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Antibiotic > STD > Flashcards

STD Flashcards

1
Q

Definition: STDs

A

STDs are infections that are spread primarily through person-to-person sexual contact

AKA Sexually transmitted infections (STIs) or venereal diseases (VD)

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2
Q

microorganism that cause STD

A

Bacteria, viruses, fungi or protozoa can cause these infections.

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3
Q

Under the Infectious Diseases Act (IDA): what STD need

Notification ??

A

 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

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4
Q

Epidemiology

A

top is chlamydia
second is gonorrhoea

age 20-34 higher rate coz sexual activity / ignorant

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5
Q

Mode of transmission

A

 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)

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6
Q

STI caused by bacteria

A

 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

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7
Q

STIs caused by viruses

A

 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

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8
Q

STIs caused by fung

A

 Vaginal candidiasis - candida albicans

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9
Q

STIs caused by parasites

A

 Scabies - Sarcoptes scabiei

 Pediculosis pubis - Phthirus pubis

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10
Q

Risk factors

A

 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

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11
Q

Individual Prevention Methods

A

 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
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12
Q

how to use condom correctly?

A

if lubrication is need use water base product.

as oil ones can damage the condom and decrease efficacy

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13
Q

S & S of gonorrhoea

A

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

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14
Q

Diagnosis of gonorrhoea

A

 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)

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15
Q

if gonorrhoea dont treat what happen

A

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.

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16
Q

gonorrhoea causing microbes

A

bacteria - Neisseria gonorrhoeae (intracellular gramnegative diplococci)

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17
Q

Incubation and symptom onset after infection: of gonorrhoea

A

3-5d, range 2-10d

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18
Q

infection sites of gonorrhoea

A 
 Urethritis 
 Cervicitis 
 Proctitis 
 Pharyngitis 
 Conjunctivitis 
 Disseminated

 Indiv infected maybe asymptomatic

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19
Q

transmission of gonorrhoea

A

sexual contact, vertical

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20
Q

Management- uncomplicated urogenital gonococcal infections

A

 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)

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21
Q

Advantage of azithromycin

A

 Single dose hence improve compliance

 Substantially higher prevalence of gonococcal resistance to tetracycline than to azithromycin

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22
Q

why need give azithromycin in gonorrhoea

A

Co-infection with uncomplicated genital C. trachomatis is common hence treatment to include chlamydial treatment

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23
Q

Management of sex partners with gonorrhorea

A
  • 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).
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24
Q

Chlamydia

S&S

A

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

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25
Q

diagnosis

chlamydia

A

chlamydia is diagnosed by urine (NAAT) PCR test or antigen detection

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26
Q

Chlamydial Infections caused by

A

Chlamydia trachomatis

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27
Q

ncubation and symptom onset after infection:

A

5-14 days, range 7-35 days

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28
Q

Complications of chlamydial

A

per gonorrhea

male: epididymitis, prostatitis, urethral stricture, disseminated disease

Females – Pelvic inflammatory disease, ectopic pregnancy, infertility, disseminated disease

Disseminated – skin lesions, tenosynovitis, monoarticular arthritis.

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29
Q

transmission of chlamydial

A

sex, vertical

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30
Q

Management of chlamydial

A

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
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31
Q

Azithromycin single dose possible due to its prolonged serum and tissue half-life

A

Azithromycin single dose possible due to its prolonged serum and tissue half-life

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32
Q

Erythromycin might be less efficacious than azithromycin or doxycycline

A

Erythromycin might be less efficacious than azithromycin or doxycycline

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33
Q

Levofloxacin and ofloxacin are effective while other fluoroquinolone did not consistently eradicate chlamydial infection.

A

Levofloxacin and ofloxacin are effective while other fluoroquinolone did not consistently eradicate chlamydial infection.

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34
Q

chylamydial infection:

Treatment is highly effective, test-of-cure is not required unless specific concerns (eg pregnancy, non-adherence) or symptoms persist.

A

chylamydial infection:

Treatment is highly effective, test-of-cure is not required unless specific concerns (eg pregnancy, non-adherence) or symptoms persist.

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35
Q

Management of sex partners w chlamydia

A
  • 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
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36
Q

RECOMMENDED for chylamydia

A

RECOMMENDED
- Azithromycin 1g PO single dose
OR
- doxycycline 100mg PO BID 7days

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37
Q

alternative regimens for chylamydia

A

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
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38
Q

1st line for gonorrhoea

A

1st LINE:
IM Ceftriaxone 250mg single dose + PO azithromycin 1g x single dose (concurrently)

ceftriaxone is for nessiera gonorrhoea
Azithromycin is for chylamdia

39
Q

gonorrhoea alternative due to allergy

A

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.
40
Q

Syphilis caused by

A

Treponema pallidum (spirochetes)

41
Q

syphilis s and s

ingeneral

A

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

42
Q

Transmission of syphilis

A

 Sexual transmission only when mucocutaneous syphilitic lesions are present
 Transplacental from mother to child

43
Q

Incubation and symptom onset syphilis

A

after infection:
10-90 days,

mean 21 days.

44
Q

syphilis if no treatment

A

for several years, can cause heart problems, blindness, brain infections.

45
Q

Syphilis stages

A 
primary 
secondary
latent 
(early <1yr; late >1 yr)
tertiary 
neurosyphilis
46
Q

primary syphilis
general onset
site of infection
sign and symptoms

A

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.

47
Q

secondary syphilis
general onset
site of infection
sign and symptom

A

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

48
Q

latent syphilis

A

Develops 4-10 wks after secondary stage in untreated or inadequately treated indiv

site of infection
Possible multisystem involvement

SNS:
Asymptomatic but serology positive

49
Q

tertiary syphilis

A

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.

50
Q

neurosyphilis

A

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.

51
Q

syphilis diagnosis

A
  • 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

52
Q

nontreponemal serology testing

A

 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

53
Q

treponemal tests

A

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

54
Q

high rate of coinfection of syphilis and ________, hence all persons diagnosed with syphilis should be tested for ________

A

HIV

HIV

55
Q

Regimen for syphilis
primary
secondary
early latent (<1yr duration)

if allergy
counselling

A

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

56
Q

regimens for secondary syphilis

counsel and allergy

A

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

57
Q

regimen for early latent (<1year duration)

syphilis

A

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

58
Q

regime for late latent (>1year) or unknown duration or tertiary syphilis

allergy counsel

A

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.

59
Q

regime for tertiary syphilis

allergy counsel

A

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.

60
Q

neurosyphilis regime
allergy
counsel

A

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

61
Q

monitoring for syphilis

A

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

62
Q

Management of sex partners

A

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.

63
Q

Genital herpes SNS

A

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.

64
Q

diagnosis of genital herpes

A

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

65
Q

W/O treatment for herpes

A

baby born with herpes might die or have serious brain, skin, or eye problems

can increase chance of HIV

66
Q

most recurrent genital herpes are caused by

A

HSV 2

67
Q

cycle of HSV infection

A

The cycle of HSV infection occurs in five stages: primary mucocutaneous infection, infection of the nerve ganglia, establishment of latency, reactivation, and recurrent outbreaks.

68
Q

transmission of HSV

A

Transmission via transfer of body fluids and intimate skin to-skin contact

69
Q

incubation period for HSV

A

2-14days

mean = 4days

70
Q

vesicles in HSV develope over

A

7-10days,

heal in 2-4weeks

71
Q

Intermittent viral shedding (even if asymptomatic)
 Chronic and life-long viral infection
 May not be symptomatic while shedding and transmission occurs

(GENITAL HERPES)

A

Intermittent viral shedding (even if asymptomatic)
 Chronic and life-long viral infection
 May not be symptomatic while shedding and transmission occurs

(GENITAL HERPES)

72
Q

NO CURE FOR HERPES

MEDICATION REDUCE THE SEVERITY AND SUPPRESS THE FREQUENCY OF ATTACKS

A

NO CURE FOR HERPES

MEDICATION REDUCE THE SEVERITY AND SUPPRESS THE FREQUENCY OF ATTACKS

73
Q

presentation and symptoms of herpes

A

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)

74
Q

management of herpes

A

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

75
Q

Antiviral treatment

points to note

A

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.

76
Q

Antiviral for first episode

SE + counsel

A

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.

77
Q

Recurrent Genital Herpes points

A

 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

78
Q

Chronic Suppressive Therapy

PROS

A

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)

79
Q

Chronic Suppressive Therapy

CONS

A

 Cost
 Compliance
 Adverse drug reactions
 Recurrence occurs at baseline frequency when discontinued
 resistance? - reported but association with chronic suppressive therapy uncertain

80
Q

Chronic suppressive therapy

A 
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

81
Q

Episodic Therapy

Pros and cons

A

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

82
Q

Episodic therapy

A 
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
83
Q

Counseling of persons with HSV infection

A

 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

84
Q

Management of sex partner

HSV

A

 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

85
Q

Human Papillomavirus (HPV)

A

 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.

86
Q

HPV vaccine

A

 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

87
Q

(Cervarix®):

A

(Cervarix®): types 16 and 18

88
Q
  • Quadrivalent
A
  • Quadrivalent vaccine (Gardasil®): types 6, 11, 16 and 18
89
Q
  • 9-valent (Gardasil 9®):
A
  • 9-valent (Gardasil 9®): types 6, 11, 16, 18, 31, 33, 45, 52, and 58
90
Q

 Quadrivalent or 9-valent vaccine

A

 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

91
Q

 HPV vaccines can be administered regardless of history of anogenital warts, abnormal Pap/HPV tests, or anogenital precancer

A

 HPV vaccines can be administered regardless of history of anogenital warts, abnormal Pap/HPV tests, or anogenital precancer

92
Q

 Women who have received HPV vaccine should continue routine cervical cancer screening if they are aged ≥21 years

A

 Women who have received HPV vaccine should continue routine cervical cancer screening if they are aged ≥21 years

93
Q

Why is the management and prevention of STDs important?

A

 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

Antibiotic (21 decks)

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