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Sexually transmitted infections Flashcards

1
Q

How do you test for gonorrhea infection?

A

Molecular testing with NAAT

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2
Q

When would you do a culture for gonorrhea?

A

TOC in cases of persistent symptoms
+NAAT for TOC should be followed up with culture

Performed 7-14 days after treatment

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3
Q

Is a retesting for presence or absence of gonorrhea infection necessary? if so when?

A

Yes within 3 months

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4
Q

What is the treatment for gonorrhea infection and dose?

A

Ceftriaxone 500mg IM x 1 dose for weight <150kg

Ceftriaxone 1g IM x 1 dose for weight >150kg

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5
Q

What is the alternative treatment for gonorrhea infection?

A

Azithromycin + gentamicin

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6
Q

What is the recommended follow up after treatment for gonorrhea?

A

retest within 3 months

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7
Q

Patient counseling after testing positive for STI?

A
  1. Recommend refraining from intercourse until at least 7 days after treatment. Do no engage in intercourse if partner has not be tested and treated
  2. Recommend testing for other STIs such as chlamydia, Syphillis, HIV
  3. Obtain pregnancy test
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8
Q

What is the expedited partner therapy for gonorrhea?

A

Cefexime 800mg PO

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9
Q

What are risk factors that increase risk of STI?

A
  1. New sexual partner within 60 days
  2. Multiple sexual partners
  3. Partner with multiple sexual partners
  4. Partner recently treated for STI
  5. Trading sex for money or drugs
  6. Having sex with a sex worker
    7.
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10
Q

What are high risk groups for STI?

A
  1. Young age 15-24
  2. incarcerated
  3. Men having sex with men
  4. History of STI
  5. HIV positive
  6. Pregnant
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11
Q

When is the recommended screening for HIV?

A

All adults and adolescents age 13-75 y/o or all individuals seeking screening for STIs

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12
Q

When is the recommended screening for gonorrhea and chlamydia indicated?

A

Annually for women <25y/o

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13
Q

When is the recommended screening for trichomonas?

A

Recommended in high prevalence settings or females at increased risk for STIs

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14
Q

What are the STI screening recommendations for women 25 and older?

A

Only screen for women with high risk behaviors or in high risk settings.

Screen for chlamydia, gonorrhea, trichomonas, syphillis, hepatitis B if not vaccinated

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15
Q

What is the screening recommendation for hepatitis C?

A

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

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16
Q

If a patient presents requesting STI testing what should you test for?

A

Chlamydia
Gonorrhea
Trichomonas
Syphillis
HIV

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17
Q

What is the recommended test for chlamydia?

A

NAAT vaginal swab

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18
Q

What is the recommended test for gonorrhea?

A

NAAT vaginal swab

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19
Q

What is the recommended test for trichomonas?

A

NAAT vaginal swab

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20
Q

What is the recommended test for HIV?

A

HIV 1/2 antigen antibody immunoassay combination test followed by confirmatory HIV 1/2 antibody differentiation immunoassay

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21
Q

What is the recommended test for syphillis?

A

Nontreponemal test= RPR VDRL

Treponemal test= FTA-Abs

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22
Q

What are signs of PID?

A

Pelvic pain with either CMT, uterine tenderness or adnexal tenderness

23
Q

Which syphilis serologic test typically stays positive for life and which usually returns to negative after treatment?

A

Treponemal test typically stays positive for life

Nontreponemal test typically seroconverts to negative

24
Q

What is the treatment for the different stages of syphilis?

A

Primary, secondary, early latent= PCN G 2.4mu
Late latent, tertiary= PCN G 2.4mu x 3 doses weekly
Neurosyphillis= IV PCN G

25
What is early latent syphillis?
Asymptomatic with positive serologic evidence of T. palladium that was acquired in last 12 months
26
What is late latent syphilis?
Asymptomatic with positive serologic evidence of T palladium infection without known timeframe of acquisition
27
What is the alternative treatment for syphillis if PCN allergy?
doxycycline 100mg BID for 14-28 days
28
What is a treatment for HIV?
Dulotegovir + tenoforvir + lamivudine
29
What is PrEP for HIV?
Preexposure prophylaxis for patients without HIV taking antiretrovirals as an effective prevention strategy
30
For patients that are adherent to PrEP how much can transmission be reduced with PrEP?
99%
31
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
32
What should you do before initiating PrEP?
Perform STI testing= Chlamydia, gonorrhea, syphillis, HIV, Hep B and Hep C Pregnancy test
33
What is the regime for PrEP?
Oral= Tenofovir + disoproxil+fumarate+emtricitabine Injection= cabotegravir LA
34
What can BV increase your risk for?
STIs Preterm birth endometritis cuff cellulitis
35
How do you diagnose BV?
Amsels criteria= 3 criteria met Homogenoeus thin white discharge pH >4.5 Clue cells >20% +KOH test
36
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
37
What is the alternative treatment for BV
Tinidazole 1g x 5 days Secondiazole 2g once
38
What is recurrent BV?
3 or more documented BV infections in 1 year
39
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
40
What is the gold standard for diagnosing BV Infection?
Gram stain
41
What is the preferred management for yeast infection?
Oral or topical azole Flucanazole 150mg PO Clotrimazole 1% cream for 7 days
42
How do you diagnose recurrent yeast infection?
Vaginal culture
43
How do you define recurrent yeast infection?
3 or more documented infections in 1 year
44
What is the management for recurrent yeast infection?
Fluconazole 150mg a 3 doses followed by maintenance therapy with fluconazole 150mg weekly for 6 months
45
What is the alternative treatment for chlamydia?
Azithromycin 1g PO x 1 dose Levofloxacin 500mg daily for 7 days
46
What is the preferred treatment for nonpregnant females with chlamydia?
Doxycycline 100mg BID for 7 days
47
What is the preferred treatment for pregnant women with chlamydia infection?
Azithromycin 1g PO x 1 dose
48
What is the preferred treatment for trichomonas infection?
Metronidazole 500mg BID for 7 days
49
What is the alternative treatment for trichomonas?
Tinidazole 2g PO x 1 dose
50
Recommended inpatient treatment for PID?
Ceftiaxone 1g IV q24hrs + doxycycline + flagyl or Cefoxitin 2g IV q6hr + doxycycline
51
Recommended alternative parental regime for PID?
Gent+ clindamycin
52
Recommended outpatient treatment for PID?
Ceftriaxone 500mg + Doxycycline + flagyl for 14 days
53
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

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