Approach to STI Flashcards
what are the 5Ps to include in a sexual history?
P - partners - numbers, gender
P - practices - vaginal, oral, anal insertive/receptive
P - protection
P - past history of STIs
P - pregnancy prevention
what are RF for STIs?
- 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
what is the most common STI in canada? what are the top 4?
chlamydia
chlamydia > gonorrhea, HPV, genital herpes
what is an STI?
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
what are bloodborne STIs vs bodily fluid STIs?
bloodborn: HIV, hep B/C, syphilis
bodily fluids: chlamydia, gonorrhea
T/F: gonorrhea has evolved and is gaining antimicrobial resistance
T, abx stewardship is important, should C&S to ensure tx is occuring
what bacteria causes chlamydia?
chlamydia trachomatis
GN
anaerobic
intracellualr obligate
what bacteria causes gonorrhea?
Neisseria gonorrhoeae
obligate human pathogen
do pts with chlamydia and gonorrhea usually have s/s? Y/N
N
most pts are often asymptomatic reservoirs of disease
in what populations is it important to screen for STIs?
- <25Y and sexually active
- MSM
- pregnancy
- known HIV
- those with known RF
- those with potential exposure
common s/s that are shared between chlamydia and gonorrhea
- purulent discharge
- dysuria
- dyspareunia
- bleeding b/w periods or post-coital
- prostatitis
- epididymitis
- anal discharge, blood, pain
what neonatal complications can result from chlamydia and gonorrhea if mom is infected during pregnancy?
neonatal pneumonia and conjunctivitis
what is one or two s/s that are only found in chlamydia?
conjunctivitis, pharyngitis
how do you tx chlamydia?
azithromycin one dose IM OR 7 day course of doxycycline
*tetracyclines are teratogenic in preg
how do you tx gonorrhea?
ceftriazone
+ tx for chlamydia: azithromycin one dose or 7d course of doxycycline
what STI ix do you run for females?
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
what STI ix do you run for males?
first catch urine or urethral swab – tests for chlamydia and gonorrhea
offer bloodwork for HIV syphilis, hep B and C
when should you offer repeat screening for someone post STI tx?
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
what pt education would you provide to pts tested positive for STI?
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
what LT complications can arise from STIs?
pelvic inflammatory disease
infertility and increased risk of endometriosis - specifically in females
trachoma - blindness – for STI in eyes
what abx are contraindicated in preg?
- tetracyclines
- chloramphenicol (lincosamide; protein synth inhibitor)
- fluoroquinolones (DNA synth inhibitor)
- streptomycin (aminoglycoside; PSI)
- sulfonamides drugs
what are some examples of abx safe in preg?
- penicillin
- cephalosporins
- clindamycin
