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PHAR 253 > STI's > Flashcards

STI's Flashcards

1
Q

what are some resourced for information/patient education on STI’s?

A

PHAC STBBI guides
communicable disease control manual
CPS - STI’s
DynaMed
RxFiles - anti-infectives

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2
Q

define an STI

A

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

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3
Q

what are the 3 categories of STIs?

A

viral
bacterial
parasitic/fungal

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4
Q

examples of a viral STI

A

HPV
HIV
HSV
hep B

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5
Q

examples of bacterial STIs

A

chlamydia
gonorrhea
syphilis

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6
Q

example of parasitic/fungal STI

A

trichomoniasis

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7
Q

which STI can be spread through the blood?

A

syphilis

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8
Q

what does STBBI stand for?

A

sexually transmitted and blood-borne infection

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9
Q

what are the risk factors for STI’s?

A

multiple partners
anon or casual sex partners
unprotected sex
previous sti
substance use
use of meds for ED
social environments

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10
Q

which populations are effected more by STIs?

A

indigenous people
gay, bisexual people
transgender
youth and young adults
people who use drugs
prostitutes

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11
Q

how can we help prevent STIs?

A

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

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12
Q

where can someone be tested for STIs?

A

primary care provider
public health
hospital

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13
Q

what are the barriers to seeking testing?

A

underestimate personal risk
perception that STIs are not serious
fearful of procedures
self-conscious about genital exam
stigma

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14
Q

how can notify a partner about an STI?

A

the individual
health care provider
MHO (medical health officer)

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15
Q

which STIs can be prevented by barrier protection?

A

HIV
HBV
chlamydia
gonorrhea

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16
Q

what is barrier protection?

A

external condoms
internal condoms
dental dams

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17
Q

which STIs do condoms NOT provide complete protection?

A

syphilis
HPV
HSV

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18
Q

what are the goals of therapy?

A

treat the infection
abolish symptoms
decrease spread to sexual partners
decrease vertical transmission to newborns
reduce transmission of HIV
decrease probability of complications

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19
Q

what are the potential complications of STIs?

A

infertility
chronic pain
sepsis

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20
Q

which medications are free of charge in SK for STIs?

A

amoxicillin
azithromycin
cefixime
doxycycline

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21
Q

how are STIs spread?

A

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

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22
Q

which STI can be transmitted through breastfeeding?

A

HIV

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23
Q

pregnancy complications with chlamydia

A

preterm birth
conjuntivitis and pneumonia in newborn

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24
Q

pregnancy complications with gonorrhea

A

endometritis and pelvic sepsis
ophthalmia neonatorum and systemic infection in newborn

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25
Q

pregnancy complications with syphilis

A

systemic symptoms
fetal loss

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26
Q

when should pregnant ppl be tested for STIs?

A

early in pregnancy
again in the third trimester if ongoing risk

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27
Q

syndromes of STIs

A

cervicitis
epididymitis
pelvic inflammatory disease
proctitis
urethritis
vaginitis
anogenital ulcers

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28
Q

cause of trichomoniasis

A

thrichomonas vaginalis

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29
Q

symptoms of trichomoniasis

A

pruritis
odor
off-white or yellow, frothy discharge

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30
Q

treatment for trichomoniasis

A

metronidazole 2g PO single dose OR
500mg PO BID for 7 days
*need to treat sexual partners

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31
Q

what is the bacteria that causes chlamydia?

A

chlamydia trachomatis (gram negative)

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32
Q

why might chlamydia be under-treated?

A

because the majority of people with infection are asymptomatic

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33
Q

symptoms of chlamydia

A

most are asymptomatic
dysuria - painful to pee
urethritis -> dyspareunia(painful sex)
cervicitis - abnormal bleeding/discharge, dyspareunia
proctitis - pain, diarrhea, bleeding, discharge
conjunctivitis

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34
Q

female complications with chlamydia

A

pelvic inflammatory disease
ectopic pregnancy
infertility
chronic pelvic pain
reiter syndrome

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35
Q

male complications with chlamydia

A

epididymo-orchitis
reiter syndrome

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36
Q

what is the preferred treatment for chlamydia?

A

doxycycline 100mg BID x 7 days
OR
azithromycin 1g in a single dose

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37
Q

what is the alternative treatment for chlamydia?

A

levofloxacin 500mg QD x 7 days

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38
Q

what is the treatment of chlamydia for pregnant and lactating people?

A

azithromycin(normal)
amoxicillin
erythromycin

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39
Q

counselling points for doxycycline for chlamydia

A

take with food
taking with iron or calcium may decrease absorption
photosensitivity

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40
Q

counselling points for azithromycin for chlamydia

A

GI upset - can use prophylactic antiemetics to help with nausea

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41
Q

when would you have to redose azithromycin for chlamydia?

A

if the person throws up within an hour of taking it

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42
Q

how long should you abstain from sexual activity without barrier protection after treatment?

A

until treatment of person and partners is complete and symptoms have resolved (7 days after one dose therapy, end of multiple-dose therapy)

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43
Q

when is a test of cure(TOC) recommended?

A

when symptoms persist
compliance is suboptimal
preferred treatment was not used
prepubertal
pergnancy

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44
Q

when is repeat screening recommended?

A

3 months post-treatment due to risk of reinfection

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45
Q

what causes lymphogranuloma venereum(LGV)?

A

chlamydia trachomatis genotypes L1, L2, L3 which are more invasive than non-LGV genotypes

46
Q

what does LGV affect?

A

lymph tissue

47
Q

what are the stages of LGV?

A

primary
secondary
tertiary

48
Q

what is the preferred treatment for LGV?

A

doxycycline 100mg BID x 21 days

49
Q

what is an alternate treatment for LGV?

A

azithromycin 1g once weekly x 3 weeks

50
Q

what causes gonorrhea?

A

neisseria gonorrhoeae

51
Q

what can happen when gonorrhea is left untreated?

A

can become chronic

52
Q

what are the most common STIs in Canada?

A

most common: chlamydia
2nd most common: gonorrhea
3rd most common: syphilis

53
Q

symptoms of gonorrhea in females

A

*often asymptomatic
vaginal discharge
lower abdominal pain
dysuria
cervical discharge
bartholinitis
dyspareunia
rectal pain and discharge with proctitis

54
Q

symptoms of gonorrhea in males

A

urethral discharge
dysuria
urethral itch
testicular pain, epididymitis
rectal pain and discharge with proctitis

55
Q

female complications with gonorrhea

A

pelvic inflammatory disease
infertility and risk of ectopic pregnancy
chronic pelvic pain

56
Q

male complications with gonorrhea

A

epidiymo-orchitis

57
Q

general complications of gonorrhea

A

disseminated gonococcal infection (DGI) = spectrum including arthritis, tenosynovitis, dermatitis, endocarditis, meningitis
reactive arthritis
perihepatitis

58
Q

what is the preferred treatment for gonorrhea?

A

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

59
Q

what is the alternate treatment for anogenital gonorrhea?

A

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

60
Q

what is the alternate treatment for pharyngeal gonorrhea?

A

cefixime 800mg PO single dose PLUS azithromycin 1g PO single dose

61
Q

counseling points for gonorrhea

A
  • 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
62
Q

when are TOC cultures recommended for gonorrhea?

A

within a week for all positive sites and repeat screening is recommended 6 months post-treatment

63
Q

what causes syphilis?

A

treponema pallidum

64
Q

symptoms of primary syphilis

A

painless lesion (chancre)
regional lymphadenopathy
3 weeks (3-90 days)

65
Q

symptoms of secondary syphilis

A

rash
fever
malaise
lymphadenopathy
mucous lesions
condyloma lata
alopecia
meningitis
headaches
uveitis
retinitis
2-12 weeks (2 weeks to 6 months)

66
Q

symptoms of early latent syphilis

A

asymptomatic (positive serology)
< 1 year

67
Q

symptoms of late latent syphilis

A

asymptomatic (positive serology)
>/= 1 year

68
Q

symptoms of cardiovascular syphilis

A

aortic aneurysm
aortic regurgitation
coronary artery ostial stenosis
10-20 years

69
Q

symptoms of gumma syphilis

A

tissue destruction of any organ
1-46 years (most cases 15 years)

70
Q

symptoms of neurosyphilis, ocular syphilis

A

can be asymptomatic
headaches
vertigo
personality changes
dementia
ataxia
otic symptoms
ocular symptoms
early: within first year
late: 1-20 years

71
Q

what are the tertiary stages of syphilis?

A

cardiovascular syphilis
gumma
neurosyphilis, ocular syphilis

72
Q

symptoms of early congenital syphilis

A

2/3 may be asymptomatic
anemia
rhinitis
onset < 2 years

73
Q

symptoms of late congenital syphilis

A

anemia
neurosyphilis
bone involvement
hutchinson’s teeth
persistence > 2 years after birth

74
Q

what is the preferred treatment for primary, secondary and early latent syphilis?

A

benzathine penicillin G-LA 2.4 million units IM single dose

75
Q

what is the alternate treatment for primary, secondary and early latent syphilis?

A

doxycycline 100mg BID x 14 days

76
Q

what is the preferred treatment for late latent, cardiovascular syphilis, and gumma?

A

benzathine penicillin G-LA 2.4 million units IM weekly for 3 doses

77
Q

what is the alternate treatment for late latent, cardiovascular syphilis, and gumma?

A

doxycycline 100mg BID x 28 days

78
Q

counseling points for syphilis

A
  • 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
79
Q

what is a Jarisch-Herxheimer reaction?

A
  • 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
80
Q

what is the most common STI in the world?

A

HPV

81
Q

what are the low-risk types of HPV and what can they lead to?

A

6 and 11
may lead to anogenital warts, cervical lesions, and rare conditions such as recurrent respiratory papillomatosis

82
Q

what are the high-risk types of HPV and what can they lead to?

A

16 and 18
may lead to cancer - cervical, oropharyngeal, vulva, vagina, penis, anus

83
Q

HPV genital wart symptoms

A

asymptomatic
itchiness
discomfort during intercourse
bleeding with intercourse or shaving
warts on genitals

84
Q

HPV cancer symptoms

A

cervical cancer - little to no discomfort, hence regular screening
lesions can bleed, itch, cause pain

85
Q

what is the treatment for anogenital warts?

A

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

86
Q

counselling for HPV treatment

A

avoid contact with healthy skin
refrain from sexual activity while undergoing treatment

87
Q

side effects of HPV treatments

A

skin reactions: itching, tenderness, erythema, ulceration

88
Q

what vaccines are available for HPV?

A

gardasil 9
cervarix - type 16 and 18

89
Q

what cause HSV?

A

herpes simplex virus type 1 and 2

90
Q

what is HSV-1 primarily associated with?

A

oral infection but may cause genital herpes

91
Q

what is HSV-2 primarily associated with?

A

genital infection but may also present orally as a result of oro-genital transmission (rare)

92
Q

how is HSV transmitted?

A

unprotected sex and via delivery of baby

93
Q

what does genital herpes increase risk of?

A

acquisition of HIV by two-fold

94
Q

where does HSV reside?

A

intracellularly within hots cell ganglia for life

95
Q

symptoms of primary infection of HSV

A

extensive, painful, bilateral vesiculo-ulcerative genital or anal lesions
fever, malaise, myalgia, headache (76%)
tender inguinal lymphadenopathy (80%)

96
Q

what is the duration of a primary infection of HSV?

A

17-20 days

97
Q

symptoms of recurrences after primary infection of HSV

A

prodromal symptoms for 1-2 days
unilateral localized small patch painful genital vesicles and ulcers
systemic symptoms - 5-12%

98
Q

what is the duration for a recurrence of HSV?

A

9-11 days

99
Q

symptoms of non-primary infection of HSV

A

dont last as long
less severe
less extensive

100
Q

what are the complications of non-primary infections of HSV?

A

meningitis
extragenital lesions

101
Q

what is the duration of a non-primary infection of HSV?

A

16 days

102
Q

what is the primary treatment for genital herpes?

A

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

103
Q

what is the primary treatment in pregnancy for genital herpes?

A

acyclovir 200mg QID x 5-10 days

104
Q

what is the primary treatment for severe genital herpes?

A

IV acyclovir 5mg/kg infused over 60 minutes q8h, convert to oral therapy once significantly improved

105
Q

what is the treatment for recurrent genital herpes?

A

valacyclovir 500mg BID or 1g daily x 3 days OR
famciclovir 125mg BID x 5 days OR
acyclovir 200mg 5x/day x 5 days

106
Q

what is the suppressive therapy for genital herpes?

A

acyclovir 200mg 3-5x/day or 400mg BID OR
famciclovir 250mg BID OR
valacyclovir 500mg daily(<9/yr) or 1000mg daily(>9/year)

107
Q

what is the suppressive treatment of genital herpes in pregnancy?

A

acyclovir 200mg QID OR
acyclovir 400mg TID OR
valacyclovir 500mg BID

108
Q

what is neonatal herpes?

A

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

109
Q

what is the treatment for neonatal herpes?

A

acyclovir 45-60mg/kg/day IV in three equal 8-hourly infusions, each over 60 minutes for 14-21 days

110
Q

counseling for HSV

A

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

111
Q

what causes monkeypox?

A

orthopoxvirus

112
Q

what are the symptoms of mpox?

A

rash
lymphadenopathy
systemic symptoms
self-resolving within 2-4 weeks

PHAR 253 (8 decks)

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