STI 1 and 2 Flashcards
What are the 5 “P”s of taking a good sexual history?
partners practices protection from STDs past STDs precaution of pregnancy
Why is it important for all patients with an STD to be evaluated for HIV?
many STDs facilitate the transmission of HIV: Chlamydia Gonorrhoeae BV HSV 1,2 Syphilis Chancroid Granuloma inguinal (Klebsiella granluomatosis)
Is the immunity due to prior infection durable in the case of STIs?
no, in general, prior infection does not protrect against re-infection
Define cervicitis.
visible purulent endocervical exudate and/or sustained endocervical bleeding induced by gentle passage of a cotton swab through the cervical os
Contrast the presentation of gonococcal and nongonococcal uretheritis.
gonococcal infection incubation is less than 4 days, presents with severe dysuria and the discharge is profuse yellow or green
NGU incubation is in the range of 7-14d, with mild dysuria and slight discharge that is gray (minor)
Describe the diagnostic tests that would differentiate GU and NGU.
GU: gram stain shows many WBC with intracellular gram negative diplococci
NGU: gram stain shows WBC and no diplococci (suggestive for C. trachomatis)
both show > WBC per oil immersion or >10 WBC on first void UA of AM (alternate PCR of urethral swab or urine specimen)
What is the standard tx. for GU and NGU.
GU: ceftriaone 250 IM plus: azithromycin 1000mg PO x1 OR doxycycline 100mg PO BIDx 7
NGU: Azithromycin 1g PO x1 or doxycycline 100mg BID x 7d
this regimen also treats for chlamydia
What are the suite of recommendations that usually accompany STI treatment.
abstain from sex for 7d
notify partners for eval, tx and testing
test for other STDs including HIV
repeat testing recommended in 3-6mo
What is the clinical presentation of mucopurulent cervicitis?
common that patient is asymptomatic, symptoms can include abnormal vaginal discharge and intermetnstrual bleeding (esp. after sex)
Name important criteria and considerations for diagnosis of mucopurulent cervicitis?
at least one of the major diagnostic criteria: mucopurulent endocervical exudate or sustained endocervical bleeding induced by passage of a cotton swab
gram stain or NAAT of cervical, vaginal or urine specimens can be helpful
MUST ALWAYS evaluate for upper tract disease (PID)
When is test of cure recommended in the treatment of mucopurulent cervicitis?
if the patient is pregnant
if the GC regimen did not include cefrtriaxone
Which STI are women and men more likely to get based on gender
women 2.5x more likely to get Chlamydia
women have a higher incidence of Gonorrhea
men have a greater incidence of Syphilis
What is the target for Chlamydia screening?
annal screening for women <25yo, highest rates seen in women ages 15-24
Describe the pathogenesis of Chlamydia.
C. trachomatis is an intracellular bacterial pathogen that infects urethral, rectal, cervical, and upper reproductive tract epithelial cells, epidermal cells in men and conjunction and pulmonary columnar cells
C. trachomatis reproduces through and elementary (enters and /reticulate body lifecycle
Contrast complication of Chlamydia in men and women
men: epidiymitis, prostatitis and reactive arthritis
Women: PID, tubal infertility, ectopic pregnancy, chronic pelvic pain
Discuss the presentation of neonatal infection with chlamydia and its treatment.
Neonatal inclusion conjunctivitis occurs within 5-12d of birth and requires ORAL antibiotics
Neonatal C. trachomatis pneumonia occurs within 8 weeks of birth and requires ORAL antibiotics
perinatal screening can eliminate 90% of infections
What is the standard treatment for chlmydia?
Azithromycin 1g PO x1
OR
Doxycycline 100mg PO BIDx7d
Describe the risk of transmission man > woman vs. woman > man for gonorrhea
male > female 50-70% per exposure
female > male 20% per exposure
Describe the gram stain of N. gonorrhea.
intracellular bacterial pathogen that is a diplococcus with prominent pilli
** it is important to gram stain and culture all sites of sexual contact
Who is more likely to be asymptomatic with N. gonorrhoeae, men or women?
men <10% asymptomatic
women up to 80% asymptomatic
Describe the symptoms of Pharyngeal and anorectal gonorrhea
pharyngeal gonorrhea is almost always asymptomatic
anorectal gonorrhea presents with pruritus, tenasmus, discharge and bleeding