Sexually Transmitted Infections Flashcards
- which population is disproportionally impacted by STDs including P&S syphilis and gonorrhea?
- Who is getting STDs?
- MSM
- In 2019 over half (55.4%) of reported cases of STDs were among adolescentes and young adults aged 15-24 years
what is the current screening recommendation for chlamydia & gonorrhea?
- screen all sexually active females under age 25 annually
- if positive rescreen 3-4 months after treatment due to high rate of re-infection
individuals should refrain from sexual intercourse until they have completed the seven day treatment regimen (Or seven days have elapsed after single-dose treatment) any symptoms have resolved and sexual partners have been treated.
- most common bacterial cause of sexually transmitted gentital infection
- often asymptomatic
- clinical syndromes in females- genitourinary tract infection, cervicitis, dysuria-pyuria syndrome, PID, perihepatitis, pregnancy complications, also- conjunctivitis, phayngitis, reactive arthritis
chlamydia
testing for chlamydia?
- NAAT (nucleic acid amplification testing)
- preferred testing: Vaginal swab; self swab or endocervical swab with speculum exam
- urinary study (first catch urine)- up to 10% less infections detected this way
treatment of chlamydia?
- empiric therapy for chlamydial infection should be offered to a persons who present with symptoms of cervicitis, pelvic inflammatory disease, urethritis, epididymitis, or acute proctitis OR if they have recent known or possible exposure
- Doxycylcine 100mg twice daily for seven days
- Major cause of cervicitis in women which can later result in pelvic inflammatory disease (PID), infertility, ectopic pregnancy and chronic pelvic pain
- remember screeening for all women < 25, MSM and those at high risk
- urogenital infections: cervicitis, urethritis, PID, bartholinitis
Testing is the same as chlamydia
Gonorrhea
treament of gonorrhea?
- ceftriaxone 500mg IM
- urethritis and cervicitis, similar risk factors as other STIs (think this if no clinical response to empiric therapy of GC/Chlamydia)
- coinfection with other STIs including bacterial STIs and HIV
- Test symptomatic patients, use NAAT testing
- no routine screening, tests less available
- TX: azithromycin, fluoroquinolones
Mycoplasma Genitalium
- An inflammatory disorder of the upper female genital tract, most typically presenting as salpingitis (fallopian tube infection)
- lower abdominal pain (usually) may be unilateral or bilateral
- dyspareunia (sometimes)
- vaginal discharge or bleeding (occasionally)
- sx may be absent, subtle or mild
- Cervical Motion Tenderness
Always consider in diff. dx of acute abdominal pain in women
Pelvic inflammatory disease
PID complications?
- Ectopic pregnancy
- tubo-ovarian abscess
- infertility
- chronic pelvic pain
How can you diagnose PID?
Minimum Criteria: lower abdomen/pelvic pain, plus one or more
- adnexal tenderness (unilateral or bilateral) or
- uterine tenderness or
- cervical motion tenderness
Additional non-specific criteria that support PID diagnosis:
- oral temp > 38.3C
- abnormal cervical or vaginal micropurulent discharge
- abundant WBCs on vaginal wet mount
- Elevated ESR or CRP
- documented chlamydial or gonococcal infection
Treatment of PID?
- a singular IM dose of ceftriaxone, doxycyline + metronidazole
doxycycline and metronidazole BID for 14 days
Recent sexual partners (60 days) of patients diagnosed with these STIs should be treated empiracally with same regimen for what STIs
- chlamydia
- gonorrhea
- syphilis (6 months)
- trichomniasis
- PID
Common cause of first episode genital herpes and causes almost all recurrent genital herpes
HSV-2
is an increasingly important cause of first epidsode genital herpes, but recurrences are infrequent
HSV-1
