STI Flashcards
chlamydia biology
obligate intracellular bacteria w/ 15 serovars, gram negative
trachoma: A, B, Ba, C
genital tract/conjunctivitis: D-K
LGV (lymphogranuloma venereum): L1, L2, L3
chlamydia female presentation
cervicitis, PID, fitz-hugh-curtis, tubo-ovarian abscess
what is fitz-hugh-curtis
hepatic fibrosis and scarring w/ PID (10%), presents with RUQ tenderness and pain
“violin-string” adhesions on upper liver surface
incubation period for chlamydia
7-21 days
best test for chlamydia diagnosis
Nucleic acid amplification test (NAAT) - cervical/vaginal swab
When should I treat someone for chlamydia?
test positive, tests positive for gonorrhea, clinical syndrome suspicious for chlamydia (PID, cervicitis, urethritis), known or possible sexual exposure
how do I treat chlamydia?
doxycycline 100mg PO q 12 hours x 7 days
or
azithro 1 g PO once, or levofloxacin 500mg x 7
TREAT PARTNERS
Neisseria gonorrhea biology
gram negative diplococci, obligate aerobe
catalase +, oxidase +
can be cultured on thayer-marten agar (chocolate agar)
can’t ferment maltose (stays red)
is chlamydia or gonorrhea more symptomatic?
gonorrhea - espeically in wimpy men
incubation period for gonorrhea
2-5 days
gonorrhea in men
urethritis (PURULENT discharge, usually more than chlamydia), epididymitis, prostatitis, proctatis
gonorrhea in women
cervicitis (purulent!), PID, perihepatitis (fitz), inflammation of bartholin’s glands
gonorrhea common presentations
pharyngitis (associated with higher risk of disseminated + can be more resistant to treatment), proctitis (tenesmus, bleeding, discharge)
what are some of the disseminated gonococcal infections
arthritis-dermatitis syndrome
purulent arthritis
endocarditis
meningitis
Arthritis-Dermatitis Syndrome
Triad of polyarthralgia (joint pain - can migrate), tenosynovitis (infection of tendon - wrists, fingers, ankles, toes), + dermatitis (painful lesions - pustular or vesicular)
usually have fever/constitutional symptoms
Purulent arthritis
Mono or oligo-articular arthritis, joint pain/swelling, distal joints (knee, wrist, ankle), need to culture synovial fluid
Best way to diagnose gonorrhea
NAAT (urine, rectal, cervical/vaginal, throat)
Culture is necessary for sites of dissemination (blood, synovial fluid) - gram negative diplococci
When should I treat for gonorrhea?
+ test, + for chlamydia, clinical syndrome suspicious (PID, cervicitis, urethritis), known/possible exposure
TREAT PARTNERS
how do I treat gonorrhea?
Ceftriaxone 500mg IM x1
Disseminated infection requires longer course (depends on type)
incubation period for HSV2
2-12 days - most transmission occurs while contact case is asymptomatic
primary herpes infection
more severe + longer (can last 2-4 weeks)
local symptoms: pain, itching, dysuria, discharge, inguinal lymphadenopathy
systemic: fever, headache, myalgia
recurrent herpes infection
milder - prodrome of tingling/irritation then lesion develops ~12-24 hours later
more likely to have recurrent episodes if primary infection was prolonged
usually 2-6/year
how should I diagnose herpes?
NAAT - swab a lesion
How should I treat herpes?
Primary infection - antiviral therapy
Further treatment depends on patient (episodic treatment, chronic suppression, no tx)
HSV drugs
Acyclovir
Famciclovir
Valacyclovir
HSV is my FAV
Primary HSV infection
Acyclovir, famciclovir, valacyclovir for 7-10 days
Episodic tx of HSV
start tx when patient has prodromal symptoms or w/in one day of developing lesions (same FAV drugs)
HSV suppressive therapy
reduces frequency of recurrences and shedding (decrease by 70-80%)
frequency of outbreaks naturally decreases over time (assess if need for chronic suppression)
trichomonas vaginalis
protozoa, flagellated organism, exclusively sexually transmitted
trichomonas in males
usually asymptomatic!!
urethritis, increased risk for getting HIV
trichomonas in women
vaginitis - profuse, frothy discharge (often malodorous), genital irritation, mucosal erythema, cervical petechiae (strawberry cervix)
how to diagnose trichomonas
NAAT is best
could see on wet mount
trichomonas treatment
women: metronidazole 500mg q12 x7
men: metronidazole 2g PO x 1
Treat everyone!
