Exam 4: Sexually Transmitted Infections Flashcards
Which 3 STIs can be acquired at birth?
C. trachomatis
N. gonorrhoeae
Herpes
Which STI can be transmitted transplacentally?
Syphilis
Which STIs can cause Ophthalmia neonatorum in babies?
Chlamydia
Gonorrhea
Which STIs can cause neurological impairment in babies?
Syphilis
Herpes
Condoms will not provide protection against which STIs?
Those spread by skin-to-skin contact
-Genital Herpes
-HPV
-Syphilis
Which condoms are compatible with both water and oil based lubricants?
Polyurethane
Natural membrane condoms will not protect against which STIs?
HIV
HBV
True or False: People already using PrEP do not need PEP
True
What is PrEP?
FDA approved medication to prevent HIV in adults and adolescents weighing >/= 77lb (35kg)
What medications are used in PrEP?
Emtricitabine + Tenofovir
Emtricitabine + Tenofovir alafenamide
Cabotegravir (IM)
What is the time window that PEP can be used?
72 hours or less since exposure
What is nPEP?
nonoccupational post-exposure prophylaxis
What are the 2 possible nPEP regimens?
Both are 3 drug regimens
Preferred:
Tenofovir disoproxil fumarate po daily
+
Emtricitabine po daily
+
Raltegravir or Dolutegravir po daily
Alternative:
Tenofovir disoproxil fumarate po daily
+
Emtricitabine po daily
+
Darunavir po daily
+
Ritonavir po daily (enhancer, no effect on condition)
How long does nPEP therapy last?
28 days
When is the HPV vaccine recommended?
Age 11 or 12
(can start at age 9)
*Also recommend vaccination for everyone through age 26 if not vaccinated when younger
In patients 27-45, discuss the benefit
The HPV vaccine is given as a series of how many doses?
2 or 3 depending on age at initiation
HPV vaccines do not protect against what?
Existing infection
When does the HPV vaccine work best?
Before HPV exposure
Gonorrhea is a major cause of what disease?
Pelvic inflammatory disease
What is the primary site of gonorrhea infection in women?
Endocervix
What is the predominant manifestation of gonorrhea in men?
Acute urethritis
True or False: If gonorrhea is left untreated in men it will spontaneously resolve after several weeks
True
A gonorrhea infection in what part of the body is more likely to have treatment failure?
Pharyngeal
If gonorrhea is not treated in babies what can it cause?
Ophthalmia neonatorum
if not treated properly, this can lead to corneal ulceration and blindness
What is the standard test performed to diagnose gonorrhea?
Nucleic acid amplification test (NAAT)
How does gonorrhea appear on a gram stain?
Gram-negative diplococci with PMNs
What is the most common co-infection with gonorrhea?
Chlamydia
What are the treatment options for Uncomplicated gonococcal infections of the Cervix, Urethra, and Rectum?
<150kg:
-Ceftriaxone 500mg IM x 1
-Chlamydia not excluded: Doxycycline 100 mg po BID x 7 days
-Chlamydia + Pregnant: Azithromycin 1 g PO x 1
> /=150kg:
-Ceftriaxone 1g IM x 1
-Chlamydia not excluded: Doxycycline 100 mg PO BID x 7 days
-Chlamydia + Pregnant: Azithromycin 1 g po x 1
If ceftriaxone is not available for treatment of Uncomplicated Gonococcal Infections of the Cervix, Urethra, and Rectum, what options do we have?
Gentamicin 240 mg IM x 1 + Azithromycin 2 g PO x 1
Cefixime 800 mg PO x 1
-Chlamydia: Doxycycline 100 mg PO BID x 7 days
-Chlam+Pregnant: Azithromycin 1 g PO x 1
What are the treatment options for Uncomplicated Gonococcal Infections of the Pharynx?
<150kg:
-Ceftriaxone 500 mg IM x 1
-Chlamydia: Doxycycline 100 mg PO BID x 7 days
-Chlam + Pregnant: Azithromycin 1 g PO x 1
> /= 150 kg:
-Ceftriaxone 1 g IM x 1
-Chlamydia: Doxycycline 100 mg PO BID x 7 days
-Chlam + Pregnant: Azithromycin 1 g PO x 1
no alternatives for pharynx
When should a test of cure be performed for gonococcal infections?
7-14 days after initial treatment
Patients with gonococcal infections should abstain from sexual activity for how long?
7 days after treatment
What is expedited partner therapy?
An infected individual’s sexual partner may be treated without being seen in the clinic, the therapy is delivered by the patient to them
What drugs are used in Expedited Partner Therapy for chlamydia?
Cefixime 800 mg PO x 1
(add doxycycline 100 mg PO BID x 7 if chlamydia not excluded)
Consider azithromycin 1 g PO x 1 if adherence is a concern
All patients with syphilis should also be tested for what?
HIV
What is primary syphilis?
After exposure, a painless lesion (chancre) appears at the site of entry
highly infectious
-chancres will disappear spontaneously without treatment 3-6 weeks
When does secondary syphilis develop?
2-6 weeks after primary
What does secondary syphilis look like?
Characterized by a variety of mucocutaneous eruptions
Lesions appear anywhere on the body
Symptoms disappear in 4-10 weeks
What is latent syphilis?
Have positive serologic test but no other evidence of disease
Latent syphilis is divided into what two stages?
Early latent
Late latent
What is early latent syphilis?
Patient is potentially infections
Defined as 1 year from the onset of infection
What is late latent syphilis?
Patient is considered non-infectious
exception: pregnancy (infectious to baby)
What is tertiary (late) syphilis?
Inflammatory phase of the disease
Can affect any organ
When can neurosyphilis occur?
Any stage of syphilis
How do we diagnose Primary syphilis?
Presence of T. pallidum on dark-field microscopy
How do we diagnose Secondary syphilis?
Spirochete may be found in cutaneous lesions and lymph nodes
What serologic tests can be used to diagnose syphilis?
Nontreponemal Test
-detects reagin
-positive test indicates presence of any stage of syphilis
*negative in incubating syphilis and early primary syphilis
*note that late latent and tertiary syphilis remain seropositive for life
Treponemal Test
-more sensitive than non-treponemal
-uses T. pallidum
What is the treatment of choice for all stages of syphilis?
Penicillin G (parenteral)
What is our treatment of choice for Primary and Secondary Syphilis?
Benzathine Penicillin G 2.4 million units IM x 1 dose
If the patient has a penicillin allergy, what can be used for Primary and Secondary Syphilis treatment?
Doxycycline 100 mg PO BID x 14 days
or
Tetracycline 500 mg PO QID x 14 days
or
Azithromycin 2 g PO QID x 14 days
What is the preferred treatment for Early Latent Syphilis (<1 year duration)?
Benzathine Penicillin G 2.4 million units IM x 1 dose
What can we use for treatment if a patient with Early Latent Syphilis (<1 year duration) has a PCN allergy?
Doxycycline 100 mg PO BID x 14 days
or
Tetracycline 500 mg PO BID x 14 days
no azithromycin
What is the preferred treatment option for both late latent syphilis (> 1 yr duration or unknown duration) and tertiary syphilis?
Benzathine penicillin G 2.4 million units IM once weekly x 3 weeks
What are the treatment options if the patient has a PCN allergy for both late latent syphilis (> 1 yr duration or unknown duration) and tertiary syphilis?
Doxycycline 100 mg PO BID x 28 days
or
Tetracycline 500 mg PO QID x 28 days
What are the treatment options for neurosyphilis?
Aqueous crystalline penicillin G 3-4 million units IV q4h x 10-14 days
(can also be continuous infusion)
*(may administer benzathine penicillin 2.4 million units IM once weekly x 3 weeks after completion of IV therapy)
Procaine penicillin 2.4 million units IM daily + Probenecid 500 mg PO QID
x 10-14 days
Penicillin allergy:
Ceftriaxone 2 g IM or IV daily x 10-14 days
Why do we not use benzathine penicillin G in neurosyphilis?
It does not penetrate the CSF
Aqueous is better for prolonged exposure
How does treatment of syphilis in patients who are HIV+ differ?
It is the same except that there are no alternative PCN allergy treatments for Early latent or Late latent
What is the only drug option for syphilis in pregnancy?
Penicillin
-this is the only agent that protects and treats the fetus
What is the Jarisch-Herxheimer reaction?
Acute febrile reaction
Begins 2-4 hours after initiating syphilis therapy, may last 12-24 hours
Do not confuse with a penicillin allergy
More common in early-stage syphilis since there is an increased bacterial load
True or False: Most people with chlamydia are asymptomatic
True
Chlamydia can cause what diseases in infants?
Neonatal eye infection
Afebrile interstitial pneumonia
What is the standard treatment of chlamydia?
Doxycycline 100 mg PO BID x 7 days
What are the alternative regimens for chlamydia?
Azithromycin 1 g PO x 1 dose
Levofloxacin 500 mg PO q 24h x 7 days
What are the treatment options for chlamydia in pregnancy?
Standard: Azithromycin 500 mg PO x 1 dose
Alternative: Amoxicillin 500 mg PO TID x 7 days
How long should patients abstain from sex after chlamydia therapy?
7 days
What kind of bacteria is mycoplasma genitalium?
Motile, flask-shaped bacteria, NO CELL WALL
How is treatment for mycoplasma genitalium determined?
Depends on availability of resistance testing
What is the treatment for Macrolide-susceptible mycoplasma genitalium?
Doxycycline 100 mg PO BID x 7 days
followed by
Azithromyin 1 g po x 1 followed by 500 mg PO daily x 3 days
(total azithromycin = 2.5 g)
What is the treatment for Macrolide-resistant mycoplasma genitalium?
Doxycycline 100 mg PO BID x 7 days
followed by
Moxifloxacin 400 mg PO daily x 7 days
What treatment should we use if testing is not available with mycoplasma genitalium?
Use the macrolide-resistant treatment
What are the 2 types of genital herpes simplex virus?
Herpes simplex virus type 1 (HSV-1)
Herpes simplex virus type 2 (HSV-2)
Which virus type is the cause of most genital herpes infections?
HSV-2
What are the 2 types of primary infection with HSV?
First-episode primary infection
-has prolonged duration of symptoms
-this is the first exposure
First-episode nonprimary genital herpes
-Infection in patients with clinical or serological evidence of a prior HSV infection at a different body site
What are the treatment options for the first clinical episode of genital herpes?
Acyclovir 300 mg PO TID
or
Famciclovir 250 mg PO Tid
or
Valacyclovir 1 g PO BID
How long do we treat the first clinical episode of genital herpes?
7-10 days
What are the treatment options for recurrent infections of herpes? (choose 1)
Acyclovir 800 mg PO BID x 5 days
OR Acyclovir 800 mg PO TID x 2 days
Famciclovir 125 mg PO BID x 5 days
OR Famciclovir 1 g PO BID x 1 day
Valacyclovir 500 mg PO BID x 3 days
OR Valacyclovir 1 g PO daily x 5 days
In severe herpes disease, what additional treatment can we use?
Acyclovir 5-10 mg/kg/dose IV q8h for 2-7 days or until clinical improvement
*Follow by oral therapy to complete at least 10 days
What therapies can we use in suppressive therapy for herpes?
Use one daily:
Acyclovir 400 mg po BID
Famcicloir 250 mg PO BID
Valacyclovir 500 mg PO daily (not as effective)
Valacyclovir 1 g PO daily
Who should use daily suppressive therapy in herpes treatment?
Patients with frequent recurrence (>/= 6 per year)
What is the only drug class that shows efficacy in trichomoniasis?
Nitroimidazoles
not metronidazole gel
How is treatment for trichomoniasis determined?
Men
Women
HIV+
What is the treatment for trichomoniasis in women?
Metronidazole 500 mg PO BID x 7 days
Alternative: Tinidazole 2 g PO x 1 dose
What is the treatment for trichomoniasis in men?
Metronidazole 2 g PO x 1 dose
Alternative: Tinidazole 2 g PO x 1 dose
What is the treatment for Trichomoniasis in HIV+ patients?
Metronidazole 500 mg PO BID x 7 days
What clinical pearl is important to remember with metronidazole use?
Avoid alcohol
Excreted in breast milk
What is the standard treatment regimen for pelvic inflammatory disease?
Ceftriaxone 1 g IV q 24 h
+
Doxycycline 100 mg IV or PO q12h
+
Metronidazole 500 mg IV or 100 mg PO q12h
for 14 days
How long does therapy for pelvic inflammatory disease last?
14 days
What are the alternative regimens that can be used for pelvic inflammatory disease?
Ampicillin/Sulbactam + Doxycycline
Severe allergy: Clindamycin + Gentamicin
What is the IM/Oral treatment regimen that can be used for pelvic inflammatory disease?
Ceftriaxone IM + Doxycycline PO + Metronidazole PO
