Lecture 8 - STI & VVI Flashcards
reasons for inc in STI
more raw dogging
Using tinder
Lack of funding programs
inc monitoring
opioid epidemic
Overall STI risk factors
Age = 15-20
Gender
Racial/ethic minority
MSM
Socioeconomic status
host susceptibility
Behavioral risk
5 P’s of Sexual history
Partners
Practices
Past history of STIs
Protection from STIs
Pregnancy plans
HPV vaccine indication
can get as young as 9yrs old
recommended 11-12yrs old, and everyone < 26yrs old
can give to ppl 27-45 yrs old
What does Gardasil cover
HPV 6 + HPV 11 = Genital warts
HPV 16 + HPV 18 = 2/3 Cervical cancer
What does Gardasil 9 cover
Same as Gardasil but also….
HPV 31,33,45,52,58 which cause…penile/vulvar/anal/oropharyngeal cancers
Chlamydia + Gonorrhea screening
annual for sexually active women, also men
at risk pregnant women
women < 35 and men < 30 in correctional facilities
Syphillis screening
all pregnant women
at least anauly for gay and bi men
Trichomoniasis screening
Annually for HIV infected women
risk after getting syphilis after having sex with someone just once?
50-60%
Syphilis Testing and Diagnosis
Darkfield microscopy = only primary/seconday syphillis
nontrep + treponema test…need to do both…start with nontrep 1st
Primary syphilis presentation
single, painless, indurated lesion (chancre) and can go away on its own
1 lesion**
Secondary Syphilis presentation
flulike symptoms, lymph adenopathy
pruritic or nonpruritic rash
also disappears on its own
Primary and secondary syphilis treatment
preferred:
Benzathine Penicillin G 2.4 million unit one dose
alternative:
Doxy 100 BID 14 days**
tetracycline 500 QID X 14 days
Ceftriaxone 1-2g IM/IV 10-14 days
Early vs Late latent syphilis
Early = < 1yr exposure
Late >1 yr or unknown exposure
Early & Late latent syphilis treatment
Early = same as Primary/Secondary
Late =
Pref: Benzathine penicillin G 2.4 mil units Im weekly X 3 weeks
Alt: Doxy 100 BID X 28, Tetra 500 QID X 28
Tertiary syphilis treatment
Pref: Benzathine penicilli G 2.4 mil unit IM weekly X 3 weeks
Alt = consult ID if PCN allergy
Jarische-Herxheimer Reaction pre treatment
steroids or anti-histamines 24-48hrs to prevent minimize reaction
Prednisone to abort
Neurosyphilis therapy
Pref: Aqueous crystalline penicillin G 18-24mil unit/day admin Q4hr or continuous IV 10-14 days
Alt: Procaine penicillin 2.4mil unit IM + probenecid 500mg QID for 10-14 days
Syphilis follow-up
Month 6/12 for primary/secondary
Latent/Tertiary 6/12/24
looking for 4 fold decrease
CSF for neuro Q6 months
Occular = check eyes
Gonorrhea preferred treatment for non-disseminated
< 150kg = ceftriaxone 500mg
> 150kg = ceftriaxone 1000mg
if chlamydial not excluded, treat chlamydia with dox 100 BID X 7 days, azimuth 1g X 1 if preg
Gonorrhea Alternative treatment for non-disseminated
ceph allergy = gent 250 IM X 1 + Azimuth 2g PO
if ceftriaxone No available, cefixime 800mg X 1
Disseminated gonorrhea preferred treatment
Ceftriaxone 1g Q24hr w/ duration depending on infection
Disseminated gonorrhea alternative treatment
Cefotaxime 1gm IV Q8h
Disseminated gonorrhea alternative treatment
Cefotaxime 1gm IV Q8hGonorrhea follow up
Gonorhea followup
repeat testing 3 months
test recent partners ( < 60 days), unless last exposure > 60 then test that person
dont have sex until treated and resolved 7 days after single dose
if you see purulent puss then think…
chlamydia
if clear = gonorrhea
Chlamydia treatment preferred
Doxy 100mg BID X 7 days
Chlamydia treatment alternative
Azimuth 1g X 1 = preg
Levo 500mg QD X 7 days
Chlamydia follow-up
should test at 3 months and for other STI
no sex until clear and partners should test too
