STIs Flashcards
STi jmeans
an infection spread mainly via sexual contact
STBBI means
an infection transmitted via blood or sexual
which of the following is false
1. rates of STIs have increased dramatically
2. goals to reduce incidence include improving access to testing, treatment, and ongoing care + reducing stigma and discrimination
3. there was less STIs reported during covid than expected- likely due to lower actual prevalence and social distancing
4. STIs may be asymptomatic for a long time
5. YMSM are at increased risk for STIs
3- likely underreporting
why are YMSM at increased risk fro STIs
of partners
freq of sex without a condom
overlapping sexual networks
frequency of anal sex
STIs have 4 major effects on sexual and repro health, which include
fertility issues
increased risk of HIV acquisition
vertical transmission of STIs
increased risk of cancer
vertical transmission of STIs causes the following in children
stillbirth, neonatal death, low birth weight, prematurity, sepsis
what are the 5 Ps for taking a sexual hx
partners, practices, protection, past hx STIs, prevention of pregnancy
what are 3 painful ulcers that are STIs
genital herpes
chanceroid
LGV
what are 3 painless ulcers that are STIs
syphilis
granuloma
inguinale
what are 2 genital warts/ ectoparasites
HPV, pubic lice
what are 5 causes of urethritis/ cervicitis
gonorrhea, chlamydia, trichomoniasis, mycoplasma and ureaplasma
a woman has a discharge sample that shows gram - intracellular diplococci. this is most likely
1. gonorrhea
2. syphilis
3. pubic lice
4. trichomoniasis
1
what is the second most frequently reported notifiable STI in Alberta and Canada
gonorrhea
why is there national concern about gonorrhea
emergence of drug resistant strains
RFs for gonorrhea include
multiple/ new partners, unprotected sex, alcohol/ SU, sex workers and street involved youth
____% pts with gonorrhea are also coinfected with chlamydia
25-30%
what is the causative pathogen of gonorrhea
neisseria gonorrheae
how is gonorrhea transmitted
via sexual activity
perinatal possible
how long is the incubation period for gonorrhea
2-7 days
there is an increased rate of gonorrhea in _______ > ________
males > females
gonorrhea increases HIV acquisition due to ___________ increasing ________ of HIV
urethritis increases viral shedding of HIV
men with gonorrhea are typically _____ (more/ less) sx than females
more- females more likely to be detected via exam/ testing
nongonococcal urethritis is likely
chlamydia- less commonly mycoplasma/ ureaplasma
urethritis sx nclude
inflam of urethra, discharge, dysuria, possibly itchiness or irritation
gonorrhea may be refered to as
the drip or the clap
hyperacute gonococcal conjunctivitis can lead to
corneal ulceration and blindness
neonatal gonorrheal infection predominantly occurs from
preinatal exposure to mother’s infected cervix during birth- can be prevented with routine prenatal screening
what are the 2 most common manifestations of neonatal gonorrhea
ophthalmia neonatorum - causes blindness
neonatal sepsis/ meningitis
why is erythromycin 0.5% ung OU given to all newborns
to prevent ophthalmia neonatorum- reduce preventable blindness
disseminated gonococcal infection can occur through _____________ and occurs predominantly in ___________
hematogenous spread
women
list 2 organ systems that DGI can affect
skin
tendon sheaths/ joints
pericardium
endocardium (infective endocarditis)
meningitis
bacterial hepatitis
T or F: samples of arthritis in gonorrhea may be sterile
T
gonorrhea may cause ___ in females and _____ in males
PID
epididymo-orchitis
gonorrhea is often asymptomatic ____% in women
50%
PID refers to the infection of the ___, ____, and/or ____ typically as a result of ________ in females
infection of the uterus, fallopian tubes, ovaries
ascending spread
what are the 2 most common pathogens for PID
gonorrhea, chlamydia
tx for PID include
often hospital admit + antibitotics targeting pathogens for 7-14d
what are some complications of PID
tubo-ovarian abscess, damage to uterine wall, reduced fertility
fertility issues = most common comp of PID
how is gonorrhea dx
often highly sus by hx and physical along
can confirm dep on sit affected
how is urethritis/ cervicitis caused by gonorrhea dx
urine NAT testing - detects dead organisms too
- can also do swab
how is eye/pharynx/ rectal involvement caused by gonorrhea dx
gram stain, culture and sensitivity
gonorrhea is generally sus to
cephalosporns
meropenem/imipenem, ertapenem, aztreonam
what is the pref and alt tx for uncomplicated urethral and cervical gonorrheal infxn in heterosexual/ preg
pref: cefixime + azithro
alt: ceftriaxone + azithro
T or F: azithromycin can be used as monotx in gonorrhea
F- resistance reported- must use with cefixime or ceftriaxone
in the tx of gonorrhea, abstinence from unprotected sex for ___ is rec to protect others
7 days
how long after tx are you noncontagious anymore for gonorrhea? how long should you wait to have unprotected sex?
24hrs after start
7 days wait
what is the pref and alt tx for MSM + pharyngeal gonorrheal infections
pref: ceftriaxone + azithro (risk of drug resistant gonorrhea may be higher in MSM pop)
alt: cefixime + azithro
what are the recs for TOC for GC
rec for all cases with urine NAT 3-4wks after completion of tx + rescreen after 6mths
a pt presents with dysurea and discharge, no visible organisms are seen on microscopy- what is the dx likely?
chlamydia- atypically = can’t be stained
what is the most common reported notifiable STI in alberta
chlamydia
what is the most common cause of urethritis and cervicitis
chlamydia
chlamydia can infect (4)
urogenital, rectal, pharyngeal, conjunctival
females are ____ likely to be affected than males by chlamydia
more (gonorrhea = less)
chlamydial serovars A-C causes
conjunctivitis aka trachoma
chlamydia serovars D-K causes
urogenital tract infection
chlamydia serovars L1-L3 causes
invasive disease, another STI called lymphogranuloma venereum (LGV)
how is chlamydia transmitted
mostly sexual contact
some vertical
how long is chlamydia’s incubation period
7-21 days
why are chlamydia species atypical
no peptidoglycan cell wall
which has the longer incubation period- gonorrhea or chlamydia
chlamydia- 7-21 days = longer than gonorrhea 2-7 days
______ is an autoimmune inflam response that can happen in response to chlamydia trachomatis infections and gonorrhea
reactive arthritis
what is the classic triad of reactive arthritis from chlamydia
can’t see- anterior uveitis
can’t pee- urethritis/ cervicitis
can’t climb a tree- inflam monoarthritis
reactive arthritis typically happens ____ after chlamydia infection
1-6wks
what is the tx of RA from chlamydia
antibiotics for infection, NSAIDs for acute phase of reactive arthritis
T or F: most cases of reactive arthritis are short lived + resolve sponatneously
T
chlamydia can threaten male fertility through ______ and ______
epididymitis and epididymo-orchitis
what is epididymo-orchitis
infection involving both the epididymis and testis
describe epididymo-orchitis in males sx from chlamydia
scrotal pain, unilateral swelling/ redness + tenderness
tx for chlamydial epididymo-orchitis in males
antibiotics (ex- ceftriaxone + azithro) F2-3wks
epididmyal abscess can form in the ______ which then requires ____________
vas deferens
surgical incision and drainage
how is chlamydia dx
often highly sus via hx and physical
urethritis = urine or swab NAT
difficult to culture- requires special media
chlamydia is generally sus to
amoxicillin/ ampicillin
amoxi/clav
fluoroquinolones
erythro/clarithro/azithromycin
doxy/mino/tigecycline
what is the rec tx for cervical, urethral, and pharnygeal chlamydia if gonorrhea test is negative (pref + alt)? what about P/BF?
pref: azithro
alt: doxycycline
perg/BF
- pref: azithro
alt: amoxi
what is the pref and alt tx for rectal chlamydia
pref: doxy
alt: azithro
T or F: a TOC is not necessary for rectal chlamydia
F- still rec
T or F: a TOC for chlamydia is not routinely indicated
T
when is a TOC rec for chlamydia
when adherence is suboptimal
tx is not provided in line with alberta guidelines
client is perpubertal
a nongenital site is involved
client is pregnant
what is the pref test for TOC for chlamydia + when
NAAT 3-4wks after tx + rescreening after 6mths
trichomonas vaginalis is a ____ STI
parasitic/ protozoan
how is trichomoniasis trasmitted
sexual contact with direct contact or fluids
trichomoniasis more often affects
females
trichomoniasis is typically ________ (asymptomatic/ symptomatic) in males
asymptomatic
what is the presentation of trichomoniasis
forthy/ yellow green vaginal discharge +/- fishy odor, sorenses, dysuria, dyspareunia
how is trichomoniasis diagnosed?
NAT+ for urine, microscopic testing
in those infected with trichomoniasis, coinfection with _______ is common
G/C
_____________ is one of the only STIs that can be prevented by an effective vaccine
genital warts
what is the pathogen that causes HPV?
HPV
what is the most common VIRAL STI
HPV
HPV increases the risk of _______ in women and _________ in men
cervical cancer in women
oropharangeal/ rectal cancer in men
________ HPV vaccines are highly effective at preventing urogenital cancers + anogenital warts
9-valent
what HPV types are oncogenic
16, 18
T or F: routine testing for HPV is not available
T
how is HPV dx
direct examination with hands or lens
colposcopy for visible warts of cervix and anus + urethroscopy if extensive meatal warts
pap smears
dx of HPV is confirmed by
response to liquid nitrogen tx
T or F: no tx garantees cure of clinical lesions, none are superior to other
T
what are 3 options for genital wart tx
cryotx
surgical tx
home initiated therapies
what are 3 home approved tx for genital warts
podofilox
imiquimod
sinecatechins
during pregnancy, ___ or —- is pref as tx for genital warts
liquid nitrogen
trichloroacetic acid
HPV should be given at age ____ for ____, as early as ____ if question of sexual abuse/ assult
11-12yrs for all girls and boys
9yrs of SA
in alberta, pts are able to receive the HPV vaccine for free to age
26
what pathogen causes syphilis
trepnema pallidum
syphilis is a gram ___, ___ (shape_
gram - spirochete
what is known as the “great imitator” in STIs
syphilis
how is syphilis transmitted
sexual contact
vertical transmission
T or F: syphilis increases susceptibiltiy to HIV
T
in congenital syphilis, pts are often _____ at birth, then _______
asymptomatic
then develop problems later in life
most pts with congenital syphilis are infected during
pregnancy
what is the screening rec for syphilis for pregnant women
screen in 1st trim + rescreen at delivery
early congenital syphilis is in months ___
0-3
describe the sx of late congenital syphilis
gummatous ulcers of nose/ palate
saber shins/ frontal bossing
corneal scarring from interstitial keratitis
sensorineural hearing loss
T or F: tx of newborns with penicillin may prevent manifestations of congenital syphilis
F- may or may not
when does primary syphilis happen after exposure? how long does it take to resolve?
21 days
resolves spontaneously in 4-6wks
secondary syphilis often develops _____wks after primary syphilis
2-12
when is a syphilis patient contagious
1. primary phase
2. secondary phase
3. early latent phase
4. late latent phase
5. 1-3
6. all of the above
5
when does tertiary syphilis tend to occur
years- decades after initial infection
in secondary syphilis, pts will have _______ and can be reactive to ——-
high grade bacteremia
reactive to penicillin
what are the 3 steps in screening syphilis
- syphilis EIA- if + then proceed to 2
- TPPA: a confirmatory test, if + proceed to 3
- RPR: most important- tells if previously treated + current status
what is defined as tx failure in syphilis
decrease of less than 4x RPR in 6-12mths or 12-24mths if later
why is syphilis not resistant to penicillin
mutation to PBP results in a fatal error incompatible with life
also incapable of doing horizontal gene transfer
what drugs are used to tx primary, secondary, or early latent syphilis
pen G F 1 dose or doxy F 14 d
what drug is used to tx late latent syphilis
pen G F3 doses or doxy F 4wks
what is used for tx of syphilis in preg women who are allergic to penicillin
must undergo desensitization prior to tx
what is the potential mech of desensitization for syphilis
IgE internalization or counter regulation
getting limited mast cell degranulation until it is depleted
desensitization to penicillin lasts up to ——–
4 half lives (48hrs for penicillin_
where is penicillin desensitization usually done
ICU
should you pretreat pts undergoing desensitization with CS or antihistamines
no
when can you stop serological syphilis FU
once RPR nonreactive (unless HIV +)
when to FU for infectious syphilis/ HIV negative
serology at 1, 3, 6, 12 mths or until RPR nonreactive
when to FU for noninfectious syphilis/ HIV negative
serology at 12 and 24mths (unless RPR nonreactive)
T or F: pts may be reinfected with syphilis
T- no immunity
what is the structure and group of HHVs
group 2, dsDNA virus
icosahedral, enveloped
seropositivity (IgG+) to HHVs is equal to
age
HHV is transmitted ______(2), an affects M ___F
sexual, vertical
M>F
what host cells typically control HHV infection
CD8 T lymphocytes
how long is inculation for HHV
~7d
T or F: HHV pts can still be contagious in recovery period after primary infection
T
severe disseminated herpes virus disease may occur in those who are _____ or _________
sus + exposed to high inoculum
immunodeficient
whatre the sx of severe disseminated herpes virus disease
viral meningoencephalitis (seizures, altered LOC, HA), ANS dysfxn, herpesvirus pneumonia, viral hepatitis
reactivation of HHV typically leads to _____ (more/less) severe sx at the original site of disease
less
genital herpes typically last _____ and resolves _______
2wks
spontaneously
describe the herpesvirus lief cycle and pharmacologic targets
attach/ fusion - uncoating - transcription/ translation - assembly/ packaging - egress
HHV uses ___ ribosomes to translate viral protein
host
what is the primary pharm target for HHV
DNA dependent DNA polymerase
most HHV antivirals mimic free floating DNA pairs = chain termination = stops replication
Ig _____ spikes in primary infection then fluctuates periodically even if asymptomatic
IgM
IgM+/IgG- is confirmatory for ________ of HHV
primary disease
how is HSV diagnosed
clinically with corresponding serology +/- PCR testing if active disease (swab blood/ CSF if active lesions)
MOA of acyclovir, valacyclovir, ganciclovir, valganciclovir, and cidofovir
interferes with DNA polymerase by mimicking nucleosides = chain termination
foscarnet acts as a ___________ and disrupts DNApolymerase
pyrophosphate analog
T or F: valacyclovir is often preferred to acyclovir due to better bioavailability and frequency of dosing
T
tx of HSV with valacyclovir decreases time to resolution by ______, time to healing by ______, and duration of viral shedding by _____ if started within 72hrs of onset
resolution by 2 days
time to healing by 4 days
duration of viral shedding by 7 days
chronic suppression for HSV is used if
> 6 outbreaks/yr
suppressive tx for HSV in pregnant women is required to start at _______ until ________
36wks until delivery
what antivirals are safe to use in pregnancy
acyclovir, valacyclovir
