplex, Trichomonads, fungal or viral infectionsUrethral discharge scant to profuse clear to brown, yellow, white, or green,
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