27/28 - STDs Flashcards
Chlamydia Trachomatis
Transmission & Long Term Complications
Typical - Anal/Vaginal/Oral Sex
- *Vertical Transmission**
- -> Baby = conjunctivitis & pneumonia
Long Term Complications:
Damage to FEMALE Reproductive system
10% of untreated women:
PID / Chronic pelvic pain / infertility / felopian tube dmg
Syphilis
DIAGNOSIS / TESTS
Serologic Tests:
RPR** + **EIA
need BOTH to confirm disease
RPR = non-treponemal & non-specific
measured titer –> used to monitor TX response or Re-Infection
correlates w/ disease activity
4-Fold Titer change = CLINICALLY SIGNIFICANT
1:2 = lowest
EIA = treponemal & specific
CONFIRMS DISEASE
but is positive for ENTIRE life –> can’t tract treatment progression
LATENT SYPHILIS
Presentation
- Untreated Primary or Secondary Stage*
- LACKS CLINICAL MANIFESTATIONS*
Detected by:
Serologic Testing = RPR + EIA
EARLY LATENT SYPHILIS
acquired within 12 months & patient remains INFECTIOUS
LATE LATENT SYPHILIS
acquired >1 year or unknown duration
thought to be NON-infectious
Treated like TERTIARY syphilis
Chlamydia Trachomatis
Testing & Follow-Up
NAAT
Nucleic Acid Amplification Test
Urine Sample –> 24 hour return
also for RECTAL & OROpharyngeal SWABS
RTC in 3 MONTHS
for ALL, to check for RE-INFECTION (common)
or RTC if sx persist after treatment
PARTNER NOTIFICATION
refer all sex partners in past 60 DAYS
EPT = expidited partner therapy
Neurosyphilis
TREATMENT
PCN ALLERGY
CSF Evaluation (Lumbar Puncture) –> confirm diagnosis
LIMITED DATA - NO GOOD ALTERNATES
- *Ceftriaxone 2gm QD IM/IV**
- *IM/IV for 10-14 days**
PREGNANT PATIENTS:
Can’t take Doxy –> PCN DESENSITIZATION
HERPES
Primary Infection
Signs & Symptoms
Incubation period b4 onset of lesions = 5 days
w/o tx –> 20-30 day infection
One or MORE blisters
on or around genital area, can break and leave a
PAINFUL SORE
that takes weeks to heal
(Syphilis is only 1 blister and no pain)
1/3 show systemic sxs:
fever / malaise myalgia
1-10% develop:
aseptic meningitis - neck rigidity / HA
HERPES
S/Sx
- *PRODROMAL**
- *burning / itching / tingling** @ site of infection
- -> lesion within 12-24hr
TREAT ASAP
- *Almost ALL persons** w/ symptomatic 1st HSV episode get recurrence of genital lesions
- *3-4 episodes a year**
- *Reactivates periodically** caused by factors:
- *stress / UV light / menses / trauma / illness**
Late Latent** & **Tertiary Syphilis
TREATMENT
- *Benzathine Penicillin G 2.4mil units IM**
- *WEEKLY** for 3 WEEKS
if patients MISS >14 days –> START OVER
Late latent
no sxs+confirmed by RPR + EIA
> 1 year or Unknown
Tertiary Syphilis
CV Complications + Gummatous Lesions
1/3 of patients untreated –> 10-30 years later
Neisseria Gonorrhea
Gonococcal Cervicitis
1st Line Treatment
CEFTRIAXONE 250mg IM
oral doesnt have high bactericidal levels at anatomic sites
+
Azithromycin 1g
OR
Doxycycline 100mg BID x7days
for Chlamydia coverage
quinolones are RESISTANT now
& resistance to cephalosporins are rising –> surveillance is crucial
Chlamydia Trachomatis
Male & Female
SYMPTOMS
MOST COMMONLY: ASX DISEASE
reason for ROUTINE screening = women <25y/o q1year
Symptoms occur 1-3 weeks AFTER & are similar to UTI
Burning urination / Dysuria
Discharge
Swollen lymph nodesingroin
symptoms are SIMILAR to GONORRHEA
What STD has this condition and what is it?
SeroFast
SYPHILIS
Pts continue to have low RPR titers d
espite adequate treatment
Ex.
1:2 or 1:4 for many years
Syphilis
Epidemiology & Transmission
- *MEN** > Women
- *MSM epidemic**
Caused by:
Treponema Pallidum = Spirochete
Sexual contact w/ infectious lesions during:
PRIMARY** or **SECONDARY
stages
less common in utero / non-genital body contact w/ infectious lesions / blood borne
SYPHILIS
COUNSELING
Important for PARTNERS & INFECTED
Initiate treatment for recurrent disesae
@time of PRODROMAL SXs or 1st Blister
Transmission can occur during ASx periods
NO SEX
when lesions/prodromal Sxs present = highest risk of infection
CONDOMS
Neisseria Gonorrhea
Testing & Follow-Up
NAAT
Nucleic Acid Amplification Test
Bacterial culture –> ANTIMICROBIAL RESISTANCE TEST
Alternate Regimen** –> **RTC for TEST OF CURE in 14-21 DAYS
PARTNER NOTIFICATION
refer all sex partners in past 60 DAYS
RTC in 3 MONTHS?? - was for Chlamydia
for ALL, to check for RE-INFECTION (common)
Neisseria Gonorrhea
PREGNANCY
Treatment & Special Considerations
- *SAME AS NORMAL TREATMENT**
- except DOXY is C/I in pregnancy*
CEFTRIAXONE 250mg IM
+
Azithromycin 1g
Repeat NAAT (3 weeks) to confirm eradication
– FOR PREGNANT
HERPES
Supressive Treatment for Recurrent disease
Supressive Therapy –> ↓outbreaks by 70-80%
↓Frequency & ↓Risk of HSV transmission
- BUT*
- *Can result in DRUG RESISTANCE**
Recommended doses:
- *Acyclovir 400mg BID**
- *Valacyclovir 1g QD**
Neisseria Gonorrhea
Testing Recommendations?
CDC Recommendations:
ANNUAL GONORRHEA TESTING FOR:
All Sexually active WOMEN <25yo
(Same as Chlamydia)
commonly co-infected with CHLAMYDIA
Late Latent** & **Tertiary Syphilis
TREATMENT
PCN ALLERGY
Doxycyline 100mg BID
for 28 DAYS
+ close clinical & serologic follow-up
Late latent
no sxs+confirmed by RPR + EIA
> 1 year or Unknown
Tertiary Syphilis
CV Complications + Gummatous Lesions
1/3 of patients untreated –> 10-30 years later
HERPES
DIAGNOSIS
Clinical Diagnosis
most common, just can tell
PCR
is the preferred assay to CONFIRM
but is not often done –> need to scrape base of lesion
Serologic Testing
also available, but seldom used, just tells you if you had it
Syphilis
Secondary Stage Presentation
Untreated infxn –> hematogenous dissemination
in 4-8 weeks after Chancre appreance
“Great Imitator”
Variety of Sxs –> affect many organs
RASH on PALMS & SOLES
is most common, but can occur in other areas
Tongue Lesions** + **ALOPECIA
Lymphadenopathy / low grade fever / weight loss
pain in bone + joints
Chlamydia Trachomatis
PREGNANCY
Treatment & Special Considerations
Azithromycin 1g Single dose
STILL THE SAME
For Pregnant w/ allergy:
- *Amoxicillin 500mg TID x7days**
- Doxycycline & Quinolone (levo) are C/I in pregnancy*
REPEAT NAAT** in **3 WEEKS
to confirm eradication for PREGNANCY:
Still RTC 3 months later & possibly for 3rd trimester
to avoid vertical transmission / neonatal infxn
Syphilis
Primary Stage Presentation
CHANCRE
Single - PAINLESS ulcer
stage where spirochetes enter body
Sxs occur ~3 weeks after exposure
Ulcer will heal with scarring 2-8 weeks REGARDLESS of Treatment
Chlamydia
Epidemiology
WOMEN 66% > men
BOTH are ASx (asymptomatic)
Most Common in:
Adolescents** & **Young Adults
MOST COMMON STD
Intracellular Bacterium
Neurosyphilis
Presentation
Can occur at:
ANY STAGE of Disease
typically 2mo-2years after initial infxn
Treponemal Invasion of CNS
Symptoms:
Meningitis-like = Alterned Mental Status
Cranial Nerve Dysfxn / Stroke / Sensory-motor deficit
Primary / Secondary / Early Latent (<1 yr)
TREATMENT
PCN ALLERGY
Doxycycline 100mg BID x 14 days
requires close serologic follow up –> more likely to have tx failure
Primary
Chancre
Secondary
sytematic symptoms
rash on palm/soles + alopecia + fever + weight loss
Early Latent
no sxs - confirmed by RPR + EIA
but < 1 year
Primary / Secondary / Early Latent (<1 yr)
TREATMENT
Benzathine PENICILLIN G 2.4mil units IM
for one dose, 1.2mil/syringe into each gluteus
Primary
Chancre
Secondary
sytematic symptoms
rash on palm/soles + alopecia + fever + weight loss
Early Latent
no sxs - confirmed by RPR + EIA
but < 1 year
Chlamydia Trachomatis
1st Line Treatment
Azithromycin 1g
in one dose
NO RESISTANCE FOUND + improved adherence
OR
Doxycycline 100mg BID x7days
NOT FOR WOMEN
may be more effective for Rectal infxn / LGV (caused by C serovars)
RTC in 3 MONTHS
HERPES
Severe Disease
Classification&TREATMENT
Disseminated Infxn
severe morbidity / mortality –> hospitilization
Pneumonia / Hepatitis / Encephalitis
IV ACYCLOVIR 5-10 mg/kg** **q8h
for 10 days
HSV ENCEPHALITIS** –> **21 DAYS
HERPES
Recurrent / Episodic
TREATMENT
- *Acyclovir 400mg TID**
- *x5 days**
- *Valacyclovir 1gm QD**
- *x5 days**
topical not effective
HERPES
1st Episode TREATMENT
- *Acyclovir 400mg TID**
- *7-10 days**
- *Valacyclovir 1gm BID**
- *7-10 days**
Start within
24 HOURS of First Episode
Neisseria Gonorrhea
Gram (-) Diplococci
Male & Female
SYMPTOMS
MALES have Sx
Burning urination / Dysuria / Discharge - 90% have sxs by day 5
DGI = Disseminated Gonococcal Infection:
petechial skin rash, septic arthritis, endocarditis, meningitis
FEMALES** = **often ASx 50%
untreated –> PID / tubal scarring / infertility
Syphilis
MONITORING
Test RPR Titers** –> fall by at least **4-fold
@
6 / 12 / 24 months
takes a MONTHS for RPR to decline
For SEX PARTNERS:
Persons exposed for 90** **DAYS should be referred for treatment
if serologic test not available
was 60 days for other
Chlamydia Trachomatis
Alternate Treatment / Allergic
Levofloxacin 500mg BID x7days
RTC in 3 MONTHS
For Pregnant w/ allergy:
Amoxicillin 500mg TID x7days
Doxycycline & Quinolone (levo) are C/I in pregnancy
Neurosyphilis
TREATMENT
CSF Evaluation (Lumbar Puncture) –> confirm diagnosis
HOSPITILAZTION REQUIRED:
- *Aqueous Crystalline Penicillin G 18-24mil units**
- *3-4mil units IV q4 hours** for 10-14 days
Can occur at:
ANY STAGE of Disease
typically 2mo-2years after initial infxn
Treponemal Invasion of CNS
Symptoms:
Meningitis-like = Alterned Mental Status
Cranial Nerve Dysfxn / Stroke / Sensory-motor deficit
Chlamydia Trachomatis** & **Neissria Gonorrhea
Important Counseling
CONDOM USE
PARTNER NOTIFICATION
all sex partner in past 60 days
EPT = expidited partner therapy
RTC in 3 Months
for all to check for re-infection, RTC if sxs PERSIST
pregnant is 3WEEKS
Avoid SEX for 7 DAYS after tx** & **after sex partners treated
HIV + Syphilis Testing
Neisseria Gonorrhea
Alternate Treatment / Allergic
when CEFTRIAXONE IM is NOT available:
CEFIXIME 400mg PO single dose
+
Azithromycin 1gm OR Doxycyline 100mg BID x7days
- if severe PCN/Cephalosporin Allergy:*
- *GEMIFLOXACIN 320mg_ + _Azithromycin 2GM single dose**
- zithro has gonorrhea activity but needs 2GRAM DOSE*
Alternate Regimen: RTC for TEST OF CURE (NAAT) in 14-21 Days
Chlamydia Trachomatis
Testing Recommendations?
CDC Recommendations:
ANNUAL CHLAMYDIA TESTING FOR:
All Sexually active WOMEN <25yo
+
All MSM (male sex w/ male)
+
Sexually active HIV infected persons
Neisseria Gonorrhea
Gram (-) Diplococci
Transmission & Long Term Complications
Typical - Anal/Vaginal/Oral Sex
- *Vertical Transmission** –> Baby
- *Co-infection w/ Chlamydia is COMMON**
Long Term Complications:
- *Damage to FEMALE Reproductive system**
- *PID** / Chronic pelvic pain / infertility / felopian tube dmg
Which STD has the ADR of:
Jarisch Herxheimer Reaction
and what is it?
SYPHILIS
Acute Febrile Rxn = HA / Myalgia / Fever
within the first
48 hours of treatment
most common in those with high RPR primary disease
treat with Antipyretics
Neisseria Gonorrhea
EPIDEMIOLOGY
- *MEN** > Women
- but might be because* MEN have Sx –> reported
Gram (–) Dipococci
2nd Most Common
Herpes
Epidemiology
HSV-1** or **HSV-2
Genital / Oral
chronic/lifelong viral infection = NOT curable
Recurrence is MALE > Female, 3-4 episodes for first few years
Transmission:
Typically occurs in patients UNAWARE they have infxn
Active lesions –> MORE INFECTIVE
VERTICAL TRANSMISSION
TERTIARY SYPHILIS
Presentation
1/3 of patients who have not been treated –> tertiary
10-30 years
AFTER initial infection
CARDIOVASCULAR COMPLICATIONS
+
GUMMATOUS LESIONS
