STI's (Final Exam) Flashcards
this STI is the most commonly diagnosed and reported bacterial STI in canada; it is more common in females than males and is more common in younger adults
weakly gram-negative, intracellular bacteria
chlamydia
this is the second most common diagnosed and reported STI in Canada; it is more common in females than males and is more common in younger adults
gram-negative intracellular diplococcus bacteria
gonorrhoea
this STI was previously rare in Canada but is becoming more prevalent. is it more common in males than females and is more common in older adults
higher # of outbreaks in MSM, sex workers
syphilis
this STI is very common as ~70% of the adult population will have at least one genital ___ infection over their lifetime. mostly affects adolescent and young men and women but can affect all ages
HPV - human papilloma virus
this STI is common and is very common in young men and women; females are more affected than males
genital herpes (HSV-1 and 2)
what are some risk factors for STI’s
- sexual contact with someone that has an STI
- sexual active < 25 y/o
- new sexual partner or > 2 parters in one year
- no barrier contraception
- sex with blood, sharing toys
- injection drug use
- substance use
- survival sex/sex workers and their clients/homelessness
- anonymous sexual patterns
- victims of sexual abuse
- previous STI
which STI’s are reportable to provincial public heath
- chlamydia
- gonorrhoea
- syphilis (Primary, secondary and latent)
- chancroid
- viral hepatitis
- HIV
when is STI screening offered?
- based on symptom presentation
- through routine health screening
routine STI testing should normally include tests for which STIs? is there anything different that needed to be tested in women vs men?
- chlamydia
- gonorrhoea
- syphillis
- HIV
- Viral hepatitis (HAV, HBV, HCV)
** trichomonas should be added on for women **
true or false: infection with STI increases the risk of HIV transmission
true
HIV is more commonly transmitted through the blood. With STI’s, inflammation can cause micro fissures and lesions which can lead to easier HIV transmission
what two types of screening are used for Chlamydia trachomatis and Neisseria gonorrhoea
urine and swabs
what type of sample is taken to screen for syphilis
blood
this is highly sensitive and is the test of choice when screening asymptomatic individuals for Clamydia and gonorrhoea; preferred specimens are first void urine or self-collected vaginal swab
NAAT
what are some counselling points for preventing STI’s
- condom use for all sexual activity (avoid condoms with nontoxynol-9 spermicide can cause lesions in genital area
- STI modes of transmission
what is the incubation period for chlamydia
2-6 weeks
symptoms usually appear within 3 weeks - however 50% of cases are asymptomatic
what is the incubation period for gonorrhoea
2-7 days
symptoms usually occur within a week of exposure, however may be asymptomatic
true or false: rectal and pharyngeal infections of gonorrhoea are more likely to be asymptomatic
true
what are the genital symptoms that present in chlamydia and gonorrhoea
- urethritis (dysuria, urethral discharge & pruritus) in pts with penis
- unilateral, posterior testicular pain and sweilling
- cervicitis (discharge, intermenstrual bleeding)\
- if untreated, could cause pelvic inflammatory disease (PID)
what are the extra-genital symptoms of chlamydia and gonorrhoea
- proctitis and tenesmus (feeling like need to go to bathroom but cannot do anything - bladder and bowel)
- oropharyngeal infections with gonorrhoea (sore throat, etc.)
when should treatment of chlaymdia be considered?
- +ve chlamydia test
treat empirically if: - diagnosis of syndrome compatible with chlamydia infection
- diagnosis of chlamydia infection in a sexual partner
- as co-treatment with diagnoses of gonorrhoea
what are the tx options for chlamydia
doxycycline 100mg po BID x7/7 OR azithromycin 1g as a single dose if poor compliance is expected
what is the treatment for LGV
doxycycline 100mg po BID x21/7
if vomiting occurs more than 1 hours post-single dose therapy for chlamydia is there a need to repeat the dose?
no
what is the first line therapy for gonorrhoea?
cephalosporins
e.g. Ceftriaxone 250mg IM in a single dose + azithromycin 1g po as a single dose
e.g. Cefixime 800mg po as a single dose + azithromycin 1g po as a single dose
if there is an allergy to cephalosporins, what would be the next best option for treatment of gonorrhoea
high dose azithromycin mono therapy
what is the first line treatment for gonorrhoea in MSM
ceftriaxone ** know this ** 250mg IM as a single dose + azithromycin 1g po as a single dos
for chlamydia and gonorrhoea, all sexual partner within the past __ days should be tested and empirically treated
60
when being treated for chlamydia or gonorrhoea, how long should the patient abstain from unprotected sexual contact?
until full course of treatment is complete for all partners or for 7 days after single dose treatment
when should test of cure be completed for chlamydia to see if the infection is still present?
4 weeks after therapy is completed with a urine sample
when should test of cure be completed for gonorrhoea to see if the infection is still present?
3-7 days after completion of therapy (swab based)
4 weeks after therapy is completed with a urine sample
when should testing be repeated for chlamydia and gonorrhoea
repeat testing is recommended at 3-6 months due to high reinfection risk
this is an infection of the female upper genital tract involving endometrium, fallopian times, pelvic peritoneum. most common infectious cause of lower abdominal pain in women.
other sx’s may include: fever, foul smelling discharge, dysuria, irregular menstrual periods.
if long term can lead to:
- tubal factor infertility
- ectopic pregnancy
- chronic pelvic pain
pelvic inflammatory disease (PID)
is PID a mnomicrobial or polymicrobial infection
polymicrobial
what is the usual duration of abx treatment for PID
14 days
what organisms should broad spectrum abx cover for PID
- N. gonorrhoea
-C. trachomatis - gram negative facultative bacteria
- streptococci
which type of bacteria cause the smelly vaginal discharge in PID
anaerobic bacteria (e.g. bactericides, peptostreptococcus, etc.)
what are the treatment options for PID for those who are hospitalized
cefoxitin 2g IV q6h + Doxycycline 100mg (IV or PO) BID - stop IV therapy 24 hours after clinical improvement - continue PO doxy for 14 days
Clindamycin 900mg IV q8h + Gentamicin IV or IM OD
stop IV therapy after 24 hrs of clinical improvement - continue PO doxy or clindamycin for 14 days
what are the treatment options for outpatients with PID
ceftriaxone 250mg IM as a single dose + doxycycline 100mg po BID x 14/7
cefoxitin 2g IM + probenecid 1g po as a single dose with doxycycline 100mg po BID x 14/7
other parenteral 3rd gen cephalosporin + doxy x 14/7
*MAY ADD METRONIDAZOLE 500MG PO BID X 14 DAYS for anaerobic coverage -> avoid alcohol during and 24 hr after treatment completion
this stage of syphilis occurs 3 to 90 days after contact. a chancre/esion may be present on genitals, anus, or in the mouth.
primary syphilis
this stage of syphilis occurs 2 weeks to 6 months after contact. rash is present (often on palms, soles of feet, trunk/back area) + fever, malaise, mucosal lesions, headaches, etc.
secondary syphilis
this is known as asymptomatic syphilis. if < 1 year duration can still transmit the disease, if > 1 yr duration, non- infectious
latent syphilis
this is known as late syphilis
- cardiovascular syphilis
- gumman (destruction of any organ)
- neurosyphilis <- may be asymptomatic or symptomatic (h/a, vertigo, loss of hearing, personality changes, dementia, ataxia)
tertiary syphilis
this type of serologic testing for syphilis measures antibody vs T. palladium antigens. usually reactive for life. includes TP (T. palladium) and TP-PA (T. palladium particle agglutination)
Treponemal tests
this type of serologic testing for syphilis is non-specific for T. palladium. measures antibody directed at cardiolipid-lechithin cholesterol antigen. titres correlates with disease activity
non-treponemal tests
serology for syphilis can yield false negative results in primary syphilis - when should retesting be done?
negative result should be repeated in 2-4 weeks in suspicious cases or known contacts of positive syphilis cases
what is the drug of choice for syphilis?
Long-acting benzathine penicillin G (Bicillin-LA)
** know this **
if patient has a true allergy to penicillin and Bicillin-LA cannot be used to treat syphilis, what is the alternative agent that can be used
doxycycline
this is an reaction associated with antibiotic treatment for syphilis (and other spirochetes). it is believed to be mediated by release of pro-inflammatory cytokine.
* occurs within 24 hours of treatment, usually follows treatment of early syphilis
- characterized by fever, rigours, rash, headache and myalgias
it is a self limited reaction which resolves within 24 hours -> it is not an allergic reactions and can be managed with antipyretics
Jarisch-Herxheimer reaction
what is the preferred treatment for primary, secondary and early latent syphilis
Benzathine Penicillin G 2.4 million units IM as a single dose
what is the preferred treatment for late latent, latent syphilis of unknown duration, cardiovascular and other tertiary syphilis NOT involving CNS
Benthathine Penicillin G 2.4 million units IM weekly x 3 doses
what is the preferred treatment for neurosyphilis
Penicillin G 3-4 million units IV q4h (16-24 million units/day) for 10-14 days
**IV thus these pts are usually admitted to hospital
what should be counselling points regarding post syphilis treatment
- abstain from unprotected intercourse until treatment of both partners is complete and adequate serologic response is obtained
- serology should be repeated as follows:
primary or secondary syphilis: 1, 3 ,6 and 12 months post treatment
late latent and tertiary syphilis: 12 and 24 months post-treatment
HPV is classified into high and low risk groups based on the likelihood to cause cancer. high risk groups includes HPV type __ and __ that cause cervical, anogenital and some head and neck cancers
16 and 18
HPV is classified into high and low risk groups based on the likelihood to cause cancer. low risk groups includes HPV types that cause warts, most are HPV types __ and __
6 and 11
how is HPV transmitted
Transmitted through penetrative vaginal. anal and oral sex, as well as digital-vaginal sex and skin-to-skin contact.
vertical transmission may occur as well (giving birth)
how can HPV be prevented
- condom use
- cancer screening (e.g. Pap smear - cervical and anal)
- HPV vaccination (Cervarix - protects against HPV 16 and 18 which are the high risk groups for cancer) + (Gardasil 9 - protects against HPV 6, 11 , 16. 18 and more)
HPV can cause these types of warts. they can be internal or external. usually asymptomatic, flat, cauliflower in appearance. could cause pruritus, local discharge or bleeding. NO IMPACT ON FERTILITY!! recurrence is common
anogenital warts
what is the incubation period of anogenital warts
3 weeks to 8 months
true or false: watchful waiting to see if spontaneous clearance will occur is appropriate for anogenital warts
true
when may patients self treat for anogenital warts
if able to identify and reach all lesions
when should patients be clinician-treated for anogenital warts
- pregnancy
- internal warts
what are some external self-treatments for anogenital warts
Imquimod 3.75% or 5% cream
5% - apply qhs 3x/week
3.75% - apply qhs daily
wash area with mild soap and water 8h after application
podophyllotoxin 0.5% - apply to visible wart BID with cotton swab x 3 days then take 4 days off and repeat
sinecatechins 10% topical ointment - apply 0.5 cm ointment strand to lesions TID
these two do not need to be washed off
true or false: genital herpes is usually caused by HSV-1
false - usually caused by HSV-2 but may be caused by oral-genital contact with HSV-1
what is the incubation period of genital herpes
6 days
true or false: lesions need to present in order to get genital herpes
false - transmission occurs through contact with lesions, mucosa, genital secretions and oral secretions where HSV is present
true or false: condoms reduce genital herpes transmission
true - by 50%
this clinically presents as a diagnostic lesion of a cluster of vesicles on an erythematous background. could involve triggers such as stress,, illness, sexual intercourse, menstrual cycle, etc.
genital herpes
what is the difference in the clinical presentation of an initial symptomatic episode of primary vs non-primary genital herpes
primary:
- extensive, painful lesions
- fever, myalgia
- tender lymph nodes
- more at risk for complications
- may take 2-3 weeks to resolve
non-primary
- less extensive genital lesions
- less likely to have systemic symptoms or complications
- duration less prolonged
this classification of genital herpes is usually due to reactivation of latent sacral sensory ganglion infection. typically localized small painful genital lesions. chance of systemic symptoms. prodromal symptoms such as burning, tingling and itching may occur. flare may only last ~ 1 week
recurrent episode of genital herpes
what is some non-pharmacological suggestions for a pt with genital herpes
- keep lesions clean with gentle washing (mild soap and water)
- saline baths, antipyuretics, analgesics
what are the treatment options for someone having their first episode of genital herpes
acyclovir 200mg po fives times a day x 5-10 days
famciclovir 250mg po TID x 5/7
valacyclovir 1000 mg po BID x 10/7
what are the treatment options for someone having a recurrent episode of genital herpes
valacyclovir 500mg po BID or 1g po daily x 3 days
famciclovir 125 mg po BID x 5 days
acyclovir 200 mg po five times a day x 5 days
what are the suppressive therapy options for genital herpes
acyclovir 200mg po tid to five times a day or 400mg BID
famciclovir 250mg BID
valacyclovir 500 mg po daily
true or false: acyclovir, famciclovir and valacyclovir can be used in pregnancy
true - may reduce the need for C-section to prevent neonatal herpes
how should STI testing occur for someone who is pregnant
all pregnant women should undergo testing for HIV, HBV, chlamydia, gonorrhoea and syphilis at their first prenatal visit
screening should be repeated at each trimester
*important b/c STI’s at delivery poses risk to newborn
