Lecture 13 - STI Flashcards
Who gets tested for chlamydia?
annual for sexually active women <25
What STIs do we test in a pregnant pt?
syphilis
HIV
Chlamydia
HBV
What STIs are tested annually in HIV+ women?
trichomonus
HPV
Which STIs do we report to the health department?
Chalmydia Gonorrhea Neonatal herpes Syphilis Chancroid
When do people get the HPV vaccine?
ages 9-14: 2 doses 6-12 months apart
ages 15-26: 3 doses 0,1,6 months apart
What are the 5Ps of risk assessment for STIs?
partners practices prevention of pregnancy prevention of STIs past hx of STIs
Chlamydia tachomatis
obligate intercellular bacterial parasite
less transmissible than GC
transmitted by sexual contact and perinatally
many men and most women are asymptomatic
high incidence of co-infection with N/gonorrhea
What is the clinical manifestations of Chlamydia?
incubation 7-14 days
Men:
urethritis - dysuria, mild urethral discharge (less purulent than GC)
complications: epididymitis, prostatitis, procitis, can cause strictures, abscessess
Women:
cervicitis - mild discharge, urethritis - dysuria, mild urethral discharge
complications: endometritis, salpingitis, PID
pharyngitis
reactive arthritis
in infants: conjunctivitis, PNA (prophylaxis treatment at birth)
Lymphogranuloma venereum
endemic in africa, SE asia, caribbean
primary lesion: asymptomatic papule or ulcer, heals rapidly, occurs 3-30 days post infection
secondary: days to weeks - adenopathy
Lymphogranuloma venereum
seen, but rare, with chlamydia
endemic in africa, SE asia, caribbean
primary lesion: asymptomatic papule or ulcer, heals rapidly, occurs 3-30 days post infection
secondary: days to weeks - adenopathy
How do you dx chlamydia?
NAAT - nucleic acid amplification tests
DFA - direct fluorescent antibody
What is the treatment for chlamydia?
azithromycin 1g single dose treatment
doxycycline 100mg twice daily for 7 days (not in pregnancy –remember doxy effects teeth of children)
for LGV treat for at least 3 weeks
Neisseria gonorrheae
gram negative intracellular diplococci
more cases reported in men
transmitted perinatal and sexual contact
What is the clinical manifestation of neisseria gonorrheae?
incubation 2-10 days
men: purulent discharge, dysuria, urethritis, or may be asymptomatic
women: vaginal discharge, dysuria, cervicitis, 90% may be asymptomatic
anorectal gonorrhea: proctitis, purulent discharge
pharyngeal disease
conjunctivitis in the newborn: purulent exudate within a week of delivery
co-infection with chlamydia 10-15% of pts
in most cases sxs resolves without tx
Complications of gonorrhea
10-20% ascending infection: PID, endometritis, salpingitis, tubo-ovarian abscess
acute epididymitis
disseminated disease “arthritis dermatitis syndrome”
How do you dx gonorrhea?
NAAT
gram said: specific for genital infections in male
What is the treatment of gonorrhea?
Ceftriaxone 250mg IM + 1g Azithromycin PO
alternative:
cefixime 400mg PO + 1gm Azithromycin PO
risk of resistance coming
PID risk factors
cigarette smoking high frequency of intercourse multiple partners new sexual partner within 1 months of sxs onset recent hx of douching IUD young age at first intercourse
What is the clinical manifestation of PID?
fever >101 pelvic pain cervical motion tenderness (chandelere sign) adnexal tenderness cervical discharge
How do you dx PID?
clinical presentation
WBC >20,000
ESR >15
What is the gold standard to detect chlamydia or GC?
PCR
sample can be done with a first-catch urine or a cervical swab
other options:
gram stain cultured on chocolate agar
What is the treatment for PID?
cerftriaxone 250mg IM once + doxycycline 100mg PO twice daily for 14 days +/- metronidazole 500mg twice daily x 14 days
sexual partners should be treated
inpt treatment:
Cefotetan 2g iV q 12 hours + doxycycline 100mg PO twice daily x 14 days
Does syphilis hurt?
no
painLESS
Epididymitis
scrotal pain
Prehn’s sign
urine NAAT for GC, chlamydia
tx: according to risk + symptomatic
Prostatitis
ascending infection from urethra
reflux of infected urine
urethral instrumentation, foley catheters, surgery
sxs:
high fever, chills, perineal and back pain, UIT sxs
What are the sxs of acute prostatitis?
high fever, chills, perineal and back pain, UIT sxs
Acute vs chronic prostatitis?
acute: high fever, chills, perineal and back pain, UIT sxs
chronic:
asymptomatic to perineal discomfort, low back pain, dysuria
Microbio differs:
actue - N. gonorrheae, E. coli
chronic - E. coli, enterococci, chlamydia, ureaplasma
How do you dx prostatitis?
+/- urine culture, blood culture, CBC
How do you tx prostatitis?
Quinolone: ciprofloxacin 500mg q 12 hours x 4-6 weeks
alternative levofloxacin or norfloxcain
or Bactrim DS
Chancriod
Haemophilus ducreyi
incubation 1 day - weeks
generally confined to the genitalia
initially begins as a tender papule with surrounding erythema
forms PAINFUL ulcer
How do you dx chancroid?
clinical
culture, gram satin
“school of fish”
What is the treatment for chancroid?
azithromycin 1g PO once
or
ceftriaxone 250mg IM once
or
ciprofloxacin 500mg PO twice daily for 3 days
or
erythromycin base 500mg 3 times daily x 7 days
Granuloma inguinale
klebsiella granulomatis
rare in US
painLESS ulceration of genital lesions withOUT regional lymphadenopathy
dx: Donovan bodies on tissue biopsy
tx: Azithromycin 1g weekly once per week for 3 weeks
Syphilis
treponema pallidum
highly infectious: transmitted by sexual contact, transplacentally, transfusion, needle stick, most infectious early in disease
majority of cases are 15-30 yo
higher rates in MSM
What is the clinical manifestation of primary syphilis?
incubation periods 3-90 days
Chancre forms at site of inoculation: initially painless papule, erodes with raised borders
heals within 3-6 weeks
can be multiple, atypical, or absent
can be present on the cervix, mouth, perianal area
accompanied by adenopathy
What is the clinical manifestation of secondary syphilis?
begins 2-8 weeks after appearance of chancre
disseminated disease
maculopapular rash can involve any surface of the body, presence on PALMS and SOLES is HIGHLY suggestive
papule can coalesce to form gray-white highly infectious plaques called CONDYLOMATA LATA
Latent syphilis
no clinical manifestation, but positive serology (usually)
Tertiary syphilis clinical manifestation
progressive inflammatory disease, can affect any organ
neurosyphilis
CV syphilis
late benign syphilis
Neurosyphilis Parenchymatous disease Syphilitic otitis Cranial nerve palsies Gummas
Neurosyphilis
NOT DONE HERE
How do you dx syphilis?
darkfield examination is dx method
serological tests: nonspecific, non-treponemal reaginic tests: VDRL and RPR
-false negatives in primary, most reliable for secondary syphilis, false positive can occur (pregnancy, SLE, and HIV)
become positive 3-6 weeks after inoculation
non-treponemal tests:
-RPR is used primarily for screening; VDRL primarily for CSF (neurosyphilis)
treponemal tests:
FTA-ABS
TPHA (+ on CSF for neurosyphilis)
What is the treatment of syphilis?
early disease (less than 1 year) - PCN G benzathine 2.4 MU, IM
neurosyphilis IV PCN = only option
alternative to PCN: doxycycline, ceftriaxone
Primary vs reactive HSV
primary:
often asymptomatic
painful clusters of vesicles
systemic sxs
reactive:
often asymptomatic
prodrome then vesicles at same site
What is the treatment for herpes?
Primary/suppressive (6+/year)/recurrent
acyclovir
famcyclovir
valacyclovir
HPV
human papilloma virus
cancers of the cervix, vulva, vagina, penis, anus
transfer skin to skin
2/3 of sexual contacts develop disease
respiratory papillamatosis in children
infection often asymptomatic
Which HPV is associated with malignancies?
6, 11 = warts
16, 18, 31, 33, 35 – cancer (and flat warts)
What is the clinical manifestation of HPV?
flesh to gray colored papules either sessile or pedunculated, they may merge into plaques
in men, usually on the penile shaft, urethra may be involved
in women, usually posterior introitus, labia
flat condylomas on cervix, vagina
perianal warts
How do you dx HPV?
clinical (warts)
application of acetic acid solution
HPV DNA detection
How do you treat HPV?
no treatment is curative and relapses are common
Prevention of HPV?
Gardasil
Pubic Lice Clinical Presentation
not done here
What is the treatment for pubic lice?
not done here
Scabies presentation
not done here
Scabies treatment
not done here
