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STIs Flashcards

1
Q

Describe some ways to provide good care for a patient with an STI.

A

have a safe, private, and respectful environment
-safety is subjective
-check your assumptions and personal values/beliefs
-ensure confidentiality
-build rapport and trust
encourage questions and and revisit information as needed
use concise, plain language
use inclusive and non-stigmatizing language

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2
Q

What is 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 are passed through blood

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3
Q

What are the three categories of STIs?

A

viral: HPV, HIV, hepatitis B, HSV
bacterial: chlamydia, gonorrhea, syphilis
parasitic/fungal: trichomoniasis

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4
Q

What does STBBI stand for?

A

sexually transmitted and blood borne infection

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5
Q

What are the risk factors for STIs?

A

multiple partners (concurrently or over time)
anonymous or casual sex partners
sex without the use of barrier protection
sex with person(s) with an STI
previous STI
substance use (drug, alcohol or both)
use of medications for ED
history of intimate partner or sexual violence
social environments

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6
Q

Which populations are disproportionally affected by STIs?

A

Indigenous people
gbMSM
transgender
youth and young adults
people who use drugs
incarcerated or previously incarcerated people
people engaged in the sale or purchase of sex

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7
Q

True or false: STIs do not affect people in the same way

A

true

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8
Q

How can health care providers incorporate STI prevention into practice?

A

assessing and discussing risk
educating ppl about signs and symptoms and the asymptomatic nature of many infections
helping individuals recognize and minimize their risk
offering vaccination where indicated
offering screening and testing, as appropriate
providing treatment, follow up and counselling to individuals and their partner(s)

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9
Q

Discuss the importance of screening and testing for STIs.

A

many STIs are asymptomatic
even if no symptoms are present, the infection can still be passed to other people
a person treated for an STI in the past can be still be re-infected
test for one - test for all

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10
Q

Who can perform STI testing?

A

primary care provider, public health, or hospital
sexual health clinics in Saskatchewan

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11
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
perceived and anticipated attitudes of HCPs and clinic staff
stigma

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12
Q

Describe reporting of STIs.

A

STIs are reportable communicable disease
HCPs report to MHO who reports to Chief Medical Health Officer
reports available on Sask government website

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13
Q

Which STIs are nationally notifiable?

A

chlamydia
gonorrhea
syphilis
hepatitis
HIV
chancroid

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14
Q

What is the importance of partner notification?

A

critical to prevention and control
goal: assist individuals to inform partners about risk and honour their right to make informed health care decisions
confidential
individual, HCP, MHO may notify partner

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15
Q

What are examples of barrier protection?

A

external condoms
internal condoms
dental dams

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16
Q

What is the importance of barrier protection?

A

decrease risk of acquiring and transmitting the majority of STIs, including HIV, HBV, chlamydia, gonorrhea

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17
Q

Which STIs do barrier protection not provide protection against?

A

syphilis, HPV, HSV
lesions and asymptomatic shedding can occur in areas not covered

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18
Q

Which condoms are not recommended as barrier protection?

A

spermicidal lubricated condoms containing nonoxynol-9

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19
Q

What are the goals of therapy for STIs?

A
  1. treat the infection
  2. abolish symptoms
  3. decrease spread to sexual partners
  4. decrease vertical transmission to newborns
  5. reduce transmission of HIV
  6. decrease probability of complications, such as infertility, chronic pain, sepsis
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20
Q

Which antibiotics are provided free of charge by Sask Health for STIs?

A

amoxicillin
azithromycin
cefixime
doxycycline

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21
Q

How are STIs spread?

A

from person to person through:
-contact with semen, vaginal fluid or other bodily fluids during vaginal, anal or oral sex with a condom
-skin to skin contact during sexual activity
-sharing toys
some can be passed through blood transfusions and transplants
some can be transmitted vertically during pregnancy and labour
HIV can be transmitted through breastfeeding

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22
Q

What are the complications of chlamydia, gonorrhea, and syphilis in babies?

A

chlamydia:
-preterm birth, conjunctivitis, pneumonia in newborn
gonorrhea:
-endometritis and pelvic sepsis, ophthalmia neonatorum and systemic infection in newborn
syphilis:
-systemic symptoms, fetal loss

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23
Q

When should pregnant women be tested for STIs?

A

early in pregnancy and again in 3rd trimester if ongoing risk and treated before giving birth

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24
Q

What are the STI-associated syndromes?

A

cervicitis
epididymitis
pelvic inflammatory disease
proctitis
urethritis
vaginitis
anogenital ulcers

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25
What is the cause of vulvovaginal candidiasis? What are the symptoms?
cause: candida albicans symptoms: pruritis, white, clumpy, curdy discharge
26
What is the cause of trichomoniasis? What are the symptoms?
cause: trichomonas vaginalis symptoms: pruritis, odour, off-white or yellow, frothy discharge
27
What is the cause of bacterial vaginosis? What are the symptoms?
cause: mycoplasma and gardnerella vaginalis symptoms: fishy odour, grey or milky, thin copious discharge
28
What is the treatment of vulvovaginal candidiasis?
fluconazole 150mg po x single dose topical azole antifungals: clotrimazole, miconazole, terconazole *not necessary to treat asymptomatic patients*
29
What is the treatment of trichomoniasis?
metronidazole 2g po x single dose OR 500mg po BID x 7d *treat sexual partners*
30
What is the treatment of bacterial vaginosis?
metronidazole 500mg po BID x 7d OR 2g po x single dose metronidazole 0.75% 5g PV x 5d clindamycin 2% 5g PV x 7d *not necessary to treat asymptomatic patients unless undergoing procedure or high risk pregnancy*
31
Which infections are anogenital ulcers often caused by?
HSV lymphogranuloma venereum syphilis
32
Which infection usually causes anogenital warts?
HPV types 6 and 11
33
What is the etiology of chlamydia?
chlamydia trachomatis -most common nationally reportable STI in Canada -may be under-detected because majority of people with infection asymptomatic
34
True or false: you cannot give empiric therapy for chlamydia, lab testing is required
false empiric treatment may be given without lab testing
35
What are the symptoms of chlamydia?
*most individuals are asymptomatic* most common: -dysuria -urethritis (dysuria, dyspareunia) -cervicitis (abnormal bleeding, abnormal discharge, dyspareunia) -proctitis (pain, diarrhea, bleeding, discharge) -conjunctivitis (tearing, discharge, inflammation, swelling/redness of eye)
36
What are the symptoms of chlamydia in children?
conjunctivitis pneumonia
37
What are the complications of chlamydia?
female genitalia: -pelvic inflammatory disease -ectopic pregnancy -infertility -chronic pelvis pain -Reiter syndrome male genitalia: -epididymoorchitis -Reiter syndrome
38
What is Reiter syndrome?
reactive arthritis that affects joints, eyes, urethra, skin
39
What is the preferred treatment for chlamydia?
doxycycline 100mg po BID x 7d or azithromycin 1g po single dose
40
What is the alternative treatment for chlamydia?
levofloxacin 500mg po OD x 7d
41
What is the treatment of chlamydia if pregnant or lactating?
options: -azithromycin 1g po single dose -amoxicillin 500mg po TID x 7d -erythromycin 2g/d po in divided doses x 7d -erythromycin 1g/d po in divided doses x 14d
42
What are some points to provide regarding doxycycline, azithromycin and sexual activity during a chlamydia counsel?
doxycycline: -take with food, Fe or Ca may decrease absorption, photosensitive azithromycin: -GI upset abstain from sexual activity with or without barrier protection until treatment of person and partners is complete (7d after one dose therapy) and symptoms have resolved
43
Describe follow-up for chlamydia.
TOC recommended when symptoms persist, compliance is suboptimal, preferred treatment not used, prepubertal, pregnancy repeat screening recommended 3 months post-treatment due to risk of reinfection SK: TOC 3-4wks following + and repeat annually, every 3-6 months, or after any new partner
44
What is the etiology of lymphogranuloma venereum (LGV)?
chlamydia trachomatis genotypes L1, L2, L3 which are more invasive than non-LGV genotypes -relatively rare, some outbreaks reported in Canada
45
Which tissue does LGV preferentially affect?
lymph
46
Differentiate between the stages of LGV.
primary: -3 to 30d incubation -small painless papules at site of inoculation secondary: -2 to 6wks after primary lesion -swollen lymph nodes, proctocolitis, systemic symptoms -cardiac involvement, meningitis, ocular inflammatory disease tertiary: -chronic inflammatory lesions leading to scarring -lymphatic obstruction -genital and rectal strictures and fistulae -possible extensive destruction of genitalia
47
What is the preferred treatment for LGV?
doxycycline 100mg po BID x 21d possible treatment: azithromycin 1g po once weekly x 3wks
48
What is the etiology of gonorrhea?
neisseria gonnorrheae -2nd most common nationally reportable STI in Canada
49
What occurs if gonorrhea is left untreated?
infections become chronic *reinfections are common with gonorrhea*
50
Which STI has a high rate of concomitant infection with gonorrhea?
chlamydia *treat for both*
51
What are the symptoms of gonorrhea?
female genitalia: -vaginal discharge -lower abdominal pain -abnormal vaginal bleeding -dysuria -cervical discharge -bartholinitis -dyspareunia -proctitis male genitalia: -urethral discharge -dysuria -urethral itch -testicular pain, epididymitis -proctitis
52
What are the complications of gonorrhea?
female genitalia: -pelvic inflammatory disease (infertility and risk of ectopic pregnancy) -chronic pelvic pain male genitalia: -epididymoorchitis both: -disseminated gonococcal infection -reactive arthritis -perihepatitis
53
What does therapy of gonorrhea depend on?
site of infection and probability of resistance
54
Why do we treat gonococcal infections with combination therapy?
improve efficacy and potentially delay resistance *resistance is an issue with gonorrhea*
55
What is the recommended combination therapy for gonorrhea?
3rd gen cephalosporin with either azith or doxy
56
What is the treatment of gonorrhea if the primary site of infection is anogenital?
ceftriaxone 250mg IM single dose + azithromycin 1g po single dose OR cefixime 800mg po single dose + azithromycin 1g po single dose
57
What is the treatment of gonorrhea if the primary site of infection is pharyngeal?
ceftriaxone 250mg IM single dose + azithromycin 1g po single dose
58
What is the alternative treatment for gonorrhea if the primary site of infection is anogenital?
ceftriaxone 250mg IM single dose + doxycycline 100mg po BID x 7d OR cefixime 800mg po single dose + doxycycline 100mg po BID x 7d
59
What is the alternative treatment for gonorrhea if the primary site of infection is pharyngeal?
cefixime 800mg po single dose + azithromycin 1g po single dose
60
True or false: cross-sensitivity between penicillin's and 2nd or 3rd gen cephalosporins is high
false
61
When should someone repeat a dose of azithromycin?
if they vomit within an hour of dose
62
What are the recommendations for sexual activity after being treated for gonorrhea?
abstain from sexual activity without barrier protection until treatment of person and partners is complete (7d after one dose therapy) and symptoms have resolved
63
Describe follow-up for gonorrhea.
TOC cultures recommended within a week for all + sites or NAAT 2-3wks after treatment completed repeat screening recommended 6 months post-treatment SK: TOC 3-4wks following + and repeat annually, every 3-6months or after any new partner
64
What is the etiology of syphilis?
treponema pallidum -3rd most common nationally notifiable STI in Canada -rates of infection increasing rapidly (females, gbMSM, congenital) -SK among highest rates in Canada
65
How is syphilis transmitted?
contact with chancres
66
Which STI has universal screening recommended in pregnancy?
syphilis
67
Which patients experience more rapid progression to neurosyphilis and more aggressive and atypical signs of infection?
those with HIV
68
List the stages of syphilis and their clinical manifestations.
primary -painless lesion (chancre), regional lymphadenopathy -time: 3 weeks (3-90 days) secondary -rash, fever, malaise, lymphadenopathy, mucous lesions, condyloma lata, alopecia, meningitis, headaches, uveitis, retinits -time: 2-12wks (2wks-6mo) early latent -asymptomatic (+ serology) -time:<1yr late latent -asymptomatic (+ serology) -time: >1yr tertiary: -cardiovascular syphilis, gumma *neurosyphilis and ocular syphilis can occur at any stage*
69
What is the preferred treatment for primary, secondary, and early latent syphilis?
benzathine penicillin G-LA 2.4 million U IM single dose
70
What is the preferred treatment for cardiovascular syphilis, gumma, late latent syphilis?
benzathine penicillin G-LA 2.4 million U IM weekly for 3 doses
71
What is the alternative treatment (penicillin allergy) for primary, secondary, early latent syphilis?
doxycycline 100mg po BID x 14d exceptional circumstances and when close follow-up is assured: -ceftriaxone 1g IV or IM daily x 10d
72
What is the alternative treatment for cardiovascular syphilis, gumma, and late latent syphilis?
consider penicillin desensitization doxycycline 100mg po BID x 28d in exceptional circumstances and when close follow-up is assured: -ceftriaxone 1g IV or IM daily x 10d
73
Which form of syphilis should be referred to a neurologist or ID specialist?
neurosyphilis
74
What is the treatment of syphilis during pregnancy?
benzathine penicillin G-LA 2.4 million U IM single dose
75
What are the recommendations for sexual activity after being treated for syphilis?
abstain from sexual contact until the lesions are completely healed and it has been 7d since they received their final dose of treatment condoms advised for all sexual encounters
76
Describe follow-up for syphilis.
no TOC treatment response based on clinical picture and nontreponemal test titre change (4 fold decrease by 6 months)
77
What is the Jarisch-Herxheimer reaction?
acute febrile reaction accompanied by headache, myalgia, chills, and rigors occurs within 1st 24hrs after initiation of any syphilis therapy NOT an allergic reaction, but rather reaction to therapy manage with NSAIDs
78
What is the most common STI in the world?
HPV -over 200 types -atleast 40 types known to infect mucosa of the anogenital tract and oropharynx -infections with multiple types possible
79
Infections with which type of HPV are associated with low/no cancer risk?
6 and 11 -may lead to anogenital warts, cervical lesions, and rare conditions such as recurrent respiratory papillomatosis
80
Infections with which type of HPV may lead to cancer?
16 and 18 -cervical, oropharyngeal, cancer of vulva, vagina, penis, anus *virtually all cases of cervical cancer are attributable to HPV*
81
What are the genital wart symptoms of HPV?
asymptomatic itchiness discomfort during intercourse bleeding with intercourse or shaving warts on penis or vulva
82
What are the cancer symptoms of HPV?
cervical cancer causes little to no discomfort , hence regular screening (pap test) lesions can bleed, itch, cause pain wherever located
83
What is the treatment of HPV?
treatment of anogenital warts: topical and ablative -imiquimod cream 3.75% daily and wash off after 8h or 5% cream 3x/wk apply and wash off after 6-10h -sinecatechins 10% ointment apply 0.5cm strand TID, washing off not needed
84
What are some tips to provide for HPV treatment?
avoid contact with healthy skin refrain from sexual activity while undergoing treatment pain reduction: lidocaine/prilocaine, injectable lidocaine
85
Which types of HPV does Gardasil 9 protect against?
6, 11,16, 18 PLUS 31, 33, 45, 52, 58
86
Describe Gardasil 9.
approved for individuals aged 9-45yrs IM injection (deltoid preferred) dose: -0.5ml x 3 doses (0, 2, 6 months) -9-14yo: 0.5ml x 2 doses (0, 6 months) -immunocompromised: 3 dose series 97% vaccine efficacy for preventing CIN or more severe disease in HPV naive 16-26 yos
87
What are the adverse effects of Gardasil 9?
local injection site reaction headache fever nausea dizziness fatigue diarrhea oropharyngeal pain upper abdominal pain
88
True or false: Gardasil 9 is not publicly funded in Sask
false
89
What is the etiology of HSV?
herpes simplex virus type 1 and 2 -HSV 1 is primarily associated with oral infections but may cause genital herpes -HSV 2 is primarily associated with genital infection but may also present orally as a result of oro-genital transmission
90
How is HSV transmitted?
unprotected sex and via delivery of baby higher risk with open sores, also asymptomatic viral shedding *common in adolescents and adults, women>men*
91
Is HSV curable?
virus establishes itself intracellularly within host cell ganglia for life
92
What are the symptoms of a primary HSV infection?
extensive, painful, bilateral vesiculo-ulcerative genital or anal lesions fever, malaise, myalgia, headache tender inguinal lymphadenopathy duration: 17-20d
93
What are the symptoms of HSV recurrences?
prodromal symptoms for 1-2d unilateral localized small patch painful genital vesicles and ulcers systemic symptoms: 5-12% duration: 9-11 days
94
What are the symptoms of a non-primary HSV infection?
dont last as long less severe less extensive duration: 16d
95
What are the complications of HSV?
meningitis extragenital lesions
96
What is the treatment for primary genital herpes?
acyclovir 200mg po 5x per day for 5-10d famciclovir 250mg po TID for 5d valacyclovir 1000mg po BID for 10d pregnancy: acyclovir 200mg po QID x 5-10d severe: IV acyclovir 5mg/kg infused over 1h q8h *topicals not effective*
97
What is the treatment for recurrent genital herpes?
valacyclovir 500mg po BID or 1g po daily x 3d famciclovir 125mg po BID x 5d acyclovir 200mg po 5x/d for 5d *start within hours*
98
What are the treatment options for genital herpes suppressive therapy?
acyclovir 200mg po TID-5x/d or 400mg po BID famciclovir 250mg po BID valacyclovir 500mg po daily (<9 recurrences/yr) 1000mg daily (>9) pregnancy: acyclovir 200mg po QID or 400mg po TID or valacyclovir 500mg po BID
99
How does neonatal herpes occur?
when baby is delivered through an infected vagina initial symptoms ~4wks of age results in generalized systemic infection involving liver, other organs, CNS and skin
100
What is the treatment of neonatal herpes?
acyclovir 45-60mg/kg/d IV in three equal 8-hourly infusions, each over 60 minutes for 14-21d
101
List some counselling points to discuss during an HSV counsel.
antivirals will decrease severity and duration of symptoms, but not prevent recurrences use as early as possible (preferably <6h) and until lesions are healed abstain from sexual contact during symptomatic episodes until lesions are completely healed always use a condom as asymptomatic viral shedding may occur (may not eliminate risk of transmission when lesions not limited to genital area) *lifelong infection*
102
What is monkeypox?
viral zoonotic disease caused by orthopoxvirus transmission: any form of direct contact with lesions, bodily fluids, mucosal surfaces or respiratory secretions of infected person or shared contaminated objects management: supportive care, smallpox antiviral
103
What are the symptoms of mpox?
incubation: 3-21 days symptoms: -rash (more prominent on face and extremities) -lymphadenopathy -may be preceded by systemic symptoms (fever, myalgia, fatigue) -self resolving within 2-4wks
104
Which stages of syphilis are infectious?
primary secondary early latent

PHAR253 (16 decks)

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