Sexually Transmitted Infections Flashcards
HSV Infection
HSV 1 and HSV 2
Both serotypes can cause either type of infxn
Very common: 50 mil. in US.
Types of HSV infxn
Primary: infxn w/o antibodies to HSV 1 or 2
Non-primary: first episode infxn due to acquiring HSV-1 w/ antibodies to HSV-2 or vice versa.
Recurrent: The lesion and the serum have the same antibodies.
Primary HSV
Highly variable symptoms
Sx tend to be more severe in women
Local itching, dysuria, lymphadenopathy
HSV transmission
Highly transmittable
Can be transmitted by oral/genital
Greater risk with male source
70% transmission in asymptomatic patients
Condom use declines HSV transmission by ____%
50
HSV diagnosis
Viral culture if lesions present
PCR study
Serology for type specific antibody
HSV Tx
Acyclovoir (Zovirax)
Famcilovir (Famvir)
Valacyclovoir (Valtrex)
Primary HSV should be treated within 72 hrs**
Recurrent HSV Tx
Chronic suppressive therapy
Episodic therapy: Treat at prodromal symptoms for 3 days.
HSV in Pregnancy
Most common transmission is from direct contact of fetus with infected vaginal secretions.
Maternal immunity is important**
Do a prophylactic c-section if active lesions at birth
Syphillis
Causative agent: Treponema Palidum
Cannot be cultured, but serologic tests available
Can be seen with dark field microscopy
Is a reportable disease in the US
Syphilis: who to screen
Pt w/ suspected disease High-risk populations Multiple partners Pregnant women Hookers/Jiggalos Sexually active HIV folks Man on man action
Syphilis is associated with increased risk for acquisition of _____?
HIV.
All patients diagnosed with syph should be given the option for HIV testing.
Syphilis Transmission
Primary and secondary produces chancres, mucous patches and condyloma lata.
Transmission from an infected person is 30%
Can be spread by kissing and touching
Can be passed through the placenta
Primary Syphilis
Incubation period of 2 - 3 weeks.
A papule forms and soon ulcerates to the chancre
Chancres heal within 3 - 6 weeks without tx
Bilateral lymphadenopathy
The syphilis chancre is usually ______.
Painless
Secondary Syphilis
Weeks to months later 20% of people w/ untreated infxns will develop systemic illness.
Rash, condyloma lata, systemic symptoms, hepatitis, GI abnormalities, musculoskeletal/renal abnormalities
Tertiary Syphilis
1 - 25 years after secondary syphilis
subcutaneous granulomas
ascending thoracic aorta dilates, aortic regurg
CNS symptoms
Syphilis Neuro symptoms
Early: Meningitis, meingiovascular disease
Late: General paresis, tabes dorsalis, ocular, otosyphilis
Neurosyphilis
When suspected do an LP
Lymphocytic pleocytosis
Need to follow CSF during tx to ensure a response
Tx of early syphilis
2.4 million units benzathine PCN G IM
For primary and secondary, early latent
If PCN allergic, doxycycline 100mg BID for 14 days
Neurosyphilis Tx
IV penicillin 3-4 million units q 4 hrs
OR
18 - 24 million units/day continuous infusion for 10 - 14 days
Patients w/ PCN allergy should be desensitized!
Non-PCN regimens are ____ ______ for patients w/ neurosyphilis.
NOT recommended.
PCN G is drug of choice
Syphilis monitoring
Pts should be reexamined clinically and serologically at 6 and 12 months after tx
Human Papillomavirus (HPV)
Double stranded DNA virus
More than 100 types of HPV
75 - 80% of sexually active adults will acquire HOV before the age of 50
HPV manifestations
Genital warts Bowenoid Papules and bowens disease Giant Condyloma Carcinoma of genito areas Plays a role in squamous cell carcinomas of head, neck and oral cavity.
Which are the 2 types of HPV associated with 70% of cervical cancer?
HPV 16 and 18
What are the 2 types of HPV that cause 90% of genital warts?
HPV 6 and 11
Most HPV infxns resolve in ___ to ___ months.
6 - 12 months
Anogenital warts
Most common viral STD in U.S.
67% of pt pop is women
Anogenital wart Dx
Usually made by visual inspection
5% acetic acid turns lesion white
Warts Tx
Spontaneous regression occurs in 20-30% of cases
All therapies have 30 - 70% regression
Ablative therapies
Excisional therapies
HPV Vaccine
Gardasil - oncogenic and warts
Cervarix - just oncogenic
Common cause of urethritis in males
Gonorrhea
Trichomonas Vaginalis
Accounts for 20 - 35% of vaginitis
Flagellated Protozoan
Organism identified in 30-40% of male sexual partners of infected women.
Trichomoniasis presentation in women
Asymptomatic carrier state Purulent, maladorous thin discharge (70%) Burning, pruritis Dysuria, frequency Dyspareunia, postcoital bleeding
Trichomoniasis Dx
Vaginal swab: wet mount shows motile trichomonads-diagnostic
Classic, green frothy foul smelling discharge
Elevated pH, increased PMN’s
Trichomoniasis Tx
Tinadazole or Metronidazole (flagyl)
SIngle oral dose of 2 mg
Metronidazole 500mg BID for 7 days for symptomatic pregnant women
Male partners must be treated as well
Trichomoniasis in men
Usually transient w/ spontaneous resolution
typical urethritis symptoms
Tx is usually because of +female dx or NGU
NGU = ?
Non-gonococcal urethritis
Neisseria Gonnorrhoeae
Second most commonly reported communicable disease in US.
Increasing abx resistance
Gonorrhea Manifestations
Women: any portion of genital tract (PID) Most common site is cervix Urethritis Anorectal infxn/proctitis Men: Urethritis, epididymitis, proctitis
Disseminated Gonococcal Infections (DGI)
Occurs in 1 - 3% of infected pt’s.
More common in women
Tenosynovitis, dermatitis, polyarthralgias
DGI presentation
Purulent arthritis
Painless lesions, transient
Multiple inflamed tendons
Gonorrhea Dx
Gram stain for urethritis in men
NAAT - optimal method
Gonorrhea Tx
Ceftriaxone: 250mg IM single dose PLUS (for chlamydia) Azithromycin (1 gram dose single) OR Doxycycline 100mg BID for 7 days
Chlamydia Trachomitis
Small gram- organism
Persistent infxn is common
Screen women, treat men empirically
Chlamydia manifestations in women
Cervicitis, urethritis, PID
30% of women will develop PID if untreated
Can cause pregnancy complications
Chlamydia manifestations in men
Urethritis
Epididymitis
Proctitis: uncommon
Chlamydia Dx
Culture
NAAT - gold standard
This is a reportable infxn
Chlamydia Tx
Azithromycin 1 gram single dose
doxycycline 100mg BID for 7 days
Test for cure in pregnant patients
