B8.053 Update on Sexually Transmitted Diseases Flashcards
criteria that justify routine screening
- serious health disorder that can be detected before symptoms develop
- treatment more beneficial when begun before symptoms develop
- reliable, inexpensive, acceptable screening test
- costs of screening are reasonable in relation to anticipated benefits
sites/sources of screening for STDs
cervix urine vaginal (self collected) serum saliva (HIV) male urethra
technologies for STD screening
antibody response: syphilis
NAAT: chlamydia, HSV
culture: help with resistance panels for gynococci
microscopy
vaccines for STDs
HBV
HPV
mayyybe GC (coming)
characterize chlamydia trachomatis
gram indeterminate (most closely related to gram -)
unique biphasic life cycle
-elementary bodies transmit the disease
-reticular body infective form (intracellular growth within host cells)
diseases caused by chlamydia
urethritis
cervicitis
PID
long term sequelae of chlamydia
fallopian tube damage
infertility
ectopic pregnancy
why is chlamydia the silent epidemic
most are asymptomatic
don’t need symptoms to still suffer from long term sequelae
how is chlamydia trending in the US?
going up
who should be screened for chlamydia
women under 25 presenting for a regular office visit
recommended treatment of chlamydia
azithromycin 1g PO single dose
doxycycline 100 mg po BID for 7 days
alternative ttx for chlamydia
erythromycin 500 mg po QID for 7 days
ofloxacin 300 mg po BID for 7 days
levofloxacin 500 mg po q d for 7 days
does screening help prevent chlamydia associated sequelae?
yup
canadian study
what % of women who should be screened for chlamydia actually get screened
50ish percent or less
gonorrhea on gram stain
gram neg diplococci
gonorrhea discharge
white, purulent
women can be asymptomatic
culture medium for gonorrhea
thayer-martin
chocolate
look for abx resistance
is gonorrhea going up in the US
yup
what is stressful about treating gonorrhea
rapidly develops resistance
when we use one antibiotic a lot, we can’t use it indefinitely
dont want to hit 5% elevated MIC
treatment of gonorrhea
ceftriaxone 250 mg in a single IM dose PLUS azithyomycin 1 g PO in a single dose OR doxycycline 100 mg PO BID for 7 days
characterize HPV
small DNA virus
>100 types, 20 infect genital tract
cancer causing HPV
16, 18
wart causing HPV
6, 11
description of HPV genital warts
raised, dry
no exudate
not much induration
patient applied treatment for genital warts
podofilox, imiquimod, or sinecatechins
provider applied treatment for genital warts
podophyillin
cryotherapy
trichloroacetic acid
syphilis primary chancre
8-10 mm sore indurated firm lots of lymphocytes no exudate "clean"
who do you see syphilis chancres on?
men
women are usually inside vagina or on cervix, not visualized and asymptomatic
secondary syphilis sign
palmar, plantar rash
blanches with pressure (vasculitis)
what does the increase in congenital syphilis parallel
increase in women with primary and secondary syphilis
treatment of syphilis
benzathine penicillin G
- 4 million units IM
- long acting depo
- spirochetalcidal level for several weeks
traditional syphilis screening sequence
RPR > TP-PA
reverse syphilis screening sequence
EIA or CIA > qualitative RPR > if negative TP-PA
guidelines for prevention of congenital syphilis
screening
-first prenatal visit, 28 weeks, delivery
-take action on positives
treatment with penicillin
-accept no substitutes; do desensitization for allergies
education
STD from most to least prevalent
HPV HSV2 trichomoniasis chlamydia HIV HBV gonorrhea syphilis
characterize genital herpes
due primarily to HSV2, but genital HSV1 increasing
herpesvirus family (dsDNA, enveloped)
latency and reactivation
genital ulcers in herpes
multiple
small
painful
serous
chanroid genital ulcers
multiple large painful dirty presents with lymphadenopathy
noninfectious genital ulcers
lichen planus
Behcet syndrome
Crohn’s disease
treatment for first episode of genital herpes
acyclovir 400 mg PO 3 times a day
acyclovir 200 mg PO 5 times a day
valacyclovir 1 g BID
-all for 7-10 days
