STI Flashcards
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
Treatment of another STI should be given at the same time as gonorrhea. Name this STI
Chlamydia trachomatis infection
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
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
Name the most common sexually transmitted infection in Canada
Chlamydia trachomatis
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
A male presents with with symptoms suggestive of chlamydia trachomatis infection. List FOUR
Urethral itch
Urethritis
Urethral discharge
Testicular pain
List FIVE symptoms of chlamydial infection in females
80% asymptomatic Cervicitis Dyspareunia Post-coital bleeding Vaginal discharge Vaginal bleeding Urethral dischage
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
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)
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
What are the criteria for Reiters syndrome?
Reactive arthritis
Conjunctivitis
Cervicitis (females)
Urethritis (males)
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
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)
What is the second most common STI in Canada?
Neisseria gonorrhea infection
List FOUR symptoms of gonorrhea in men
Epididymitis Urethral discharge/itch Testicular pain Testicular swelling Rectal pain/discharge
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%
What are some general symptoms of gonorrhea?
- Pharyngeal infection
- Conjunctivitis
- UTI Sx
- Proctitis
- Arthritis
- Dermatitis
What are some disseminated complications of gonorrhea?
Disseminated arthritis, dermatitis, endocarditis, meningitis (ADEM)
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
What investigations would you order to confirm your diagnosis of gonorrhea?
Nucleic acid amplification test (NAAT) of urethral or urine sample
You have a homo patient with gonorrhea, what is the first line treatment?
Ceftriaxone 250mg IM x 1
You have a female patient with a pharyngeal confirmed infection of gonorrhea, what is your first line treatment?
Ceftriaxone 250mg IM x 1
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
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)
