Sexually Transmitted Diseases: Schoenwald Flashcards
1 in __ people in the US have an STI
-___ million new STIs in 2018
5
- 26 million*
- HALF of new STIs were among youth aged 15-24 in the US
- New STIs total nearly $16 billion in direct medical costs
STD Prevention and Control:
-Education/ counseling?
- Education and counseling to reduce risk of STD acquisition
- Detection of asymptomatic and/or symptomatic persons unlikely to seek evaluation
- Effective dx and tx
- Evaluation, tx, and counseling of infected persons and sexual partners
STD Prevention and Control:
describe preexposure vaccination
**hepatitis A, B and HPV
Medical Interview Important:
-The 5 P’s
Partners Prevention of Pregnancy Protection from STDs Practices Past History of STDs
Prevention Messages
-Tailor to personal risk(patient)
Interactive counseling
- Don’t forget about adolescents
- Specific about actions needed for prevention or acquisition of STD
- Inform about specific tests performed
Preexposure vaccines:
-Hepatitis B vaccine is recommended for:
ALL sexually active persons
Preexposure vaccines:
-Hep A vaccine recommended for:
MSM
Preexposure vaccines:
-HPV vaccine recommended for–>
ACIP recommendation ages 9-26
-**Males and females
Prevention Methods:Male Condoms
-Consistent/correct use of latex condoms are effective in preventing:
sexual transmission of HIV infection and can reduce risk of other STDs
-*80% less likely to transmit HIV when condoms utilized
Prevention Methods:Male Condoms
-Likely to be more effective in prevention of infections transmitted by ______
fluids from mucosal surfaces (GC,CT, trichomonas, HIV) than those transmitted by skin-skin contact (HSV,HPV, syphilis, chancroid) up to 70% risk reduction for HPV
Male condoms:
___% breakage rate
-2%
T/F: Non latex available-higher breakage and slippage rate
True!
ie:
–Synthetic and lambskin
–Lambskin-larger pores (10 times the diameter of HIV viral particle, 25 times the size of HBV)
Female condoms provide an effective mechanical barrier to ______
viruses
Prevention Methods: Spermicides
-N-9 vaginal spermicides are NOT effective in preventing :
CT, GC, or HIV infection
Frequent use of spermicides/N-9 have been associated with _____
genital lesions
Spermicides alone are NOT recommended for:
STD/HIV prevention
N-9 should NOT be used as microbicide or lubricant during ____ intercourse
anal
MSM=
males who have sex with males
for all MSM, what must occur? (i.e. screening and counseling)
-STD/HIV sexual risk assessment and client-centered prevention counseling
- **Annual STD screening for MSM at risk
- -HIV and syphilis serology
- Pharyngeal NAAT, GC (oro-genital)
- Rectal NAAT, GC/CT (receptive anal IC)
About ___ of the cases of syphilis are in MSM in the US
2/3
____ preferred testing for GC/CT
**NAAT
GC=gonoccocal, NAAT=nucleic acid amplification test
MSM annual screening:
-includes 3 tests
- HPV screening-anal pap smear
- HBsAg testing
- Hepatitis C Ab testing
WSW=
women having sex w women
WSW:
-HPV risk up to __% in those reporting never having sex with men
30%
WSW:
-also are a higher concern for ____
- HIV
- GC/Chlamydia
- Trichomonas and BV a concern
HIV testing is ____
IMPORTANT
HIV:
-opt out testing–
testing-notifying patient that test will be performed unless they decline
HIV testing should be included for ALL Pts in which demographic?
Pregnant women**
STDs of Concern
- Actually, all of them
- “Sores” (ulcers):
- -Syphilis
- -Genital herpes (HSV-2, HSV-1)
- Others UNCOMMON in the U.S.
In US, ____ and syphilis majority of cases of ulcers in young
HSV
List 3 Ex’s of other STDS of concern that are uncommon in the US (KNOW FOR BOARD EXAMS)
- -Lymphogranuloma venereum
- -Chancroid
- -Granuloma inguinale
Non infectious etiology of ulcers (list Ex’s)
Carcinoma Trauma Psoriasis Fixed drug eruption Yeast
STDs of concern Cont.
-Describe “Drips” (aka discharges)
- Gonorrhea
- Chlamydia
- Nongonococcal urethritis / mucopurulent cervicitis
- Trichomonas vaginitis / urethritis
- Candidiasis (vulvovaginal, less problems in men)
Other MAJOR STD concerns: that is it’s own category
-hint: genital HPV
Genital HPV (especially type 16, 18) and Cervical Cancer
Genital Ulcer Diseases – Does It Hurt?
-Painful (list ex’s)
- Chancroid
- Genital herpes simplex
Genital Ulcer Diseases – Does It Hurt?
-Painless (list Ex’s)
- Syphilis
- Lymphogranuloma venereum
- Granuloma inguinale
Genital Ulcers: Herpes Virus (HSV1/HSV2)
- How common ?
- ___% of adults in the US infected
- MC infectious etiology of genital ulcerations
- **32-50% of adults in US infected(50 million)
Genital Ulcers: Herpes Virus (HSV1/HSV2)
- often transmitted ______
- HSV1 or HSV 2 is the most frequent cause of genital herpes?
- **unknowingly-asymptomatic viral shedding
- **HSV 2 most frequent
Herpes (HSV1/HSV2)
-Sx/clinical presentation
**Multiple painful vesicles on erythematous base, persist 7-10 days
Herpes can last how long?
- Chronic, lifelong infection
- Majority of cases undiagnosed
Herpes:
-serological testing?
*Serological testing high rate of false negative
Herpes Testing:
- viral studies:
- what is the test of choice??
culture and PCR preferred methods of testing
-**PCR is test of choice for CSF
(herpes simplex can cause a meningeal infection, so we add in the PCR of CSF to make sure it hasnt infected the brain)
Herpes:
-primary lesions are associated with fever and ______
bilateral adenopathy
Herpes:
Recurrent lesions–>
no fever or adenopathy
Herpes:
-Describe the prodrome
Prodrome= tingling or burning 18-36 hours prior lesion
Gold standard dx test for Herpes lesion
**Tzank smear
KNOW
Other dx tests for herpes
culture, serologies (many false negatives)
Tzanc smear=
–positive if _____
=**Gold standard test for HSV
-Positive if reported as presence of multinucleated giant cells
Genital HerpesFirst Clinical Episode: tx?
- **Acyclovir 400 mg tid or
- Acyclovir 200 mg 5 times daily or
- Famciclovir 250 mg tid - OR Valacyclovir 1000 mg bid
-**Duration of Therapy 7-10 days
(just remember acyclovir and famciclovir are primary ones)
Genital Herpes Episodic Therapy: tx?
-Acyclovir 400 mg 3x daily x 5 days OR -Acyclovir 800 mf BID x 5 days OR -Acyclovir 800 mg TID x 2 days OR -Famiciclovir 125 mg BID x 5 days OR -Famciclovir 1000 mg BID x 1 day OR -Valacylcovir 500 mg BID x 3 days OR Valacyclovir 1 gm PO daily x 5 days
Genital Herpes: supression
-Reduces frequency by ____% in frequent recurrence (>6/yr)
70-80%
supression= someone on an antiviral every day of the yr– IF they have 6 or more episodes during a year
Genital HerpesDaily Suppression: tx regimen
Acyclovir 400 mg bid or Famciclovir 250 mg bid or Valacyclovir 500-1000 mg daily
Genital Herpes: Treatment in Pregnancy
- Available data do not indicate an increased risk of major birth defects (first trimester)
- Limited experience on pregnancy outcomes with prenatal exposure to valacyclovir or famciclovir
- Acyclovir may be used with first episode or severe recurrent disease
Genital Herpes: Treatment in Pregnancy
–Risk of transmission to the neonate is ___% among women who acquire HSV near delivery
30-50%
Genital Herpes: Counseling
- Natural history of infection, recurrences, asymptomatic shedding, transmission risk
- *Individualize use of episodic or suppressive therapy
- **Abstain from sexual activity when lesions or prodromal symptoms present
- Inform partners
- **Risk of neonatal infection
Genital Herpes: Counseling
-describe the risk of neonatal infection (ie pregnant women giving birth)
Women without symptoms can deliver vaginally, IF ulcer present–>c section
Genital Ulcers: Syphilis
-describe the increasing incidence
- **Incidence increasing esp in HIV + men and MSM, also in IV drug usage
- 71% increase in numbers in US since 2014
Syphilis:
- etiology? (what organism)
- Describe the “Chancre”
- **Caused by Treponema pallidum
- Chancre-papule that ulcerates-painless
Genital Ulcers:
- active infection classified as:
- -Primary=
- -Secondary=
- -Tertiary=
- Primary (ulcer)
- Secondary(skin rash, lymphadenopathy), neurologic(altered mental status, stroke, meningitis)
- Tertiary (cardiac or gummatous lesions)
Syphilis staging:
-Describe Early Latent
Reactive testing within 1 year of infection-no symptoms
Syphilis staging:
-Describe Late Latent
- Reactive testing greater than 1 year after onset of infection or timing cannot be determined
- No symptoms
Syphilis testing:
-what is the Gold standard test?
**Darkfield examination of exudate/tissue =gold standard
Syphilis testing:
-other dx tests: Serologic tests (describe the 2 types)
- Nontreponemal tests-RPR,VDRL
- -Reactivity fades over time
- Treponemal tests-fluorescent trepenemal ab(FTA-AB)
- ->Once positive, usually stays positive
Primary Syphilis - Clinical Manifestations
-Incubation period=
10-90 days (Average of 3 weeks)
Primary Syphilis - Clinical Manifestations
-describe the Chancre:
-Early: macule/papule –> erodes
Late: clean based, painless, indurated ulcer with smooth firm borders
- Unnoticed in 15-30% of patients
- Resolves in 1-5 weeks
- *****HIGHLY INFECTIOUS
