STI Flashcards by Trien Van

Culture-testing results of a urine sample are positive for gonorrhea.

Assuming this patient has no allergies, what are TWO possible preferred oral treatments for gonorrhea that may be considered? Specify drug names, dosage, and duration of treatment.

Cefixime 800mg po x 1
Ceftriaxone 250mg IM x 1

Cephalopsorin allergy:
Azithromycin 2g po x 1
Spectinomycyin 2g IM x 1

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Treatment of another STI should be given at the same time as gonorrhea. Name this STI

Chlamydia trachomatis infection

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In Canada, gonorrhea is a reportable disease. What further issues (both personal and related to public health) are appropriate to address with the patient? List THREE

Any other sexual contacts the patient has had (contact tracing)
Education on risk of contracting other STIs (HIV, Hepatitis, syphilis)
Marriage Counselling

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In testing of urine samples for STIs, a positive result is very dependent on specimen collection. What collection techniques improve the yield from specimen testing? List TWO

1st urine catch of urine

Collect urine sample at least 2hrs after the patient has voided

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Name the most common sexually transmitted infection in Canada

Chlamydia trachomatis

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What are the general symptoms of Chlamydia trachomatis and Neisseria gonorrhea?

Urinary symptoms - frequency, urgency, dysuria and pelvic pain
In some cases chlamydia may have conjunctivitis

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A male presents with with symptoms suggestive of chlamydia trachomatis infection. List FOUR

Urethral itch
Urethritis
Urethral discharge
Testicular pain

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List FIVE symptoms of chlamydial infection in females

80% asymptomatic
Cervicitis
Dyspareunia
Post-coital bleeding
Vaginal discharge
Vaginal bleeding
Urethral dischage

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You suspect a patient may have a Chlamydial trachomatis infection. How would you confirm this diagnosis?

Nucleic acid amplification test (NAAT) of cervical, urethral, urine sample

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If your patient was male, what are some potential complications of Chlamydial or Gonorrhea infection?

Epididymitis/orchiditis
Urethritis
Conjunctivitis
Reactive arthritis (inflammation of large joint due to infection)

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What are some potential complications of chlamydial or gonorrheic infection in a female?

Pelvic inflammatory disease
Infertility
Chronic pelvic pain
Increased rate of ectopic pregnancy

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What are the criteria for Reiters syndrome?

Reactive arthritis
Conjunctivitis
Cervicitis (females)
Urethritis (males)

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How would you manage this patient from a public health perspective?

Partner tracing to report to pubic health (60d)
Advise condom use to prevent transmission
No sex for at least 7d post treatment

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Your patient is confirmed to have a Chlamydia trachomatis infection, how would you treat this patient?

Azithromycin 1g po x 1 (use in preggers/breastfeeding and retest 3-4wks to ensure cure)
Doxycycline 100mg po bid x 7d
Always treat for gonorrhea as often coinfected (see gonorrhea Tx)

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What is the second most common STI in Canada?

Neisseria gonorrhea infection

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List FOUR symptoms of gonorrhea in men

Epididymitis
Urethral discharge/itch
Testicular pain
Testicular swelling
Rectal pain/discharge

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Gonorrhea and chlamydia have some similar symptoms, list THREE different symptoms

Pelvic pain, urethritis, cervicitis, vaginal discharge, vaginal bleeding, post-coital bleeding, pelvic inflammatory disease
Deep dyspareunia
Bartholinitis
Perihepatitis
Rectal pain/discharge
Asymptomatic in 80%

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What are some general symptoms of gonorrhea?

Pharyngeal infection
Conjunctivitis
UTI Sx
Proctitis
Arthritis
Dermatitis

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What are some disseminated complications of gonorrhea?

Disseminated arthritis, dermatitis, endocarditis, meningitis (ADEM)

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In what groups of patients with gonorrhea would you swab and culture?

Men who have sex with men (MSM)
Non-genital infections (pharyngeal, cervical)
Resistant/refractory to treatment

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What investigations would you order to confirm your diagnosis of gonorrhea?

Nucleic acid amplification test (NAAT) of urethral or urine sample

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You have a homo patient with gonorrhea, what is the first line treatment?

Ceftriaxone 250mg IM x 1

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You have a female patient with a pharyngeal confirmed infection of gonorrhea, what is your first line treatment?

Ceftriaxone 250mg IM x 1

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You have a patient refractory to your first line treatments of gonorrhea, what else can you prescribe?

Azithromycin 2g po x 1 + Ceftriaxone 1g IM x 1

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What medication do you use if your patient has gonorrhea and is allergic to cephalosporins?

Azithromycin 2g po x 1

How would you manage a patient with gonorrhea?

Sexual contact tracing and report to public health Treat with appropriate antibiotics Could culture infection 3-7d post treatment to assess success NAAT 2-3wk post Tx Repeat screen 6 months post Tx

What are the Human Papilloma Virus subtypes responsible for causing cancer?

HPV 16 & 18

What are the Human Papilloma Virus subtypes responsible for causing warts?

HPV 6 +11

List FIVE types of cancer that may be caused by HPV

``` Pharyngeal Genital Cervical Vaginal Vulvar Rectal ```

You see cauliflower like warts on the genitalia, what is the dermatological diagnosis?

Condyloma acuminate Females (cervix, vagina, anus) Male (penis, anus)

How would you diagnose an HPV infection?

``` PAP smear Colposcopy Visible inspection HPV testing Anoscopy ```

List TWO options for primary prevention

Gardisil (HPV 6, 11, 16, 18) immunization in 9-26yo | Cervarix (HPV 16, 18) immunization in 9-26yo

True or False: Condom use had not been shown to limit transmission of HPV

True

How would you treat HPV infection in non-pregnant women?

Observe (90% clear in 2yrs) Symptomatic (vaginal, urethral, anal infection): *Physician applied: Cryotherapy/Trichloracetic acid 80-90% -> Surgical excision/cautery/laser -> Interferon/Podophillin resin External skin: *Pt applied imiquimod 5%/podofilox 0.5%

How would you treat a pregnant patient with HPV infection?

1st line: Cryotherapy, Trichloracetic acid | 2nd line: surgical excision, cautery, laser

Describe the classic dermatological sign of a herpes simplex virus infection

Vessicles on an erythematous base leading to ulcerations

What are the common prodromal symptoms of HSV infection?

``` Pruritus Tingling Burning Pain Associated with fevers and myalgias ```

Herpes simplex virus infections are typically a clinical diagnosis, what other investigations could you order to confirm the diagnosis?

``` Serum herpes simplex virus antibody testing Viral swabs for: -culture -antigen testing -PCR ```

This is your patient's first episode of an HSV infection, how would you treat this patient?

Acyclovir 400mg po tid x 5-7d | Valacyclovir 1000mg po bid x 5-7d

This is your patient's 4th oral herpes outbreak this year, how would you treat this patient?

Dx: Acute recurrent herpes simplex virus infection (

Your patient had 7 episodes of herpes this year, how would you treat this patient?

Dx: Chronic suppressive (>6 eps/yr) Tx: Acyclovir 400mg po bid x 3-6 months Valcyclovir 500mg po daily x 3-6months

How would you treat a pregnant woman with vaginal herpes?

1st episode: acyclovir 200mg po FIVE times per day x 5-10d | Prior infection within previous year: Prophylaxis at 36wks with acyclovir 200mg po qid OR valacyclovir 500mg po bid

List the symptoms of primary syphilis

Painless papule/ulcer (chancre) | Lymphadenopathy

List the symptoms of secondary syphilis.

``` Rash Fever Malaise Lymphadenopathy Headache Mucous lesions Uveitis Retinitis ```

Your patient has primary syphilis, how would you treat? What if they now had secondary syphilis?

Non-preggers: Benzathine Penicillin G 2.4M units IM x 1 OR Doxycycline 100mg po bid x 14d Preggers: Benzathine Penicillin G 2.4M units IM weekly x 1-2 weeks Same treatment in SECONDARY syphilis

What are the expected symptoms in a patient with tertiary syphilis?

``` Neurologic abnormalities Vertigo Dementia Ataxia Aortic aneurysm Aortic root dilatation ```

List the symptoms of latent syphilis

Patients are ASYMPTOMATIC silly!

How would you treat a patent with tertiary syphilis?

- No signs of neurosyphilis - Benzathine Penicillin G 2.4M units IM weekly x 3 weeks - neurosyphilis = Benzathine Penicillin G 3-4M units IV q4h x 10-14d

How would you treat a patient with syphilis but has no symptoms?

Dx: latent syphilis Preggers: Benzathine Penicillin G 2.4M units IM weekly x 3 weeks øPreggers: Early latent (1yr from infection) = same Tx as Preggers

Describe the classic dermatological sign of a herpes simplex virus infection

Vessicles on an erythematous base leading to ulcerations

What are the common prodromal symptoms of HSV infection?

``` Pruritus Tingling Burning Pain Associated with fevers and myalgias ```

Herpes simplex virus infections are typically a clinical diagnosis, what other investigations could you order to confirm the diagnosis?

``` Serum herpes simplex virus antibody testing Viral swabs for: -culture -antigen testing -PCR ```

This is your patient's first episode of an HSV infection, how would you treat this patient?

Acyclovir 400mg po tid x 5-7d | Valacyclovir 1000mg po bid x 5-7d

This is your patient's 4th oral herpes outbreak this year, how would you treat this patient?

Dx: Acute recurrent herpes simplex virus infection (

Your patient had 7 episodes of herpes this year, how would you treat this patient?

Dx: Chronic suppressive (>6 eps/yr) Tx: Acyclovir 400mg po bid x 3-6 months Valcyclovir 500mg po daily x 3-6months

How would you treat a pregnant woman with vaginal herpes?

1st episode: acyclovir 200mg po FIVE times per day x 5-10d | Prior infection within previous year: Prophylaxis at 36wks with acyclovir 200mg po qid OR valacyclovir 500mg po bid

List the symptoms of primary syphilis

Painless papule/ulcer (chancre) | Lymphadenopathy

List the symptoms of secondary syphilis.

``` Rash Fever Malaise Lymphadenopathy Headache Mucous lesions Uveitis Retinitis ```

Your patient has primary syphilis, how would you treat? What if they now had secondary syphilis?

Non-preggers: Benzathine Penicillin G 2.4M units IM x 1 OR Doxycycline 100mg po bid x 14d Preggers: Benzathine Penicillin G 2.4M units IM weekly x 1-2 weeks Same treatment in SECONDARY syphilis

What are the expected symptoms in a patient with tertiary syphilis?

``` Neurologic abnormalities Vertigo Dementia Ataxia Aortic aneurysm Aortic root dilatation ```

List the symptoms of latent syphilis

Patients are ASYMPTOMATIC silly!

How would you treat a patent with tertiary syphilis?

- No signs of neurosyphilis - Benzathine Penicillin G 2.4M units IM weekly x 3 weeks - neurosyphilis = Benzathine Penicillin G 3-4M units IV q4h x 10-14d

How would you treat a patient with syphilis but has no symptoms?

Dx: latent syphilis Preggers: Benzathine Penicillin G 2.4M units IM weekly x 3 weeks øPreggers: Early latent (1yr from infection) = same Tx as Preggers

Name the organism that causes syphilis

Treponema pallidum

List TWO risk factors for syphilis

Men who have sex with men Sex workers Clients of sex workers

How is syphilis transmitted?

Oral sex Vaginal sex Anal sex

List THREE diagnostic tests for syphilis

Veneral Disease Research Lab Reactive (VDRL reactive) Rapid Plasma Reagin (RPR) T. pallidum Enzyme Immunoassay (TP-EIA) Dark field microscopy of mucosal lesions Direct fluorescent antibody testing of lesions Serum Polymerase Chain Reaction (Serum PCR)