Flash Cards
How’d you get my name?
From someone who has this disease and cares enough about you to suggest that you may need an examination
Who gave you my name?
I can’t give you that information because it’s strictly confidential. Likewise, I’m not going to share information about you with anybody
How do I know this isn’t a joke or that someone gave my name to get back at me?
I wouldn’t be out here talking to you if I wasn’t sure this is serious and for real. What makes you think it could be a joke?
Do I have the disease?
Not necessarily, but you’ve been exposed. Not everyone who’s exposed gets the disease, but the only way to be sure is to be examined as quickly as possible. What time tomorrow will you be able to come to the clinic?
I haven’t had sex with anyone in over a month.
This may not have been in the last month. It could have been many weeks or months ago. That doesn’t lessen the risk, and the need to get an examination as soon as possible. What time today will you be at the clinic, in order to get tested and, if necessary, treated?
But I feel fine. I haven’t had any sores, rashes, discharges, or anything
Many people with it don’t experience any signs or symptoms. That’s why you were fortunate that someone wanted us to inform you and give you the opportunity to get tested. What time today can I tell the doctor that you’ll be in?
What are you accusing me of? I haven’t had sex with anyone but my husband!
Ma’am, I’m not trying to accuse you of anything. I just wanted to let you know that you have been exposed to an STD. I wanted to give you the opportunity to come in and get tested. What time today (or tomorrow) can you come into the clinic?
There isn’t anything wrong with me. I went to the doctor just last week.
What prompted you to go see your doctor? What tests were performed and what treatment was received?
“Like I said, I feel fine. I don’t see what the big deal is. I noticed a sore last month, but now it’s gone. Can’t this just go away on its own?”
Thomas, even though you may feel fine and not notice any symptoms, syphilis can still cause a lot of damage. It may be present in your body for several years with no symptoms, but if left untreated, syphilis can severely damage your heart, eyes, brain, and nervous system. It is important that you get treated as soon as possible.
“Wow, that all sounds very serious. Is treatment painful? Am I going to need a bunch of shots?”
I’m glad to hear that you want to receive treatment. Most likely, you’ll only need one shot of an antibiotic. When can you visit the local STD clinic to receive treatment?
“I don’t know about that. I’m scared of needles, and I really don’t want my parents finding out about this. I’m not sure what to do.”
Thomas, syphilis is a serious health problem. To protect your health and your partners’ health, it is important that you receive treatment. The doctors at the clinic will take great care of you, and all of this will stay confidential - nobody else will find out.
What is the interview period for Chlamydia and gonorrhea cases?
Symptomatic -
60 days before onset of symptoms through date of treatment
Asymptomatic -
60 days before date of specimen collection, through date of treatment if patient was not treated at time specimen was collected
Who should receive treatment in chlamydia / gonorrhea investigation
Anyone who has tested positive
Anyone who was a sexual partner of an infected person during the 60 days prior to symptoms –> treatment should be presumptively treated, along with testing and evaluation
S/S Chlamydia
Most are asymptomatic
- Pain or burning during urination
- Rectal pain or discharge
Women:
- Abnormal vaginal discharge
- Pain or bleeding during intercourse
- Bleeding between menstrual periods
- Nausea
- Fever
- Lower back / abdominal pain
Men:
- Urethral discharge
- Urethritis
S/S Gonorrhea
- Burning sensation when urinating
- Rectal discharge
- Anal itching, soreness, or bleeding
- Painful bowel soreness and bleeding
Women:
- increased vaginal discharge
- vaginal bleeding between periods
Men:
- white, yellow, or green discharge from penis
- painful or swollen testicles
Bacteria that causes gonorrhea
Neisseria Gonorrhoeae
What are the complications from untreated chlamydia?
Women:
- PID
- Poor birth outcomes
- Infertility
Men:
- Epididymitis
What are the complications from untreated gonorrhea?
Women:
- PID
- Infertility
- Ectopic Pregnancy
- Chronic Pain
Men:
- Epididymitis
- Can spread to other organs
- Urethral scarring which causes difficulty urinating + infertility
Where to test for Chlamydia and Gonorrhea
Men:
- Urethral swab
- Urine
Women:
- Vaginal swab
Rectal and oropharyngeal swabs if infected at those locations.
- Oro swabs may report chlamydia during gonorrhea testing because some NAAts detect both bacteria from a single specimen
How can chlamydia and gonorrhea be spread?
- Sex (vaginal, oral, or anal)
- Mother to baby during childbirth
Bacteria that causes chlamydia
Chlamydia trachomatis
Bacteria that causes syphilis
Treponema Pallidum
How is syphilis Spread?
- Direct contact with a syphilis sore (chancre).
- Pregnant people with syphilis can transmit the infection to their unborn child (bacteria that causes syphilis can cross the placenta)
Can occur in / around penis, vagina, anus, rectum, lips or mouth
What is the term for a baby born with syphilis?
Congenital Syphilis
What is the range of time people can develop symptoms of syphilis?
10 to 90 days
Average is 21 days
Symptoms of Primary Stage syphilis
One or more chancres. Usually firm, round, and painless. Appears at the location where syphilis entered the body
How long do Primary stage syphilis chancres last?
3 to 6 weeks and they heal regardless of whether a person receives treatment
S/S of Secondary Stage syphilis
Skin rashes and / or mucous membrane lesions (sores in the mouth, vagina, or anus).
- May appear as rough, red, or reddish-brown spots on the palms of the hands and bottoms of the feet. May occur on other parts of body.
Additional S/S:
- Fever
- Swollen lymph nodes
- Sore throat
- Patchy hair loss
- Headache
- Weight loss
- Muscle aches
- Fatigue
What is latent stage syphilis
A period where there are no visible signs or symptoms of syphilis
What is early latent syphilis?
When infection occurs in past 12 months
What is late latent syphilis
When infection occurs more than 12 months ago
What is latent syphilis of unknown duration
When there is not enough evidence to confirm initial infection within the previous 12 months. Latent syphilis can last for years
What is tertiary syphilis?
rare, but occurs as a result of untreated syphilis infections.
can appear 10 - 30 years after a person gets infected and can be fatal.
Affects brain, nerves, eyes, heart, and other organs
What is neurosyphilis?
When syphilis has invaded the nervous system
What is ocular syphilis?
When syphilis has invaded the visual system
What is ostosyphilis?
When syphilis has invaded the auditory and / or vestibular system
When should pregnant women be tested for syphilis?
At their first prenatal visit
- Those that are high risk may need testing during 3rd trimester and at delivery
What is the treatment for primary, secondary, or early latent syphilis?
For primary, secondary, or early latent:
- Benzathine penicillin G 2.4 million units adminstered intramuscularly in a single dose
What is the treatment for late latent or latent unknown duration syphilis?
For late latent or latent unknown duration:
- Benzathine penicillin G 7.2 million units, administered as 3 dose of 2.4 million units intramuscularly at weekly intervals
What is the treatment for neuro, ocular, or otosyphilis?
For Neuro, ocular, or otosyphilis
- Aqueous crystalline penicillin G 18-24 million units per day, administered as 3-4 million units intravenously every 4 hours or continuous infusion, for 10 - 14 days
Syphilis treatment options for non-pregnant patients who are allergic to penicillin
- doxycycline
- tetracycline
- ceftriaxone (for neurosyphilis)
How can syphilis be prevented?
Correct use of condoms reduces the risk, but transmission can occur with lesions not covered by a condom
What is the treatment for uncomplicated gonorrhea infections?
A single dose of 500 mg of intramuscular ceftriaxone
If chlamydial infection has not been excluded, treat for chlamydia as well
- over 330 pounds should receive 1 g ceftriaxone
What are the different treatment options for Chlamydia?
- Doxycycline 100 mg orally 2 times / day for 7 days
2.
Azithromycin 1 g orally in a single dose
OR
Levofloxacin 500 mg orally once daily for 7 days
What parts of the body can Gonorrhea infect a person?
Mucous membranes of the reproductive tract, mouth, throat, eyes, and rectum
What is DGI?
Disseminated gonococcal infection
- If left untreated, this is when gonorrhea can spread to the blood and throughout the body
What are complications of a baby who contracts gonorrhea during delivery?
Blindness, joint infection, blood infection
When can a person being treated for gonorrhea begin having sex again?
After treatment has been completed and they no longer have symptoms
How can the risk of getting gonorrhea be reduced?
Condoms reduce the risk
How can the risk of getting chlamydia be reduced?
Condoms can reduce the risk
Who should receive testing for chlamydia?
Sexually active women should get tested every year if:
- They are younger than 25
- Are older than 25 with risk factors (new or multiple sex partners, or a partner who has an STD)
How long should a person with chlamydia wait until having sex again?
Until they and their partners have completed treatment. If receiving a single dose, should wait 7 days after taking the medicine. If given 7 days of doses, wait until last dose is finished
What is the interview period for HIV?
1 or 2 years before date of first positive HIV test
- 10 years for all current or former spouses
If there is a documented HIV negative test result < 12 month, period can be shortened to the date of that negative test
What is the interview period for Primary syphilis?
90 days prior to date of onset of primary lesion through date of treatment
What is the interview period for secondary syphilis?
6.5 months (90 day incubation + 5 week primary lesion + 10 week latency period) prior to date of onset of secondary symptoms through the date of treatment
If no symptoms (early latent) 8 months (adding 6 week / 1.5 month maximum secondary symptoms)
What is the interview period for early latent syphilis?
1 year prior to start of treatment
Maximum incubation period for syphilis
90 days
Maximum duration of primary lesion (syphilis)
5 weeks (CDC site says 3-6 weeks)
Maximum latency period after primary lesion (syphilis)
10 weeks
Maximum duration of secondary symptoms (syphilis)
6 weeks
710 Code
Syphilis, Primary
Syphilis Primary Code
710
720 Code
Syphilis - Secondary
Secondary syphilis code
720
730 code
Syphilis - Early Latent
Syphilis - Early Latent Code
730
200 Code
Chlamydia
Chlamydia code
200
300 Code
Gonorrhea
Gonorrhea Code
300
Hep C code
Acute - 051
Chronic - 054
Define:
Window Period
The time between when a person is exposed to a bacteria or virus and when a test can accurately detect the organism
What can be done if exposed to HIV within the last 72 hours?
Referred for post-exposure prophylaxis (PEP)
What is the HIV incubation period?
Within 2 - 4 weeks after infection
Flu like symptoms
Chlamydia Retesting / Test of cure
All individuals diagnosed with chlamydia should be retested 3 months after completing treatment.
Test of Cure:
Only recommended for pregnant women - 3 to 4 weeks after completing therapy
Gonorrhea Retesting / Test of Cure
All individuals diagnosed with Gonorrhea should be retested 3 months after completing treatment.
Test of Cure:
Recommended for individuals with pharyngeal gonorrhea treated with an alternative regimen 3 to 4 weeks after completing therapy
How long can HCV survive outside the body at room temperature?
Up to 3 weeks
How long can HBV live outside the body?
At least 7 days
What percentage of adults recover from HBV infection and do not become chronically infected?
95%
What percentages of children and infants will remain chronically infected with HBV?
Infants - 90%
1 - 5 year olds - 25 - 50%
Syphilis Ghosting Hierarchy
- Existing primary lesion
- Historical primary lesion
- Ghosted primary lesion
- Secondary symptom
Ghosting a source
Being at the inoculation point of the patient suspected of being a spread. Make this point the center of the partner’s ghosted lesion. The ghosted lesion should then begin and end 1 1/2 weeks on either side of the center point to give a total 3 week ghosted lesion
Ghosting a spread
Begin at the center of the lesion suspected to be the source of infection. Equate this to the inoculation point for the patient for whom the spread ghost is being developed. The onset of the ghosted lesion should be drawn 3-weeks after the ghosted inoculation point, and the ghosted lesion should have a 3-week duration.
HAV prevention
Vaccination (children 12+)
- Can do a combo Hep A and Hep B vaccine usually given as 3 separate doses over 6 months
Can also receive vaccine within 2 weeks of exposure. May receive globulin in addition to vaccine depending on age and health (over 40, immunocompromised)
For infants 6-11 months traveling outside US, a travel sized dose can be given
HBV prevention
Vaccination (infants and above)
- Can do a combo Hep A and Hep B vaccine usually given as 3 separate doses over 6 months
Can also receive vaccine and/or HBIG (hepatitis B immune globulin) as soon as possible, ideally within 24 hours of exposure
HAV transmission
Found in the stool and blood of people who are infected.
Transmitted when virus is ingested
- oral-anal sex
- eating contaminated food or drink
Can you get Hep A again?
No - lifetime immunity
How is Hep A diagnosed?
Blood test
HBV Transmission
Spread when blood, semen, or other body fluids from a person infected with the virus enters the body of someone who is not infected.
- sexual contact, sharing needles / syringes, mother to baby at birth, items w/ blood (toothbrushes, razors)
Can you get Hep B again?
No - lifetime immunity
What medication treats Hep B?
No medication available to treat acute Hep B. Just rest, nutrition, and fluids.
Chronic Hep B has medication available, but does not lead to a cure
What medication treats Hep A?
No medication for Hep A.
- Rest, nutrition, and fluids
Hep C Testing Recommendations
CDC recommends one-time Hep C testing of all adults 18 years of age and older, and all pregannt women during every pregnancy.
People with risk factors should be tested regularly
What percentage of people with Hep C develop a chronic infection?
More than 50%
How long does it take to cure most people with Hep C?
8 to 12 weeks if it doesn’t develop to chronic
Hep C prevention
No vaccine available.
Avoid behaviors that spread disease, especially injecting drugs
How is Hep C spread?
- Sharing drug injection equipment
- Birth
- Uncommon but can spread through sex (more often MSM)
- non-sterile instruments for tattoos or body piercings
- Sharing personal items like razors, toothbrushes, or things that may have come into contact with blood)
Can you get Hep C again?
Yes. You can be infected even if you already cleared the virus and were cured.
Can Hep C be spread through sexual contact?
Yes, but the risk of transmission from sexual contact is believed to be low
Do most people who contract Hep C have symptoms?
No. Most people are asymptomatic.
If they develop symptoms, it’s about 2-12 weeks after exposure
How soon after exposure to HCV can a test tell if someone is infected?
it can take 8-11 weeks for an HCV antibody test to be positive.
A nucleic acid test (NAT) that detects HCV RNA (also called a PCR test) can tell if a person is infected within 1-2 weeks of exposure
What is the treatment for HCV?
Treatment for all people is 8-12 weeks of oral therapy (pills) and cure over 90% with few side effects.
Bacteria that causes tuberculosis
Mycobacterium tuberculosis (Mtb)
How long can Active TB Disease germs stay in the air?
several hours, depending on the environment
Can someone with Latent TB spread TB to others?
No. They have TB bacteria in his/her body that are alive, but inactive.
(HIV)
Human Immunodeficiency Virus
(AIDS)
Acquired Immune Deficiency Syndrome
How is HIV transmitted?
from an infected person via:
- unprotected sexual contact
- sharing of needles
- mother to child during birth process
- breast feeding
- Transfusion of blood or organ transplants
*Blood is the major means of transmission
S/S of HIV
Within a few weeks, some people develop fever, fatigue, and body rush. Other s/s = heacahce, swollen lymph glands, sore throat, feeling achy, nausea, vomiting, diarrhea and night sweats
Recommended screenings for HIV positive patients
- Hep B
- Hep C
- Tuberculosis
- Chlamydia
- Gonorrhea
- Syphilis
Also vaccinate against HBV and HAV
Hepatitis D requirements
Must also be infected with HBV. Needs the helper function of HBV to replicate
Can Hep D be prevented?
If not already infected with HBV, you can vaccinate against HBV to avoid HDV transmission
S/S of Hepatitis
- Fever
- Fatigue
- Loss of appetite
- Nausea
- Vomiting
- Abdominal pain
- Dark urine
- Clay-colored stool
- Joint pain
- Jaundice
Incubation period of Hep A
approximately 28 days with a range of 15-50
Incubation period of Hep B
6 weeks to 6 months, but most symptoms begin 90 days after exposure
Which type of viral hepatitis is not vaccine preventable?
Hepatitis C
What is VCA?
Visual Case Analysis
Ghosting criteria for related cases
- One sex partner must be infectious at the time of sexual contact
- Primary lesions on two related people are compatible (penis/vagina, penis/anus, penis/oral)
- Must be a reasonable course of disease
Ghosting basic assumptions
- Syphilis is acquired from someone who is in the primary stage of the disease at the time of sexual exposure
- Primary lesions are compatible
- Patient has a 3 week incubation period
- Patient develops a 3 week primary lesion
- Patient has no more than a 4 week latency period between primary and secondary stages of syphilis
What is disseminated TB?
When tubercle bacilli enter the bloodstream and are carried to all parts of the body, where they grow and cause disease in multiple sites.
LTBI
Latent TB Infection
- Immune system keeps bacilli under control. No symptoms and cannot spread TB to others
Symptoms of TB Disease
Pulmonary
- Cough lasting 3 weeks or more
- Pain in the chest when coughing or breathing
- Coughing up sputum or blood
General TB symptoms
- Weight loss
- Loss of appetite
- Fatigue
- Malaise
- Fever
- Night Sweats
Drug resistant TB
M. tuberculosis organisms that are resistant to at least one of the first line TB treatment drugs
What are the first-line TB treatment drugs
2 best:
- isoniazid
- rifampin
- pyrazinamide
- ethambutol
TB - Primary resistance
When drug-resistant TB can be transmitted person to person
TB - Secondary resistance
Develops during TB treatment because patient wasn’t treated with appropriate regimen or did not follow as prescribed.
XDR TB
Extensively drug-resistant TB
Occurs if the tubercle bacilli are resistant to isoniazid and rifampin, PLUS resistant to any fluoroquinolone and at least one of the three injectable second-line drugs
What are the three injectable second line drugs for TB?
- amikacin
- kanamycin
- capreomycin
MDR TB
Multidrug-resistant TB
If tubercle bacilli are resistant to at least isoniazid and rifampin
Poly-resistant TB
resistant to at least two TB drugs, but not both isoniazid and rifampin
Mono-resistant TB
Only resistant to one drug
How is TB spread
From person to person through the air (droplet nuclei)
TST
Mantoux Tuberculin Skin Test
Uses needle and syringe to inject tuberculin between layers of the skin, usually on forearm. After 48 to 72 hours, arm is examined for a reaction (induration)
Testing for TB after contact
Recent contacts who have tested negative should retest 8 to 10 weeks after the last time they were in contact with a person who has TB
What is the minimum amount of time that TB disease must be treated?
6 months
What are two methods for detecting M. tuberculosis infection?
- Mantoux Tuberculin Skin Test
- Interferon-gamma release assays
What are 3 major consequences of PID?
- Infertility
- Ectopic Pregnancy
- Chronic Pelvic Pain
What are most cases of PID caused by?
STDs
How is PID diagnosed?
- Pelvic Exam
- Imaging
- Surgical Techniques
Clinicians tend to “over diagnose” PID rather than “underdiagnose” it
Describe the characteristics of women most at risk for PID
Sexually active younger women with unsafe sex practices (more likely to get N. Gonorrhoeae and C. Trachomatis)
Symptoms of PID
- Heaviness or dull aching of lower abdomen
- Fever of 99-100
- Dyspareunia (Pain during or after sexual intercourse)
- Backache
- Malaise
(Only about 20% will have these symptoms)
Treatment for PID
Usually treating the organisms that cause PID (N. Gonorrhoeae and C. Trachomatis)
Kassowitz Law
The longer the duration of untreated syphilis infection, the less likely the fetus will be infected
Jarisch Herxheimer Reaction
Occurs within 24 hours of antibiotic treatment of syphilis
- Fever
- Chills
- Rigors
- Nausea
- Vomiting
- Headache
Late congenital syphilis
- Untreated beyond 2 years of age
Early congenital syphilis
- S/S before 2 years of age
Ectopic Pregnancy
Pregnancy occurring anywhere except in the uterus. Usually refers to pregnancy that occurs in the fallopian tubes.
Non-binary
genderqueer
gender expansive
Describes people who identify beyond the traditional girl/woman/female-boy/man/male binar
Gender fluid
Describes a person whose gender identity is not fixed
Pangender
Describes a person whose gender identity comprises multiple genderes
Agender
Describes a person who identifies as having no gender or who does not experience gender as part of their identity
What are affirmed names?
Some transgender and gender diverse people have a name that is different than the name on their legal and insurance documents. It is important to ask people what their name and pronouns are
Examples of pronouns
Gender diverse people may have the singular pronoun “They/them” or may have recently developed pronouns like “ze / hir / hirs.” Some people do not use any pronouns and just use their name
What are “Bottom” gender affirmation surgeries?
Vaginoplasty
phalloplasty
metoidioplasty
