STI Flashcards
What are the three categories of STIs?
Viral
bacterial
Parasitic/fungal
What is STBBI?
Sexually transmitted and blood borne infection
What is the goal of therapy with STIs?
With respect to Fertility and pregnancy what can chlamydia impact?
preterm birth, conjunctivitis and pneumonia in newborn
With respect to Fertility and pregnancy what can Gonorrhea impact?
endometritis and pelvic sepsis, ophthalmia
neonatorum and systemic infection in newborn
With respect to Fertility and pregnancy what can syphilis impact?
systemic symptoms, fetal loss
When should pregnant people be tested for STIs?
early in pregnancy and again in third trimester if ongoing risk and treated before giving birth to decrease the risk of problems during pregnancy and delivery, and resulting complications for the baby
What is the treatment for Vulvovaginal candidiasis?
Fluconazole 150 mg PO x single dose
Topical azole antifungals – clotrimazole, miconazole, terconazole
What is the treatment for Trichomoniasis
Metronidazole 2 g PO x single dose OR 500 mg PO BID x 7 days
What is the treatment for Bacterial Vaginosis
Metronidazole 500 mg po BID x 7 days or 2 g PO x single dose
Metronidazole 0.75%
5 g PV x 5 days (x 10 days plus twice weekly x 4-6 months if recurrent)
Clindamycin 2% 5 g PV x 7 days
What type of symptoms occur with Trichomoniasis
Pruritis Odour
Off-white or yellow, frothy discharge
What type of symptoms occur with Bacterial Vaginosis
Fishy odour
Grey or milky, thin, copious discharge
What is the most common nationally reported sti in canada?
Chlamydia
With respect to chlamydia can empiric treatment be given without lab testing?
Yes!
What is the presentation of chlamydia in female genitalia?
- Cervicitis
- Vaginal discharge
- Lower abdominal pain
- Dysuria
- Abnormal vaginal bleeding
- Painful intercourse
- Conjunctivitis
- Proctitis
What is the presentation of chlamydia in male genitalia?
- Urethritis (discharge, pain)
- Urethral itch
- Dysuria
- Testicular pain
- Conjunctivitis
- Proctitis
What is the presentation of chlamydia in infants/children?
- Conjunctivitis * Pneumonia
What is the preferred treatment for chlamydia? (2)
Doxycycline 100 mg PO BID for 7 days
or
Azithromycin 1 g PO in a single dose
What is the secondary treatment for chlamydia?
Levofloxacin 500 mg PO once a day for 7 days
What is the preferred treatment for pregnant and lactating people for chlamydia? (4)
Azithromycin 1 g PO in a single dose
or
Amoxicillin 500 mg PO TID for 7 days
or
Erythromycin 2 g/day PO in divided doses for 7 days
or
Erythromycin 1g/day PO in divided doses for 14 days
What are the key counselling points for people with chlamydia?
abstain from sexual activity without barrier protection until treatment of person and partners is complete (7 days after one dose therapy, end of multiple dose therapy) and symptoms have resolved
Is Test of cure recommended for chalmydia?
Yes and repeat screening 3 months.
Sask-TOC 3-4 weeks following positive repeat testing in all individials 6 months post as re-infection risk is high
What is the presentation of primaryLGV?
3-30 days incubation
Small painless papules at site of inoculation (often unnoticed)
What is the presentation of SecondaryLGV?
2-6 weeks after primary lesion
Swelling of lymph nodes Proctocolitis
Systemic symptoms like fever, fatigue, arthritis, pneumonitis, hepatitis; rarely
cardiac involvement, meningitis , ocular inflammatory disease
What is the presentaiton of teriaryLGV?
Chronic inflammatory lesions lead to scarring;
lymphatic obstruction causing genital elephantiasis; genital and rectal strictures and
fistulae; possible extensive destruction of genitalia
What is the second most common reported STI in canada?
Gonorhea
When gonorrhoea is left untreated?
infections become chronic
high rates of concomitant infection with chlamydia and gonorrhoea hence?
Treat for both
What is the complications of Gonorrhea with respect to female genitalia?
- Pelvic inflammatory disease →infertility and risk of ectopic pregnancy
- Chronic pelvic pain
What is the complications of Gonorrhea with respect to male genitalia?
- Epididymo-orchitis
What are the shared complications of Gonorrhea
- Disseminated gonococcal infection (DGI) = spectrum including arthritis, tenosynovitis, dermatitis, endocarditis, meningitis
- Reactive arthritis
- Perihepatitis
What is the preferred treatment of Gonorrhea (Non throat)
Ceftriaxone 250 mg IM in a single dose dose PLUS azithromycin 1 g PO in a single dose
or
Cefixime 800 mg PO in a single dose PLUS azithromycin 1 g PO in a single dose
What is the preferred treatment of Gonorrhea (Throat)
Ceftriaxone 250 mg IM in a single dose dose PLUS azithromycin 1 g PO in a single dose
What is an issue with using doxycycline in Gonorrhea treatment?
It is CI in pregnancy
For follow up Gonorrhea cases what is recomended?
TOC cultures recommended within a week for all positve sites
SK TOC cultures 4-5 days following treatment, NAAT not recommended,
- Retest 6 months following since reinfection is high
What is the third most common STI in canada?
Syphilis
What is the issue with Syphilis as comparred to other STIs
- Untreated syphilis has many complications
- Universal screening recommended in pregnancy
- HIV → more rapid progression to neurosyphilis and more aggressive and atypical
signs of infection
When taking Doxycycline what counselling points should be given?
o Take with food
o Taking with iron or calcium may
decrease absorption
o Photosensitivity
When taking Azithromycin what counselling points should be given?
GI upset - prophylactic antiemetics
How long should someone abstain from sexual activity with chlamydia?
Abstain from sexual activity without barrier protection until treatment of person and partners is complete (7 days after one dose therapy, end of multiple dose therapy) and symptoms have resolved
What is the primary treatment for LGV?
Doxycycline 100mg PO BID for 21 days
What are the symptoms of gonorrhea as it relates to the female genitalia?
- Vaginal discharge
- Lower abdominal pain
- Abnormal vaginal bleeding
- Dysuria
- Cervical discharge
- Bartholinitis – inflammation of
Bartholin’s glands - one on each side
of vaginal opening - Dyspareunia
- Rectal pain and discharge with
proctitis
What are the symptoms of gonorrhea as it relates to the male genitalia?
- Urethral discharge
- Dysuria
- Urethral itch
- Testicular pain, epididymitis
- Rectal pain and discharge with
proctitis
What is the clinical manifestations of the primary stage of syphilis symptoms?
Painless lesions
Regional lymphadenotpathy
What is the clinical manifestations of the secondary stage of syphilis symptoms?
Rash, fever, malaise, lymphadenopathy, mucous lesions, condyloma lata, alopecia, meningitis, headaches, uveitis, retinitis
What is the clinical manifestations of the early latent stage of syphilis symptoms?
Asymptomatic
What is neurosyphilis and ocular syphilis?
Ranges from asymptomatic to headaches, vertigo, personality changes, dementia, ataxia, Argyll Robertson pupil, otic symptoms, ocular symptoms
What is the treatment for syphilis? Primary secondary and early latent
Pen G-LA as a single dose
What is the treatment for syphilis late, late latent, and other?
Pen G-LA IM weekly for 3 doses
What are the key counselling points with syphilis?
- Abstain from sexual contact until the lesions are completely healed and it has been 7 days since they received their final dose of treatment
- Condoms should be advised and encouraged for all sexual encounters
- PHAC: Advise all people with potentially infectious lesions such as chancres,
condylomata lata and/or rash of secondary syphilis to abstain from sexual contact until symptoms have resolved and for 7 days after treatment
What follow up care is require for syphilis?
No test for cure, but nontreponemal test should have a four fold change at 6 months
What is Syphilis – Jarisch-Herxheimer Reaction?
- Acute febrile reaction accompanied by headache, myalgia, chills and rigors
- Occurs within 1st 24 hours after initiation of any syphilis therapy
- NOT an allergic reaction, but rather reaction to therapy
What is available for HPV?
Vaccines
What is the primary treatment for genital herpes?
Acyclovir 200mg PO five times per day for 5-10 days
OR
Famciclovir 250mg PO TID for 5 days
OR
Valacyclovir 1000mg PO BID for 10 days
