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Josh johnson std's 2014 +++ lecture

Troy Pennington
Troy Pennington
Troy PenningtonEmergency Physician at Arrowhead Regional Medical Center

Josh Johnson DO STD Board Review 2014

Josh johnson std's 2014 +++ lecture

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Board Review STD’s (+++)
Josh Johnson, PGY III
Judith says:
• Multiple STD’s frequently occur together

• When an STD is suspected treat for
gonorrhea and chlamydial infection
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
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.
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
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)
Ad

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Josh johnson std's 2014 +++ lecture

  • 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

Editor's Notes

  1. Dx: clinical dx, ELISA/DNA tests to confirm (urine/cervical swab)Violin strings