88. Sexually Transmitted Infections (24%) Flashcards
Nommez des symptômes sont atypiques ou non spécifiques d’une ITS
- dysurie
- infections vaginales récidivantes
Chez les patients à haut risque symptomatiques d’une ITS, traitez ou pas avant les résultats ?
Traitez les avant d’obtenir la confirmation des résultats par le laboratoire.
Après confirmation d’une ITS, débutez quoi ?
- le traitement du (des) partenaire(s) :
- la recherche des contacts avec l’aide d’organisme communautaire ou de la santé publique.
Devant un tableau clinique fortement suspect d’une ITS, quoi faire si test ITSS neg ?
malgré un résultat de test négatif, n’excluez pas le diagnostic d’une ITS
(c.-à-d. de sensibilité, de spécificité ou autres limitations des tests).
Describe the five Ps of STI history (5)
- Partners (past year)
- Practices (vaginal, oral, anal, other)
- Prevention : STI - condom use, Hep A/B vaccination
- Pregnancy/contraception
- Previous STI testing
Name : STI Risk Factors
- 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
Describe : Window period
Repeat testing at 6w, 12w, 6mo in the case of sexual assault
- 1w - Gonorrhea
- 2w - Chlamydia
- 12w - Syphilis, HIV, HBsAg /HCV Ab
If Gono/chlam negatiev and persisten symptoms, consider what?
other pathogens such as Mycoplasma genitalium, or Trichomonas vaginalis
Describe tx : Gonorrhea (3)
- Ceftriaxone 500mg IM x1
- If weight ≥150kg (300lb), Ceftriaxone 1g IM is recommended
- Treat concurrently for chlamydia if chlamydial coinfection not excluded
Describe tx : Gonorrhea (3)
- Chlamydia: Doxycycline 100mg PO BID x7d or Azithromycin 1g PO x1
- Doxycycline PO preferred for rectal chlamydia
- Azithromycin 2g PO preferred in pregnancy
Describe tx : Syphilis
Pen G
Describe trichomoniasis (3)
- green-yellow malodorous discharge
- burning
- dyspareunia
Describe tx : Trichomoniasis
- Metronidazole 2g PO x1
- Treat partner
Bacterial STI or trichomonas should abstain from unprotected sex until 7d after treatment of both partners complete
Describe tx : HSV1/HSV2
Acyclovir, Famciclovir ou Valacyclovir
Describe tx : HPV
- 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
Describe sx : BV (2)
- white-grey malodorous discharge
- no dyspareunia)
Describe tx : BV (2)
Metronidazole 500mg PO BID x7-14d or gel
Describe tx : Candidiasis (4)
- pruritus
- soreness
- white clumpy
- normal pH 4-4.5)
Describe tx : Candidiasis
Fluconazole 150mg PO x1 or topical cream/intravaginal/suppository (clotrimazole, miconazole)
Describe : Reporting to public health and partner notification
- Gono/chlam up to 60 days (or last partner if no sexual partners)
- Longer if syphilis, Hep B, HIV
Presumptive treatment of partners with how many days for who? (4)
- 90d for syphilis (if >90d can test first)
- 60d of symptoms (or most recent if >60d) for gono/chlam
- Current sex partners for trichomoniasis
- Notify HIV partners and PEP offered if within exposure within 72h
Refrain from sexual activity for how long after STI?
7d post-treatment (and 7d post-treatment for all partners) and resolution of symptoms
Describe follow-up testing in : Chlamydia
PCR >3w after treatment)
- Persistent symptoms
- Re-exposure
- Pregnancy
- Poor adherence
- Alternate antibiotic use (eg. Azithromycin to treat rectal)
- Chlamydia genotype L
Describe follow-up testing in : Gonorrhea
All gonorrhea given increasing resistance (PCR >2w after treatment, or culture >3d after treatment)
Describe follow-up testing in : 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
Describe signs/sx : Pelvic inflammatory disease (5)
Suspect in sexually active women with pelvic/lower abdominal pain and one of: Adnexal, cervical motion, uterine tenderness
Additional criteria to increase specificity
- 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)
How to confirm dx : Pelvic inflammatory disease (5)
Confirm with pelvic imaging (ultrasound, CT, MRI)
