STDs Flashcards
CDC vaccination recommendations: Females and Males
Recommend for routine vaccination at age 11 or 12 (can start at age 9) and through age 26 for females or age 21 for males (males may be vaccinated through age 26)
MSM and immunocompromised persons
Through age 26 if not vaccinated previously
Urethritis
Discharge of purulent/mucopurulent material from the urethra, and burning upon urination
Commonly asymptomatic
Bacterial pathogen of importance in males in Neisseria gonorrhea
Urethritis diagnosis
> /= 5 WBC/hpf on gram-stain of swab, or evaluation of 1st void urine with + leukocyte esterases or >/= 10 WBC/hpf
Specific gonorrhea/Chlamydia tests should be performed
N. gonorrhea gram stain
G- intracellular diplococci
Chlamydia gram stain
nothing on gram stain
Treatment of uncomplicated gonococcal infection of cervix/urethra/rectum and pharynx
Ceftriaxone 250mg IM x 1
PLUS
Azithromycin 1g PO x 1
Disseminated/Complicated Gonococcal Infections (DGI) s/sx
Chills Fever Arthralgias Skin lesions Tenosynovitis of small joints Septic arthritis
DGI
results from gonococcal bacteremia that disseminates into skin, joints, CNS, and heart
Disseminated/Complicated Gonococcal Infections therapy
Ceftriaxone 1g IV/IM q24h PLUS Azithromycin 1g PO x 1 - at least 1 week of total therapy
Continued therapy outpatient - can switch to PO agent guided by antimicrobial susceptibility testing 24-48 hours after substantial clinical improvement
Gonococcal Endocarditis and Meningitis Treatment
Ceftriaxone 1-2g IV q24h PLUS Azithromycin 1g PO x 1 Meningitis duration: 10-14 days Endocarditis: > 4 weeks
Pelvic Inflammatory Disease consequences
Infertility
Ectopic pregnancies
Chronic pelvic pain
When is empiric therapy initiated for PID?
In sexually active women and other women at risk for STDs if they are experiencing pelvic or lower abdominal pain, if no cause for the illness other than PID can be identified, and if one or more of the following minimum criteria are present on pelvic examination:
Cervical motion tenderness OR
Uterine tenderness OR
Adnexal tenderness
Organisms responsible for PID
GNRs Anaerobes N. gonorrhea Mycoplasma hominis Ureaplasma urealyticum H. influenzae S. agalactiae Chlamydia trachomatis
PID preferred parenteral Regimen A
Cefotetan 2g IV q12h
or
Cefoxitin 2g IV q6h
PLUS: Doxycycline 100mg BID
PID preferred parenteral Regimen B
Clindamycin 90mg IV q8h
PLUS: Gentamicin IV
PID inpatient duration of therapy
Doxycycline (or oral clinda) should be continued for 14 days.
IV therapy should continue for at least 24-48 hours beyond the 1st sign of improvement.
When tubo-ovarian abscess is present, use PO clinda/flagyl and doxy to provide more effective anaerobic coverage
PID outpatient treatment
Only for mil-to-moderately severe acute PID
If no response in 72 hours, should be reevaluated to confirm diagnosis and given IV therapy
Preferred PID outpatient treatment regimen A
Ceftriaxone 250mg IM x 1 PLUS Doxycycline x 14 days w/ or w/out Metronidazole 500mg BID x 14 days
Preferred PID outpatient treatment regimen B
Cefoxitin IM x 1 + probenecid PO x 1 PLUS Doxycycline x 14d w/ or w/out metronidazole x 14d
Preferred PID outpatient treatment regimen C
Cefotaxime/Ceftizomine IV
PLUS
Doxycycline x 14 days
w/ or w/out metronidazole x 14 days
Syphilis
caused by a spirochete: Treponema pallidum, which is highly infectious, especially in early stages (chancre)
Primary syphilis
Average incubation period = 21 days
Chancre develops at site of inoculation as a painless papule which becomes ulcerated and indurated; non tender and filled with spirochetes
Lasts 1-5 weeks, resolves on its own
Secondary syphilis
Rash (hands, feet), lymphadenopathy, alopecia, H/A, weight loss
Lasts 2-6 weeks, fever
1st year of disease = highly infectious
Latent Syphilis
No clinical manifestations
Serologic evidence only
Early latent
< 1 year duration
Infectious
Late latent
> 1 year duration
Not infectious
Tertiary syphilis
Late manifestations (skin, bone, CNS, heart)
May be asymptomatic or accompanied by manifestations
Must examine the CSF with a lumbar puncture to see if CNS is involved
Early definitive diagnostic test
Direct fluorescent antibody (DFA) test of lesion exudates or tissue
Nontreponemal tests
Venereal disease research laboratory (VDRL) and rapid plasma reagin (RPR)
Treponemal tests
Fluorescent treponemal antibody absorbed (FTA-ABS) and T pallidum particle agglutination (TP-PA)
Early stage syphilis treatment
Benzathine PCN G 2.4 mU IM x 1
Late stage syphilis treatment
If no abnormal findings:
Benzathine PCN G 2.4 mU IM qweek x 3 weeks
Neurosyphilis
Aqueous PCN G 18-24 mU IV/day x 10-14 days (given as 3-4 mU q4h or continuous infusion)
FOLLOWING TREATMENT:
Benzathine PCN G 2.4 mU/week IM x 3 weeks
Syphilis in pregnancy
According to stage; must desensitize PCN if pregnant and allergic to PCN
Adverse Drug Reactions during syphilis treatment
Jarisch-Herxheimer reactions: within 2-3 hours of PCN injection
Acute, febrile reaction (HA, myalgias) within 24 hours after treatment of syphilis
NOT AN ALLERGIC RXN
Give APAP/fluids
HSV primary infection
Mucocutaneous lesion: resolves in 2-3 weeks
Virus moves into ganglia (latency period)
1st episode is most severe, associated with systemic symptoms
Symptoms usually start ~1wk after initial exposure with prodromal symptoms of tingling, itching, burning
Can have multiple leasions
Local pain, itching and urethral or vaginal discharge lasts 11-14 days, with complete disappearance of lesion in 3-6 weeks
Virus sheds, can be spread to other areas
Prodromal stage
Hrs-days
Vesicles appear
Vesicles erupt
Painful genital ulcers
HSV contagious period
When virus is shedding
Most contagious during ulcerative stage
HSV treatment: first clinical episode
7-10 days
Acyclovir
Famciclovir
Valacyclovir
HSV treatment: episodic recurrent infection
1-5 days
Acyclovir
Famciclovir
Valacyclovir
HSV treatment: daily suppressive therapy (for pts with >/= 6 recurrences/yr)
Use daily for a year. Stop then re-evaluate
Acyclovir
Famciclovir
Valacyclovir
HSV and pregnancy
Infant is a risk of life-threatening infection when it passes through the canal, especially if the mom is having 1st episode
Risk is lower with recurrent episodes
Latent herpes: less risk, therefore doesn’t indicate C-section and method of delivery is up to the physician
Bacterial vaginosa
Polymicrobial clinical syndrome resulting from replacement of the normal H2O2 producing lactobacillus sp. in the vagina with high concentrations of anaerobic bacteria
Common causes of bacterial vaginosa
Associated with having multiple sex partners, a new sex partner, douching and lack of vaginal lactobacilli
Bacterial vaginosa diagnostic considerations
Can be diagnosed by the use of clinical criteria or gram stain
Thin, white discharge that smoothly coats the vaginal walls
Presence of “clue cells” on microscopic examination
pH of vaginal fluid > 4.5
Fishy odor of vaginal discharge before or after addition of 10% KOH
Bacterial vaginosa preferred treatment
- flagyl 500mg PO BID x 7 days
- metro gel 0.75% intravaginally qhs x 5 days
- clinda cream 2% intravaginally qhs x 7 days
Trichamoniasis causative organism
Protozoan Trichomonas vaginalis
Trichomoniasis diagnosis
Microscopy of vaginal secretions
Culture
Trichomoniasis
Sex partners with T. vaginalis should be treated
Patients should be instructed to avoid sex until they and their sex partners are cured
Trichomoniasis preferred treatment
Metronidazole 2g PO x 1
or
Tinidazole 2g PO x 1
