Sexually transmitted infections Flashcards
How do you test for gonorrhea infection?
Molecular testing with NAAT
When would you do a culture for gonorrhea?
TOC in cases of persistent symptoms
+NAAT for TOC should be followed up with culture
Performed 7-14 days after treatment
Is a retesting for presence or absence of gonorrhea infection necessary? if so when?
Yes within 3 months
What is the treatment for gonorrhea infection and dose?
Ceftriaxone 500mg IM x 1 dose for weight <150kg
Ceftriaxone 1g IM x 1 dose for weight >150kg
What is the alternative treatment for gonorrhea infection?
Azithromycin + gentamicin
What is the recommended follow up after treatment for gonorrhea?
retest within 3 months
Patient counseling after testing positive for STI?
- Recommend refraining from intercourse until at least 7 days after treatment. Do no engage in intercourse if partner has not be tested and treated
- Recommend testing for other STIs such as chlamydia, Syphillis, HIV
- Obtain pregnancy test
What is the expedited partner therapy for gonorrhea?
Cefexime 800mg PO
What are risk factors that increase risk of STI?
- New sexual partner within 60 days
- Multiple sexual partners
- Partner with multiple sexual partners
- Partner recently treated for STI
- Trading sex for money or drugs
- Having sex with a sex worker
7.
What are high risk groups for STI?
- Young age 15-24
- incarcerated
- Men having sex with men
- History of STI
- HIV positive
- Pregnant
When is the recommended screening for HIV?
All adults and adolescents age 13-75 y/o or all individuals seeking screening for STIs
When is the recommended screening for gonorrhea and chlamydia indicated?
Annually for women <25y/o
When is the recommended screening for trichomonas?
Recommended in high prevalence settings or females at increased risk for STIs
What are the STI screening recommendations for women 25 and older?
Only screen for women with high risk behaviors or in high risk settings.
Screen for chlamydia, gonorrhea, trichomonas, syphillis, hepatitis B if not vaccinated
What is the screening recommendation for hepatitis C?
Atleast once in lifetime at age 18 or older
Ongoing screening recommended for men having sex with men, HIV, sex partner with hepatitis C, Patient using prep to prevent HIV
If a patient presents requesting STI testing what should you test for?
Chlamydia
Gonorrhea
Trichomonas
Syphillis
HIV
What is the recommended test for chlamydia?
NAAT vaginal swab
What is the recommended test for gonorrhea?
NAAT vaginal swab
What is the recommended test for trichomonas?
NAAT vaginal swab
What is the recommended test for HIV?
HIV 1/2 antigen antibody immunoassay combination test followed by confirmatory HIV 1/2 antibody differentiation immunoassay
What is the recommended test for syphillis?
Nontreponemal test= RPR VDRL
Treponemal test= FTA-Abs
What are signs of PID?
Pelvic pain with either CMT, uterine tenderness or adnexal tenderness
Which syphilis serologic test typically stays positive for life and which usually returns to negative after treatment?
Treponemal test typically stays positive for life
Nontreponemal test typically seroconverts to negative
What is the treatment for the different stages of syphilis?
Primary, secondary, early latent= PCN G 2.4mu
Late latent, tertiary= PCN G 2.4mu x 3 doses weekly
Neurosyphillis= IV PCN G
What is early latent syphillis?
Asymptomatic with positive serologic evidence of T. palladium that was acquired in last 12 months
What is late latent syphilis?
Asymptomatic with positive serologic evidence of T palladium infection without known timeframe of acquisition
What is the alternative treatment for syphillis if PCN allergy?
doxycycline 100mg BID for 14-28 days
What is a treatment for HIV?
Dulotegovir + tenoforvir + lamivudine
What is PrEP for HIV?
Preexposure prophylaxis for patients without HIV taking antiretrovirals as an effective prevention strategy
For patients that are adherent to PrEP how much can transmission be reduced with PrEP?
99%
What patients are eligible for PrEP?
All sexually active patients should be informed about PrEP
Next obtain a sex and drug history to determine if the patient is at high risk of acquiring HIV
High risk= injection drug use, Men having sex with men, transgender women have condoles anal sex, heterosexual couple with partner that is at high risk, being diagnosed with gonorrhea or syphillis
What should you do before initiating PrEP?
Perform STI testing= Chlamydia, gonorrhea, syphillis, HIV, Hep B and Hep C
Pregnancy test
What is the regime for PrEP?
Oral= Tenofovir + disoproxil+fumarate+emtricitabine
Injection= cabotegravir LA
What can BV increase your risk for?
STIs
Preterm birth
endometritis
cuff cellulitis
How do you diagnose BV?
Amsels criteria= 3 criteria met
Homogenoeus thin white discharge
pH >4.5
Clue cells >20%
+KOH test
What is the preferred treatment for BV?
PO Flagyl 500mg BID for 7 days
Intravaginal metro gel 0.75% 5g applicator for 5 days
Clindamycin cream 2% 5g applicator for 7 days
What is the alternative treatment for BV
Tinidazole 1g x 5 days
Secondiazole 2g once
What is recurrent BV?
3 or more documented BV infections in 1 year
How do you treat recurrent BV?
Treat current infection with flagyl PO or gel then do suppressive treatment with metro gel 2x/wk for 4-6 months
What is the gold standard for diagnosing BV Infection?
Gram stain
What is the preferred management for yeast infection?
Oral or topical azole
Flucanazole 150mg PO
Clotrimazole 1% cream for 7 days
How do you diagnose recurrent yeast infection?
Vaginal culture
How do you define recurrent yeast infection?
3 or more documented infections in 1 year
What is the management for recurrent yeast infection?
Fluconazole 150mg a 3 doses followed by maintenance therapy with fluconazole 150mg weekly for 6 months
What is the alternative treatment for chlamydia?
Azithromycin 1g PO x 1 dose
Levofloxacin 500mg daily for 7 days
What is the preferred treatment for nonpregnant females with chlamydia?
Doxycycline 100mg BID for 7 days
What is the preferred treatment for pregnant women with chlamydia infection?
Azithromycin 1g PO x 1 dose
What is the preferred treatment for trichomonas infection?
Metronidazole 500mg BID for 7 days
What is the alternative treatment for trichomonas?
Tinidazole 2g PO x 1 dose
Recommended inpatient treatment for PID?
Ceftiaxone 1g IV q24hrs + doxycycline + flagyl
or
Cefoxitin 2g IV q6hr + doxycycline
Recommended alternative parental regime for PID?
Gent+ clindamycin
Recommended outpatient treatment for PID?
Ceftriaxone 500mg + Doxycycline + flagyl for 14 days
When is inpatient management recommended for PID?
Pregnancy
Failed outpatient management
Systemic illness
Unable to follow outpatient management
TOA
Surgical emergencies can’t be excluded
