STD Part 2 Flashcards
Which infection significantly increases risk of acquiring HIV?
Chlamydia
Chlamydia signs and symptoms
Silent infection - most are asymptomatic
See cervicitis in women - mucupurulent endocervical discharge, easily induced endocervical bleeding; can lead to pelvic inflammatory disease
Urethritis in men and women (looks like UTI)
Conjunctivities (can also be transmitted to child during delivery)
How to treat chlamydia?
Azithromycin 1 g PO single dose
or
Doxycycline 100 mg PO twice daily for 7 days
Note: Same as gonorrhea!
Follow-up for chlamydia treatment?
Test of cure is NOT recommended unless the patient is pregnant, compliance to treatment is in question, symptoms persist, or reinfection is suspected
Wait at least 3 weeks before testing NAAT because it could lead to false positives. It tests for protein targets, not viable organisms, and these can take a while to clear out
Describe bacterial vaginosis
Basically Lactobacillus sp replaces normal flora in the vagina and causes infection
Associated with having multiple sex partners, a new sex partner, douching, lack of condom use, and lack of vaginal lactobacilli
Treatment for bacterial vaginosis?
Treat symptomatic women:
Metronidazole 500 mg BID for 7 days
Metronidazole gel, insert one applicatorful daily for 5 days
Clindamycin cream, insert one applicatorful at bedtime for 7 days
Follow up for bacterial vaginosis treatment?
Not necessary if symptoms resolve; women should be advised to return for evaluation if symptoms return
Describe trichomoniasis
Caused by trichomonas vaginalis, a flagellated/motile protozoan
Women infected are 3-5 times more likely to have gonorrhea than those who don’t have it
Clinical presentation of trichomoniasis?
Taked 3-28 days for incubation
Site of infection in men is the urethra, in women it’s the endocervical canal. Other sites can be rectum, oropharynx, eye
Signs and symptoms: Men can be asymptomatic, may have discharge/dysuria
Women can be asymptomatic, some have discharge
If trichomoniasis can be asymptomatic why do we care?
It can lead to pelvic inflammatory disease in women, male infertility, premature labor/low birth weight, cervical neoplasia (cancer)
How to diagnose trichomoniasis?
Wet mount exam of vaginal discharge; look for pear shaped flagellated organisms
Also can check vaginal pH, if greater than 5 it usually indicates presence of T vaginalis or gardenerella vaginalis
Treatment of Trichomoniasis?
Symptomatic and asymptomatic infections should be treated:
Metronidazole 2 g PO single dose (big doses = side effects)
Tinidazole 2 g PO in a single dose
Pregnancy: Metronidazole 2 g PO single dose
Do we contact partners of women with bacterial vaginosis?
No
Do we contact partners of women/men with trichomoniasis?
Yes they should be treated
Follow up for trichomoniasis?
Rescreen at 3 months following initial infection in sexually active women
Describe herpes infections
Type 1 is oropharyngeal, type 2 is genital
First episode primary: Initial genital infection in individuals lacking antibodies against HSV-1 or HSV-2
First episode non-primary: Initial genital infections with clinical or serologic evidence of prior HSV infection (usually type 1)
Recurrent: Appearance of genital lesions at some time following healing of first-episode infection
Signs and symptoms of herpes?
Primary infection: most are asymptomatic or minimally symptomatic; multiple painful lesions on external genitalia developing over 7-10 days and taking 2-4 weeks to heal; flu like symptoms
Recurrent infections: Prodrome in 50%, associated with fewer lesions that are more localized, and shorter duration (heal in 7 days vs 2-4 weeks); symptoms are also milder
This is because we already have active antibodies against the virus in recurrent infections
How to diagnose Herpes
Cell culture and PCR
Cell culture sensitivity is low; declines over time
PCR assays look for HSV DNA and are more sensitive
Negative cultures do NOT excluse HSV infections because viral shedding is intermittent
How to treat first episode of herpes?
Acyclovir 400 mg TID or 200 mg 5 times daily for 7-10 days
Famciclovir 250 mg TID for 7-10 days
Valacyclovir 1 g once daily for 7-10 days ***
In severe disease use IV acyclovir followed by oral acyclovir
How to treat recurrent herpes infections - active?
Valacyclovir 1 g daily for 5 days
or 500 mg BID for 3 days
NOTE: Must be within 24 hours of lesion onset or during the prodrome that precedes some outbreaks
How to treat recurrent herpes infections - suppressive?
Valacyclovir 500 mg or 1000 mg PO daily
500 mg dose appears less effective than 1000 mg in patients with more than 10 recurrences per year
What is the most common STD?
HPV
What are the types of HPV
Oncogenic types (cancer) - cause cervical and anogenital cancers
Non-oncogenic types: PV types 6 and 11 cause genital warts and recurrent respiratory papillomatosis
Describe clinical presentation of HPV
Asymptomatic is common and usually self-limited
Transmitted through oral, vaginal, or anal sex
Usually appear as a small bump or group of bumps in the genital area varying in shape and size; can appear weeks or months after contact with infected partner
If left untreated they could go away, get bigger, or increase in number
How to treat genital warts caused by HPV?
Imiquimod 3.75% every night or 5% cream at bedtime 3x weekly for up to 16 weeks (but could weaken condoms or vaginal diaphragms!)
Podofilox 0.5% solution or gel applied twice daily for 3 days followed by 4 days of no therapy (cycle repeated as necessary for up to 4 cycles)
Sinecatechins 15% ointment - apply 3 times daily for up to 16 weeks; do not wash off after using
NOTE: PODOFILOX IS CONTRAINDICATED IN PREGNANCY
How to prevent HPV?
Cervarix - women only (no protection against warts)
Gardasil 4 or Gardasil 9 - men and women
9 is the best
Who is required to get the HPV vaccine?
Routine HPV vaccine at age 11 or 12 years, could begin series at 9
Also recommended for females age 13-26
Males age 13-21
Males 22-26 MAYBE
Men who have sex with men and immunocompromised persons through age 26 years if not vaccinated previously
What are the 5 P’s?
Partners Prevention of pregnancy Protection from STD's Practices Past history of STDs
Cervical diaphragms are good against most STD’s but does not include…
HIV
Are topical microbicides and spermicides helpful?
No they provide no additional protection against HIV or other STI’s
