Lecture 8 - STI & VVI

Question 1

reasons for inc in STI

Answer 1

more raw dogging
Using tinder
Lack of funding programs
inc monitoring
opioid epidemic

Question 2

Overall STI risk factors

Answer 2

Age = 15-20
Gender
Racial/ethic minority
MSM
Socioeconomic status
host susceptibility
Behavioral risk

Question 3

5 P’s of Sexual history

Answer 3

Partners
Practices
Past history of STIs
Protection from STIs
Pregnancy plans

Question 4

HPV vaccine indication

Answer 4

can get as young as 9yrs old
recommended 11-12yrs old, and everyone < 26yrs old
can give to ppl 27-45 yrs old

Question 5

What does Gardasil cover

Answer 5

HPV 6 + HPV 11 = Genital warts
HPV 16 + HPV 18 = 2/3 Cervical cancer

Question 6

What does Gardasil 9 cover

Answer 6

Same as Gardasil but also….

HPV 31,33,45,52,58 which cause…penile/vulvar/anal/oropharyngeal cancers

Question 7

Chlamydia + Gonorrhea screening

Answer 7

annual for sexually active women, also men
at risk pregnant women
women < 35 and men < 30 in correctional facilities

Question 8

Syphillis screening

Answer 8

all pregnant women
at least anauly for gay and bi men

Question 9

Trichomoniasis screening

Answer 9

Annually for HIV infected women

Question 10

risk after getting syphilis after having sex with someone just once?

Answer 10

50-60%

Question 11

Syphilis Testing and Diagnosis

Answer 11

Darkfield microscopy = only primary/seconday syphillis

nontrep + treponema test…need to do both…start with nontrep 1st

Question 12

Primary syphilis presentation

Answer 12

single, painless, indurated lesion (chancre) and can go away on its own

1 lesion**

Question 13

Secondary Syphilis presentation

Answer 13

flulike symptoms, lymph adenopathy

pruritic or nonpruritic rash

also disappears on its own

Question 14

Primary and secondary syphilis treatment

Answer 14

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

Question 15

Early vs Late latent syphilis

Answer 15

Early = < 1yr exposure
Late >1 yr or unknown exposure

Question 16

Early & Late latent syphilis treatment

Answer 16

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

Question 17

Tertiary syphilis treatment

Answer 17

Pref: Benzathine penicilli G 2.4 mil unit IM weekly X 3 weeks
Alt = consult ID if PCN allergy

Question 18

Jarische-Herxheimer Reaction pre treatment

Answer 18

steroids or anti-histamines 24-48hrs to prevent minimize reaction

Prednisone to abort

Question 19

Neurosyphilis therapy

Answer 19

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

Question 20

Syphilis follow-up

Answer 20

Month 6/12 for primary/secondary
Latent/Tertiary 6/12/24

looking for 4 fold decrease

CSF for neuro Q6 months
Occular = check eyes

Question 21

Gonorrhea preferred treatment for non-disseminated

Answer 21

< 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

Question 22

Gonorrhea Alternative treatment for non-disseminated

Answer 22

ceph allergy = gent 250 IM X 1 + Azimuth 2g PO

if ceftriaxone No available, cefixime 800mg X 1

Question 23

Disseminated gonorrhea preferred treatment

Answer 23

Ceftriaxone 1g Q24hr w/ duration depending on infection

Question 24

Disseminated gonorrhea alternative treatment

Answer 24

Cefotaxime 1gm IV Q8h

Question 25

Disseminated gonorrhea alternative treatment

Answer 25

Cefotaxime 1gm IV Q8hGonorrhea follow up

Question 26

Gonorhea followup

Answer 26

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

Question 27

if you see purulent puss then think…

Answer 27

chlamydia

if clear = gonorrhea

Question 28

Chlamydia treatment preferred

Answer 28

Doxy 100mg BID X 7 days

Question 29

Chlamydia treatment alternative

Answer 29

Azimuth 1g X 1 = preg

Levo 500mg QD X 7 days

Question 30

Chlamydia follow-up

Answer 30

should test at 3 months and for other STI

no sex until clear and partners should test too