STD Flashcards
Definition: STDs
STDs are infections that are spread primarily through person-to-person sexual contact
AKA Sexually transmitted infections (STIs) or venereal diseases (VD)
microorganism that cause STD
Bacteria, viruses, fungi or protozoa can cause these infections.
Under the Infectious Diseases Act (IDA): what STD need
Notification ??
Gonorrhoea, non-gonococcal urethritis, syphilis, chlamydia, genital herpes
HIV/ AIDS
Viral Hepatitis
Notification should be done within 72 hours of diagnosis
Purpose: For monitoring and evaluating of national control programmes
Notification of STIs (excluding HIV/AIDS) is not meant for case detection or contact tracing
Only demographic data (age, gender, ethnicity, nationality) for epidemiologic analysis is required
Partner notification is mandatory in HIV/AIDS
Epidemiology
top is chlamydia
second is gonorrhoea
age 20-34 higher rate coz sexual activity / ignorant
Mode of transmission
mainly by sexual contact with an infected person
by direct contact of broken skin with open sores, blood or genital discharge
by receiving contaminated blood
from an infected mother to her child during pregnancy (eg syphilis, HIV)
or childbirth (eg chlamydia, gonorrhea, HSV) — increase with vagina birth
or breastfeed (HIV)
STI caused by bacteria
Syphilis - Treponema pallidum
Gonorrhoea - Neisseria gonorrhoeae
Non-gonococcal urethritis —>
1) Chlamydia trachomatis
2) Ureaplasma urealyticum
3) Mycoplasma genitalium
Chancroid - Haemophilus ducreyi
Lymphogranuloma venereum (LGV) - Chlamydia trachomatis
Granuloma inguinale - Calymmatobacteria granulomatis
STIs caused by viruses
Ano-genital herpes - herpes simplex virus (HSV) type 1 & 2
Ano-genital warts - human papillomavirus (HPV)
Viral Hepatitis - Hepatitis A, B, C virus
(B and C is transmitted sexually and vertically)
AIDS/HIV infection - human immunodeficiency virus (HIV) type 1 & 2
Molluscum contagiosum - molluscum contagiosum virus
STIs caused by fung
Vaginal candidiasis - candida albicans
STIs caused by parasites
Scabies - Sarcoptes scabiei
Pediculosis pubis - Phthirus pubis
Risk factors
Unprotected sexual intercourse
Number of sexual partner
- Those with multiple sexual partners are more likely to acquire and transmit STI
- Those with sexual contact with people who have multiple sexual partners
MSM
Prostitution (CSW)
Illicit drug use
Individual Prevention Methods
Abstinence and reduction of number of sex partners
- long-term, mutually monogamous relationship with an uninfected partner
Barrier contraceptive methods
- male latex condoms when used correctly
Avoid drug abuse and sharing needles
Pre-exposure vaccination
- HPV, Hep A, Hep B,
HIV pre-exposure prophylaxis. pharmacotherapy medication to prevent
- spermicide w condom
how to use condom correctly?
if lubrication is need use water base product.
as oil ones can damage the condom and decrease efficacy
S & S of gonorrhoea
1 week after sexual contact with an infected partner, a person may present with a yellow discharge from the genitals and pain when urinating.
Symptoms (uncomplicated urogenital gonorrhoea)
- Males: purulent urethral discharge, dysuria, urine frequency
Females - mucopurulent vaginal discharge, dusuria, urinary frequency
Diagnosis of gonorrhoea
Gram-stain smear
–> genital discharge shows gram-negative diplococci within PMNs
Culture – confirmatory
( not frequently done coz no need to do AST. unless recurrence a lot and suspect resistance)
Nucleic acid amplification tests (NAAT) –> Polymerase chain reaction (PCR)
if gonorrhoea dont treat what happen
infection may lead to genital defects and spread to parts of the reproductive system, pevis, joints and heart
male: epididymitis, prostatitis, urethral stricture, disseminated disease
Females – Pelvic inflammatory disease, ectopic pregnancy, infertility, disseminated disease
Disseminated – skin lesions, tenosynovitis, monoarticular arthritis.
gonorrhoea causing microbes
bacteria - Neisseria gonorrhoeae (intracellular gramnegative diplococci)
Incubation and symptom onset after infection: of gonorrhoea
3-5d, range 2-10d
infection sites of gonorrhoea
Urethritis Cervicitis Proctitis Pharyngitis Conjunctivitis Disseminated
Indiv infected maybe asymptomatic
transmission of gonorrhoea
sexual contact, vertical
Management- uncomplicated urogenital gonococcal infections
The incidence of Neisseria gonorrhoeae resistant to Ciprofloxacin was 61.9% in 2006 vs 74.4% in 2008
(INCREASED IN RESISTANCE)
Fluoroquinolones no longer recommended for treatment.
Dual antibiotics therapy to slow emergence of resistance and improve treatment efficacy.
1st LINE:
IM Ceftriaxone 250mg single dose + PO azithromycin 1g x single dose (concurrently)
ceftriaxone is for nessiera gonorrhoea
Azithromycin is for chylamdia
IF ALLERGIC TO AZITHROMYCIN:
- IM Ceftriaxone 250mg single dose + doxycycline 100mg BID x 7days
IF ALLERGIC TO PENCILLIN / CEFTRIAXONE
- IM spectinomycin 2g single dose + PO azithromycin 2g single dose
- IM gentamicin 240mg + PO Azithromycin 2g X single dose.
Test of cure not required unless symptoms persist (usually reinfection w resistance)
Advantage of azithromycin
Single dose hence improve compliance
Substantially higher prevalence of gonococcal resistance to tetracycline than to azithromycin
why need give azithromycin in gonorrhoea
Co-infection with uncomplicated genital C. trachomatis is common hence treatment to include chlamydial treatment
Management of sex partners with gonorrhorea
- Sex partners in the last 60 days should be evaluated and treated. If last sexual exposure > 60 days, the most recent partner to be treated.
- Persons treated for gonorrhea should be instructed to abstain from sexual activity for 7 days after treatment and until all sex partners are adequately treated (7 days after receiving treatment and resolution of symptoms, if present).
Chlamydia
S&S
1 - 3 weeks after sexual contact with an infected partner, a person may present with a white or yellow discharge from the genitals and pain when urinating.
however female often present with no sign of symptoms
Presentation similar to gonorrhoea, perhaps milder
diagnosis
chlamydia
chlamydia is diagnosed by urine (NAAT) PCR test or antigen detection
Chlamydial Infections caused by
Chlamydia trachomatis
ncubation and symptom onset after infection:
5-14 days, range 7-35 days
Complications of chlamydial
per gonorrhea
male: epididymitis, prostatitis, urethral stricture, disseminated disease
Females – Pelvic inflammatory disease, ectopic pregnancy, infertility, disseminated disease
Disseminated – skin lesions, tenosynovitis, monoarticular arthritis.
transmission of chlamydial
sex, vertical
Management of chlamydial
RECOMMENDED
- Azithromycin 1g PO single dose
OR
- doxycycline 100mg PO BID 7days
alternative regimens
- erythromycin base 500mg PO QDS x7days
- Erythromycin ethylsuccinate 800mg PO QID X 7days
- levofloxacin 500mg OD X 7days
- ofloxacin 300mg PO BID x 7days
Azithromycin single dose possible due to its prolonged serum and tissue half-life
Azithromycin single dose possible due to its prolonged serum and tissue half-life
Erythromycin might be less efficacious than azithromycin or doxycycline
Erythromycin might be less efficacious than azithromycin or doxycycline
Levofloxacin and ofloxacin are effective while other fluoroquinolone did not consistently eradicate chlamydial infection.
Levofloxacin and ofloxacin are effective while other fluoroquinolone did not consistently eradicate chlamydial infection.
chylamydial infection:
Treatment is highly effective, test-of-cure is not required unless specific concerns (eg pregnancy, non-adherence) or symptoms persist.
chylamydial infection:
Treatment is highly effective, test-of-cure is not required unless specific concerns (eg pregnancy, non-adherence) or symptoms persist.
Management of sex partners w chlamydia
- Sex partners in the last 60 days should be evaluated and treated. If last sexual exposure > 60 days, the most recent partner to be treated.
- Patients should be instructed to abstain from sexual intercourse until they and their sex partners have completed treatment. Abstinence should be continued until 7 days after a single-dose regimen or after completion of a 7-day regimen and resolution of symptoms, if present
RECOMMENDED for chylamydia
RECOMMENDED
- Azithromycin 1g PO single dose
OR
- doxycycline 100mg PO BID 7days
alternative regimens for chylamydia
alternative regimens
- erythromycin base 500mg PO QDS x7days
- Erythromycin ethylsuccinate 800mg PO QID X 7days
- levofloxacin 500mg OD X 7days
- ofloxacin 300mg PO BID x 7days
1st line for gonorrhoea
1st LINE:
IM Ceftriaxone 250mg single dose + PO azithromycin 1g x single dose (concurrently)
ceftriaxone is for nessiera gonorrhoea
Azithromycin is for chylamdia
gonorrhoea alternative due to allergy
IF ALLERGIC TO AZITHROMYCIN:
- IM Ceftriaxone 250mg single dose + doxycycline 100mg BID x 7days
IF ALLERGIC TO PENCILLIN / CEFTRIAXONE
- IM spectinomycin 2g single dose + PO azithromycin 2g single dose
- IM gentamicin 240mg + PO Azithromycin 2g X single dose.
Syphilis caused by
Treponema pallidum (spirochetes)
syphilis s and s
ingeneral
1week - 3 weeks after sexual contact with an infected person, a painless sore appears on the genital, anus or mouth. The sore heals by itself without treatment but rashes will appear on the face, palm and soles
Transmission of syphilis
Sexual transmission only when mucocutaneous syphilitic lesions are present
Transplacental from mother to child
Incubation and symptom onset syphilis
after infection:
10-90 days,
mean 21 days.
syphilis if no treatment
for several years, can cause heart problems, blindness, brain infections.
Syphilis stages
primary secondary latent (early <1yr; late >1 yr) tertiary neurosyphilis
primary syphilis
general onset
site of infection
sign and symptoms
Incubation period:
10-90d (mean 21d). Heals spontaneously in 1-8wks.
Site of infection:
External genitalia, perianal region, mouth, throat
SNS: single, painless, indurated lesion (chancre) –> erode –> ulcerate –> heal; regional lymphadenopathy.
secondary syphilis
general onset
site of infection
sign and symptom
Develops 2-8wks after initial infection in untreated or inadequately treated indiv.
Disappears in 4-10 wks if untreated.
site of infection:
Multisystem involvement due to hematogenous and lymphatic spread
SNS:
rash (non-pruritis on palm and soles),
mucocantaneous lesions, flu-like symptoms, lymphadenopathy
latent syphilis
Develops 4-10 wks after secondary stage in untreated or inadequately treated indiv
site of infection
Possible multisystem involvement
SNS:
Asymptomatic but serology positive
tertiary syphilis
Develops in approx 30% of untreated or inadequately treated indiv 10-30 yrs after initial infection
site of infection:
Possible multisystemheart, eyes, bones, joint
SNS:
Gummatous lesions, impaired movement,
heart-aortic insufficiency.
neurosyphilis
CNS involvement can occur at any stage of syphilis
site of infection:
CNS
SNS:
cognitive dysfunction, motor or sensory deficits, opthalmic or auditory symptoms, SNS of meningitis, stroke.
syphilis diagnosis
- Darkfield microscopic exam of serous material from suspected lesion.
* confirmatory
* good for early stage since treponemal serology may not be reactive early in disease
2types of serology diasnosis can be done also
1) nontreponemal
2) treponemal
nontreponemal serology testing
Uses nontreponemal antigen (cardiolipin) to detect treponemal antibodies
2 different commonly used test
1) Venereal Disease Research Laboratory (VDRL) slide test
2) Rapid plasma reagin (RPR) card test
A positive test can indicate the presence of any stage of syphilis
The result reported in the quantitative VDRL/RPS test is the most dilute serum concentration with a positive reaction (eg 1:16, 1:32, 1:64)
1:64 has highest load
Antibody titres can be quantified and correlates with disease activity hence used as a tool to monitor response to treatment (VDRL/RPR are not interchangeable; need to use the same test for monitoring)
Nontreponemal test titres usually declines after treatment and can become non-reactive with time.
Less specific, hence more a screening tool ie when test is positive need to be confirmed with a treponemal test
treponemal tests
Uses treponemal antigen to detect treponemal antibody
Eg T. pallidum Haemaggluntination test (TPHA), T. pallidum passive particle agglutination assay (TPPA)
Treponemal tests are more sensitive and specific than nontreponemal tests. Because these tests are technically more demanding and are more expensive, they are used primarily as confirmatory rather than as screening tests.
May remain reactive for life, hence not for monitoring response to treatment
high rate of coinfection of syphilis and ________, hence all persons diagnosed with syphilis should be tested for ________
HIV
HIV
Regimen for syphilis
primary
secondary
early latent (<1yr duration)
if allergy
counselling
IM Benzathine penicillin G 2.4 million unit x 1 dose
if pencillinc allergy
PO doxycycline 100mg bid x 14days
Counseling:
Take with food to reduce GI upset.
Take with a glass of water and main upright for at least 30min to prevent heartburn.
Do not take with milk, Ca or Fe, take 2 hrs apart.
SE: GI, Photosensitivity
regimens for secondary syphilis
counsel and allergy
IM Benzathine penicillin G 2.4 million unit x 1 dose
if pencillinc allergy
PO doxycycline 100mg bid x 14days
Counseling:
Take with food to reduce GI upset.
Take with a glass of water and main upright for at least 30min to prevent heartburn.
Do not take with milk, Ca or Fe, take 2 hrs apart.
SE: GI, Photosensitivity
regimen for early latent (<1year duration)
syphilis
IM Benzathine penicillin G 2.4 million unit x 1 dose
if pencillinc allergy
PO doxycycline 100mg bid x 14days
Counseling:
Take with food to reduce GI upset.
Take with a glass of water and main upright for at least 30min to prevent heartburn.
Do not take with milk, Ca or Fe, take 2 hrs apart.
SE: GI, Photosensitivity
regime for late latent (>1year) or unknown duration or tertiary syphilis
allergy counsel
IM benzathine penicillin G 2.4MU once a week x 3 doses
penicillin allergy:
PO doxycycline 100mg BID x 28days.
Counseling:
Take with food to reduce GI upset.
Take with a glass of water and main upright for at least 30min to prevent heartburn.
Do not take with milk, Ca or Fe, take 2 hrs apart.
regime for tertiary syphilis
allergy counsel
IM benzathine penicillin G 2.4MU once a week x 3 doses
penicillin allergy:
PO doxycycline 100mg BID x 28days.
Counseling:
Take with food to reduce GI upset.
Take with a glass of water and main upright for at least 30min to prevent heartburn.
Do not take with milk, Ca or Fe, take 2 hrs apart.
neurosyphilis regime
allergy
counsel
IV crystalline pencillin G 3-4 MU q4h x 10-14days
OR
IM procaine penicillin G 2.4MU daily PLUS
probenecid 500mg QID x 10-14days
After that
continue with
IM benzathine pencillin G 2.4 MU once a week x 3 doses (OPTIONAL)
penicillin allergy:
IV/ IM ceftriaxone 2g daily x 10-14 d
If concern for cross-sensitivity – skin test to confirm penicillin allergy, desensitize if necessary
monitoring for syphilis
Therapeutic response
1) The Jarisch-Herxheimer reaction is an acute FEBRILE reaction frequently accompanied by HA, MYALGIA, and other symptoms that usually occur within the first 24 hours after any therapy for syphilis. Antipyretics will help but not prevent.
Primary / secondary: Quantitative VDRL or RPR at 6 and 12 months
treatment success = decrease of VDRL or RPR titre by at least fourfold (eg 1:16 to 1:4)
Latent syphilis: 6, 12 and 24 months
Neurosyphilis: CSF examination every 6 month until CSF normal
Treatment failure at 6 mths
show sign and symptoms of disease OR
Failure to decr VDRL or RPR titre by fourfold or incr (1:4 to 1:16)
Retreat (IM Benzathine pen 2.4MU weekly x 3) and re-evaluate for unrecognised neurosyphilis
Management of sex partners
Persons exposed sexually to a patient who has syphilis in any stage should be evaluated clinically and serologically and treated
Persons exposed within the 90 days preceding the diagnosis of primary, secondary, or early latent syphilis in a sex partner might be infected even if seronegative; therefore, such persons should be treated presumptively.
Persons exposed >90 days preceding the diagnosis of primary, secondary, or early latent syphilis in a sex partner should be evaluated clinically and serologically and treated accordingly.
Genital herpes SNS
there is no definite incubation period for genital herpes but it presents as small blisters which breakdown to form ulcers in the genital or anal region.
there may be swelling of groin lymph nodes. the irst infection is usually more severe and last 2-3 weeks. For some people whose immune systems do not work properly, genital herpes outbreaks may be unusally severe and long lasting.
diagnosis of genital herpes
diagnosed by its characteristic appearance, a culture or blood test.
1) Patient history (previous lesion/ sexual contact with similar lesions)
2) presentation and symptoms
3) virologic tests
- viral cell culture and PCR for HSV DNA are the preferred HSV tests (*)
4) serologic tests
Antibodies to HSV develop during the first several weeks after infection and persist indefinitely.
Serology is not useful for first episode infection as it takes between 6 and 8 weeks for serological detection following a first episode
W/O treatment for herpes
baby born with herpes might die or have serious brain, skin, or eye problems
can increase chance of HIV
most recurrent genital herpes are caused by
HSV 2
cycle of HSV infection
The cycle of HSV infection occurs in five stages: primary mucocutaneous infection, infection of the nerve ganglia, establishment of latency, reactivation, and recurrent outbreaks.
transmission of HSV
Transmission via transfer of body fluids and intimate skin to-skin contact
incubation period for HSV
2-14days
mean = 4days
vesicles in HSV develope over
7-10days,
heal in 2-4weeks
Intermittent viral shedding (even if asymptomatic)
Chronic and life-long viral infection
May not be symptomatic while shedding and transmission occurs
(GENITAL HERPES)
Intermittent viral shedding (even if asymptomatic)
Chronic and life-long viral infection
May not be symptomatic while shedding and transmission occurs
(GENITAL HERPES)
NO CURE FOR HERPES
MEDICATION REDUCE THE SEVERITY AND SUPPRESS THE FREQUENCY OF ATTACKS
NO CURE FOR HERPES
MEDICATION REDUCE THE SEVERITY AND SUPPRESS THE FREQUENCY OF ATTACKS
presentation and symptoms of herpes
part of diagnosis
classical painful multiple vesicular or ulcerative lesions
Also local itching, pain, tender inguinal adenopathy (lymphadenopathy)
Flu-like symptoms (e.g., fever, headache, malaise) during first few days after appearance of lesions.
Prodromal symptoms like mild burning, itching or tingling are seen in approximately 50% of patients prior to appearance of recurrent lesions (in recurrent disease).
Symptoms less severe in recurrent disease (less lesions, heal faster, milder symptoms)
management of herpes
1) Goal
- Relieve symptoms, shorten clinical course, prevent complications and recurrences, decr transmission
2) Supportive care
- Warm saline bath relieves discomfort
- Good genital hygiene to prevent superinfection
- Counseling regarding natural history
Antiviral treatment
points to note
for HSV
1) Oral acyclovir, famciclovir and valacyclovir proven to
- Reduce viral shedding by 7 days
- Reduce duration of symptoms by 2 days and
- Reduce time to healing of 1st episode by 4 days
Comparable efficacy and tolerability. Choice dependent on patient compliance and cost.
Does not prevent latency or affect frequency and severity of recurrent disease after drug is discontinued
Maximum benefit when initiated at the earliest stage of disease (within 72 hrs)
Topical antiviral offers minimal clinical benefit, can cause local irritation hence its use is discouraged.
Antiviral for first episode
SE + counsel
Acyclovir (Zovirax®)
(Zovirax®)
400mg TID for 7–10 days
200mg 5x/day for 7–10 days
IV 5-10 mg/kg q8h x 2-7 days, complete with PO for a total 10 days (for severe disease)
Acyclovir inhibits viral DNA polymerase –> inhibits DNA synthesis and replication.
F = 10-20%
T1/2 ~3hr
Counseling: Take without regards to food, after food if GI upset.
SE: Malaise, headache, nausea, vomiting, diarrhoea. Maintain adequate hydration to prevent crystallisation in renal tubules
Valacyclovir (Valtrex®)
1g BID for 7-10days
F = 55%
T1/2~ 3hr
Counseling: Per aciclovir including hydration. Headache is main SE
Treatment can be extended if healing is incomplete after 10 days of therapy.
Recurrent Genital Herpes points
Almost all persons with symptomatic first episode genital HSV-2 infection will experience recurrent flares
Patients have a median of 4 recurrences the year after first symptomatic episode
Antiviral therapy used as episodic or chronic suppressive therapy
Management: Chronic Suppressive or Episodic Therapy
Choice is based on patient’s preference
Chronic Suppressive Therapy
PROS
Pros
reduces the frequency of recurrences by 70%– 80% in patients who have frequent recurrences (i.e. >6 recurrences per year)
many patients report no symptomatic outbreaks
hence improved quality of life
established long term safety & efficacy (acyclovir 6 yrs, famciclovir & valaciclovir 1yr)
decr risk of transmission (in combination with consistent condom use and abstinence during recurrences)
Chronic Suppressive Therapy
CONS
Cost
Compliance
Adverse drug reactions
Recurrence occurs at baseline frequency when discontinued
resistance? - reported but association with chronic suppressive therapy uncertain
Chronic suppressive therapy
Acyclovir 400mg orally twice a day OR Valacyclovir 500mg* orally once a day OR valacyclovir 1g orally once a day OR Famiciclovir 250mg orally twice a day
VALACYCLOVIR 500mg OD might by less effective than other valacyclovit or acyclovir dosing regimens in persons who have ery frequent recurrences (eg >= 10 episodes per year)
Duration is patient- and disease- course dependent. Patients with complicated disease course eg disseminated disease (encephalitis, meningitis, keratitis), usually in immunocompromised hosts, may need indefinite suppression
Episodic Therapy
Pros and cons
Pros
Shorten duration and severity of symptoms
Less costly vs chronic suppression
Patient more likely to be compliant
Cons
Requires initiation of therapy within 1 day of lesion onset or during the prodrome that precedes some outbreaks
Does not reduce risk of transmission
Episodic therapy
Acyclovir 400mg PO TID for 5 days OR Acyclovir 800mg PO BID for 5 days OR Acyclovir 800mg TID PO for 2 days OR Valacyclovir 500mg PO BID for 3 days OR Valacyclovir 1g PO for 5 days
Counseling of persons with HSV infection
Educate concerning the natural history of the disease
Encourage to inform their current and future sex partners
Sexual transmission of HSV can occur during asymptomatic periods.
All persons with genital herpes should remain abstinent from sexual activity with uninfected partners when lesions or prodromal symptoms are present.
The risk of HSV sexual transmission can be decreased by the daily use of valacyclovir or aciclovir by the infected person.
Recent studies indicate that latex condoms, when used consistently and correctly, might reduce the risk for genital herpes transmission.
Risk for neonatal HSV infection
Increased risk for HIV acquisition
Management of sex partner
HSV
Symptomatic sex partners should be evaluated and treated in the same manner as patients who have genital lesions.
Asymptomatic sex partners of patients who have genital herpes should be questioned concerning histories of genital lesions and offered type-specific serologic testing for HSV infection
Human Papillomavirus (HPV)
Approximately 100 types of HPV identified, at least 30 of which can infect the genital area.
Most sexually active persons become infected with HPV at least once in their lifetime.
Most HPV infections are self-limited and are asymptomatic.
The human papillomavirus (HPV) can induce epithelial cell proliferation.
Oncogenic, high-risk HPV infection (e.g., HPV types 16 and 18) causes most cervical, penile, vulvar, vaginal, anal, and oropharyngeal cancers and precancers.
- Persistent oncogenic HPV infection is the strongest risk factor for development of HPV-associated precancers and cancers.
Non-oncogenic, low-risk HPV infection (e.g., HPV types 6 and 11) causes genital warts and recurrent respiratory papillomatosis.
Prevention of HPV infection will reduce the number of women who die from cervical cancer, the second most common cancer in women.
HPV vaccine
3 types:
- Bivalent vaccine (Cervarix®): types 16 and 18 - Quadrivalent vaccine (Gardasil®): types 6, 11, 16 and 18 - 9-valent (Gardasil 9®): types 6, 11, 16, 18, 31, 33, 45, 52, and 58
ACIP recommends HPV vaccine in all females aged 9 to 26 years and all males aged 9 to 21 years
All 3 may be used in female; only Gardasil can be used in male.
All offer protection against HPV types 16 and 18 that cause up to 66% of cervical cancers 9-valent vaccine protects against five additional types accounting for 15% of cervical cancers
(Cervarix®):
(Cervarix®): types 16 and 18
- Quadrivalent
- Quadrivalent vaccine (Gardasil®): types 6, 11, 16 and 18
- 9-valent (Gardasil 9®):
- 9-valent (Gardasil 9®): types 6, 11, 16, 18, 31, 33, 45, 52, and 58
Quadrivalent or 9-valent vaccine
Quadrivalent or 9-valent vaccine has additional protection against HPV types 6 and 11 that associated with genital warts;
- can also be used in males aged 9 to 26 years
Usual schedule: (via IM injection)
1) For 15 years and older: 0, 1-2, 6 months 2) For < 15 years old: 0, 6-12mths
HPV vaccines can be administered regardless of history of anogenital warts, abnormal Pap/HPV tests, or anogenital precancer
HPV vaccines can be administered regardless of history of anogenital warts, abnormal Pap/HPV tests, or anogenital precancer
Women who have received HPV vaccine should continue routine cervical cancer screening if they are aged ≥21 years
Women who have received HPV vaccine should continue routine cervical cancer screening if they are aged ≥21 years
Why is the management and prevention of STDs important?
To reduce related morbidity, progression to complicated disease To prevent HIV infection
- Increased risk of HIV transmission or acquisition in patients with genital herpes, gonococcal and syphilis infections
To prevent serious complications in women
- STIs are the main preventable cause of infertility - Prevention of HPV reduces number of women with cervical cancer
To protect the babies
- Untreated STIs are associated with congenital and perinatal infections in the neonates, premature deliveries and neonatal death or stillbirth
