STI's Flashcards
what are some resourced for information/patient education on STI’s?
PHAC STBBI guides
communicable disease control manual
CPS - STI’s
DynaMed
RxFiles - anti-infectives
define an STI
infection passed from one person to another through sexual activity, including vaginal, oral or anal sex as well as genital skin-to-skin contact. Some STI’s are spread through blood
what are the 3 categories of STIs?
viral
bacterial
parasitic/fungal
examples of a viral STI
HPV
HIV
HSV
hep B
examples of bacterial STIs
chlamydia
gonorrhea
syphilis
example of parasitic/fungal STI
trichomoniasis
which STI can be spread through the blood?
syphilis
what does STBBI stand for?
sexually transmitted and blood-borne infection
what are the risk factors for STI’s?
multiple partners
anon or casual sex partners
unprotected sex
previous sti
substance use
use of meds for ED
social environments
which populations are effected more by STIs?
indigenous people
gay, bisexual people
transgender
youth and young adults
people who use drugs
prostitutes
how can we help prevent STIs?
assessing and discussing risk
educating about signs and symptoms
help ppl recognize and minimize risk
offering vaccination when indicated
providing treatment, follow up and counseling
where can someone be tested for STIs?
primary care provider
public health
hospital
what are the barriers to seeking testing?
underestimate personal risk
perception that STIs are not serious
fearful of procedures
self-conscious about genital exam
stigma
how can notify a partner about an STI?
the individual
health care provider
MHO (medical health officer)
which STIs can be prevented by barrier protection?
HIV
HBV
chlamydia
gonorrhea
what is barrier protection?
external condoms
internal condoms
dental dams
which STIs do condoms NOT provide complete protection?
syphilis
HPV
HSV
what are the goals of therapy?
treat the infection
abolish symptoms
decrease spread to sexual partners
decrease vertical transmission to newborns
reduce transmission of HIV
decrease probability of complications
what are the potential complications of STIs?
infertility
chronic pain
sepsis
which medications are free of charge in SK for STIs?
amoxicillin
azithromycin
cefixime
doxycycline
how are STIs spread?
contact with semen, vaginal fluid or other body fluids during vaginal, anal or oral sex without a condom
skin-to-skin contact during sexual activity
sharing toys
which STI can be transmitted through breastfeeding?
HIV
pregnancy complications with chlamydia
preterm birth
conjuntivitis and pneumonia in newborn
pregnancy complications with gonorrhea
endometritis and pelvic sepsis
ophthalmia neonatorum and systemic infection in newborn
pregnancy complications with syphilis
systemic symptoms
fetal loss
when should pregnant ppl be tested for STIs?
early in pregnancy
again in the third trimester if ongoing risk
syndromes of STIs
cervicitis
epididymitis
pelvic inflammatory disease
proctitis
urethritis
vaginitis
anogenital ulcers
cause of trichomoniasis
thrichomonas vaginalis
symptoms of trichomoniasis
pruritis
odor
off-white or yellow, frothy discharge
treatment for trichomoniasis
metronidazole 2g PO single dose OR
500mg PO BID for 7 days
*need to treat sexual partners
what is the bacteria that causes chlamydia?
chlamydia trachomatis (gram negative)
why might chlamydia be under-treated?
because the majority of people with infection are asymptomatic
symptoms of chlamydia
most are asymptomatic
dysuria - painful to pee
urethritis -> dyspareunia(painful sex)
cervicitis - abnormal bleeding/discharge, dyspareunia
proctitis - pain, diarrhea, bleeding, discharge
conjunctivitis
female complications with chlamydia
pelvic inflammatory disease
ectopic pregnancy
infertility
chronic pelvic pain
reiter syndrome
male complications with chlamydia
epididymo-orchitis
reiter syndrome
what is the preferred treatment for chlamydia?
doxycycline 100mg BID x 7 days
OR
azithromycin 1g in a single dose
what is the alternative treatment for chlamydia?
levofloxacin 500mg QD x 7 days
what is the treatment of chlamydia for pregnant and lactating people?
azithromycin(normal)
amoxicillin
erythromycin
counselling points for doxycycline for chlamydia
take with food
taking with iron or calcium may decrease absorption
photosensitivity
counselling points for azithromycin for chlamydia
GI upset - can use prophylactic antiemetics to help with nausea
when would you have to redose azithromycin for chlamydia?
if the person throws up within an hour of taking it
how long should you abstain from sexual activity without barrier protection after treatment?
until treatment of person and partners is complete and symptoms have resolved (7 days after one dose therapy, end of multiple-dose therapy)
when is a test of cure(TOC) recommended?
when symptoms persist
compliance is suboptimal
preferred treatment was not used
prepubertal
pergnancy
when is repeat screening recommended?
3 months post-treatment due to risk of reinfection
what causes lymphogranuloma venereum(LGV)?
chlamydia trachomatis genotypes L1, L2, L3 which are more invasive than non-LGV genotypes
what does LGV affect?
lymph tissue
what are the stages of LGV?
primary
secondary
tertiary
what is the preferred treatment for LGV?
doxycycline 100mg BID x 21 days
what is an alternate treatment for LGV?
azithromycin 1g once weekly x 3 weeks
what causes gonorrhea?
neisseria gonorrhoeae
what can happen when gonorrhea is left untreated?
can become chronic
what are the most common STIs in Canada?
most common: chlamydia
2nd most common: gonorrhea
3rd most common: syphilis
symptoms of gonorrhea in females
*often asymptomatic
vaginal discharge
lower abdominal pain
dysuria
cervical discharge
bartholinitis
dyspareunia
rectal pain and discharge with proctitis
symptoms of gonorrhea in males
urethral discharge
dysuria
urethral itch
testicular pain, epididymitis
rectal pain and discharge with proctitis
female complications with gonorrhea
pelvic inflammatory disease
infertility and risk of ectopic pregnancy
chronic pelvic pain
male complications with gonorrhea
epidiymo-orchitis
general complications of gonorrhea
disseminated gonococcal infection (DGI) = spectrum including arthritis, tenosynovitis, dermatitis, endocarditis, meningitis
reactive arthritis
perihepatitis
what is the preferred treatment for gonorrhea?
ceftriaxone 250mg IM single dose PLUS azithromycin 1g PO single dose
OR (for anogenital)
cefixime 800mg PO single dose PLUS azithromycin 1g PO single dose
what is the alternate treatment for anogenital gonorrhea?
ceftriaxone 250mg IM single dose PLUS doxycycline 100mg BID x 7 days
OR
cefixime 800mg PO single dose PLUS doxycycline 100mg BID x 7 days
what is the alternate treatment for pharyngeal gonorrhea?
cefixime 800mg PO single dose PLUS azithromycin 1g PO single dose
counseling points for gonorrhea
- cross-sensitivity between penicillins and second or third-generation cephalosporins is low
- resistance is a concern - encourage adherence, treating all partners
- azithromycin can be taken with food to minimize nausea or anti-emetics
when are TOC cultures recommended for gonorrhea?
within a week for all positive sites and repeat screening is recommended 6 months post-treatment
what causes syphilis?
treponema pallidum
symptoms of primary syphilis
painless lesion (chancre)
regional lymphadenopathy
3 weeks (3-90 days)
symptoms of secondary syphilis
rash
fever
malaise
lymphadenopathy
mucous lesions
condyloma lata
alopecia
meningitis
headaches
uveitis
retinitis
2-12 weeks (2 weeks to 6 months)
symptoms of early latent syphilis
asymptomatic (positive serology)
< 1 year
symptoms of late latent syphilis
asymptomatic (positive serology)
>/= 1 year
symptoms of cardiovascular syphilis
aortic aneurysm
aortic regurgitation
coronary artery ostial stenosis
10-20 years
symptoms of gumma syphilis
tissue destruction of any organ
1-46 years (most cases 15 years)
symptoms of neurosyphilis, ocular syphilis
can be asymptomatic
headaches
vertigo
personality changes
dementia
ataxia
otic symptoms
ocular symptoms
early: within first year
late: 1-20 years
what are the tertiary stages of syphilis?
cardiovascular syphilis
gumma
neurosyphilis, ocular syphilis
symptoms of early congenital syphilis
2/3 may be asymptomatic
anemia
rhinitis
onset < 2 years
symptoms of late congenital syphilis
anemia
neurosyphilis
bone involvement
hutchinson’s teeth
persistence > 2 years after birth
what is the preferred treatment for primary, secondary and early latent syphilis?
benzathine penicillin G-LA 2.4 million units IM single dose
what is the alternate treatment for primary, secondary and early latent syphilis?
doxycycline 100mg BID x 14 days
what is the preferred treatment for late latent, cardiovascular syphilis, and gumma?
benzathine penicillin G-LA 2.4 million units IM weekly for 3 doses
what is the alternate treatment for late latent, cardiovascular syphilis, and gumma?
doxycycline 100mg BID x 28 days
counseling points for syphilis
- abstain from sexual contact until lesions are completely healed and it has been 7 days since they received their final dose of treatment
- condoms should be advised
- no TOC - treatment response based on symptom resolution
what is a Jarisch-Herxheimer reaction?
- acute febrile reaction accompanied by headache, myalgia, chills and rigors
- occurs within 1st 24 hours of syphilis therapy - reaction to therapy
- manage with NSAID
- may induce early labour or cause fetal distress in pregnancy
what is the most common STI in the world?
HPV
what are the low-risk types of HPV and what can they lead to?
6 and 11
may lead to anogenital warts, cervical lesions, and rare conditions such as recurrent respiratory papillomatosis
what are the high-risk types of HPV and what can they lead to?
16 and 18
may lead to cancer - cervical, oropharyngeal, vulva, vagina, penis, anus
HPV genital wart symptoms
asymptomatic
itchiness
discomfort during intercourse
bleeding with intercourse or shaving
warts on genitals
HPV cancer symptoms
cervical cancer - little to no discomfort, hence regular screening
lesions can bleed, itch, cause pain
what is the treatment for anogenital warts?
Topical and ablative
imiquimod cream (immune modulator)
- 3.75% cream daily and wash off after 8 hours OR
- 5% cream 3x/week apply and wash off after 6-10 hours
sinecatechins 10% ointment (extract of dried green tea leaves)
- apply 0.5cm strand TID, washing off not needed
counselling for HPV treatment
avoid contact with healthy skin
refrain from sexual activity while undergoing treatment
side effects of HPV treatments
skin reactions: itching, tenderness, erythema, ulceration
what vaccines are available for HPV?
gardasil 9
cervarix - type 16 and 18
what cause HSV?
herpes simplex virus type 1 and 2
what is HSV-1 primarily associated with?
oral infection but may cause genital herpes
what is HSV-2 primarily associated with?
genital infection but may also present orally as a result of oro-genital transmission (rare)
how is HSV transmitted?
unprotected sex and via delivery of baby
what does genital herpes increase risk of?
acquisition of HIV by two-fold
where does HSV reside?
intracellularly within hots cell ganglia for life
symptoms of primary infection of HSV
extensive, painful, bilateral vesiculo-ulcerative genital or anal lesions
fever, malaise, myalgia, headache (76%)
tender inguinal lymphadenopathy (80%)
what is the duration of a primary infection of HSV?
17-20 days
symptoms of recurrences after primary infection of HSV
prodromal symptoms for 1-2 days
unilateral localized small patch painful genital vesicles and ulcers
systemic symptoms - 5-12%
what is the duration for a recurrence of HSV?
9-11 days
symptoms of non-primary infection of HSV
dont last as long
less severe
less extensive
what are the complications of non-primary infections of HSV?
meningitis
extragenital lesions
what is the duration of a non-primary infection of HSV?
16 days
what is the primary treatment for genital herpes?
acyclovir 200mg 5x/day x 5-10 days OR
famciclovir 250mg TID x 5 days OR
valacyclovir 1000mg BID x 10 days
*topicals not effective
what is the primary treatment in pregnancy for genital herpes?
acyclovir 200mg QID x 5-10 days
what is the primary treatment for severe genital herpes?
IV acyclovir 5mg/kg infused over 60 minutes q8h, convert to oral therapy once significantly improved
what is the treatment for recurrent genital herpes?
valacyclovir 500mg BID or 1g daily x 3 days OR
famciclovir 125mg BID x 5 days OR
acyclovir 200mg 5x/day x 5 days
what is the suppressive therapy for genital herpes?
acyclovir 200mg 3-5x/day or 400mg BID OR
famciclovir 250mg BID OR
valacyclovir 500mg daily(<9/yr) or 1000mg daily(>9/year)
what is the suppressive treatment of genital herpes in pregnancy?
acyclovir 200mg QID OR
acyclovir 400mg TID OR
valacyclovir 500mg BID
what is neonatal herpes?
occurs when baby is delivered through an infected vagina
initial symptoms ~4 weeks of age
results in genreralized systemic infection involving liver, other organs, CNS and skin
what is the treatment for neonatal herpes?
acyclovir 45-60mg/kg/day IV in three equal 8-hourly infusions, each over 60 minutes for 14-21 days
counseling for HSV
antivirals decrease severity/duration but don’t prevent recurrences
use as early as possible
abstain from sexual contact during symptomatic episodes
always use a condom as asymptomatic viral shedding can occur
what causes monkeypox?
orthopoxvirus
what are the symptoms of mpox?
rash
lymphadenopathy
systemic symptoms
self-resolving within 2-4 weeks
