STIs Flashcards
what is the definition of an STI?
an 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 spread through the blood
what are the groups of STIs?
viral: HPV, HIV, HSV
bacterial: chlamydia, gonorrhea, syphilis
parasitic/fungal: trichomoniasis
what are some risk factors for STIs
multiple partners concurrently or over time
anonymous or casual sex partners
sex without use of barrier protection
social environment
sex with person(s) with an STI
previous STI
use of medication for ED
history of intimate partner or sexual violence
what groups of people are at an increase risk of STIs?
indigenous peoples
gay, bisexual and other men who have sex with men (gbMSM)
incarcerated or previously incarcerated people
transgender people
youth and young adults
people who use drugs
people engaged in the sale or the purchase of sex
T or F
a person treated for an STI in the past is unable to be re-infected with the same STI
False
What are the SK communicable disease control management guidelines?
screen using risk assessment, offer testing based on results
individuals with ongoing risk for infection should be routinely tested for chlamydia, gonorrhea, syphilis, HIB, Hep B, Hep C
test for one test for all
what are the PHAC sexually transmitted and blood born infection guidelines?
guidelines for health professionals
screening recommended specific to STI
offer in the course of route with special attention to those with risk factors
Which STIs are nationally notifiable?
chlamydia, gonorrhea, syphilis, hepatitis, HIV, chancroid
what are the goals of therapy for treating STIs?
treat the infection
abolish symptoms
decrease spread to sexual partners
decrease vertical transmission to newborns
decrease transmission of HIV
decrease probability of complications such as infertility, chronic pain, sepsis
When should pregnant women be tested for STIs?
early in pregnancy and again in the 3rd trimester if ongoing risk
treatment before birth to reduce the risk of problems during pregnancy and delivery and complications for baby
what does vaginal discharge look like when infected with candidiasis?
pruritis, white, clumpy, curdy discharge
what does vaginal discharge look like when infected with trichomoniasis?
pruritis, odour, off white or yellow frothy discharge
what does vaginal discharge look like when infected with bacterial vaginosis?
fishy odour, grey or milky, thin copious discharge
what is the treatment of bacterial vaginosis?
metronidazole PO or metronidazole or clindamycin PV
is it necessary to treat asymptomatic BV?
no
only if undergoing procedure or high risk pregnancy
which STIs discussed in class are spread through skin to skin contact?
HSV, HPV, syphilis
which STIs discussed in class are vertically transmitted to baby?
all
chlamydia, HSV, gonorrhea, HPV, syphilis
which STIs discussed in class are curable?
chlamydia, gonorrhea, syphilis
which STIs discussed in class affect fertility?
chlamydia, gonorrhea, syphilis
what causes chlamydia?
chlamydia trachomatis (gram negative)
what are the common symptoms of chlamydia?
most people are asymptomatic
dysuria
urethritis
cervicitis
proctitis
conjunctivitis (if in eye)
what are the symptoms of chlamydia in women?
cervicitis, vaginal discharge, lower abdominal pain, dysuria, abnormal vaginal bleeding, painful intercourse, conjunctivitis, proctitis
what are the symptoms of chlamydia in men?
urethritis (discharge, pain), urethral itch, dysuria, testicular pain, conjunctivitis, proctitis
what are the symptoms of chlamydia in infants/children?
conjunctivitis, pneumonia
what are the complications of chlamydia in women?
pelvic inflammatory disease
ectopic pregnancy
infertility
chronic pelvic pain
Reiter syndrome
what are the complications of chlamydia in men?
epididyo-orchitis
Reiter syndrome
what is Reiter syndrome?
reactive arthritis that affects joints, eyes, urethra, skin
what is the preferred treatment of chlamydia?
doxycycline 100mg PO BID x 7d
or
azithromycin 500mg PO QD x 7d
what is the alternative treatment of chlamydia?
levofloxacin 500mg PO QID x7d
what is the treatment of chlamydia in pregnancy?
azithromycin 1g PO in single dose
or
amoxicillin 500mg TID x 7d
or
erythromycin 2g/d PO div x 7d
or
erythromycin 1g/d PO div x 14 d
what are some counselling points for pts taking doxycylcine?
take with food
take with iron or calcium may decrease absorption
photosensitivity
what are some counselling points for pts taking azithromycin?
GI upset
may need prophylactic antiemetics
what do you tell a pt being treated for chlamydia about sexual activity?
abstain from sexual activity w/o barrier protection until treatment of person and partners is complete (7 days after one dose therapy, end of multiple dose therapy) and symptoms have resolved
what is the follow up for patients being treated for chlamydia?
TOC recommended when symptoms persist, compliance is suboptimal, preferred treatment not used, prepuberty, pregnancy
repeat screening recommended 3 months post treatment due to risk of infection
what is lymphogranuloma venereum (LGV)?
chlamydia trachomatis genotypes L1, L2, L3 which are more invasive than non-LGV genotypes
preferentially affect the lymph tissue
what is the timeline and symptoms of the 3 stages of LGV?
primary: 3-30 days incubation
small painless papules at site of inoculation (often unnoticed)
secondary: 2-6 wks after primary lesion
swelling of lymph nodes, proctocolitis, systemic symptoms like fever, fatigue, arthritis, pneumonitis, hepatitis
rarely: cardiac involvement, meningitis, ocular inflammatory disease
tertiary: chronic inflammatory lesions lead to scarring
lymphatic obstruction causing genital elephantiasis; genitals and rectal strictures and fistulae, possible extensive destruction of genitalia
what is the preferred and alternative treatment of LGV?
preferred:
doxycycline 100mg PO BID x 21d
alternative:
azithromycin 1g PO once weekly x 3w
what causes gonorrhea?
Neisseria gonorrhoeae
why do we treat chlamydia and gonorrhea together?
high rates of concomitant infection
what are the symptoms of gonorrhea in females?
vaginal discharge
lower abdominal pain
dysuria
cervical discharge
Bartholinitis
dyspareuria
rectal pain
discharge with proctitis
what are the symptoms of gonorrhea in men?
urethral discharge
dysuria
urethral itch
testicular pain
epididymitis
rectal pain
discharge with proctitis
what are the complications of gonorrhea in females?
pelvic inflammatory disease –> infertility and risk of ectopic pregnancy
chronic pelvic pain
disseminated genital infection (DGI)
reactive arthritis
perihepatitis
what are the complications of gonorrhea in males?
epididymo-orchitis
disseminated genital infection (DGI)
reactive arthritis
perihepatitis
what is disseminated genital infection (DGI)?
spectrum including arthritis, tenosynovitis, dermatitis, endocarditis, meningitis
why do we treat gonococcal infections with combination therapy?
improves efficacy and potentially delays resistance
T or F
there is an issue with resistance in the treatment of chlamydia?
False
T or F
there is an issue with resistance in the treatment of gonorrhea
True
What is the preferred treatment of anogenital gonorrhea?
ceftriaxone 250mg IM in a single dose PLUS azithromycin 1g PO in a single dose
or
cefixime 250mg PO in a single dose PLUS azithromycin 1g PO in a single dose
what is the alternative treatment of anogenital gonorrhea?
ceftriaxone 250mg IM in a single dose PLUS doxycycline 100mg PO BID x 7d
or
cefixime 800mg PO in a single dose PLUS doxycycline 100mg PO BID x 7d
when is doxycycline CI?
in pregnant and breastfeeding women
what is the preferred treatment for pharyngeal gonorrhea?
ceftriaxone 250mg IM in a single dose PLUS azithromycin 1g PO in a single dose
what is the alternative treatment of pharyngeal gonorrhea?
cefixime 800mg PO in a single dose PLUS azithromycin 1g PO in a single dose
what do you tell a pt being treated for gonorrhea about sexual activity?
abstain from sexual activity without barrier protection until treatment of person and partners is complete (7 days after one dose therapy, end of multiple dose therapy) and symptoms have resolved
how long after taking single dose azithromycin will you have to retake the dose if you vomit?
within 1 hour
what is the follow up for gonorrhea?
TOC cultures recommended within a week for all positive sites or NAAT 2-3 weeks after treatment completed
repeat screening recommended 6 months post treatment
what causes syphilis?
treponema pallidum (spirochete)
how is syphilis transmitted?
via contact with chancres
what tends to happen in concurrent infections of syphilis and HIV?
more rapid progression to neurosyphilis and more aggressive and atypical signs of infection
what is the timeline and symptoms of primary syphilis?
3-90 days
painless lesion (chancre), regional lymphadenopathy (swollen lymph nodes in genital area)
what is the timeline and symptoms of secondary syphilis?
2 wks to 6 months
rash, fever, malaise, lymphadenopathy, mucous lesions, condyloma lata, alopecia, meningitis, headaches, uveitis, retinitis
what is the timeline and symptoms of early latent syphilis?
asymptomatic syphilis for less than 1 year
what is the timeline and symptoms of late latent syphilis?
asymptomatic syphilis for more than 1 year
what stages of syphilis are infectious?
primary, secondary, and early latent
what is the timeline and symptoms of tertiary syphilis?
CV syphilis (10-20 years): aortic aneurysm, aortic regurgitation, coronary artery ostial stenosis
gumma (1-46 years –> usually 15 year): tissue destruction of any organ; manifestations depends on site involved
when can neurosyphilis occur?
at any stage
early: within 1st year
late: 1-20 years
what are the symptoms of neurosyphilis?
ranges from asymptomatic to headaches, vertigo, personality changes, dementia, ataxia, Argyll Robertson pupil, otic and ocular symptoms
in what group of people is neurosyphilis typically asymptomatic?
immunocompromised
what is the test for diagnosising neurosyphilis?
lumbar puncture
what is the timeline and symptoms of early congenital syphilis?
onset < 2 years
2/3 may be asymptomatic
anemia, neurosyphilis, rhinitis, osteochondritis, hepatosplenomegaly, mucocutaneous lesions, fulminant disseminated infection
what is the timeline and symptoms of late congenital syphilis?
persistence > 2 years after birth
anemia, neurosyphilis, interstitial keratitis, lymphadenopathy, hepatosplenomegaly, bone involvement, anemia, Hutchinson’s teeth
what is the preferred treatment for primary, secondary and early latent syphilis?
Benzathrine penicillin G-LA 2.4 million U IM as a single dose
2 pre-filled syringes
deep so typically one syringe injected into each butt cheek
what is the treatment for primary, secondary, and early latent syphilis in penicillin allergy?
doxycycline 100mg PO BID x 14 d
what is the alternative treatment for primary, secondary and early latent syphilis and when can it be used?
ceftriaxone 1g IV or IM daily x 10d
only used in exceptional circumstances and when close follow up is assured
what is the preferred treatment for late, late latent, CV syphilis, gumma?
Benzathine penicillin G-LA 2.4 million U IM weekly for 3 doses
when would you give 3 doses of benzathine penicillin G-LA empirically?
when we do not know what stage/when infection was acquired
what is the alternative treatment for late, late latent, CV syphilis, gumma and when can it be used?
ceftriaxone 1g IV or IM x 10 d
can be used in exceptional circumstances and when close follow up is assured
what is the treatment for late, late latent, CV syphilis, gumma in penicillin allergy?
doxycycline 100mg PO BID x 28 d
strongly consider penicillin desensitization
what is the treatment for neurosyphilis?
refer to neurologist or infectious disease specialist
IV antibiotics x 14d
what is the treatment of syphilis in pregnancy?
benzathine penicillin G-LA 2.4 million U IM as a single dose
some experts suggest treating primary, secondary and early latent cases with 2 doses particularly in the 3rd trimester
what do you tell a pt being treated for syphilis about sexual activity?
abstain from sexual contact until the lesions are completely healed and it has been 7 days since they received final dose of treatment
condoms should be advised and encouraged for all sexual encounters
when is follow up recommended for syphilis?
primary, secondary, early latent: 3, 6, and 12 months
late latent and tertiary (not neurosyphilis): 12 and 24 months
when is follow up recommended for syphilis in people who have HIV?
3, 6, 12 and 24 months post treatment
when is follow up screening done for syphilis in pregnant women?
primary, secondary, early latent: monthly until delivery if at high risk of re-infection
1, 3, 6, and 12 month post partum
late latent: at time of delivery and 12 and 24 months post partum
what is Jarisch-Herxheimer reaction?
acute febrile reaction accompanied by headache, myalgia, chills and rigors
occurs within 1st 24 hours after initiation of any syphilis therapy
NOT an allergic reaction
what is the problem with Jarisch-Herxheimer reaction in pregnancy?
it may induce early labour or cause fetal distress
what is the most common STI worldwide?
HPV
what are the symptoms of genital warts?
asymptomatic
itchiness
discomfort during intercourse
bleeding with intercourse or shaving
warts of penis or vulva (cauliflower like)
what are the symptoms of cervical cancer?
often causes little to no discomfort
lesions can bleed, itch, cause pain wherever located
what is the topcial treatment of anogenital warts?
imiquimod cream (Aldara P, Zyclara): immune modulator
3.75% cream daily and wash off after 8 hours or 5% cream 3x/wk apply and wash off after 6-10 hours
sinecatechins 10% ointment (veregen): apply 0.5cm strand TID, wash off not needed
clinician applied: podophyllin 25%, tricholoracetic acid
what are the ablative treatment of anogenital warts?
cryotherapy
CO2 laser
electrosurgery
surgical excision
what are some counselling points for treating anogenital warts?
avoid contact with healthy skin
refrain from sexual activity while undergoing treatment
what are some side effects of anogenital wart treatment?
itching, tenderness, erythema, ulceration
which HPV types cause cervical cancer?
16 and 18 cause 70%
31, 33, 45, 52 and 58 cause 20%
which HPV types cause anal cancers?
16 and 18 cause 90%
which HPV types cause anogenital warts?
6 and 11
what types of HPV does Gardisil-9 protect agaisnt?
6, 11, 16, 18, 31, 33, 45, 52, 58
who is approved for Gardasil-9?
all individuals aged 9-45
what is the dosing for Gardasil-9?
9-14: 0.5 mL x 2 doses (0, 6 months)
15+: 0.5 mL x 3 doses (0, 2, 6 months)
immunocompromised: 3 dose series
what are some adverse effects of Gardasil-9?
local injection site reaction, headache, fever, nausea, dizziness, fatigue, diarrhea, oropharyngeal pain, upper abdominal pain
which types of HPV did Gardasil cover?
6, 11, 16, 18
not available anymore
what types of HPV does ceravix cover?
16 and 18
what is the difference between HSV-1 and HSV-2
HSV-1 is primarily associated with oral infection 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 (rare)
T or F
genital herpes increases the risk of acquisition of HIV?
True
increases the risk two-fold
what are the symptoms and duration of a primary HSV infection?
extensive, painful, bilateral, vesiculo-ulcerative genital or anal lesions
fever, malaise, myalgia, headache (67%)
tender inguinal lymphadenopathy (80%)
duration: 17-20 days
what are the symptoms and duration of a non-primary HSV infection?
doesnt last as long and is less severe and extensive
duration: 16 days
what are the symptoms and duration of recurrent HSV infection?
tend to be more mild and dont last as long
prodromal symptoms for 1-2 days
unilateral localized small painful genital vesicles and ulcers
systemic side effects in 5-12%
duration: 9-11 days
what are some complications of genital HSV?
meningitis, extragenital lesions
what is the treatment of primary HSV infection?
acyclovir 200mg PO five times per day x 5-10 days
or
famicyclovir 250mg TID x 5d
or
valacyclovir 1000mg PO BID x 10d
T or F
topical treatments can be used for HSV?
False
what is the treatment for primary HSV in pregnancy?
acyclovir 200mg PO QID x 5-10d
what is the treatment for severe primary HSV infection?
IV acyclovir 5mg/kg infused over 60 minutes q8h, convert to oral therapy once significantly improvedwh
what is the treatment of recurrent HSV infections?
valacyclovir 500mg PO BID or 1g PO daily x 3d
or
famicylovir 125mg PO BID x 5d
or
acyclovir 200mg PO 5x/d
when is it best to start therapy for a recurrent HSV infection?
within 6-12 hours to reduce severity and duration
who is eligible for suppression therapy of HSV?
anyone who has 6 or more recurrences a year, has significant complications, or have partners without herpes
what can be used for suppression therapy of HSV?
acyclovir 200mg PO 3-5x a day OR 400mg PO BID
or
famicyclovir 250mg PO BID
or
valacyclovir 500mg PO daily (for pts with 9 or fewer recurrences per year) OR 1000mg daily (for pts who have more than 9 recurrences a year)
what can be used for suppression therapy of HSV in pregnancy?
acyclovir 200mg PO QID or 400mg PO TID
or
valacyclovir 500mg PO BID
how does neonatal herpes occur?
when baby is deliver through an infected vagina (active infeciton)
when does neonatal herpes present itself?
around 4 wks of age
what are the complications of neonatal herpes?
generalized systemic infection involving liver, other organs, CNS and skin
mortality in nearly 60% of cases, 70% will experience severe or fatal complications
what is the treatment for neonatal herpes?
acyclovir 45-60mg/kg/d IV in 3 equal 8 hourly infusions, each over 60 mins for 14-21 days
what are some counselling points for HSV treatment?
antivirals will decrease severity and duration of symptoms but will not prevent recurrences
use as early as possible and until lesions are healed
abstain from sexual contact during symptomatic episodes until lesions are completely heaed
always use a condom as asymptomatic viral shedding can occur
life long infection
what is monkey pox (MPOX)?
viral zoonotic disease caused by orthopoxvirus
how is Mpox transmitted?
any form of direct contact with lesion, body fluids, mucosal surfaces or respiratory secretions of infected person or shared contaminated objects
what is the management of mpox?
supportive care
small pox antiviral
what is the vaccine for mpox?
imvamune (smallpox) vaccine
PEP and PrEP
what is the incubation period of mpox?
3-21 days
what are the symptoms of mpox?
rash: more prominent on fact and extremities – macules –> papules –> pustules –> crusting
lymphadenopathy
may be preceded by systematic symptoms (fever, myalgia, fatigue)
how long does mpox infection last?
self resolving within 2-4 weeks
