STDs Flashcards
What is the most common cause of preventable infertility?
STIs
What are the routine STD screening recommendations?
- annual screening for all sexually active women age 24 and younger for chlamydia and gonorrhea
- annual screening for chlamydia and gonorrhea in asymptomatic women over age 24 who are at high risk for infection
- HIV screening for females aged 13-64 at least once in their lifetime and annually thereafter based on risk factors
What is expedited partner therapy?
treatment of a STD-positive patient’s sexual partner despite the partner not undergoing physical evaluation or testing
Chlamydia trachomatis
- a gram-negative, obligate intracellular bacterium which preferentially infects columnar epithelial cells
- the most frequently reported infectious disease in the US
- often asymptomatic but may present with mucopurulent cervicitis, watery vaginal discharge, or irregular intermenstrual vaginal bleeding
- may be complicated by an ascending infection leading to mild salpingitis, PID if left untreated, or Reiter’s syndrome of uveitis, urethritis, and arthritis
- diagnosis is based on nucleic acid amplification tests of endocervical swab specimens
- sexually active women under the age of 24 should be screened annually
- treat using macrolides or tetracyclines and add ceftriaxone to treat presumed co-infection with gonorrhea; patients should be abstinent for seven days and until all partners are treated
- test of cure is not recommended unless patients have persistent symptoms or the provider suspects non-adherence
- all women should be retested 3 months after treatment or at their well-woman exam due to the risk of reinfection
What is unique about serotypes A-C of chlamydia?
they are transmitted via hand-to-eye contact or via fomites and cause trachoma, a chronic infection leading to blindness (#1 cause of blindness worldwide)
What is unique about serotypes D-K of chlamydia?
they are sexually transmitted and cause urethritis/PID with a watery discharge, ectopic pregnancy, neonatal pneumonia with staccato cough, and neonatal conjunctivitis
What is unique about serotypes L1-L3 of chlamydia?
they cause lymphogranuloma venereum, which manifests as a painless genital ulcer followed weeks later by painful inguinal lymphadenopathy
Neisseria gonorrhea
- a gram-negative intracellular diplococcus
- risk factors are inconsistent condom use, previous or coexisting STD, and exchange of sex for money or drugs
- in men, it presents as urethritis, prostatitis, or orchitis, typically with a mucopurulent or purulent discharge
- in women, signs and symptoms are often mild and overlooked but classically includes a thick, white, purulent discharge
- may be complicated by PID or Fitz-Hugh Curtis syndrome; may cause asymmetric septic arthritis; and infection facilitates transmission of HIV
- diagnosed based on culture, nucleic hybridization, or NAAT; gram stain can be used for diagnosis of symptomatic men but is not recommended for asymptomatic men or for women
- treat with IM ceftriaxone plus an oral dose of azithromycin for presumed chlamydial infection
PID
- an infection of the upper genital tract as a result of direct spread of a pathogen along mucosal surfaces from the cervix
- primarily caused by C. trachomatis and N. gonorrhoeae
- the greatest risk factor is prior PID but a recently placed IUD also conveys some risk; protective factors are OCPs and infection during the progesterone-dominant phase of the menstrual cycle when the endocervical mucus is thick
- may present with vaginal discharge, abnormal vaginal bleeding, guarding, cervical motion tenderness, rebound tenderness, adnexal tenderness, fever or chills, or elevated WBC count
- may be complicated by adhesions and infertility, tubal damage, hydrosalpinx, TOA, or Fitz-Hugh-Curtis syndrome
- treatment is with ceftriaxone and azithromycin
- hospitalization with IV therapy is suggested for patients in which surgical emergencies cannot be excluded, are pregnant, doesn’t respond to oral therapy, is non-adherent, has severe symptoms, or has a TOA
- because it is often asymptomatic empiric treatment is recommended for sexually active young women with no other cause of illness who are also found to have uterine tenderness, adnexal tenderness, or cervical motion tenderness
Describe the presentation of tubo-ovarian abscesses.
patients present as acutely ill with high fever, tachycardia, severe pelvic and abdominal pain, and nausea and vomiting
What are the criteria for diagnosing acute salpingitis?
- cervical motion, uterine, or adnexal tenderness
- plus temperature, mucopurulent discharge, abundant WBCs on microscopy of vaginal fluid, elevated ESR, elevated CRP, or laboratory confirmation of N. gonorrhea or C. trachomatis infection
What is Fitz-Hugh-Curtis syndrome?
a complication of gonorrheal or chlamydial PID in which there is fibrosis and scarring of the anterior surface of the liver following ascension of the infection from the pelvis through the right paracolic gutter
Genital Herpes
- caused by infection with a DNA virus
- HSV-2 is more common and is more likely to cause a recurrence; however, HSV-1 genital infections are becoming more common
- the primary infection is typically most severe and includes a flu-like syndrome with neurologic involvement after which painful vesicles appear, which lyse and progress to shallow, painful ulcers with a red border before resolving after one week; some patients then experience aseptic meningitis with fever, headache, and meningismus
- the virus remains dormant in the dorsal root ganglia and recurrences present as vesicular lesions that are less painful and persist for only 2-5 days often with a prodrome of burning or vulvar pain
- viral shedding occurs for up to three weeks after lesions appear
- diagnosis is made based on viral culture and PCR
- first-episode treatment includes acyclovir, famciclovir, or valacyclovir for 7-10 days; warm water baths, analgesics, and topical lidocaine can relieve the pain
- recurrent therapy is most effective when initiated during the prodrome and is typically administered for 3-5 days; patients with frequent occurrences may be offered daily suppressive therapy, which reduces frequency and likelihood of transmission to uninfected partners
- antivirals reduce the duration of viral shedding and shorten the symptomatic disease course but do not affect the long-term disease course or likelihood of recurrence
- pregnant women with a history of genital herpes require special care during the prenatal course
How do HSV-1 and HSV-2 differ?
- HSV-1 is associated with cold sore lesions of the mouth
- HSV-2 is more commonly associated with genital infections
- HSV-1 genital infections are far less likely to have recurrences
How should herpes be managed during pregnancy?
- routine antepartum genital HSV testing in asymptomatic patients is not recommended
- however, pregnant women with a history of genital herpes should be screened throughout the prenatal course
- those with recurrences should be offered daily suppression therapy beginning at 36 weeks of gestation
- c-section is indicated for women with active lesions or a typical herpetic prodrome at the time of delivery
