Sexually Transmitted Infections Flashcards
General treatment goal of STD
Eradicate infection within 5-7 days (curable infections only) Alleviate symptoms Prevent reinfection Prevent further STDs Prevent spread to partners Prevent complications Contraception discussion
What is Nucleic Acid Amplification Tests (NAATs)? What is it used for?
Considered the standard of care due to high sensitivity
Wide variety of FDA-cleared specimens types: endocervical, vaginal, urethral, and urine
Used for Chlamydia and Gonorrheal
Clinical presentation of Chlamydia
About 25% of men, and 30% of women will not have ANY symptoms.
More frequently, patients are asymptomatic
When symptoms are present, they tend to be less noticeable
Urethral discharge usually is less profuse, and more mucoid or watery than the urethral discharge associated with gonorrhea
Treatment for Chlamydia
Uncomplicated urethral, endocervical, or rectal infection in adults
Azithromycin 1g PO once
OR
Doxycycline 100mg PO BID x 7 days
More alternative in ppt
Treatment for Chlamydia
Urogenital infections during pregnancy
Azithromycin 1g PO once
Is Chlamydia curable?
YES
Follow-up for Chlamydia
Treatment is highly effective; post-treatment laboratory testing is not recommended unless:
_Adherence is in question
_Symptoms persist
_Reinfection is suspected
Must wait at least 3 weeks after therapy (presence of nonviable organisms that can lead to false-positive results)
If not treated, Chlamydia can lead to ….
Men: Epididymitis, Reiter’s syndrome
Women: Pelvic inflammatory disease and associated complications (i.e. ectopic pregnancy, infertility), Reiter’s syndrome
Reiter’s syndrome
Rare
Reactive arthritis that occurs following a type of bacteria in the body
Gonorrhea
Second most commonly reported communicable disease
Difficult to control due to rapid incubation period and large number of infected individuals
More easily transmitted male female
Clinical presentation of gonorrhea
May be symptomatic or asymptomatic
May be complicated or uncomplicated
May have infections involving several anatomical sites
Most symptomatic patients not treated become asymptomatic within 6 months
If pt have gonorrhea and other diseases were not ruled out, what should we think?
Estimated 46% of people with gonorrhea also have chlamydia
All patients with gonorrhea should be treated for Chlamydia, if Chlamydia cannot be ruled out
Treatment for Gonorrhea
Ceftriaxone 250mg IM once
PLUS
Azithromycin 1g PO once
Is gonorrhea curable?
YES
Follow-up for gonorrhea
Symptoms that persist after treatment should be evaluated by culture for N. gonorrhoeae (with or without simultaneous NAAT)
A high prevalence of infection has been observed among men and women previously treated for gonorrhea
Most of these are a result of reinfection rather than treatment failure
If not treated, gonorrhea can lead to ….
Men: Epididymitis, prostatitis, inguinal lymphadenopathy, urethral stricture/urethritis
Women: Pelvic inflammatory disease and associated complications (i.e. ectopic pregnancy, infertility), disseminated gonorrhea (three times more common than in men)
Infant: blindness
EPT pt needs treatments for Chlamydia and Gonorrhea
Symptomatic: 60 days before onset of symptoms, through the date of treatment
Asymptomatic: 60 days before date of specimen collection, through the date of treatment, if patient was not on treatment at time of specimen
What do we give EPT patients for Chlamydia? Gonorrhea?
Chlamydia:
Azithromycin 1 g PO once
Gonorrhea:
Cefixime 400mg PO once
AND
Azithromycin 1g PO once
Syphilis and HIV association
Highly contagious and, if left untreated, progresses to a chronic systemic illness that can be fatal
Strong association between syphilis and HIV
May increase the risk of acquiring HIV
Immunologic defects in HIV-infected persons can cause abnormal serologic response to syphilis
Compromised immune function could accelerate the progression of syphilis – particularly to neurosyphilis
How many stages of syphillis? What are they?
3 main stages: primary, secondary, and tertiary
2 more stages associated with syphillis: latent, neurosyphillis
Primary syphillis
Painless ulcer appears at the site of infection about 10-90 days after exposure
Heals without treatment in 3-6 weeks
Secondary syphillis
Begins 3-6 weeks after ulcer heals
A rash begins to develop
May also have fever, swollen lymph nodes, sore throat, weight loss, muscle aches, fatigue, alopecia,
Condylomata lata (confused as warts) Resolves without treatment
Latent syphillis / Tertiary syphillis
Latent:
– (+) serological tests; no other evidence
– develops 4-10 weeks after secondary stage
– No signs or symptoms
Tertiary Syphilis:
_ Develops 10-30 years after infection
_ Damage to internal organs, can lead to death
_ Signs and symptoms include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, dementia, gummatous lesions involving any organ or tissue
Neurosyphillis
Develops 10-30 years after infection
May occur at any stage of syphilis
Can be asymptomatic
Signs and symptoms include meningitis, general paresis, dementia, eighth cranial nerve deafness, blindness, ocular involvement
Diagnosis of syphillis require how many tests? Why?
At least 2 tests
Treponemal and Nontreponemal
Results in false negative results during primary syphilis
Results in false positive results in those without syphilis
What are nontreponemal tests? Include what tests?
Detect antibodies that are not specifically directed against the T. pallidum bacterium
_ Venereal Disease Research Laboratory (VDRL)
_ Rapid Plasma Reagin (RPR)
What are treponemal tests? Include what tests?
Detect antibodies that specifically target T. pallidum bacterium
_ Fluorescent treponemal antibody absorbed (FTA-ABS) test
_ T. Pallidum passive particle agglutination (TP-PA) assay
_ Various enzyme immunoassays (EIAs)
FYI: nontreponemal tests
Inexpensive, easily performed
Positive results indicate any stage of syphilis
Useful for screening, progression of disease, recovery after therapy, reinfection
Antibodies in adequately treated patient disappear after about 3 years
Results can vary in HIV positive patients
Chronic false-positive results are commonly associated with heroin addiction, aging, chronic infection, autoimmune disease, malignant disease
FYI: treponemal tests
Highly specific for syphilis – unlikely to have a false positive
Once infected, antibodies remain in blood for life
Positive screening must be followed by nontreponemal test to differentiate between an active infections vs one that occurred in the past and has been treated
Interpretation of Serologic Tests Results
look in ppt or add pic later
Treatment for syphillis (1st choice vs PCN allergy)
Primary, secondary, or early latent (<1 year duration)
Benzathine penicillin G 2.4 million units IM in a single dose
For PCN allergy: Doxycycline 100mg PO BID x 14 days OR Tetracycline 500mg PO 4x daily x 14 days OR Ceftriaxone 1g IM or IV daily x 10-14 days
Treatment for syphillis (1st choice vs PCN allergy) Late latent (> 1 year duration) or latent of unknown duration, or tertiary syphilis
Benzathine penicillin G 2.4 mil units IM once a week for 3 successive weeks (7.2 mil units total)
For PCN allergy:
Doxycycline 100mg PO BID for 28 days
OR
Tetracycline 500mg PO 4x daily x 28 days
Treatment for syphillis (1st choice vs PCN allergy)
Neurosyphillis
Aqueous crystalline penicillin G 18-24 mil units IV (3-4 mil units every 4 hours or by continuous infusion) for 10-14 day
For PCN allergy
Ceftriaxone 2g daily either IM or IV for 10-14 days
Is syphillis curable?
YES
Follow-up serology for primary, secondary, or early latent (<1 year duration)
Retreatment if needed
Clinical and quantitative nontreponemal tests at 6 and 12 months for primary and secondary
At 6, 12, and 24 months for early latent
Retreatment as needed with weekly injections of benzathine penicillin 2.4 mil units IM for 3 weeks
