STIs Flashcards
What conditions screening test is ELISA
HIV
What STI produces a malordorous vaginal discharge
BV
DNA probe is used for screening (2 STI)
Chlamydia and Gonorrhea
FTA-ABS, MHA-TP are diagnostic tests for this STI
Syphillis or Trepideum pallidum
What is treatment for syphillis (early disease)
2.4million units of penicillin IM
What is the treatment for late disease syphillis
Treated with 3 doses of benzathine penicillin spaced at weekly intervals
Associated with a positive whiff test
BV
Confirmatory test is the western blot
HIV
Treated with Flagyl 500mg BID x 7 days
BV
The etiologic agent is a virus (3 STIs)
- HPV
- HIV
- Herpes
Clue cells are present on the saline wet mount
BV
Absent or decreased lactobacilli
BV
Wet prep is used for diagnosis of:
BV and trich
Treatment is acyclovir, valacyclovir and famciclovir
herpes
What STI can produce a rash on hands and feet
Syphillis
What STI produces a painless chancre
Syphillis
What STI is associated with a positive chandelier test
Pelvic inflammatory disease
What are the screening tests for HIV
EIA or ELISA
What are considerations when caring for a patient with HIV and Immunizations
- Need pneumococcoal
- tetanus
- Hep A/B and influenza
- Never administer a live vaccine
Lab testing for HIV
- CD4 count- baseline and repeat at 3-4 months
- Viral load: Baseline and q3-4 months
- Screen hepatitis
- STI screening
What is the goal of ART
Undetectable load within 16-24 weeks
What is the CD4 count when you consider prophylaxis for pneumocystis carinii
CD4 <200
What is the prophylactic treatment for pneumocystis carinii
TMP-SMX daily
What is the presentation of initial HIV infection?
- fever
- pharyngitis
- non-pruritic macular skin rash
- malaise
- headache
- lymphadenopathy
- diarrhea
- weight loss
How long does it take to develop symptoms after HIV infection?
2-4 weeks
AIDS is defined as
an absolute CD4 cell count <200 cells/mm along with certain opportunistic infections and malignancies
What are some signs and symptoms suggestive of AIDS
Opportunistic infections such as: Oral candidiasis, TB, Pneumocystis jirovecii pneumonia (most lethal), CNS toxoplasmosis, histoplasmosis, cryptosporidiosis, Kaposi’s sarcoma
What are complications of untreated STIs?
- infertility
- ectopic pregnancy
- congenital infections
- cervical cancer
- chronic pelvic pain
- chronic hepatitis
- chronic syphillis
- HIV/AIDS
Routine annual screening for chlamydia and gonorrhea includes:
- females 25 years and younger who are sexually active annually
- older females at increased risk for infection (new partner, multiple partners, sexual partner with an STI)
What is included in the physical exam for STIs
Inspection of the:
- skin
- pharynx
- lymph nodes
- anus
- pelvic/genital region
- neuro
STI screening includes
Obtaining the sexual history and assessment of risk factors for STIs. Think 5 P’s
- Partners
- Practices
- Protection
- Past history of STI
- Prevention of Pregnancy
Men who have sex with men should be screened annually for
chlamydia, gonorrhea, pharyngeal gonorrhea, HIV, syphilis and HBsAg
Pregnant women should be screened for
HIV, chlamydia, gonorrhea, syphilis and HBsAg at their first prenatal visit
Pregnant women treated for chlamydia/gonorrhea should have a test of cure
within 3-4 weeks of treatment
What are risk factors for STIs
- Young age (15-24)
- Young age of first intercourse
- Multiple sexual partners
- History of previous STI
- Use of ETOH or drugs
- Inconsistent condom use
What is the most common bacterial STI in the US
Chlamydia
What lab tests are recommended for chlamydia and gonorrhea
NAATs
What is the treatment of chlamydia?
Azithromycin 1g PO single dose or doxycycline 100mg BID x 7 days
What should you educate a patient taking doxycycline
- swallow with large glass of water because of risk for esophagitis
- Avoid sun or use sunscreen (photosensitivity)
What should you educate a patient taking azithromycin single dose for chlamydia?
takes 7 days for tx to become effective
How should sexual partners of a patient with chlamydia be treated?
Azithromycin 1g PO x 1 dose
How is chlamydia tx’d in pregnancy?
Azithromycin 1g PO x 1 dose or amoxicillin 500mg PO TID x 7days
Unlike chlamydia, gonorrhea can become _____ or ______ if left untreated
systematic or disseminated
If you have gonorrhea you must always co treat for
Chlamydia even if negative test
What are symptoms of gonorrhea?
- cervicitis (mucopurulent discharge, pain, bleeding post coital)
- Urethritis
- Proctitis in men
- Pharyngitis
- Endometritis
- Signs of disseminated gonococcal infections
What are signs of disseminated gonococcal infection
- Petechial or pustular skin lesions of the hands/fingers
- asymmetric polyarthralgia
- tenosynovitis
- oligoarticular septic arthritis
- meningitis
- endocarditis
What is an alternative to the NAAT test for gonorrhea
Thayer-Martin
Who should you screen for syphilis
- Individuals with HIV
- Men who have sex with men
- presence of any genital ulcers *esp if painless chancre
- previous STD
- Pregnancy
- IV drug use
- High risk
What is the name of the organism that causes syphilis
Treponema pallidum
What are the sx of the primary syphilis
- painless chancre (heals in 6-9 weeks if not treated)
- Chancre has clean base with well demarcated indurated margins
What are the sx of secondary syphilis
- Condyloma lata
- Maculopapular rash on palms and soles that is not pruritic
What are the sx of tertiary syphillis
- neurosyphilis
- gumma (soft tissue tumors)
- aneurysms
- valvular damage
How do you test for syphilis
Step 1: Order screening test
-RPR or VDRL
Step 2: Order confirmatory test
-FTA-ABS or MHA-TP
If both positive then diagnostic for syphilis
Treat primary, secondary syphilis
-Benzathine penicillin G 2.4 million units IM x 1 dose
What is the tx of latent syphilis (>1 year), unknown duration, tertiary without evidence of neurosyphilis?
-Benzathine penicillin G 2.4 million units IM 1x/week x 3 weeks
When treating a patient for syphilis you should recheck RDR or VDRL at
6 and 12 months (want at least 4 fold decrease pre and post treatment)
What is the first line treatment of uncomplicated gonorrheal infection
Ceftriazone 250mg IM x 1 dose plug cotreat for chlamydia with azithromycin 1g PO x 1 dose
Treatment for complicated gonorrheal infections (PID, Acute epididymitis, acute prostatitis, Proctitis)
Ceftriaxone 250mg IM x 1 dose + Co treat for chalmydia
-Doxycycline 100mg BID x 14 days +/- flagyl 500mg BID x 14 days
Risk factors for PID
- History of PID
- Multiple partners
- Age <25
What are sx of PID
- acute onset of lower abdomen or pelvic pain
- Painful intercourse (dyspareunia)
- Cervical motion tenderness and adnexal pain on bimanual exam
- Jumping/running aggravates pelvic pain
What labs should be considered in suspected PID
-NAAT test
What is fitz-hugh-curtis syndrome
A complication of PID where chlamydia +/- gonorrheal infection ascends to the liver capsule which causes extensive scarring
What are sx of fitz-hugh-curtis
- sx of PID
- RUQ abdominal pain and tenderness on palpation1
What is Jarisch-Herxheimer Reaction
- A reaction patient’s may experience within a few hours of treatment for syphilis r/t the destruction of T. pallidum
- can also occur with lyme disease
What is the sx of Jarisch-Herxheimer
- fever
- chills
- headache
- myalgia
- tachycardia
- increased respiratory rate
What is Reiter’s Syndrome
A rare disease caused by an immune-mediated reaction secondary to infection with certain bacteria:
- chlamydia
- salmonella
- shigella
- campylobacter
What are the sx of Reiter’s syndrome?
- red and swollen joints that come and go
- ulcers on the skin of the glans penis
- “I can’t see (conjunctivitis), pee (urethritis) or climb up a tree (migratory arthritis in large joints)
What are risk factors for HIV
- Sex with HIV-infected person or with gay or bisexual men
- Receipt of blood products between 1975-185
- Hx of injection drug use/partner who drugs
- Hx of other STIs
- Multiple partners
- homelessness
- inmates
Annual routine HIV screening is recommended in
- injection drug uses and their partners
- sex workers
- sex partners with HIV
- Heterosexuals with multiple partners
- Ppl being treated for hepatitis, TB or another STI
- MSM and bisexual
HIV RNA can detect HIV infection as early as
7-28 days after exposure
What other labs need to be ordered in HIV
- Hep A/B/C
- Syphilis
- Other STIs
- Cervical cytology
- TB testing
What is the HIV-1/HIV-2 antibiody with p24 with reflexes
- screening test to diagnose HIV infection
- if + lab will perform HIV-1/HIV-2 antibody differentiation immunoassay to confirm initial test
ELISA
-Older screening test if positive next step is western blot
Western blot
- Older confirmatory test
- If positive next step is HIV RNA PCR
Rapid HIV test
Screening test; results in <30 minutes if positive follow with blood test
HIV RNA PCR
Test for HIV virus directly
-1st test for infants of HIB + moms
*Use if indeterminate results on antibody-antigen testing
CD4 T-cell count
-Check before starting ART, staging HIV infection, disease progression and treatment response to ART
Viral load HIV
- Monitor treatment response
- If on ART monitor q1-2 mths until non-detectable, then q3-4 months
What is the treatment for prophylaxis for opportunistic infections
Bactrim one tablet daily
Monitoring viral load
- Check HIV RNA (viral load) 2-8 weeks after starting therapy, then 1-2 months until viral load undetectable
- monitor viral load, CD4 and CBC q3-4 months for the first 2 years of ART
What are recommended vaccines for HIV and AIDS
- Hep A
- Hep B
- Inactivated influenza
- pneumococcal
- Td/Tdap q 10 years
- HPV (until 26 years)
Education for HIV patients
- Do not handle cat litter, uncooked or undercooked meat
- avoid bird stool (histoplasmosis spores)
- Use gloves when cleaning animal cages
- Healthy lifestyle
Prevention of HIV
- Condom use with sex
- Don’t share needles or syringes
- Don’t share toothbrushes, razors
- HIV moms should not breastfeed
- Limit sexual partners
If pt is allergic to sulfa what med should they use for opportunistic infections
Dapasone 100mg PO daily
In HIV infected pregnant women when should you start AZT
Start AZT ASAP
Hairy leukoplakia, recurrent yeast and thrush create high suspicion for
HIB
What is Acute retroviral syndrome or primary HIV infection
-Influenza-like similar to mononucleosis infection, vry infectious
What are condyloma acuminata
Genital warts that appear as soft flesh-colored pedunculated, flat or papular growths
HPV vaccine is recommended for
Both girls and boys as early as age 9.
- if 1st dose <15 only need 2 doses 6-12 months apart
- if 1st dose >15, need 3 doses 0, 1-2 and 6)
Treatment for genital warts
- Podofilox 0.5% gel or cream
- Imiquimod 5%
Sx of HSV
-acute onset of small veicles on a reddened base that rupture easily and become small shallow painful ulcers
First episode treatment for HSV
Zovirax 5x/day or Valtrex TID or Favier BID x 7-10 days
Most cases of cervical cancer are caused by
HPV 16 and 18
Flare up tx for HSV
Zovirax or Valtrex or Favier BID x 5 days
Treatments for genital warts that are contraindicated in pregnancy are
Podofilox, podophylla and imiquimod
Treatment of genital wars in pregnancy includes
Cyro, laser, excision
Tzanck smear shows multinucleated giant cells with herpes virus infection
-varicella, herpes simplex
HSV for primary treatment duration is
7-10 days
HSV for breakout duration of treatment is
5 days
