Josh johnson std's 2014 +++ lecture
Download as PPTX, PDF1 like15,105 views
This document summarizes several common sexually transmitted diseases (STDs). It notes that gonorrhea and chlamydia frequently occur together and should be treated simultaneously. It reviews the signs, symptoms, complications, and treatment for chlamydia, Reiter's syndrome, lymphogranuloma venereum, gonorrhea, disseminated gonococcal infection, trichomoniasis, syphilis, chancroid, pelvic inflammatory disease, Fitz-Hugh-Curtis syndrome, and herpes simplex virus. It also briefly discusses botulism, anthrax, diphtheria and their presentations, toxins involved, and treatments.
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
- #4: Dx: clinical dx, ELISA/DNA tests to confirm (urine/cervical swab)Violin strings