Module 1 - STIs Flashcards
Pap Smear Guidelines
-when to start
21 years
Pap Smear Guidelines
-how often do you test patients between 21-29 years?
q3 years
Pap Smear Guidelines
-how often do you test patients between 30-65 years?
q3 years OR
primary hrHPV q5 years (if +, then PAP) OR
co-testing (cytology + HPV) q5 years
Pap Smear Guidelines
-how often do you test patients >65years?
No screening after adequate negative prior screening results
Which vaginal infection can you use KOH to help diagnose?
Bacterial vaginosis
Which vaginal infection would you choose a saline wet mount vs. KOH?
Trich
Chlamydia
-organism
C trachomatis
What is the most reported bacterial infectious disease in the US? (STI)
Chlamydia
Chlamydia
-transmission
sexual and vertical
Chlamydia
-common R/F
high-risk sexual practices
=adolescence, new/multiple sex partners, hx of STDs or current STD; oral contraceptive user, no barrier protection during sex; drug use; low SES; prostitution; African American Pts.
High-risk sexual practices
adolescence, new/multiple sex partners, hx of STDs or current STD; oral contraceptive user, no barrier protection during sex; drug use; low SES; prostitution; African American Pts.
Chlamydia
-S/S
-Complications
-most are asymptomatic among women and men (healthcare providers often rely on screening for chlamydial infection
-women –> PID
Chlamydia
-screening test
NAAT
-women: gold standard: cervical or vaginal swab; first void urine also acceptable (reserve for women who have never had a pelvic exam)
-men first void culture
Chlamydia
-annual screening
-sexually active: <= 25YR, annually
-sexually active: >25YR, screen if RF present
-pregnancy: 1st prenatal visit; third trimester (again) if <25yo + increased R/F
Chlamydia
-Tx
-first line: doxy 100mg 1 capsule by mouth twice daily 7d
-first line pregnancy: azithromycin 1000mg 1 dose (250mg x4 tablets = take all 4 tablets at one time) - hard on stomach
Chlamydia
-partner treatment
-referred for evaluation testing and presumptive tx if sexual contact w/ partner during 60d preceding pt onset of sx of chlamydia dx
-most recent sex partner should be evaluated even if last sexual encounter was >60d before sx onset or dx
Chlamydia
-education on when okay to resume intercourse
-7 days after single dose therapy
-after completion of doxy tx and resolution of sx
Chlamydia
-test of cure
Complete test 4W after therapy
*pertains to pregnant individuals
-should also be retested 3M after tx
Test of cure not necessary for nonpregnant individuals unless suspicion pt did not take meds correctly or sx persists or reinfection
Gonorrhea
-organism
N. gonorrhea
Gonorrhea
-transmission
sexual; vertical
Gonorrhea
-R/F
high risk sexual practices
-adolescence, new/multiple sex partners, hx of STDs or current STD, oral contraceptive user, no barrier protection during sex, drug use, low SES, prostitution, African A. patients
Gonorrhea
-S/S
asymptomatic in women
-if woman has intermenstrual bleeding w/ hx of regular periods, can be sign of STI
-males will be symptomatic –> clear/cloudy penile discharge (urethritits)
Gonorrhea
-complications
-women: PID
-men: epididymitis (inflammation of the tube at back of testicle that carries sperm); complains of unilateral testicular pain.
Gonorrhea
-screening test
-women: gold standard is a vaginal swab (first void urine is acceptable (reserve for those who haven’t had or those that refuse pelvic exams)
Gonorrhea
-annual screening
-sexually active women: screen ALL who are sexually active (all who are at risk of infection)
-pregnancy: first prenatal visit; again in third trimester
-men: men who have sex with men should be screened annually
Gonorrhea
-tx
-ceftriaxone (500mg IM)
*if positive for both chlamydia and gonorrhea, treat for both w/ 1g azithromycin PO x 1 dose (alternate is doxy 100mg 7d)
-first line tx in pregnancy: ceftriaxone + azithromycin (cannot receive doxy)
Gonorrhea
-partner tx
referred for evaluation testing and presumptive tx if they had sexual contact w/ partner during the 60d preceding pt’s onset of sex or chlamydia dx
-most recent sex partners should be evaluated and treated even if time of last sexual encounter was >60d before sx onset or dx
Gonorrhea
-education
-STI prevention, condom use, minimize disease transmission. Persons tx for gonorrhea should be instructed to abstain from sexual activity 7d after tx and until all sex partners are tx (7d after receiving tx and resolution of sx)
If patient tests positive for gonorrhea, what should you suspect?
Other STI’s
-test for other STI’s (chlamydia, syphilis, HIV)
Gonorrhea
-F/U
Men and women should be retested 3M after tx regardless if sex partner was also treated
-try to schedule R/U appt. at initial visit
-if F/U testing at 3M doesn’t happen, pt. would be retested at next pt. visit (whenever that is) –> would need to be <12M after initial tx
-repeat testing on those that are pregnant should be conducted in 3M
Syphilis
-primary
*is pt aware or unaware of infection?
*presents classically with what?
*pt. can present with what?
*sx resolution
*will serological testing be positive?
*unaware (= spreadable, most contagious time of syphilis)
*painless ulcer or canker at site of infection
*lymphadenopathy (rubbery, painless, enlarged lymph nodes occurring bilaterally)
*sx resolution w/i 3-6w
*may not be positive (too early)
Syphilis
-secondary
*clinical manifestations
*when do these sx appear?
*will serological testing be positive?
*skin rash, mucocutaneous lesions, lymphadenopathy, condyloma lata (smooth flat wart (pink to gray) that develops on genitals/anus/ mouth)
*typically appear 4-8w after appearance of first canker and persists for weeks to months
*serological testing is positive (highest than at any other stage!)
Syphilis
-tertiary
*timeline
*what can become involved
*1-20Y
*cardiac involvement, lesions, tabes dorsalis, general paresis
Syphilis
-latent
*how is this detected?
*symptomatic?
*serological testing
*asymptomatic
Stages of syphilis
primary
secondary
tertiary
latent
Syphilis
-organism
Treponema pallidum (T pallidum)
Syphilis
-transmission
sexual; vertical
Syphilis
-is the disease local or systemic?
systemic