week 2 DB response

Infe ctio n

Description Presentation Causes/Risk

Factors Treatment per

CDC Additional Info

Can dida

Fungal infection (yeast)

Vulvar itching, thick white discharge

Antibiotics use, diabetes, pregnancy, tight clothes

Fluconazole 150 mg PO single dose

Not sexually transmitted

BV Bacterial vaginosis

Thin gray discharge, fishy odor

Douching, multiple partners, new sex partner

Metronidazole 500 mg PO BID x 7 days

Not an STI, but related to sexual activity

Chl amy dia

Bacterial STI

Often asymptomatic, discharge, dysuria

Unprotected sex, <25 yrs, multiple partners

Doxycycline 100 mg BID x 7 days

Screen all sexually active females <25

Gon orrh ea

Bacterial STI Purulent discharge, pelvic pain

Same as chlamydia

Ceftriaxone 500 mg IM + doxycycline

Often co-infected with chlamydia

Tric hom onas

Protozoan STI

Frothy yellow-green discharge, odor

Unprotected sex, multiple partners

Metronidazole 2g PO single dose

Treat both partners

Cer vicit is

Inflammation of cervix often due to STI

Bleeding, discharge, pelvic pain

Chlamydia, gonorrhea

Treat based on causative organism

Can lead to PID

PID

Infection of upper reproductive tract

Pelvic pain, fever, cervical motion pain

Untreated STIs Ceftriaxone + doxycycline + metronidazole

Risk for infertility

HIV

Virus affecting immune system

Fever, fatigue, weight loss

Needle sharing, sex, mother-to- child

Antiretroviral therapy (ART)

Lifelong management

Syp hilis

Bacterial STI (Treponema pallidum)

Chancre, rash, systemic symptoms

Sexual contact with infected person

Penicillin G benzathine IM

Multiple stages; test with RPR/ VDRL

Table 2: STI Knowledge Questions

SOAP Note – Tina, 27-year-old Female

Subjective:

Chief Complaint (CC):
 “My vagina is burning, and I have painful blisters.”

HPI (OLDCARTS):

Hep B

Liver infection due to HBV

Fatigue, jaundice, nausea

Sexual contact, needle use

Supportive, antivirals for chronic cases

Vaccine available

Hep C

Liver infection due to HCV

Often asymptomatic, may cause fatigue

Blood-to-blood contact, needle sharing

Direct-acting antivirals (DAAs)

No vaccine; chronic if untreated

HS V

Herpes simplex virus (type 1 or 2)

Painful vesicles/ ulcers, fever

Sexual contact Acyclovir, Valacyclovir

Recurrent; no cure, only symptom management

Question Answer

Name 10 Risk Factors for contracting STIs and HIV

Unprotected sex, multiple partners, new partner, age <25, MSM, history of STIs, drug use, sex work, inconsistent condom use, partner with STI

Name 5 safer sex practices Use condoms, limit partners, regular testing, mutual monogamy, avoid sex under influence

Can HIV be transmitted through sweat, saliva, and tears?

No. HIV is not transmitted through sweat, saliva, or tears due to insufficient viral load

Name 2 types of intercourse at highest risk for contracting HIV

Anal sex (receptive), vaginal sex (receptive)

Why are women more susceptible to HIV in male-to- female transmission?

Larger mucosal surface area exposed, higher viral load in semen, potential microtears during sex

• The patient presented with a C/C of vaginal burning and painful blisters that began 3 days ago. The area of concern is in her left labia minora. The patient describes that blisters as painful and having a burning sensation with visible fluid-filled vesicles. Friction, urination, and tight clothing worsen the pain. The patient describes relief with cool compresses, and loose clothing. The discomfort is constant with intermittent sharp pain. She rates the pain a 6/10.

Medical History:

• no previous medical history

• no known allergies to drugs, food, or environmental factors

• no recent illnesses or hospitalizations

• vaccinations are up to date

Surgical History:

• No prior surgical history

Social History:

• #2 sexual partners in the last 6–12 months

• Use of protection (condoms)

• Tobacco, alcohol, recreational drug use, x2 a month socially

• sexual practices (oral, vaginal, anal)

Medications:

• Currently not on any medication

Allergies:

• NKDA (No Known Drug Allergies)

Objective:

Vital Signs:

• Temp: 98.6°F

• HR: 76 bpm

• BP: 112/70

• RR: 16/min

• SpO₂: 98% RA

Physical Exam:

• Genital Exam: Multiple small grouped vesicles on an erythematous base noted on the left labia minora, tender to palpation. No foul-smelling discharge. No cervical motion tenderness. No inguinal lymphadenopathy.

• Other Systems: Normal

Point of Care Testing (POCT):

• HSV PCR swab from lesion: High sensitivity and specificity for HSV-1 and HSV-2 (CDC, 2021)

• HIV rapid test: Recommended for new STI evaluation

• Urine NAAT for gonorrhea and chlamydia: Evaluate for co-infections

• Syphilis RPR and Hepatitis B/C screening: Per CDC recommendations for STI screening

Assessment/Diagnosis:

Presumptive Diagnosis:

• Genital Herpes Simplex Virus (HSV) Infection – ICD-10: A60.9

Rationale:

• Classic presentation of painful, fluid-filled vesicles on erythematous base, localized on labia minora, recent unprotected sex, no previous known episodes.

Differential Diagnoses:

1. Contact Dermatitis: Less likely—symptoms typically bilateral and not vesicular.

2. Chancroid: Rare in the U.S.; painful ulcers with ragged borders, not grouped vesicles.

3. Syphilis (Primary): Typically a painless chancre; not vesicular.

Plan:

Pharmacologic Treatment (Assuming HSV PCR Positive):

• Acyclovir 400 mg tablet PO TID for 10 days

Patient Education:

• Medication Use: Take all medication as prescribed, even if symptoms improve early.

• Side Effects: May include nausea, headache, dizziness.

• Transmission: Avoid sexual activity until lesions are fully healed. HSV can be transmitted even when asymptomatic.

• Safe Sex: Use condoms consistently to reduce recurrence transmission risk.

• Partner Notification: Partners should be informed and may need testing.

• Chronic Management: Discuss suppressive therapy if recurrences occur frequently (>6/ year).

Non-Pharmacologic Management:

• Keep area clean and dry.

• Use sitz baths and loose clothing.

• Apply cool compresses to soothe discomfort.

Follow-Up:

• Return to clinic in 1–2 weeks or sooner if symptoms worsen.

• Retesting or management for other STI test results as they return.

Complications of Non-Treatment:

• Increased risk of HIV transmission

• Severe and prolonged outbreaks, especially in immunocompromised patients

• Psychological distress

• Neonatal HSV transmission risk in future pregnancies