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