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PR3124 CA3 > STD > Flashcards

STD Flashcards

1
Q

what are examples of STIs caused by bacteria? (3)

A
  • syphilis- Treponema pallidum
  • gonorrhea- Neisseria gonorrhea
  • non-gonoccal urethritis: chlamydia trachomatis
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2
Q

what are examples of STIs caused by viruses

A

herpes simplex virus 1 and 2
human papilloma virus (HPV)
viral hepatitis
AIDS/HIV

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3
Q

examples of STIs caused by fungi (1)

A

vaginal candidiasis- candida albicans

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4
Q

examples of STIs caused by parasites

A
  • scabies

- pubic lice

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5
Q

what are the modes of transmission of gonorrhea?

A
  • mainly by sexual intercourse with infected person
  • direct contact of broken skin with open sores, blood or genital discharge
  • by receiving contaminated blood
  • from infected mother to child during pregnancy (MO crosses placenta) or childbirth (pass through bith canal)
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6
Q

what are the risk factors for STI? (5)-

A
  • unprotected sexual intercourse
  • number of sexual partners
  • MSM (men who have sex with men)
  • prostitution
  • illicit drug use- shared needles, contaminated blood
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7
Q

what are indv prevention methods for STI? (5)

A
  • abstinence and reduction of number of sexual partners
  • barrier contraceptive methods (prevent exposure of MO of sti)- eg. male condoms
  • avoid drug abuse and sharing needles
  • pre-exposure vaccination (eg. HPV, hepB)
  • post exposure prophylaxis eg. HIV
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8
Q

why is management and prevention of STDs impt?

A
  • to reduce related morbidity, and progression to complicated disease
  • to prevent HIV infection
  • prevent serious complications in women
  • protect babies
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9
Q

whcih bacteria causes gonorrhea?

A
  • Neisseria gonorrhoeae (intracellular gram neg diplococci)
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10
Q

how is gonorrhea diagnosed?

A
  • gram stain of genital dischrage
  • culture
  • PCR- to identify nucleus mateiral
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11
Q

what are the sx of uncomplicated gonorrhea? male and female?

A

male
- purulent urethral discharge, dysuria, urinary freq
females
- mucopurulent vaginal dishcarge, dysuria, urinary freq

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12
Q

what are soem complications for untreated gonorrhea? male and female

A

male
- epididymis, prostatitis, urethral stricture, disseminated disease
female
- pelvic infalm disease, extopic pregnancy, infertility, disseminated disease (enter into bloodstream)

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13
Q

hwo to manage uncomplicated urogenital gonorrhea infection?

A

dual ab therapy

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14
Q

what are teh advatnages of dual ab therapy for gonorrhea

A
  • imrpoves tx efficacy
  • slows emergence of resistance
  • treat chlamydia trachomatis- usually co-infect with uncomplicated gonorrhea
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15
Q

what is the dual ab therapy for gonorrhea

A
  • IM ceftrixone 250mg single dose + PO azithromycin 1g single dose concurrently

if allergic to azi:
- IM ceftrixone 250mg single dose + doxycycline 100mg BID x 7 days
if allergic to penicillin
- IM gentamicin 240mg single dose or + POazi 2g
- IM spectinomycin 2g single dose + PO axi 2g

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16
Q

wat are the advatnage of azithromycin? (2)

A
  • single dose, improve compliance

- higher prevalence of gonococcal resistnace to tetracycline than azi

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17
Q

what is chlamydial infection caused by?

A

chlamydia trachomatis bacteria

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18
Q

how is chlamydial infection diagnosed?

A

NAAT (PCR) or antigen detection

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19
Q

how is chlamydial infection transmitted

A

sexual contact

mother to child during childbirth

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20
Q

what is the rec regimen to treat chlamydial infection ?

A

azithromycin 1g pO single dose
or doxycycline100mg PO BD x 7days

tx highly effective, testing not req unless specific conditions or sx arise

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21
Q

what is syphilis caused by?

A

treponema pallidum bacteria

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22
Q

how is syphilis transmitted?

A

sexual transmission only when mucocutaneous syphilic lesions are present
non-sexua
- transplacental from other to child
- contaminated blood

23
Q

how is syphillis diagnosed?

A
  • darkfield microscopic exam of serous material from suspected lesions- confirmatory, good for early stage
  • serology - nontreponemal test: use nontreponemal antigen to detect treponemal ab, +VE test indicates presence of any stage of syphilis==> results reported in quantitative VDRL/RPR test
  • : less specific, screening tool. if pos, then do treponemal test
  • serology- treponemal test: to detect treponemal ab
    +: more sensitive and specific than nontreponemal tests, used as confirmatory tests
    may remain reactive for life, hence not for monitoring response to tx
24
Q

what is the ab regimen for pri/sec/early latent (<1 year) syphilis?

A

-IM benzathin penicillin G 2.4 mil units x 1 dose (slow drug release)

if penicillin allergic
- PO doxycycline 100mg BD x 14 days

25
Q

what are the counselling pointers for doxycycline?

A
  • take with food to reduce GI upset
  • remain upright
  • take with glass of water
26
Q

what is the ab regimen for late latent (>1 year) or unknown duration syphilis?

A
  • IM benzathine penicillin G 2.4mil once a week x 3 dose

if penicillin allergic
- PO doxycycline 100mg BD x 28 days

27
Q

what is the ab regimen for neurosyphilis?

A

IV crystalline penicillin G 3-4mil units q4h x 10-14 days
OR
IM procaine penicillin G 2.4MU daily + PO probenecid 500mg QID x 10-14 days

if penicillin allergy
- IV/IM ceftriaxone 2g daily x 10-14 days
if concern for cross sen, skin test to confirm penicillin allergy, desensitive if necessary

28
Q

how to monitor therapeutic response for syphilis?

A
  • jarisch - herxheimer rxn (acute febrile rxn with headache, myalgia)- usually occur within first 24h of tx

tx success= decrease in VDRL or RPR titre by at least four fold- take at 6 and 12 months

29
Q

what is considered tx failure for syphillis

A

at 6 months

  • show s/sx of disease
  • failure to decrease VDRL or RPR titre by fourfold
  • retreat and re-eval for unrecognised neurosyphilis
30
Q

properties of herpesvirus? (4)

A
  • double stranded DNA virus
  • replicate in host cell nucleus
  • persist indefinitely (lifelong) in infected host
  • periodic reactivation, esp in immunosup hosts
31
Q

what is HSV type 1

A
  • mostly in young children
  • transmission via contact
  • forms: cold sore
  • usually self limiting
  • may be reactivated by stimuli eg. fever, menstruation, sunlight, stress
  • reactivation may be clinically asx or be a life threatening disease

NOT AN STI

32
Q

what is HSV type 2

A
  • young adults
  • sexual transmission
  • genital herpes
  • may be reactivated by stimuli eg. fever, menstruation, sunlight, stress
  • reactivation may be clinically asx or be a life threatening disease
  • usually self limiting

STI

33
Q

what is varicella zoster virus?

A
  • causes 2 distinct forms of disease: varicella (chickenpox) and herpes zoster (shingles)

pri infection: chickenpox, results in diffuse vesicualr rash
reactivation: localised skin infection, shingles

NOT AN STI

34
Q

what is the antiviral tx for varicella/shingles?

A
  • Acyclovir PO 800mg 5 times daily x 7 days
  • valacyclovir PO 1g TDS x 7days
    start within 24-48h of rash to reduce duration and severity of sx
35
Q

what is the cycle of HSV infection (5 stages)

A
  • primary mucocutaneous infection
  • infection of nerve ganglia
  • establishment of latency
  • reactivation
  • recurrent outbreaks/flairs
36
Q

how is genital herpes transmitted?

A
  • transfer of body fluids

- intimate skin-to skin contact

37
Q

what is the incubation period of genital herpes

A

2-14 days (mean 4 days)

38
Q

how is genital herpes diagnosed?

what are the clinical presentation of herpes?

A

pt history: previous lesion/ sexual contact with similar lesions

presntation/sx

  • classical painful multiple vesicular or ulcerative lesions
  • local itching, pain , tender inguinal adenopathy
  • flu like sx (eg. fever, headache, malaise)
  • prodromal sx eg. mild burning, itching

*sx less severe in recurrent disease ( less lesions, heal faster, milder sx)- alr built up some form of immunity against virus

39
Q

what virologic test can be done to diagnose genital herpes?

A
  • viral cell culture

- PCR for HSV DNA

40
Q

what serologic tests can be done to diagnose genital herpes?

A
  • ab to HSV dev durign first several weeks after infection and persist indefinitely
  • not useful for first ep, takes 6-8 weeks of serological det following first ep
41
Q

what is the managmenet goal of genital herpes

A
  • relieve sx
  • shorten clinical course
  • prevent complications and recurrence
  • decrease transmission
42
Q

what supportive care can be given for genital herpes

A
  • warm saline bath to relieve discomfort
  • good genital hygiene to prevent superinfection
  • counseling on natural history
43
Q

what antiviral is given for first ep (herpes type 2)?

A
  • acyclovir PO 400mg TDS for 7-10 days
  • acyclovir IV 5-10mg/kg q8h x 2-7 days, complete with PO for total 10 days
  • valacyclovir PO 1g BID 7-10days
44
Q

MOA of acyclovir?

A

inhibit viral DNA polymerase–> inhibit DNA synthesis and rep
F: 10-20%, therefore need freq dosing
F of valacyclovir: 55%- can reduce freq and increase dose

45
Q

what is recurrent genital herpes?

A
  • almost all person with sx will experience recurrent flares

- pt hv a median of 4 recurrences in the year after first sx episode

46
Q

how to manage recurrent genital herpes?

A
  • antiviral as chronic suppressive therapy
  • episodic therapy

choice based on pt preference

47
Q

advantages of chronic sup therapy? (4)

A
  • reduce freq of recurrence by 70-80% in pt who have freq recurrences (>6/year)
  • no sx outbreaks
  • improved quality of life
  • established long term safety and efficacy
  • decreased risk of transmission (in combi with consistent condom use and abstinence)– reduces virus shedding
48
Q

cons of chronic sup therapy (4)

A
  • cost
  • compliance
  • ADR
  • recurrence occurs at baseline freq with discont
49
Q

what is the rec regimen for chronic sup therapy (3)

A
  • acyclovir 400mg PO BDS
  • valacyclovir 500mg PO OD (may be less effective for pt with freq rec)
  • valacyclovir 1g PO OD- give if pt has >10 ep/year

duration is pt and disease course dependent

50
Q

pros of episodic therapy? (3)

A
  • shorten duration and severity of sx
  • less costly
  • more likely to be compliant
51
Q

cons of episodic therapy (2)

A
  • req initiation of therapy within 1 day of lesion onset

- does not reduce risk of transmission (will not lower asx viral shedding)

52
Q

what is the rec regimen for episodic therapy

A
  • acyclovir 400mg TDS x 5 days
  • acyclovir 800mg BDS x 5 days
  • acyclovir 800mg TDS x 2 days
  • valacyclovir 500mg BDS x 3 days
  • valacyclovir 1g OD x 5 days
53
Q

how to counsel person with HSV infection

A
  • educate concerning natural history of disease
  • encourage to inform current and future sex partner
  • sexual trans can occur during asx period
  • shoudl remain abstinent from sexual activity with uninfected partner when lesions present
  • risk fo HSV sexual trans can be reduced with daily use of valacyclovir or acyclovir
  • risk for neonatal hsv infection
  • increased risk of hiv acquisition
54
Q

how is sex partner managed? (of infected HSV pt)

A
  • symptomatic partner should be evaluated and treated if hv

- asx- questioned concerning history of genital lesion, offered type specific serologic testing for hsv infection

PR3124 CA3 (6 decks)

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