STDs and a couple of add-ons Flashcards
1
Q
High risk pops (STDs, chlamydia, syphilis)
A
youth
chlamydia: black>Hispanic>white
syphilis: MSM account for 72% cases 2011, high rate of HIV coinfection
2
Q
Vulvovaginal Candidiasis causative organism(s)
A
NOT AN STD
(U) Candida albicans
can be caused by other Candida sp. or yeasts (Candida glabrata, Candida tropicalis or Torulopsis glabrata)
3
Q
Vulvovaginal Candidasis epidemiology
A
COMMON!
at least 75% of women experience 1 episonde
40-45% experience>1 episode
4
Q
Vulvovaginal Candidiases Clinical Presentation
A
-Vulvar pruritis, external dysuria, burning, dyspareunia, swelling, redness, excoriation
-thick, curd-like vaginal discharge
NORMAL VAGINAL pH (<4.5)
5
Q
Vulvovaginal Candidiasis: Risk Factors
A
taking antibiotics
immunocompromise (eg. HIV, DM, steroids)
body w/warm, most environment
6
Q
Vulvovaginal Candidiases: Dx
A
- clinical presentation
- Testing:
a. wet prep (saline & 10% KOH) w/microscope visualization of budding yeast & hyphae
b. Candida culture
- spaghetti & meatballs
7
Q
Vulvovaginal Candidiasis: UNCOMPLICATED tx
A
Uncomplicated: short course (103 days) of topical (vaginal) azole e.g. clotrimazole (OTC)
8
Q
Vulvovaginal Candidaisis: COMPLICATED definition and tx
A
def: Recurrent (> or =4 episodes in 1 yr), severe, non-albicans, patient has uncontrolled DM or immune compromise
-tx w/longer duration (7-14 d) topical azole or oral fluconazole (Diflucan)
IF NON-ALBICANS, AVOID FLUCONAZOLE-pick a different azole
9
Q
Vulvovaginal Candidiasis: tx of male partner
A
male partner DOESN’T NEED TX
UNLESS HE HAS BALANTIS (inflammation of the skin covering the glans of the penis)
10
Q
Vulvovaginal candidiasis: pregnant patients tx
A
ONLY use TOPICAL txs in pregnant pts
11
Q
What do you do if a patient has recurrent or difficult to tx yeast infections?
A
evaluate for DM, HIV
12
Q
Bacterial Vaginosis: an STD?
A
NOT an STD
13
Q
Vulvovaginal Candidiasis: an STD?
A
NOT an STD
14
Q
Bacterial Vaginosis causative organism/background
A
results from disruption of usual, "healthy" vaginal microflora (Lactobacillus sp)-allows overgrowth of bacturea cause is (U) polymicrobial, often a/w Gardnerella vaginalis & Mobiluncus sp (gram variable anaerobes)
15
Q
Bacterial Vaginosis: Clinical Presentation
A
vaginal irritation, thin white or gray discharge w/strong fishy odor
16
Q
Bacterial Vaginosis: Risk factors
A
(although NOT an STD),
- New or multiple sex partners
- douche
- can affect women that are NOT sexually active
17
Q
Bacterial vaginosis diagnosis (clinical criteria)
A
Clinical criteria (Amsel’s criteria) at least 3 of 4 present
- Thin white homogenous discharge
- Clue cells on microscopy
- Vaginal fluid pH>4.5
- Release of fishy odor when adding KOH solution (+whiff test)
18
Q
Bacterial vaginosis: lab test
A
best LAB test is Gram stain-shows anaerobes known to cause BV & lack of Lactobacilli
-Gold Standard but NOT generally used clinically
19
Q
Bacterial Vaginosis: tx
A
treat ALL PATIENTS WITH SXS
Metronidazole (Flagyl) orally for 7 days
-avoid EtOH while taking metronidazole
Metronidazole gel intravaginally for 5 dyas
Clindamycin orally or intravaginally
PREGO PTs: USE ORAL MEDS [just incase they have an infection higher up & to avoid premature birth]
20
Q
Bacterial Vaginosis: male partner tx
A
male partner DOES NOT need tx
21
Q
Bacterial Vaginosis: complications
A
- increases risk of acquiring & transmitting HIV
- increases risk of acquiring herpes, gonorrhea (GC) & chlamydia
- a/w PID (but BV is not believed to he a causative factor)
22
Q
Trichomoniasis: causative organism & description
A
Trichomonas vaginalis: single celled protozoan parasite
23
Q
Trichomoniasis: how common is this?
A
common (most common NON-VIRAL)
24
Q
Trichomoniasis: sxs appear when
A
1-4 weeks after exposure
men (U) ASYMPTOMATIC: sxs<10% of cases [male sx: clear or mucopururent urethral dc &/or dysuria]
25
Trichomoniasis clinical presentation
1. INCREASED VAGINAL pH (>4.5)
2. vaginal irritation & malodorous, frothy, yellow-green discharge
3. may see petechiae on cervix or vagina ("strawberry cervix")
[although these are the classical sxs, they occur only in some cases]
26
Trichomoniasis: dx
-visualize motile organisms on wet mount
-swab (vaginal, cervical, some tests appropriate for male urethra)
-culture (may take up to 7 days)
other technologies: eg NAAT
-pap test may identify trich
-testing is difficult in males (a little "trick":5-20% of men w/non-gonococcal urethritis (NGU) have trich
27
Nucleic Acid Amplification test (NAAT)
- biochemical technique used to detect the genetic material of an infecting organism
- faster than culture
- very sensitive (also preferred in males)
28
Trichomoniasis: tx
- treat everybody (pt & sex partners)
- Metronidazole (Flagyl) orally
- pt&partners should abstain from sex until tx is complete (high recurrence rate)
29
Trichomoniasis complications
increases risk of acquiring & transmitting HIV
30
Trichomoniasis: pregnancy considerations
trich increases risk of premature rupture of membranes, preterm delivery, low birth wt BUT TX NOT SHOW TO REDUCE RISKS
- tx recommended for pts with symptoms
- lactating women should withhold breastfeeding while taking metronidazole
31
Bacterial Vaginosis: microscopic appearahce
increased WBCs
decreased lactobacilli
many CLUE CELLS
32
Candidiasis: microscopic appearance
hyphae and buds
33
Trichomoniasis: microscopic appearance
normal epithelial cells
increased WBCs
trichomonads
34
Normal vaginal microscopic appearance
normal squamous epithelial cells
| numerous lactobacilli
35
Bacterial Vaginosis common sxs
- discharge
| - odor that gets works after intercourse, may be asymptomatic
36
Candidiasis: common sxs
- itching
- burning
- irritation
- thick, white discharge
37
Trichomoniasis: common sxs
- frothy d/c
- bad odor
- dysuria
- dyspareunia
- vulvar itching & brining
38
Normal vagina: amount of d/c, appearance of d/c
small amount of d/c
| d/c is white, clear, flocculent
39
Bacterial vaginosis: amt of d/c and appearance of d/c
amt: often increased
appearance: thin, homogenous, gray-green, white, adherent
40
Candidiasis: amount of d/c & appearance of d/c
amt: sometimes increased
appearance: white, curdy, "cottage cheese-like"
41
Trichomoniasis: amount of d/c & appearance of d/c
Amt: increased
appearance: gray-green, frothy, adherent
42
Normal vaginal pH
3.8-4.2
43
Bacterial vaginosis vaginal pH
>4.f
44
Candidiasis vaginal pH
normal (3.8-4.2)
45
Trichomoniasis vaginal pH
>4.5
46
KOH "whiff test" (amine odor) present in?
```
Bacterial vaginosis (fishy)
possibly present in Trichomonaisis (fishy)
```
47
Chlamydia: causative organism & gram stain
Chlamydia trachomatis
| GRAM NEGATIVE BACTERIUM
48
Chlamydia epidemiology
most common BACTERIAL STI in the US
| peaks in late teens, early 20s
49
Chlamydia: screening recommendations
- women < or =25 should be screened for chlamydia every year (screen older women w/risk factors)
- only screen higher risk males (correctional facilities, etc.)
- screen ALL PREGNANT PATIENTS
50
Patients infected with chlamydia are frequently co-infected with what
gonorrhea
51
Chlamydia presentation (in women, in men)
often asymptomatic, sxs 1-3 weeks after exposure
WOMEN: cervical d/c, vaginal bleeding, low abdominal pain, fever/chills, adnexal tenderness [adnexal=pain from ovary & fallopian tube]
MEN: irritated urethra(urethritis), penile d/c, dysuria
can cause oral & rectal infections
52
Chlamydia dx
Swab: cervical, vaginal or male urethral; various technologies (eg NAAT-gen most sensitive)
Urine: NAAT
Pharynx or rectal swab: NAAT, check w/lab to determine if there is a specific swab for the pharynx or rectal swab you need to use
53
Chlamydia tx: who do you treat
treat everybody [test(if possible) & tx pt & partners]
54
Chlamydia tx
tx everybody
Doxycycline orally x7d
OR
Azithromycin (Zithromax) single dose
no sex during tx
consider tx for gonorrhea too (assume coinfection)
***retest in 3-4 months***
pregnant pts: avoid doxycycline, pregnancy cat D
perform test-of-cure 3 weeks after therapy completion
55
Chlamydia complications
increases risk of acquiring & transmitting HIV
if left untx, can cause PID and associated complications
in males, can cause epididymitis
56
Chlamydia: pregnancy considerations
- may lead to preterm delivery
- may transmit to neonate during delivery
* a leading cause of CONJUNCTIVITIS(ophthalmia neonatorum) & PNEUMONIA in newborns
- can cause other respiratory tract infections
- AVOID DOXYCYCLINE IN PREGNANCY
57
Gonorrhea: causative organism & morph/gram
Neisseria gonorrhea-gram NEGATIVE DIPLOCOCCI bacterium
58
Gonorrhea background: when to symptoms occur, who do you screen
symptoms may occur 1-14 days after exposure
screen pts at risk
-pts often co-infected with chlamydia
59
Gonorrhea clinical presentation (women[W,4]and males[M,3], both [B,])
(like Chlamydia but more severe)
W: vaginal d/c, low abdominal pain, fever, cervical motion tenderness
M: irritated urethra (urethritis), white-yellowish-or green penile d/c, dysuria
B: can cause oral & rectal infections
60
Gonorrhea lab dx
swab or urine (like chlamydia)
Swab: cervical, vaginal or male urethral; various technologies (eg NAAT-gen most sensitive)
Urine: NAAT
Pharynx or rectal swab: NAAT, check w/lab to determine if there is a specific swab for the pharynx or rectal swab you need to use
61
Gonorrhea tx: who to treat
treat everybody
62
Gonorrhea tx
Ceftriaxone (Rocephin) IM (injection)
PLUS azithromycin or doxycycline (this regimen convers chlamydia too)
no sex during tx
***retest in 3-4 months***
63
Gonorrhea complications
-increase risk of acquiring & transmitting HIV
-if left untx, can cause PID & assoc. complications (in males, can cause epididymitis)
CAN CAUSE CONJUNCTIVITIS, MENINGITIS, ENDOCARDITIS & DISSEMINATED DZ
(U) need to hospitalize in disseminated dz
64
Gonorrhea: pregnancy considerations
transmittable to neonate during delivery
neonatal infections:
-can result in perforation of the globe & blindness
-most states require conjunctivitis (ophthalmia neonatorum) prophylaxis for all newborns
-topical erythromycin applied to both eyes asap after delivery
IN NEWBORNS W/SXS, ocular specimens should be tested for gonorrhea & chlamydia->always do cultures before initiating tx
-rarely can cause sepsis, arthritis, meningitis
65
Nongonococcal Urethritis (NGU): causative organism
urethritis caused be any pathogen other than gonorrhea
| eg. Chlamydia trachomatis (most common), Mycoplasma genitalium, others
66
Nongonococcal Urethritis clinical presentation
urethritis
67
Nongonococcal Urethritis dx
test for gonorrhea & chlamydia
68
Nongonococcal Urethritis (NGU) tx
- dependent on testing
- empiric tx w/azithromycin or doxycycline (like for chlamydia)
- follow-up for persistent sxs
69
Pelvic Inflammatory Disease: What is it?
general term, refers to SPECTRUM OF INFLAMMATORY disorders of the UPPER GENITAL TRACT
-endometritis, salpingitis, tubo-ovarian abscess
70
Pelvic Inflammatory Disease includes which conditions
endometritis, salpingitis, tubo-ovarian abscess
71
Pelvic Inflammatory Disease:causative organisms
- sexually transmitted organisms most common (U) chlamydia &/or gonorrhea
- other pathogens (eg. anaerobes, Haemophilus influenza, CMV)
72
PID pathophysiology
ascending infection from vagina or cervix to upper genital tract
73
PID clinical presentation: acute (6)
```
many have subtle or mild sxs
ACUTE: vaginal discharge
lower abdominal pain
cervical motion tenderness (chandelier sign)
uterine or adnexal tenderness
dyspareunia
fever (>101*F)
```
74
PID clinical presentation: chronic
occurs due to insufficient tx
| vague symptoms
75
PID risk factors
```
age<25
African American race
early onset of sexual activity
multiple sex partners
douche
IUD (only within 3 weeks of insertion)
prior history of PID
```
76
PID diagnosis & other impt testing
serum quantitative HCG (pregnancy test)
test for GC & chlamydia
-check WBCs on saline microscopy of vaginal fluid
-CBC, ESR, CRP
-ULTRASOUND: r/o ectopic pregnancy, thickening noted in areas of inflammation, tubo-ovarian abscess
-LAPAROSCOPY: visualization, can take specimens
77
PID tx
test for GC/Chlamydia, other pathogens before intiating tx
-tx empirically (presumptively)-begin prior to receiving tests results
-selection of Abs dependent on clinical scenario
OUTPATIENT REGIMEN eg.:
Ceftriaxone (Rocephin) IM injection (covers Gonorrhea)
Doxycyclinex14 days (covers Chlamydia)
Metronidazolex14days (covers trich, BV, ?maybe candidiasis?)
***FOLLOW UP WITHIN 48 HOURS
78
PID hospitalize if
(inpatient=IV tx)
- surgical emergencies can't be r/o (ectopic preg, appendicitis, ovarian torsion)
- patient is pregnant
- patient is not responding to oral antibiotics (win 48-72 hours)
- patient has tubo-ovarian abscess
- pt is very ill, eg: high fever (>202.2*F), N/V, looks sick
79
PID complications
- infertility
- ruptured tubo-ovarian abscess (surgical emergency)-life threatening
- chronic pelvic pain
- increased risk of ectopic pregnancy
- Fitz-Hugh-Curtis syndrome (perihepatitis characterized by RUQ pain & adhesions)
80
Genital Herpes: causative organism
Herpes simplex virus type 1 or type 2
81
Genital Herpes prevalence
common
| at least 50 million ppl in the US with HSV-2 genital herpes
82
HSV-2 usually cases what
genital lesions
83
Genital Herpes symptoms of most infected people
most infected have minimal or no symptoms
84
Genital Herpes is commonly acquired from....
an ASYMPTOMATIC partner
85
4 designations of genital herpes
- primary
- non-primary 1st episode
- recurrent
- asymptomatic viral shedding
86
Genital herpes pathophysiology
- spread through contact with lesions, mucosal surfaces, genital secretions or oral secretions
- viral shedding can occur when NO lesions present
- virus remains latent in nerve root ganglion
- virus may be reactivated by a change in immune status (eg. status, menses, infection)
87
Genital Herpes clinical presentation
- prodrome of burning, tingling and/or pruritis followed by outbreak of painful vesicles on erythematous base
- initial (primary) outbreak tends to be the most severe
88
Genital Herpes diagnosis
-clinical
-direct viral culture (swab): preferred method (but can get false negatives, REQUIRES ACTIVE lesion)
-Serology (blood test): some tests can detect HSV-1& HSV-2 specific Abs
limitations or serology: Abs don't (U) appear until 3-4 weeks after exposure (lesions may appear in 2-4d), a positive test is NOT definitive for GENITAL herpes
89
Genital Herpes tx (drugs and length, initial outbreak, recurrent outbreak & suppression)
Acyclovir (Zovirax), Valacyclovir (Valtrex) or Famciclovir (Famvir)
[must reduce the dose of cyclovir meds in pts w/renal insufficiency]
Tx length
initial outbreak: 7-10d
recurrent outbreak: 1-5d
suppression: daily dose, discuss discontinuation annually, REDUCES risk of transmission to partner but DOES NOT ELIMINATE RISK
90
Genital Herpes length of tx for initial outbreak
7-10 days
91
Genital Herpes length of tx for recurrent outbreak
1-5 days
92
Genital herpes tx for suppression
daily dose
discuss d/c annually
reduces risk of transmission to partner but does not eliminate it
93
Genital herpes tx meds
cyclovir's=antivirals
Acyclovir (Zovirax),
Valacyclovir (Valtrex) or
Famciclovir (Famvir)
94
Genital herpes pregnancy considerations
can be vertically transmitted to infant before, during or after delivery
- transmission during vaginal delivery is most common (C section reduces risk of transmission, risk of transmission during vaginal delivery-mom w/primary HSV-risk is 50%, mom w/recurrent HSV, risk is 1% [mom's Abs are protective]
- most (70-95%) infants with neonatal HSV are born to moms w/no known history of genital HSV
95
Neonatal HSV, 3 possible syndromes
```
localized skin, eye, mouth (SEM) dz
CNS dz (eg. encephalitis): long-term morbidity common (eg. mental retardation)
disseminated dz (organ involvement): mortality common
```
96
Prevention of neonatal HSV
- offer women w/active recurrent genital herpes suppressive viral therapy (acyclovir) at or beyond 46 weeks gestation (may reduce need for C-section)
- perform C-section delivery in women w/active genital lesions or prodromal symptoms (eg. vulvar pain or burning) at time of delivery
97
Genital Herpes: Pregnancy considerations (w/out known herpes & without known orolabial herpes)
- pregnant women WITHOUT KNOWN GENITAL HERPES: during 3rd trimester, avoid intercourse w/partners known or suspected of having genital herpes
- pregnant women WITHOUT KNOWN OROLABIAL HERPES: during 3rd trimester, avoid intercourse with partners known or suspected of having orolabial herpes
98
Human Papillomavirus: causative organism
HPV>40 types sexually transmitted
99
What is the most common STD?
HPV
| nearly all sexually-active men & women will get at least one type of HPV at some point in their lives
100
HPV can infect which areas
genital area, incl. skin of vulva, lining of vaginal, penis, anus
can also infect mouth, throat
101
HPV clinical presentation
*most never have symptoms
-visible genital warts (CONDYLOMA ACUMINATA)
soft, flesh-colored, single or multiple, flat, cauliflower-like
-precancerous/cancerous changes (anywhere infected), persistent HPV is main cause of cervical cancer
102
What is the main cause of cervical cancer?
persistent HPV
103
HPV diagnosis
visualize warts, -vinegar solution may help identification (warts may turn white), biopsy may be considered if dx uncertain
- abnormal pap (anal pap not CDC recommended), can test for HPV DNA during Pap
- no test for men
104
HPV treatment
no cure-tx is for the diseases caused by HPV
destruction of warts via:
liquid nitrogen or trichloroacetic (TCA)
or prescriptions: (podofilox ointment, topical imiquimod)
tx the precancerous/cancerous changes (eg. cervical dysplasia)
105
HPV complications (and which types have high prevalence)
~15 types lead to cervical cancer
| types 16 & 18 account for 70% of cervical cancer
106
Prevention of HPV-vaccines & descriptions
FDA licensed in 2006
Ceravarix (bivalent)-approved for girls, protects against cervical cancer (HPV types 16 & 18)
Gardasil (quadrivalent) approved for girls & boys-protects against types 16,18,6,11
protects against cervical, vulvar, vaginal, anal cancers & against warts
SERIES OF 3 INJECTIONS (like Hep B)
107
Ceravix description
bivalent, approved for girls
| protects against cervical cancer (HPV types 16 & 18)
108
Gardasil description
quadrivalent, approved for girls & boys
protects against types 16, 18,6, 11
protects against cervical, vulvar, vaginal, anal cancers & against wards
109
HPV vaccine: single injection or series
series of 3 injections (like Hep B)
110
HPV vaccine CDC recommendations
CDC recommended for girls and boys
-Girls&boys 11-12 yrs (can start as early as 9)
-Girls 13-26 yrs who have not completed series
-Boys 13-21 who have not completed series
ideally begin before sexual activity
111
HPV pregnancy considerations
rarely-can be transmitted to neonate during delivery
| very rarely causes warts in baby's throat
112
Syphilis causative organism
bacterium Treponema pallidum
113
Syphilis epidemiology
in 2011, 46,000 new cases in US
| rates highest amongst men 20-29 yo
114
Syphilis pathophysiology
transmitted through direct contact with infected lesion (usu. genitals, anus, lips, mouth)
bacteria enter the skin & in 10-90 days create a PAINLESS chancre
115
What is the "great imitator"
syphilis
116
Types of syphilis
primary, secondary, latent, late (tertiary)
117
Primary syphilis clinical presentation
painless chancre appears at location where syphilis entered body, persists for 4-6 weeks
118
Secondary syphilis clinical manifestation (4)
1. Rash (very common); (U) non-pruritic, characteristically on palms & soles of feet, not contagious
2. Condyloma lata: moist, heaped, wart-like papules; occur in intertriginous areas (most commonly gluteal folds, perineum, perianal area), highly contagious
3. Mucous patches: painless flat patches involving the oral cavity, pharynx, genitals, not painful (pt may be unaware of patches), occur in 6-30% of cases of secondary syphilis, highly infectious
4. may exp systemic sxs such as malaise, lymphadenopathy
119
Secondary syphilis length
generally persists 2-6 weeks, then enters latent phase
120
Latent syphilis clinical presentation
asymptomatic, syphilis no longer sexually transmittable, may persist for years
121
Late syphilis clinical presentation
may appear 10-20 yrs after infection acquired
develops in 15% of those untreated
causes neurologic deficits (eg. blindness, dementia) & damage to internal organs
NEUROSYPHILIS
122
Syphilis diagnosis
bacteria (from chancre) visible under darkfield microscopy
SEROLOGY: Rapid Plasma Reasin (RPR) or venereal dz research laboratory (VDRL) test
-titer indicates dz activity, may be low if false positive (eg. low titer is 1:4) false positives can occur from autoimmune dz, illness, pregnancy
CONFIRM RPR w/antibody test: FTA-ABS
123
Causes of false positive on syphilis serology & which tests are affected
autoimmune dz, illness, pregnancy
| RPR and VDRL are affected and may show a low titer if false positive
124
Syphilis, what to do if neurosyphilis (late stage is suspected)?
must do lumbar puncture & perform VDRL on spinal fluid to confirm
(U) refer to neurologist
125
Syphilis tx
```
treat everybody (test & tx sex parners)
Benzathine PCN G, 2.4 mu IM x 1 (a shot)
-additional doses required if syphilis present for >1yr: obtain pt history & contact county health dept for advice
in PCN allergy, can use ORAL DOXYCYCLINE (exception: tx HIV & preg pts w/PCN)
-check RPR titer to confirm tx success (at 3,6,12,24mos) 4 fold decrease=adequate response
```
126
How to monitor for syphilis tx success
check RPR titer to confirm tx success (at 3,4,12,24 months), 4 fold decrease=adequate response
127
Syphilis: complications
- having a chancre increases risk of acquiring & transmitting HIV
- late syphilis
128
Untreated syphilis in pregnancy: any problem with that
untx syphilis during pregnancy, ESP EARLY SYPHILIS, can lead to:
stillbirth, neonatal death, or infant disorders such as deafness, neurological impairment & bone deformities
129
Syphilis prevention (pregnancy)
- screen pregnant women at 1st prenatal visit
- if risk is high, screen & obtain sexual history again at 28 weeks & at delivery
- if pregnant pt is PCN allergic, consider desensitization with oral PCN
- monitor serology closely to confirm successful tx
130
Chancroid: causative organism
Haemophilus ducreyi
131
Chancroid epi
sporadic outbreak in US
132
Chancroid clinical presentation
- painful tender genital ulcer
- lesion produces foul-smelling discharge (that's contagious)
- inguinal adnitis (buboes)
133
Chancroid dx
- rule out syphilis
| - if chancroid suspected contact county health department
134
Lymphogranuloma venerum (LGV): causative organism & epidemiology
serotype of Chlamydia trachomatis
| background: rare in US, in US most commonly occurs in MSM
135
Lympogranuloma venereum (LGV) clinical presentation
- causes systemic infection
- unilateral inguinal bubo
- self-limited genital ulcer or papule at site of inoculation
- anal discharge & rectal bleeding
136
Lyphogranuloma venereum (LGV) dx
rule out syphilis
| if LGV suspected, contact County Health Dept
137
Pediculosis Pubis: causative organisms
pubic lice, parasite Pthirus pubis ("crab" louse)
- Clinical presentation
- tx: permethrin 1% cream rinse, others
138
Pregnant women: what STDs to screen for at first visit
- HIV, syphilis, Hep B, GC/Chlamydia
- Hep C for those at risk
- take history to assess for HSV
139
Prevalence of many STDs are highest in which age group?
Adolescents
140
Can minors consent to STD services?
yes, in all 50 states (but some states regard HIV tx separately)
141
Who should be routinely screened for GC/Chlamydia
women<25 years old
142
CDC recommends discussing HIV screening with who
everyone 13-64 years old
143
MSM what do you do w/this pop (re: STDs)
- may be at higher risk for some STDs so take a good history
- screen for HIV & syphilis annually
- offer Hep A & Hep B vaccines
144
WSW: STD risk
DO NOT ASSUME LOW RISK
145
Children w/STDs: what should be done
prompt involvement of child protective services
146
STDs: prevetion & counseling
history: assess pt risk factors
| test & treat (until all sxs resolve) everybody before resuming sexual activity
147
STD screening
screen pts age 13-64 yo for HIV
- screen those w/risk factors annually, opt out testing
- all pts with an STD should be screened for HIC (test for HIV with each new STD)
148
Which STDs to report
HIV and most STDs are reportable to azdhs
149
STD prevention: your role
talk to pts abt pre-exposure vaccines
provide prevention/risk-reduction counseling
-talk to pts about testing
-asses pts risk & test accordingly
-dx & tx infected pts
-provide or refere services for partners
-report STD/HIV in accordance with state & local laws
-keep STD/HIV reports confidential (it's the law)
