26. Infections transmissibles sexuellement Flashcards

1
Q

Sx ITSS 5 + 3

A

discharge,
dysuria,
abdominal pain,
testicular or vag pain,
skin changes

fever, weight loss, lymphadenopathy

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2
Q

questionner les 5 P

A

Partners (past year)

Practices (vaginal, oral, anal, other)

Prevention

STI - condom use, Hep A/B vaccination

Pregnancy/contraception

Previous STI testing

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3
Q

STI risk factors name 5 (11 total)

A

Previous STI

Sexual contact with person(s) known STI

Sexually active <25yo

New sexual partner

> 2 sexual partners in last year or serial one-partner relationships

No barrier contraception use

IVDU

Homelessness

Substance use, especially if associated with sex

Sex workers

Sexual assault

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4
Q

Phyical examination - ne pas oublier

A

oropharynx
inguinal lymph nodes
perianal inspection

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5
Q

Tests

A

1) Gonorrhea/Chlamydia NAAT PCR (first catch urine (any time of the day), urethral, vaginal, cervical, pharynx, rectal)

2) gono culture prior to tx due to increasing resistance

3) VDRL

4) VIH - doit être répété

5) HBV
HBsAg (Hepatitis B surface antigen): + = person is infected

anti-HBs or HBsAb (Hepatitis B surface antibody) = protected (aka past recovered infx or immunizé)

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6
Q

Périodes latentes

A

GONO : 14 jrs

chlam : 21 jrs

VIH, syphillis, HbSAg HCV: 3 mois

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7
Q

Quoi demander pour HBV et HVC comme test

A

HBV antigen and anticorps are enough

HBsAg (Hepatitis B surface antigen): + = person is infected

anti-HBs or HBsAb (Hepatitis B surface antibody) = protected (aka past recovered infx or immunizé)

NE PAS demanded: anti-HBc or HBcAb total (Hepatitis B core antibody) = car tout seul intérpétation vaut rien

Anti VHC totaux

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8
Q

HIV prophylaxis

A

Truvada plus raltegravir

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9
Q

si pas vacciné pour Hep B et exposé

A

Immunoglobulin (ideally test contact and give only if HBsAb positive)

Vaccine

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10
Q

WHen to restest for HIV, HBV, HCV

A

HIV 6w, 12w after exposure

Repeat serology 2 months after vaccine series

HCV RNA 3w after exposure (or HCV Ab 6 months after exposure)

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11
Q

If Gono/chlam negative and persistent symptoms, consider other pathogens such as

A

Mycoplasma genitalium

Trichomonas vaginalis

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12
Q

Tx codes in Qc

A

Code K ( Patient)

Code L (Partner) (lover)

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13
Q

Gono antibiotic tx

A

Gonorrhea: Ceftriaxone 500mg IM x1 (or alternative: Cefixime 800mg PO x1)

If weight ≥150kg (300lb), Ceftriaxone 1g IM is recommended

Treat concurrently for chlamydia if chlamydial coinfection not excluded

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14
Q

Chlamydia tx

A

Doxycycline 100mg PO BID x7d
or
Azithromycin 1g PO x1(if risk of non compliance but resistance!)

Doxycycline PO preferred for rectal chlamydia

Azithromycin 2g PO preferred in pregnancy

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15
Q

Trichomoniasis tx

A

Metronidazole 2g PO x1

Treat partner

Bacterial STI or trichomonas should abstain from unprotected sex until 7d after treatment of both partners complete

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16
Q

Syphilis tx depending which stage vs late latent or teriary neurosyphilis

A

Primary, secondary, and early latent syphilis:

Pen G 2.4 million units IM x1

Late latent (>1y from likely infection) or tertiary (gummatous or cardiovascular disease):
Pen G 2.4 million units IM once weekly x 3 weeks

Tertiary neurosyphilis
Pen G 3-4 million units IV q4h x 10-14d

17
Q

HSV1 tx

A

gingovostomatitis +/- pharyngitis, then recurrent herpes labialis

ACUTE
within 72h or ongoing new lesions/pain):
Valacyclovir 1000mg PO BID x 7-10d

if severe odynophagie - consider IV tx

Recurrent episodic: Famciclovir 1500mg PO x 1 dose or Valacyclovir 2g PO BID x 1 day

Chronic: Valacyclovir 500mg PO daily

18
Q

HSV2

A

Genital herpes simplex

ACUTE
within 72h or ongoing new lesions/pain):
Valacyclovir 1000mg PO BID x 7-10d (idem à labial)

Recurrent episodic: Famciclovir 1000mg PO BID x 1 day, Valacyclovir 500mg PO BID x3d

Chronic suppressive: Valacyclovir 500-1000mg PO daily

19
Q

HPV lesions

A

Imiquimod 5% cream qHS 3/week x 15w, wash off after 6-10h

Podofilox 0.5% solution BID x3d then none x4d, repeat PRN x4

Cryotherapy

20
Q

bacterial vaginosis

A

metronidazole 500mg PO BID x 7-14 jrs

21
Q

candidiase

A

fluconazole 150 mg PO x 1

22
Q

MADO

A

gono
chlam

VIH - seulement si la personne infectée a donné ou reçu du sang, des produits sanguins, des organes ou des tissus*

Hépatites virales* (ex. : VHA, VHB, VHC)

malaria

coqueluche diphterie rougeole etc

23
Q

WHen to do follow up testing

A

Chlamydia (PCR >3w after treatment)

Persistent symptoms

Re-exposure

Pregnancy

Poor adherence

Alternate antibiotic use (eg. Azithromycin to treat rectal)

Chlamydia genotype L

*
All gonorrhea given increasing resistance (PCR >2w after treatment, or culture >3d after treatment)

*
Syphilis

Primary, secondary, early latent infection: Repeat serology at 1, 3, 6 and 12 months after treatment

Late latent: Repeat serology 12 and 24 months after treatment

*
Follow-through on partner notification

24
Q

PID : Pelvic inflammatory disease / Maladie inflammatoire pelvienne quand suspecter

A

Sexually active women with pelvic/lower abdominal pain and one of: Adnexal, cervical motion, uterine tenderness

Abnormal cervical or vaginal mucopurulent discharge or cervical friability

Positive Chlamydia/Gonorrhea

Oral T>38.3

Abundant WBC (>15 WBC per hpf) on saline microscopy of vaginal secretions

Elevated ESR/CRP (less specific)

??? Confirm with pelvic imaging (ultrasound, CT, MRI)

25
Q

PID tx

A

Mild-moderate with Ceftriaxone 500mg IM x1 + Doxycycline 100mg PO BID x 14d (+/- Metronidazole 500mg PO BID x 14d for T vaginalis or anaerobic coverage for recent instrumentation)

Severe or complicated (eg. tubo-ovarian abscess) with Clindamycin 900mg IV q8h + Gentamicin 1.5mg/kg IV q8h x 14d (step down to Doxycycline)

Consider treating male partners if sexual contact 60d prior (or if >60d, most recent) to patient’s onset of symptoms (eg. Ceftriaxone 250mg IM, PLUS Azithromycin 1g PO x1 or Doxycycline 100mg PO BID x 7d)

Avoid sex until patient and partners adequately treated and asymptomatic

Re-assess if need to remove IUD 3d post -treatment