2: STIs Flashcards
A variety of clinical syndromes caused by pathogens that can be acquired and transmitted through sexual activity.
STIs
This older term primarily described gonorrhea and syphilis.
Venereal disease
Risk factors for STIs.
- Previous or current sexually transmitted infection
- Sex with multiple or new partners
- Initiating sex at a young age
- Unprotected sex
- Sex with high-risk partners
- Sex with an partner who has HIV
- Sex in exchange for money or drugs
- Sex while intoxicated
- Illegal drug use
- Injection drug use
- Mental illness
- Age < 25 years
- Living in an area with high sexually transmitted infection/HIV prevalence
- Residing in a detention or correctional facility
T/F Women are biologically more likely to become infected with STIs than men. Women are also more likely than men to acquire an STI from a single heterosexual sexual encounter.
True
T/F Women are 2-3x more likely to transmit HIV to men.
False. MEN are 2-3x more likely to transmit HIV to WOMEN.
Why are women more likely to get STIs?
- The vagina has a larger amount of genital mucous membranes exposed and is an environment more conducive to development of infections than the penis.
- Risk for trauma is greater during vaginal intercourse for women than for men
T/F Women are more likely to have asymptomatic STIs.
True. Often results in delayed treatment.
Besides problems with fewer symptoms, why might it be more difficult to diagnose women with STIs?
The anatomy of a woman makes a physical exam more difficult.
Why are adolescents more likely to get STIs?
- Lack of immunity and biologic susceptibility.
- More immature cervix. These cells recede into the cervix as a woman ages.
T/F Risk for PID can increase both with vaginal douching and greater frequency of douching.
True
Why do anal intercourse, sex during menses, and dry sex increase risk of STIs?
The bleeding and tissue trauma facilitates invasion by pathogens.
The central (endocervical) columnar epithelium protrudes out through the external os of the cervix and onto the vaginal portion of the cervix, undergoes squamous metaplasia, and transforms to stratified squamous epithelium.
Cervical ectropion
Poverty, lack of education, immigration status, and inadequate access to health care are examples of what kind of factors for STI transmission?
Social factors
T/F Women who are abused are at higher risk of STIs.
True. This may be due to lack of ability to exercise control in the situation (negotiating condom use).
Why are women who have sex with women at risk for STIs?
They may have had intercourse with a man by choice, by force, or by necessity. Their female partners may also have other STI risk factors, such as injection drug use.
What is a key factor of STI spread within geographic areas?
Sex partner mixing
How do drugs and alcohol increase risk for HIV?
- They undermine cognitive and social skills, making it more difficult to engage in protective actions.
- Decreased functioning also makes it difficult to clean drug equipment.
What education is necessary for diagnosis of STIs?
Men and women must know how to recognize the s/s of STIs or they won’t seek help.
Who should be screened for STIs?
All women who are sexually active. Through history, physical exam, and lab studies based on risk factors.
What are the 5 Ps of sexual health?
- Partners: Do you have sex with men, women, both? In the past 2 months, how many partners? In the past 12 months, how many partners? Is it possible that any partners in past 12 months had sex with someone else at the same time?
- Practices: Have you had vaginal sex? Do you use condoms? Have you had anal sex? Do you use condoms? Have you had oral sex?
- Prevention of Pregnancy: What are you doing to prevent pregnancy?
- Protection from STIs: What do you do to protect yourself?
- Past History of STIs: Have you ever had an STI? Have any of your partners ever had an STI?
Which of these are risk factors for STIs?
- Frequent vaginal infections
- Unusual vaginal discharge or odor
- Vaginal itching, burning, sores, or warts
- Sexually transmitted infections (ask about individual infections)
- Abdominal pain
- Pelvic inflammatory disease/infection of the uterus, tubes, ovaries
- Sexual assault/rape
- Physical, emotional, sexual abuse
- Abnormal Pap test
- Pain or bleeding with intercourse
- Severe menstrual cramps occurring at end of period
- Ectopic pregnancy
All of them.
When assessing for STIs, what is the first step?
Generally, a history should be taken while fully dressed.
When discussing STIs, the clinician must make sure the woman understands what about her infection?
- Which infection.
- How it is transmitted.
- Why it must be treated.
When describing a patient’s STI, what should the clinician include?
- Modes of transmission
- Incubation period
- Symptoms
- Infectious period
- Potential complications
T/F Women with HIV are likely more infectious during menses.
True
Which STIs are mandatory for reporting?
- Chancroid
- Chlamydia
- Gonorrhea
- Hepatitis
- HIV
- Syphilis
Which STIs are most common in sexually assaulted women?
- Gonorrhea
- Chlamydia
- Trichomoniasis
Which age group has the lowest rates of STIs?
Peri- and postmenopausal women
What is a possible risk for STI transmission in older women?
In older women, the dry, friable vaginal tissue that results from vulvovaginal atrophy associated with declining estrogen levels in menopause may increase microabrasions with intercourse and increase the risk for STI transmission.
Which strains of HPV cause 90% of genital warts?
- 6
- 11
Which strains of HPV that occasionally found in genital warts are associated with cervical intraepithelial neoplasia?
- 16
- 18
- 31
- 33
- 35
70% of all cervical cancer is caused by these 2 strains of HPV.
- 16
- 18
When is HPV vaccination recommended?
- Girls 11-12 years.
- Can be given as young as 9.
- Recommended for 13-26 who are not vaccinated.
T/F HPV vaccination is not recommended for women with HPV infection.
False. It protects against strains not yet encountered.
How are HPV vaccines given?
- 3 IM injections over a 6-month period.
- 2nd dose given 1-2 months after 1st (at least 4 weeks).
- 3rd dose given 6 months after 1st (at least 12 weeks).
T/F HPV vaccines are not recommended during pregnancy and lactation.
False. They are not recommended during pregnancy but can be given during lactation.
Which HPV vaccines are contraindicated in yeast hypersensitivity?
Quadrivalent and 9-valent.
How should an HPV bivalent vaccine be dosed in a woman with latex allergy?
Bivalent must be dosed from a single-dose vial rather than a prefilled syringe.
What has been reported after administration of HPV vaccine?
Syncope
T/F Women with HPV need more frequent pap tests.
False
T/F HPV testing is unnecessary in sexual partners of persons with genital warts. In contrast, STI screening for both sex partners is beneficial if one partner has genital warts.
True
Which HPV treatments are not safe during pregnancy?
- Podophyllin
- Sinecatechins
- Imiquimod
T/F HPV warts necessitates a c-section.
False. Unless the vaginal opening is blocked by large warts, a c-section is not warranted. Risk of transmission to newborn is low.
Which HSV infection increases risk of HIV?
HSV-2
_____ is common with initial HSV-2 infections.
Cervicitis is common with initial HSV-2 infections.
Why would urinary retention and dysuria occur with HSV?
Autonomic involvement of the sacral nerve root.
Ointments containing cortisone should be avoided with this infection. Occlusive ointments may prolong course of infection.
Herpes
A woman with a pain genital ulcer has recently returned from Africa. What is a likely diagnosis?
Chancroid (more common in Africa and the Caribean)
When does improvement begin with chancroid treatment?
- Reexamine in 3-7 days.
- Symptomatic improvement should be seen by 3 days.
- Clinical improvement by 7 days.
What is the incubation period for chancroid?
Usually 4-7 days, but could be as long as 3 weeks.
Which treatment for chancroid should be avoided in pregnancy?
Ciprofloxacin
When taking ivermectin for lice, what will increase bioavailability?
Take with food.
Which treatment for lice should be avoided in pregnant women?
Topical lindane
What is the recommended treatment for trichomoniasis in pregnant women?
Metronidazole 2 gm orally as single dose.
What is the recommended treatment for trichomoniasis in HIV-infected women?
Metronidazole 500 mg BID for 7 days. Single dose treatments are less effective in HIV.
While many women with chlamydia are asymptomatic, what are possible symptoms?
- Vaginal spotting
- Postcoital bleeding
- Mucoid or purulent cervical discharge
- Urinary frequency
- Dysuria
- Lower abdominal pain
- Dyspareunia
- Symptoms may mimic those of a UTI.
When is a test of cure (3-4 weeks) necessary with chlamydia?
- Pregnant women
- Persistent symptoms
- Unable to complete treatment
How long should you wait after chlamydia and gonorrhea treatment before having sex?
7 days
What treatment for chlamydia should be used in pregnancy?
Macrolide abx (azithromycin or erythromycin)
Which STIs have the highest coinfection rates and someone infected with one should be treated for the other?
Gonorrhea and chlamydia
When should cefixime be prescribed for gonorrhea?
Only if ceftriaxone is not available. There are concerns about resistance.
When should patients with gonorrhea infections be retested and why?
3 months after treatment d/t high rates of reinfection.
How should gonorrhea be treated in pregnancy?
Dual therapy of ceftriaxone 250 mg IM and azithromycin 1 gm orally as single dose.
While not necessary for diagnosis, what lab tests are recommended in severe PID?
- CBC
- ESR
Increase specificity of PID diagnosis.
When should pelvic ultrasound be performed in PID?
- Women requiring hospitalization.
- Women with a pelvic mass found upon examination.
T/F PID requires hospitalization.
False. Many are treated as outpatients with no reproductive sequelae.
What are diagnostic criteria for PID?
- Experiencing pelvic or lower abd pain.
- No cause for the illness other than PID found.
- One or more criteria are met:
- Cervical motion tenderness.
- Uterine tenderness.
- Adnexal tenderness.
When does substantial clinical improvement occur in PID?
Within 72 hours of beginning treatment.
When would an IUD be removed in PID?
If no response to treatment within 48-72 hours.
Where is the primary lesion in syphilis found?
Usually on the genitalia, but sometimes on the cervix, perianal area, or mouth.
When is syphilis only transmitted vertically?
Late latent (>1 year)
When is syphilis not infectious?
During tertiary stage.
When using VDLR or RDR for syphilis testing, what usually indicates disease?
- A high titer (more than 1:16) is usually indicative of active infection.
- A 4-fold change in titer (1:16 to 1:4 or 1:8 to 1:32) is considered clinically significant.
What suggests reinfection or treatment failure in syphilis?
Failure of titer to increase or decrease 4-fold.
When are treponenal tests (FTA-ABS and TP-PA) used in syphilis?
They are used to confirm positive nontreponemal tests.
When does seroconversion occur in syphilis?
6-8 weeks after exposure. So testing should be repeated 1-2 months after a genital lesion appears.
How is treatment monitored in syphilis?
VDRL or RPR titer tests.
When would followup testing be done in syphilis?
6, 12, 24 months. 24 months only with latent or unknown-duration syphilis.
What can happen with syphilis treatment that might be misunderstood as an allergic reaction to penicillin?
Jarisch-Herxheimer Reaction
How long after starting treatment should sex be avoided in syphilis?
Until chancre is completely healed. Use condoms until testing confirms response to treatment.
Women who experience intrauterine fetal demise (IUFD) should be screened for what?
Syphilis
How should pregnant women who are allergic to penicillin be treated in cases of syphilis?
They should be desensitized and treated with penicillin.
