Lecture 28: STIs Flashcards
What are some of the factors that can lead to STIs?
- NUMBER OF SEXUAL PARTNERS
- Teens and Twenites
- African Americans or Hispanics
- Men that have sex with Men
- Higher rates in those with Erectile Dysfunction
What is the etiologic agent and some of the epidemiology of Gonorrhea?
- Neisseria Gonorrhoeae
- Second MOST COMMON disease
- 50% are resistant to ONE antibiotic
- Higher in those that have low socioeconmic status, urban living, unmarried, previous history
What are the Clinical Manifestions of Genital infection in Menin Gonorrhea?
What is it? Symptoms? Resolution?
- Acute Urethria inflammotion
- Symptoms: Urethral discharge and dysuria
- Can resolve on its now
What are the Clinical Manifestions of Uncomplicated Gential Infections in womenin Gonorrhea?
- Mainly in the Endocervix
- 80% are asymptomatic; leading to ~15% becoming infertile
What are the Clinical Manifestions of Pharyngeal Infection in Gonorrhea?
- Asymptomatic
- Orogential Sexual Exposure
What are the Clinical Manifestions of Gonococcal Infections in the Newborn in Gonorrhea?
- From Passign through birth canal
- Commonly –> Ophthalmia Neonatorum
- NOT treated = ulceration and blindness
What is the way we Diagnose for Gonorrhea?
- Gram Stains [diplococci]
- NAAT: Standard [urine, rectum, throat]
- Swabs
- Test other STIs if HIV -
What is the Treatment for Gonorrhea when it is uncomplicated Gonococcal infection of the Cervix, Urethra and Rectum?
2021 guildlines
- Ceftriaxone 500mg IM ONCE < 150kg [1g for > 150kg]
- Has Chlamydia too: Doxycycline 100mg PO BID x 7d
- Has Chlamydia & Pregnant: Azithromycin 1g ONCE
Alternative: Gentamicin 240mg IM ONCE + Azithromycin 2g PO ONCE [only when you cant get Ceftriaxone]
What is the Treatment for Gonorrhea when it is Uncomplicated Gonococcal Infection of the Pharynx?
- Ceftriaxone 500mg IM ONCE < 150kg [1g for > 150kg]
- Has Chlamydia too: Doxycycline 100mg PO BID x 7d
- Has Chlamydia & Pregnant: Azithromycin 1g ONCE
Test -of-cure: 7-14 days after start
What are some of the important instructions to tell someone with Gonorrhea?
- Abstain from sex for 7 days after treatment
- Treat ALL sexual partners [Cefixime 800mg PO ONCE + Doxycycline 100mg PO BID x 7d]
What is the etiologic agent and some of the epidemiology of Syphilis?
- Treponema Pallidum
- 45% from Men having sex with Men
- STRONG association with HIV and Syphilis
What is the Clinical Presentation of Primary Syphilis in Syphilis?
- Paineless lesions [like chancre sore] that HIGHLY infectious
- Can dissappear without treatment (3-6w)
What is the Clinical Presentation of Secondary Syphilis in Syphilis?
- Develops 2-6w after primary onset
- Lesion are anywhere [even palms and soles]
- Can cause malaise, fever, pharyngitis, headache, anorexia, arthralgis…
- May disappear in 4-10w
What is the Clinical Presentation of Latent Syphilis in Syphilis?
Early or Late?
- Positive Serologic test but no other signs
- Early: Maybe infectious; 1 year from onset
- Late: Not infection except during pregnancy
What is the Clinical Presentation of Neurosyphilis in Syphilis?
- MAY HAPPEN AT ANY STAGE
- Causes headaches, meningismus, increased CSF
- Looking for VDRL-CSF [very specfic for it]
What is the Diagnosis for Syphilis?
Speices? Tests? Screens?
- Presence of T. Pallidum [primary]
- Testing: VDRL, RPR, USR, TRUST [(+) means any stage]
- Screening: fourfold change in titer [increase = treat]
What is the Treatment for Primary and Secondary Syphilis in Nonpregnant Adults?
- Penicillin G benzathine 2.4 mil unit ONCE IM
- Doxycycline 100mg PO BID x14d [1st alt]
- Ceftriaxone 1-2g QD IM or IV for 10-14d [2nd alt]
This includes HIV patients
What is the Treatment for Latent Syphilis in Nonpregnant Adults?
Early and Late
- Early: Penicillin G Benzathine 2.4 mil unti ONCE IM [Doxycyline 100mg PO BID for 14d]
- Latent: Penicillin G Benzathine 7.2 unit; given 3 IM doses of 2.4 mil 1 week apart [Doxycycline 100mg PO BID x28d (alt)]
This includes HIV patinets
What is the Treatment for Late Syphilis?
not neuro?
- Penicillin G Benzathine 7.2 mil units; given 3 IM dose of 2.4 mil 1 week apart
What is the Treatment for Neurosyphilis and Ocular Syphilis?
- Penicillin G 18-24 mil units per day; continuous IV for 10-14d
- Penicillin G Procaine [alt]
What is the Treatment for Primary and Secondary Syphilis in Pregnant Adults?
- Penicillin G Benzathine 2.4 mil unit ONCE IM
Pencillin is the ONLY thing that will help mother and baby
What is the Treatment for Latent Syphilis in Pregnant Adults?
Early and Late?
- Early: Pencillin G Benzathine 2.4 mil unit ONCE IM
- Late: Pencillin G Benzathine 7.2 mil unit; 3 doses of 2.4 mil unit IM 1 week apart
What is Jarish-Herxheimer Reaction?
- Flu-like reaction of headache, fever, chills, malaise, arthralgia, myalgia, tachycardia…
- May start 2-4 hours; DO NOT confuse with Penicillin allergy
What is the etiologic agent and some of the epidemiology of Chlamydia?
- Chlamydia Trachomatis
- The MOST COMMON infectious disease
- Highest among African Americans
- Untreated in women –> Infertility
What is the clinical presentations in Male, Females, Infants for Chlamydia?
- Males: dysuria, urinary frequency, mucoio urethral discharge [asymptomatic]
- Females: Most are asymtompatic; IF symptomatic [endocervicitis]
- Infants: transmitted via cervicovaginal secretion; commonly causes eye infections
What is the diagnosis for Chlamydia?
- NAAT
- Giemas Stain of Cells
- Immunofluorescence
- Cell Culture ~100% specific
What is the Treatment for Chlamydia?
Teens & adults? Pregnacy?
- Teens and adults: Doxycycline 100 mg PO BID x 7d [Alt: Azithromycin 1g PO ONCE or Levofloxiacin 500mg PO q24h x7d]
- Pregnancy: Azithromycin 1g PO ONCE [Alt: amoxicillin 500mg PO TID x 7d]
Abstain from sex for 7 days and have all sex partners tested
What is the Etiology and Epidemiology of Gential Herpes Simplex Virus Infections?
HSV 1 & 2?
- HSV 1: anogenital [mainly in young women & MSM]
- HSV 2: MOST genital herps
What is the Clinical Presentations for Primary HSV Infections?
- First-Episode: prolonged duration [Fever, headache, malasie, gential pain, discharge]
What is the Treatment for the First Clinical Episode of HSV?
- Acyclovir 400mg PO TID
- Famciclovir 250mg PO TID
- Valacyclovir 1g PO BID
Treat for 7-10 days
Same thing for those that have HIV
What is the Treatment for Recurrent HSV infections?
- Acyclovir 800mg PO BID x 5d or 800mg PO TID x 2d
- Famciclovir 125mg pO BID x 5d or 1g PO BID x1d
- Valacyclovir 500mg PO BID x 3d or 1g PO QD x 5d
Same thing for those with HIV
What is the Treatment for Trichomoniasis?
- Metronidazole
