Approach to STI

Question 1

what are the 5Ps to include in a sexual history?

Answer 1

P - partners - numbers, gender
P - practices - vaginal, oral, anal insertive/receptive
P - protection
P - past history of STIs
P - pregnancy prevention

Question 2

what are RF for STIs?

Answer 2

• sexually active <25Y
• unprotected sex, sex contact w/ known STI, pt previously had STI
• new sex partner or >2 partners in past 12M
• street-involved, homeless, +/- substance use

Question 3

what is the most common STI in canada? what are the top 4?

Answer 3

chlamydia

chlamydia > gonorrhea, HPV, genital herpes

Question 4

what is an STI?

Answer 4

infection w/ a pathogen that is transmitted by blood, semen, vaginal fluids or other bodily fluids during oral, anal, or genital sex with an infected partner

can be bacteria, virus, or parasite

Question 5

what are bloodborne STIs vs bodily fluid STIs?

Answer 5

bloodborn: HIV, hep B/C, syphilis

bodily fluids: chlamydia, gonorrhea

Question 6

T/F: gonorrhea has evolved and is gaining antimicrobial resistance

Answer 6

T, abx stewardship is important, should C&S to ensure tx is occuring

Question 7

what bacteria causes chlamydia?

Answer 7

chlamydia trachomatis
GN
anaerobic
intracellualr obligate

Question 8

what bacteria causes gonorrhea?

Answer 8

Neisseria gonorrhoeae
obligate human pathogen

Question 9

do pts with chlamydia and gonorrhea usually have s/s? Y/N

Answer 9

N
most pts are often asymptomatic reservoirs of disease

Question 10

in what populations is it important to screen for STIs?

Answer 10

• <25Y and sexually active
• MSM
• pregnancy
• known HIV
• those with known RF
• those with potential exposure

Question 11

common s/s that are shared between chlamydia and gonorrhea

Answer 11

• purulent discharge
• dysuria
• dyspareunia
• bleeding b/w periods or post-coital
• prostatitis
• epididymitis
• anal discharge, blood, pain

Question 12

what neonatal complications can result from chlamydia and gonorrhea if mom is infected during pregnancy?

Answer 12

neonatal pneumonia and conjunctivitis

Question 13

what is one or two s/s that are only found in chlamydia?

Answer 13

conjunctivitis, pharyngitis

Question 14

how do you tx chlamydia?

Answer 14

azithromycin one dose IM OR 7 day course of doxycycline

*tetracyclines are teratogenic in preg

Question 15

how do you tx gonorrhea?

Answer 15

ceftriazone
+ tx for chlamydia: azithromycin one dose or 7d course of doxycycline

Question 16

what STI ix do you run for females?

Answer 16

urine/endocervial/vaginal swab for NAAT and C&S
- tests for chlamydia, gonorrhea, BV, trichomoniasis, yeast

Pap – HPV

offer bloodwork for HIV syphilis, hep B and C

Question 17

what STI ix do you run for males?

Answer 17

first catch urine or urethral swab – tests for chlamydia and gonorrhea

offer bloodwork for HIV syphilis, hep B and C

Question 18

when should you offer repeat screening for someone post STI tx?

Answer 18

test of cure offer in chlamydia if STI not resolving or there are STI related cx

test of cure routine in gonorrhea

repeat screening recommended in 3-6M due to risk of reinfection

Question 19

what pt education would you provide to pts tested positive for STI?

Answer 19

abstain from having sex until at least 7d from the end of tx

safe sex practices

all sexual partners within 60d of positive test should also be tested

public health reporting - mandatory – discuss options, can be annonymous – can also have public health contact the partner

Question 20

what LT complications can arise from STIs?

Answer 20

pelvic inflammatory disease
infertility and increased risk of endometriosis - specifically in females
trachoma - blindness – for STI in eyes

Question 21

what abx are contraindicated in preg?

Answer 21

• tetracyclines
• chloramphenicol (lincosamide; protein synth inhibitor)
• fluoroquinolones (DNA synth inhibitor)
• streptomycin (aminoglycoside; PSI)
• sulfonamides drugs

Question 22

what are some examples of abx safe in preg?

Answer 22

• penicillin
• cephalosporins
• clindamycin