STD Flashcards
What are the mode of transmission of STIs?
Childbirth
Breastfeeding
Infected mother to child during pregnancy
Sexual contact with an infected person
Direct contact of broken skin with open sores, blood or genital discharge
Receiving contaminated blood
What are the risk factors associated with STDs?
Unprotected sexual intercourse
Number of sexual partners
Male sex with male
Prostitution
Illicit drug use
What are the preventive methods to advice sexually active patients?
Abstinence and decrease number of sexual partners
Barrier contraception
Avoid drug use and sharing of needles
DO your pre-exposure vaccinations such as HPV and Hep B
Do your pre and post exposure prophylaxis especially those having sex with high risk patients and healthcare workers
What are the clinical presentations of gonorrhea?
Purulent urethral / vaginal discharge, dysuria and urinary frequency
What are the potential complications associated with gonorrhea?
Male: Epididymitis, prostatitis, urethral stricture and disseminated disease
Females: Pelvic inflammatory disease, ectopic pregnancy, infertility, disseminated disease
What is the pathogen and how is gonorrhea detected?
Gram stain of genital discharge
Culture
NAAT
What are the treatments recommended for gonorrhea? List the dose, frequency and duration.
<150kg: Ceftriaxone 500mg IM single dose
> 150kg: Ceftriaxone 1g IM single dose
What is the alternative treatment for gonorrhea? List the dose, duration and frequency
Gentamicin 240 IM single dose + Azithromycin 2g PO single dose
How should I monitor response for patients and their sex partners?
Patients: Abstain from sexual activity for 7 days after treatment and until all sexual partners have been tested
Sex partners: Those < 60 days exposure need to be tested; those > 60 days exposed, most recent sexual encounter need to be tested
How is chlamydia diagnosed? What bacteria is of concern?
NAAT
Chlamydia trachomatis
What is the first line regimen for chlamydia?
Doxycycline 100mg BD for 7 days
What are the other alternative regimens for chlamydia if patient has issues with adherence?
Azithromycin 1g orally in a single dose
What should you advice patients and sex partners upon diagnosis of chlamydia?
Patients: abstain from sexual intercourse for 7 days after single dose was initiated OR upon completion of 7 days regimen and resolution of symptoms if present
Abstain from sex until all partners have been tested
Sex partners: Last 60 days evaluate and tested; > 60 days most recent partner to be tested
Name the various stages of syphilis and describe the various clinical presentations?
Primary: single painless ulcer at site or infection OR multiple, atypical and painful lesions at external genitalia
Secondary: skin rash, mucocutaneous lesions, patchy alopecia, lymphadectomy
Latent: Asymptomatic but picked by serology testing
Tertiary: Gummateous lesions in joints and potential cardiac involvement
Neuropsychiatric
How is syphilis diagnosed?
Treponemal and non-treponemal antibody tests
What is the treponemal antibody test used for?
Acts as a confirmatory test for the diagnosis of syphilis
What is the nontreponemal serology antibody test used for? How are the results analysed?
Screening tool that detects any stage of syphilis
Monitor the response of treatment as it will decline after treatment initiation
Quantitative result with dilute serum concentration with positive results
What is one special considerations in the use of nontreponemal serology antibody testing?
VDRL and RPR are not interchangeable, need to use the same test for monitoring purposes
What is the first line for primary, secondary and early latent syphilis?
IM Benzthiane penicillin G 2.4 mil units in a single dose
What is the alternative for primary, secondary and early latent syphilis?
PO Doxycycline 100mg BD for 14 days
What is the first line regimen for late latent or tertiary syphilis?
IM Benzthiane Penicillin G 2.4 mil units once a week (3 doses)
What is the alternative for late latent or tertiary syphilis?
PO Doxycycline 100mg BD for 28 days
What is the first line regimen for neurosyphilis?
IV Crystalline Penicillin G 3-4 MU q4h OR 18-24 MU/day as continuous infusion for 10 to 14 days
OR
IM Procaine penicillin G 2.4MU daily + PO Probenacid 500mg QD
What is the alternative regimen for penicillin resistant neurosyphilis?
IV/IM Ceftriaxone 2g daily for 10-14 days
What should we monitor for upon administration of drug for syphilis?
Jarisch-Herxheimer reaction where patient experiences acute febrile reaction of headache, myalgia within 24h
A four-fold reduction of titre to indicate treatment success
How frequent should therapeutic response be monitored for syphilis?
3, 6, 12, 18 and 24 months
Neurosyphilis should check CSF every 6 months
What to advice patients and sex partners upon diagnosis of syphilis?
Patients: Abstain from sex intercourse until lesions completely healed; advice to also check with doctor if fully treated
Sex partners: All to be evaluated and treat if positive
What are the physical clinical presentation, flu like and prodromal symptoms of genital herpes?
Physical clinical presentation: multiple painful vesicular/ulcerative lesions
Flu like: fever, headache, malaise
Prodromal symptoms: Mild burning, itching and tingling
How is genital herpes diagnosed?
Virulogic test done by viral cell culture / NAAT/ PCR
Type specific serologic test
What should you consider before ordering a type specific serologic test?
Not useful for detecting a first episode infection as it takes 6-8 weeks for serologic detection
What non-pharmacological advice can you give to patients with genital herpes?
Warm saline bath
Manage symptoms with antihistamines and analgesics
Good genital hygiene to be done
Educate natural history
What is the place in therapy of antivirals like acyclovir and valacyclovir?
Decrease viral shedding
Decrease duration of symptoms
Decrease time of healing from 1st episode
Does drug discontinuation affect genital herpes condition?
Yes
Drug does not prevent latency or affect frequency and severity of recurrent disease
What is the dose of acyclovir for first episode uncomplicated and complicated genital herpes? List the dose, duration, route and frequency
Uncomplicated: PO 400mg TDS for 7-10 days
Complicated: IV 5-10mg /kg q8h for 2-7 days
What are some counselling advice to give patients on acyclovir and valacylcovir?
Maintain hydration to prevent crystallisation in renal tubule
Take without food or after food if GI upset
What is the dose of valacyclovir for initial episodes of genital herpes?
PO 1g BD for 7-10 days
What are the types of therapy for recurrent genital herpes?
Chronic suppression or episodic
What are the advantages and disadvantages of chronic suppressive therapy?
Advantages:
- Decreased frequency of recurrences
- No symptomatic outbreak
- Improve QOL
- Long term safety and efficacy
- Decreases risk of transmission
Disadvantages: Cost and compliance
What is the dose of acyclovir for chronic suppressive therapy?
Acyclovir 400mg orally once a day
What is the dose of valacylclovir for chronic suppressive therapy?
Valacyclovir 500mg once a day if less than 10 episodes a year
OR
Valacyclovir 1g once a day
How frequent should chronic suppressive therapy be monitored?
Yearly
What are the pros and cons of episodic therapy?
Pros
- Decreases duration and severity of symptoms
- Decreased cost
- Increased compliance
Cons:
- requires initiation of therapy within 1 day of lesion onset
- Does not decrease risk of transmission
What is the dose of acyclovir for episodic therapy?
PO 800mg BD for 5 days
OR
PO 800mg TD for 2 days
What is the dose of valacyclovir for episodic therapy?
PO 500mg BD for 3 days
OR
PO 1g OM for 5 days
