Sexually Transmitted & Blood Born Infections (STBBI) Flashcards
(77 cards)
1
Q
What are STBBI’s?
A
- Infections that are spread through insertive and receptive sexual practices (vaginal, anal, or oral) with someone who is carrying the infection
2
Q
Genital Herpes and HPV are transmitted through
A
Intimate skin-to-skin contact
3
Q
HIV and Hep B are carried and transmitted through
A
The blood
4
Q
Reportable diseases
A
- Some STBBI’s are reportable or notifiable diseases
- The Public Health Agency of Canada (PHAC) stipulates which are reportable nationally
- Each province/territory can add diseases in their own jurisdiction
- Partner notification, contact tracing, testing, and treatment differ among jurisdiction
5
Q
What does VD stand for?
A
- Venereal diseases
- In the 1970s the term was changed to STD
6
Q
What does venereal refer to?
A
of or relating to sexual pleasure or interpose
7
Q
The term STI became preferred in which year?
A
2006 in Canada
8
Q
Blood-Borne Infections (BBI) refer to
A
Infections that can be carried and transmitted through the blood
9
Q
STBBI stands for
A
Both STIs and BBIs
10
Q
Healthy Public Policy - Historically
A
- Prior to antibiotics, bacterial STBBIs were untreatable
- At one point, a public policy was implemented to test men and women for syphilis prior to marriage
- An anti-VD campaign emerged in the 1920s that targeted education and treatment
- To help, municipalities sent their PH nurses to TO to train with the city’s VD division for 3 months
11
Q
A significant catalyst for change in the 1980s was
A
The appearance of AIDS
12
Q
Current Healthy Public Policy
A
- Screening for HIV, syphilis, chlamydia, gonorrhoea, and hepatitis B at the first prenatal visit
- BBI screening with blood products (blood safety)
- Immunization partnership fund
- Public health surveillance (HIV/AIDS, gonorrhoea, Hep B+C, syphilis)
13
Q
What is the Blood Safety Contribution Program (BSCP)?
A
- A program that monitor errors and adverse events associate with blood/blood product transfusions (provincial and territorial)
- Also includes transplantation of cells, tissues, and organs
14
Q
The Canadian Blood Services is mandated to provide…
A
- Safe, secure, and affordable blood and blood component systems
- Has been managing Canada’s blood system since 1998 and has not been any recorded instances of BBIs
15
Q
When did the Blood Services policy change?
A
- When over 1000 Canadians became infected with HIV from blood transfusions
16
Q
When were strict Blood Surveillance guidelines implemented?
A
1985
17
Q
What are the categories of STBBIs?
A
- Bacterial, viral or ectoparasitic infections
18
Q
What puts individuals at risk for STBBIs?
A
- A person who already has an STBBI is at risk for more
- All insertive and receptive sexual practices
19
Q
Most commonly reported bacterial STIs
A
- Chlamydia, gonorrhoea and syphilis which are primarily transmitted through unprotected vaginal/anal sex
- Infection can also pass from mother to newborn baby during delivery
- Very common for people to be asymptomatic
20
Q
Chlamydia is caused by which bacteria?
A
Chlamydia trachomatis (C.trachomatis)
21
Q
Symptoms of Chlamydia appear?
A
- Within 1-3 weeks after unprotected sex
22
Q
Where can women and men contract chlamydia?
A
- Women may contract chlamydia in the cervix, rectum, and throat
- Men in the urethra, rectum, and throat
23
Q
Rates of Chlamydia in Canada have been…
A
- Rising steadily since 1997
- Estimated 127 million cases globally in 2018
- Affects sexually active youth and young adults, especially women ages 15-24 in Canada
- Females accounted for the majority of cases
24
Q
Chlamydia can lead to what in Women?
A
- Pelvic inflammatory disease (PID)
- Tubal factor infertility
- Ectopic pregnancy
- Chronic pelvic pain
- Premature birth
- Eye infection + pneumonia in baby
- 70% of women have no symptoms/are unaware of their condition
25
Effects of Pelvic-inflammatory disease
- Abdo. pain, fever, internal abscesses, long-term pelvic pain + scarring of fallopian tubes
26
Symptoms of Chlamydia (Women)
- Cervicitis: mucopurulent endocervical discharge, easily induced endocervical bleeding
- Urethritis: pyuria, dysuria, urinary frequency
27
Chlamydia can lead to what in Men?
- Lymphogranuloma venereum which is caused by C.trachomatis
- LGV can cause proctitis (inflammation of the lining of the rectum)
- 50% of men are unaware and have no symptoms
28
Symptoms of Chlamydia (Men)
- Urethritis: discharge from penis, typically mucoid or watery
- Burning sensation when urinating (dysuria)
- Burning or itching at the tip of penis
- Epididymitis: unilateral testicular pain, tenderness, and swelling
29
Rectal Chlamydia symptoms (both men/women)
- Rectal pain
- Bleeding
- Discharge
- Mucous with stools
- Painful BM
30
Occular Chlamydia symptoms
- Appears after 2-6 weeks
- Chlamydial conjunctivitis (pink/red eye)
- Mucous discharge
- Crusting of eyelashes
- Tearing
- Photophobia
- Foreign body sensation
- Decreased vision
31
Recommended treatment of Chlamydia
Non-LGV Strains
- Azithromycin single dose
- Doxycycline 100mg BID x7days
LGV Strains
- Doxycycline 100mg BID x21days
32
Gonorrhea is caused by the bacteria...
- Neisseria gonorrhoea
- Often referred to as the clap or drip
33
Symptoms for gonorrhoea develop?
Within 2 weeks of infection
34
Gonorrhea has been notifiable since _____ and is the _____ most commonly reported bacterial STI in Canada
1924 and is the 2nd most common
35
Symptoms of gonorrhea in Women
- Unusual vaginal discharge that may be thin, watery and green or yellow in colour
- Dysuria
- Pain or tenderness in the lower abdomen
- Bleeding between periods, heavier periods, and bleeding after sex
36
Symptoms of gonorrhea in Men
- Unusual discharge from tip that may be white, yellow, or green
- Dysuria
- Inflammation of the foreskin
- Pain or tenderness in the testicles
37
Gonorrhea in the rectum, throat or eyes
- Eyes = conjunctivitis (pain, photophobia, purulent drainages)
- Rectum = pain/discomfort, itching, discharge, spots of blood on toilet paper
- Throat = sore throat and swollen lymph nodes in the neck
38
Gonococcal arthritis due to spread of bacteria... symptoms include
- Warm, red, swollen, and painful joints
39
Managment of Gonorrhea
Ceftriaxone 250mg IM once + Azithromycin 1gram PO once
or Doxycycline 100mg PO BID x7days
40
Syphilis is caused by the bacteria and has been notifiable since
- Treponema pallidum
- 1924
41
Average onset of symptoms for syphilis occurs...
21 days, but can range from 10-90 days
42
Primary Stage of Syphilis
- Patient is most infectious!!
- Chancre sore (single or multiple sores) or proctitis
- Sores appear where the syphilis has entered the body, usually firm, round small and painless
- Chancres last 3-6 weeks and heal without treatment
43
Secondary Stage of Syphilis
- Patient is infectious
- Begins with skin rash and mucous membrane lesions
- Rash is rough, red or reddish brown spots on palms of hands, soles of feet and or torso, not usually itchy
- Can also include fever, swollen lymph glands, sore throat, patchy hair loss, muscle aches, fatigue, flu-like symptoms (may also note hair or weight loss)
- Can last 2-6 weeks at a time and can come and go for up to 2 years
44
During incubation there are ____ symptoms and the individual is ____ infectious
- No symptoms and not infectious, incubation is 10-90 days from exposure to onset
- Blood test
45
Early non-primary, non-secondary Syphilis
- Patient is infectious
- May occur between primary + secondary stages and after secondary
- Infection has been identified to have occurred within the last 12 months
46
Late Stage Syphilis
- Not infectious
- No symptoms identified
- Infection identified to have occurred within the last 12 months, but no evidence of any of the other stages in past year
47
S&S of late stage Syphilis
- Tumors, blindness, paralysis, damage to nervous system, brain and other organs and may result in death
48
Management of Syphilis
- Primary/secondary syphilis: Penicillin G benzathine 2.4 million unite IM once
- Neurosyphilis: 2.4 million units IM qWeek x3
- Doxycycline, tetracycline and ceftriaxone can be used for patients with penicillin allergy
- Pregnant women should only be treated with penicillin
49
Viral STI's include
- Genital herpes simples virus (HSV)
- Human papilloma virus (HPV)
- Both are non-reportable
50
HSV and HPV are transmitted through
- Intimate skin-skin sexual contact
- Can be spread from mother to baby through childbirth (causing abnormal development or death)
51
HSV Type 1 and 2
- Type 2 is more common
- Either can cause genital infections, however HSV-2 rarely causes oral herpes
- Transmission occurs when both symptomatic and asymptomatic
- First outbreak takes 2-3 weeks to heal without treatment
- May experience burning while voiding, fever and flu-like symptoms and swollen glands
52
Diagnostic + Treatment of HSV
- Viral identification by Nucleic acid amplification test (NAAT) or viral culture
- HSV serology helpful if testing isn't available
- Treatment: PO Acyclovir, Famciclovir, Valacyclovir within first 3-4 days of symptom onset
- C-section recommended if first episode of genital herpes occurs in third trimester
- Suppressive therapy recommended for those with frequent (>6/year) or highly symptomatic recurrences
- Partner Notification not required
53
_______ is the most common STIs in Canada + worldwide
- Human Papilloma Virus (HPV)
- Many types of HPV, some lead to cancer and others to skin lesions
- Most peoples immune systems will eventually clear the infection
54
Is there a cure for HPV?
No, but many symptoms can be treated
55
Protections of HPV include
- Routine PAP smears for cervical cancer
- 3 vaccines are available to prevent types of HIV including strains that cause anal and genital cancers + anogenital warts
* Gardasil, Gardasil 9 (for females and males), and Cervarix (for females only)
* Do not contain live biologicals or DNA
56
Symptoms of HPV
- Many are asymptomatic
- Anogenital warts (Condylomata), small cauliflower looking lesions or may be flat
- In Women, warts on vulva, thigh, rectum or in the vagina or urethra with the cervix being most common site
- During pregnancy, the number and size of warts can increase
- With an inactive infection, cells appear normal under microscope during a PAP
57
What two high risk and low risk types of HPV does Gardasil + Gardasil 9 protect against?
- Types 16 and 18, which cause 70% of anal and genital cancers (HIGH)
- Types 6 and 11, which cause 90% of anogenital warts (LOW)
- Vaccines are approves for females age 9-45 and in males 9-26
- One does initially followed by one dose two months later, and another given 6 months after first dose
- Not recommended for pregnant or lactating women
58
Cost of Gardasil 9?
- $550 for all 3 doses
- HPV vaccination is covered by OHIP until the age of 26
59
Common Blood-Borne Infections (BBIs)
- HIV, Hepatitis B and Hepatitis C
- Not solely transmitted through sexual activity
- Transmission can also occur through reusing drug, tattooing or piercing equipments that has residual traces of infected blood
*Hep B+C can be transmitted through sharing razors or toothbrushes
- Can be transmitted from mother to neonate during pregnancy or birth
- Also transmitted through breast milk
60
Human Immunodeficiency Virus (HIV)
- Virus that attacks the body’s immune system
- HIV is a manageable chronic condition
- If left untreated, it causes a weakened immune system or acquired immune
deficiency syndrome (AIDS)
- Can only be transmitted through 5 body fluids: blood, semen (including pre-
cum), rectal fluid, vaginal fluid, and breast milk
61
HIV Symptoms
- Some people may not develop symptoms after contracting HIV, and could remain undiagnosed until symptoms of AIDS appear (this can be up to 10
years later)
- Symptoms may last from a few days to weeks
- 50% or more of people living with HIV may develop the following within 2-4 weeks:
o Chills
o Fever
o Fatigue
o Joint Pain
o Headache
o Sore throat
o Muscle aches
o Swollen lymph nodes
62
HIV testing
- Blood serum testing
- Some are not able to detect the virus during the first 2-4 weeks of HIV infection, however the individual is still infectious
- May repeat testing if it’s negative and there’s a possibility of having HIV
o Anonymous testing (available in some but not all provinces)
o Rapid HIV testing (point of care)
o Online testing
63
What is the HIV "The Window Period"?
- Refers to the time between HIV exposure and when a test can detect HIV in your body
- Depends on the type of HIV test used
64
Types of HIV testing used...
- Nucleic Acid Test (NAT): usually detect HIV 10-33 days after exposure and is done using venipuncture. Also tells us viral load
- Antigen/Antibody Lab test: usually detects HIV 18-45 days
after exposure and is done using venipuncture
- Rapid Antigen/Antibody test: usually detects HIV 18-90 days after exposure and is done from a finger stick sample (30 minutes for results)
- Antibody test: usually detects HIV 23-90 days after exposure and are available as self-tests (20 minutes for results)
65
Treatment of HIV
- Treatment is highly effective, and can prevent HIV transmission
* Client’s can be treated with antiretroviral medications as part of antiretroviral
therapy (ART)
- Lower the level of HIV in the body (suppresses the viral load) o Slows the spread of the virus in your body
- Helps the immune system fight off other infections
* In Canada, if you have HIV you have a legal duty to tell your sexual partners before having sex
66
True or False: Undetectable HIV = Untransmittable
True
- It can take up to 6 months to achieve an undetectable viral load on ART
- Viral load is a key determinant of HIV transmission
* Higher viral loads correlate with higher rates of both sexual and perinatal transmission of HIV
67
What is Pre-Exposure Prophylaxis (PreEP)?
- Highly effective HIV prevention strategy that HIV negative people can use to lower risk
- Involves taking antiretroviral (anti-HIV) drugs and having regular medical appointments, monitoring, and supporting
- When taken as prescribed, the risk of transmission is extremely low
- Available by prescription
- Two PrEP pills approved by Health Canada, both contain emtricitabine + either tenofovir disoproxil or tenofovir alafenamide
- Only covered under OHIP for those 24 years or younger, otherwise costs $250-280/month in Ontario
68
What is Post-Exposure Prophylaxis (PEP)?
- Can be taken after HIV exposure to help prevent infection
- Should be started as soon as possible, up to a maximum of 72 hours afterwards
- Very effective but will not prevent 100% of HIV transmissions from occurring
- Must have high adherence to the full course of PEP drugs (4 weeks) and should have no further exposures to HIV while taking PEP
* PEP is a combination of three medications
* Tenofovir disoproxil fumarate, emtricitbine, raltegravir (or dolutegravir)
69
What is Hepatitis B?
- Is a liver disease spread by contact with infected body fluids, including blood, semen and vaginal fluid
- It is more infectious than HIV
- Following infection, 50% of people are asymptomatic
- 50% will develop symptoms of fatigue, nausea, vomiting, jaundice, decreased appetite, and arthralgia
- Approximately 95% of healthy people will clear the virus, the remaining will become chronic carriers
- Those Hepatitis B may eventually develop liver cancer, liver failure, or cirrhosis
- Diagnosis is confirmed by blood tests and can be treated using antiviral drugs
70
Four Hepatitis B-containing vaccine in Canada
- Engerix-B + Engerix-B Pediatric
- Infanrix hexa, also contained diphtheria, tetanus toxoids, acellular pertussis, hep B, inactivated poliomyelitis, and conjugated Haemophilus influenza type B
- Recombivax HB, Recombinvax HB - Pediatric, Recombivax-HB Adult dialysis
- Twinrix + Twinrix Junior, combined Hepatitis A and B
* 3 vaccine series over 6 months
* Not covered under OHIP
71
What is Hepatitis C?
- Is a liver disease caused by the hepatitis C virus (HCV)
- Most commonly spread by percutaneous exposure with infected blood and less
commonly by sexual activity or perinatal exposure
- Hepatitis C can progress to cause liver injury and eventually end- stage disease
- Following infection, most people are asymptomatic
- Rates are highest among 25-29 year olds
72
Treatment of Hepatitis C
- Diagnosis is made through serum blood testing
- Medications used are called “direct-acting antivirals” (DAAs), which block the ability of the HCV to replicate
- Being cured of hepatitis C, or a sustained virological response (SVR) is achieved after a negative/undetectable HCV RNA test 12 weeks after the end of their treatment
- Treatment is based on amount of liver injury, drug interactions, genotype/strain of the HCV, length of treatment, and previous treatment experience
- Treatment is highly effective and cures of 95% of people with Hep C
* Typically includes taking pills for 8-12 weeks
* Most people don’t pay out of pocket
73
Primordial Prevention
- Preventing STBBIs and risk factors from existing
- Creation of programs and policies that keep youth off the streets, or advocating for access to comprehensive sexual health education
74
Primary Prevention
- Refers to preventing the start of disease with the goal of decreasing incidence
- Involves activities prior to any sign of disease, injury, or transmission of STBBIs
- Includes the use of penile or male condoms + vaginal or female condom
* Remember condoms are not 100% effective in protecting against herpes or HPV
- Vaccination is very valuable
75
Secondary Prevention
- Refers to early detection
- Involves regular testing and screening for STBBIs, including blood testing, urine samples, genital examination, and sometimes swabs
76
Tertiary Prevention
- Measures aimed at decreasing the progress of a disease and controlling long-term negative consequences
- Involves using medications to treat an infection
- Manage symptoms
77
Quaternary Prevention
- Methods to avoid results of unnecessary or excessive intervention
- As new medications are developed for STBBIs, is it important to ensure patients are not placed in any harm - ensuring consent is obtained in trials, and having the ability to withdraw at any time
