SEXUALLY TRANSMITTED INFECTIONS (STI)

Question 1

Sexually Transmitted Infections (STI)

Answer 1

• 60%–80% are asymptomatic
  o It is recommended for sexually active persons to be tested once a year
• Most are detected on routine exam
• Some present with burning, itching, and a vaginal discharge
• Primary lesions may be painless and blister-like, or the patient may have severe pain
• All ulcerative or wart-like lesions should be serologically tested for syphilis
• All the patient’s sexual contacts from the 10 days before onset of symptoms should be treated

Question 2

Trichomoniasis

Answer 2

• Caused by the protozoan T. vaginalis parasitic
• Symptoms for men can be asymptomatic
• Symptoms for women will develop copious green frothy discharge, odor, itchy
• STI→ both sex partners need to be treated!
• Diagnosed with vaginal microscopy

Treatment
o Flagyl (Metronidazole) 2gm PO, single dose

Question 3

Chlamydia Facts Symptoms and PE Findings

Answer 3

• Caused by Chlamydia trachomatis
• Most commonly reported STI in the U. S.
• CDC recommends persons 12yrs and older to be tested annually (even if reporting no sexual activity)
• Particularly prevalent among adolescent girls and young women
  Symptoms
• vaginal discharge, pelvic pain, dysuria
• penile discharge in men
  PE findings
• mucopurulent discharge
• friability (cervix just bleeds),
• adnexal tenderness

Question 4

Chlamydia Diagnostic Testing

Answer 4

Diagnostic tests
* wet mount
* DNA testing of urine and vaginal secretions

Question 5

Chlamydia Treatment

Answer 5

Treatment
* 1st line: Azithromycin 1 gram in a single dose OR
* 2nd line: Doxycycline 100 mg BID x 7 days
Alternative treatments
* Erythromycin 500 mg QID x 7 days OR
* Ofloxacin 300mg BID x 7 days OR
* Levofloxacin 500 mg daily x 7 days

Question 6

Gonorrhea Symptoms and PE Findings

Answer 6

• Caused by Neisseria gonorrhoeae
  Symptoms
  o similar to chlamydia: vaginal discharge, pelvic pain, dysuria
  o penile discharge in men
  o may also include menstrual irregularities
  Physical exam
  o purulent discharge
  o erythema
  o friability of the endocervix

Question 7

Gonorrhea Diagnostic tests

Answer 7

o wet mount and DNA testing

Question 8

Gonorrhea Treatment

Answer 8

Treatment
o 1st line: Ceftriaxone 250 mg IM in a single dose OR
o 2nd line: Cefixime 400 mg in a single dose OR
o 3rd line: Ciprofloxacin 500 mg in a single dose
Complications of untreated gonorrhea/chlamydia: PID, infertility
Always treat for chlamydia as well – high risk for contracting chlamydia too

Question 9

Genital Herpes Facts Symptoms and PE Findings

Answer 9

• Chronic, life-long viral infection
• At least 50 million people in the U.S. have genital herpes
• Two types have been identified – HSV-1 and HSV-2
  o The majority of cases of recurrent genital herpes are caused by HSV-2
• Can be spread EVEN IF NO SYMPTOMS!
  Symptoms
  o Primary herpes – fever, chills, malaise, dysuria, multiple, painful vesicular lesions
  o Recurrent herpes – recurrent outbreak of lesions, less painful , but preceded by prodromal symptoms
  Physical examination
• characteristic lesions are visible
• vesicular and exquisitely tender to touch

Question 10

Genital Herpes Diagnostic testing

Answer 10

viral culture, PCR

Question 11

Genital Herpes Treatment

Answer 11

o Suppressive therapy for recurrent genital herpes
 Acyclovir 400 mg BID OR
 Valacyclovir 500 mg daily
o Episodic therapy for recurrent genital herpes
 Acyclovir 400 mg TID x 5 days OR
 Valacyclovir 500 mg BID x 3 days

Question 12

Syphilis Symptoms and PE findings

Answer 12

• Caused by Treponema pallidum
• The risk of developing syphilis after contact with an infected individual is 50%
• In 2006, 64% of the reported primary and secondary syphilis cases were among men who have sex with men
• Infection manifests in distinct stages
  Primary Syphilis
• Classic skin lesion called a chancre develops
• Painless, rounded, ulcer
  Secondary Syphilis
• Maculopapular rash develops – including palms and soles of feet
  Tertiary syphilis
• Neurologic and cardiac manifestations including:
  o Murmurs, CHF, meningitis, cranial nerve palsies, cognitive dysfunction, motor and sensory deficits

Question 13

Syphilis Diagnostic testing

Answer 13

• RPR antibody level
• Recheck RPR at 6 and 12 months

Question 14

Syphilis Treatment

Answer 14

Treatment of primary and secondary syphilis
o Penicillin G – 2.4 million units IM
o Alternatives (allergy to PCN)
 Doxycycline 100 mg BID x 14 days
 Ceftriaxone 1 to 2 g daily IM or IV for 10 to 14 days
 Tetracycline 500 mg orally four times daily for 14 days
 Amoxicillin 3 g plus probenecid 500 mg, both given orally twice daily for 14 days
* Treatment of tertiary syphilis
o Penicillin G – 7.2 million units total, administered as 3 doses of 2.4 million units IM at 1 week intervals
o Alternatives (choose one):
Doxycycline 100 mg orally twice daily for four weeks
Ceftriaxone 2 g daily IM or IV for 10 to 14 days

Question 15

HIV Lab test

Answer 15

• Lab tests:
  o Antibody test (immunoassay) via blood sample which checks for antibodies to the HIV virus, urine and oral less accurate, most antibody tests after 4 wks will detect infection but will need a test at 12 weeks after exposure to be considered HIV negative
  o Antigen test checks blood for an HIV antigen called p24 which can be detected 11 days to 1 month after getting infected
  o A follow-up test should be done when screening test is positive (Western blot most common)
  o People who are at high risk should be tested every 3-6 months, occasional risk every year
  o re-test in 2 months if believed may have been exposed and first test negative