STD

Question 1

Definition: STDs

Answer 1

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

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

Question 2

microorganism that cause STD

Answer 2

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

Question 3

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

Notification ??

Answer 3

 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

Question 4

Epidemiology

Answer 4

top is chlamydia
second is gonorrhoea

age 20-34 higher rate coz sexual activity / ignorant

Question 5

Mode of transmission

Answer 5

 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)

Question 6

STI caused by bacteria

Answer 6

 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

Question 7

STIs caused by viruses

Answer 7

 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

Question 8

STIs caused by fung

Answer 8

 Vaginal candidiasis - candida albicans

Question 9

STIs caused by parasites

Answer 9

 Scabies - Sarcoptes scabiei

 Pediculosis pubis - Phthirus pubis

Question 10

Risk factors

Answer 10

 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

Question 11

Individual Prevention Methods

Answer 11

 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

Question 12

how to use condom correctly?

Answer 12

if lubrication is need use water base product.

as oil ones can damage the condom and decrease efficacy

Question 13

S & S of gonorrhoea

Answer 13

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

Question 14

Diagnosis of gonorrhoea

Answer 14

 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)

Question 15

if gonorrhoea dont treat what happen

Answer 15

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.

Question 16

gonorrhoea causing microbes

Answer 16

bacteria - Neisseria gonorrhoeae (intracellular gramnegative diplococci)

Question 17

Incubation and symptom onset after infection: of gonorrhoea

Answer 17

3-5d, range 2-10d

Question 18

infection sites of gonorrhoea

Answer 18

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

 Indiv infected maybe asymptomatic

Question 19

transmission of gonorrhoea

Answer 19

sexual contact, vertical

Question 20

Management- uncomplicated urogenital gonococcal infections

Answer 20

 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)

Question 21

Advantage of azithromycin

Answer 21

 Single dose hence improve compliance

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

Question 22

why need give azithromycin in gonorrhoea

Answer 22

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

Question 23

Management of sex partners with gonorrhorea

Answer 23

• 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).

Question 24

Chlamydia

S&S

Answer 24

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

Question 25

diagnosis | chlamydia

Answer 25

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

Question 26

Chlamydial Infections caused by

Answer 26

Chlamydia trachomatis

Question 27

ncubation and symptom onset after infection:

Answer 27

5-14 days, range 7-35 days

Question 28

Complications of chlamydial

Answer 28

per gonorrhea male: epididymitis, prostatitis, urethral stricture, disseminated disease Females – Pelvic inflammatory disease, ectopic pregnancy, infertility, disseminated disease Disseminated – skin lesions, tenosynovitis, monoarticular arthritis.

Question 29

transmission of chlamydial

Answer 29

sex, vertical

Question 30

Management of chlamydial

Answer 30

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

Question 31

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

Answer 31

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

Question 32

Erythromycin might be less efficacious than azithromycin or doxycycline

Answer 32

Erythromycin might be less efficacious than azithromycin or doxycycline

Question 33

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

Answer 33

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

Question 34

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

Answer 34

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

Question 35

Management of sex partners w chlamydia

Answer 35

* 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

Question 36

RECOMMENDED for chylamydia

Answer 36

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

Question 37

alternative regimens for chylamydia

Answer 37

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

Question 38

1st line for gonorrhoea

Answer 38

1st LINE: IM Ceftriaxone 250mg single dose + PO azithromycin 1g x single dose (concurrently) ceftriaxone is for nessiera gonorrhoea Azithromycin is for chylamdia

Question 39

gonorrhoea alternative due to allergy

Answer 39

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.

Question 40

Syphilis caused by

Answer 40

Treponema pallidum (spirochetes)

Question 41

syphilis s and s ingeneral

Answer 41

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

Question 42

Transmission of syphilis

Answer 42

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

Question 43

Incubation and symptom onset syphilis

Answer 43

after infection: 10-90 days, mean 21 days.

Question 44

syphilis if no treatment

Answer 44

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

Question 45

Syphilis stages

Answer 45

``` primary secondary latent (early <1yr; late >1 yr) tertiary neurosyphilis ```

Question 46

primary syphilis general onset site of infection sign and symptoms

Answer 46

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.

Question 47

secondary syphilis general onset site of infection sign and symptom

Answer 47

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

Question 48

latent syphilis

Answer 48

Develops 4-10 wks after secondary stage in untreated or inadequately treated indiv site of infection Possible multisystem involvement SNS: Asymptomatic but serology positive

Question 49

tertiary syphilis

Answer 49

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.

Question 50

neurosyphilis

Answer 50

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.

Question 51

syphilis diagnosis

Answer 51

* 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

Question 52

nontreponemal serology testing

Answer 52

 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

Question 53

treponemal tests

Answer 53

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

Question 54

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

Answer 54

HIV | HIV

Question 55

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

Answer 55

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

Question 56

regimens for secondary syphilis counsel and allergy

Answer 56

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

Question 57

regimen for early latent (<1year duration) | syphilis

Answer 57

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

Question 58

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

Answer 58

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.

Question 59

regime for tertiary syphilis allergy counsel

Answer 59

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.

Question 60

neurosyphilis regime allergy counsel

Answer 60

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

Question 61

monitoring for syphilis

Answer 61

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

Question 62

Management of sex partners

Answer 62

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.

Question 63

Genital herpes SNS

Answer 63

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.

Question 64

diagnosis of genital herpes

Answer 64

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

Question 65

W/O treatment for herpes

Answer 65

baby born with herpes might die or have serious brain, skin, or eye problems can increase chance of HIV

Question 66

most recurrent genital herpes are caused by

Answer 66

HSV 2

Question 67

cycle of HSV infection

Answer 67

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

Question 68

transmission of HSV

Answer 68

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

Question 69

incubation period for HSV

Answer 69

2-14days | mean = 4days

Question 70

vesicles in HSV develope over

Answer 70

7-10days, | heal in 2-4weeks

Question 71

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

Answer 71

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

Question 72

NO CURE FOR HERPES | MEDICATION REDUCE THE SEVERITY AND SUPPRESS THE FREQUENCY OF ATTACKS

Answer 72

NO CURE FOR HERPES | MEDICATION REDUCE THE SEVERITY AND SUPPRESS THE FREQUENCY OF ATTACKS

Question 73

presentation and symptoms of herpes

Answer 73

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)

Question 74

management of herpes

Answer 74

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

Question 75

Antiviral treatment | points to note

Answer 75

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.

Question 76

Antiviral for first episode SE + counsel

Answer 76

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.

Question 77

Recurrent Genital Herpes points

Answer 77

 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

Question 78

Chronic Suppressive Therapy PROS

Answer 78

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)

Question 79

Chronic Suppressive Therapy CONS

Answer 79

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

Question 80

Chronic suppressive therapy

Answer 80

``` 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

Question 81

Episodic Therapy Pros and cons

Answer 81

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

Question 82

Episodic therapy

Answer 82

``` 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 ```

Question 83

Counseling of persons with HSV infection

Answer 83

 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

Question 84

Management of sex partner | HSV

Answer 84

 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

Question 85

Human Papillomavirus (HPV)

Answer 85

 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.

Question 86

HPV vaccine

Answer 86

 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

Question 87

(Cervarix®):

Answer 87

(Cervarix®): types 16 and 18

Question 88

- Quadrivalent

Answer 88

- Quadrivalent vaccine (Gardasil®): types 6, 11, 16 and 18

Question 89

- 9-valent (Gardasil 9®):

Answer 89

- 9-valent (Gardasil 9®): types 6, 11, 16, 18, 31, 33, 45, 52, and 58

Question 90

 Quadrivalent or 9-valent vaccine

Answer 90

 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

Question 91

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

Answer 91

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

Question 92

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

Answer 92

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

Question 93

Why is the management and prevention of STDs important?

Answer 93

 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