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PHAR 253 > STIs > Flashcards

STIs Flashcards

1
Q

what is the definition of an STI?

A

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

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2
Q

what are the groups of STIs?

A

viral: HPV, HIV, HSV

bacterial: chlamydia, gonorrhea, syphilis

parasitic/fungal: trichomoniasis

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3
Q

what are some risk factors for STIs

A

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

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4
Q

what groups of people are at an increase risk of STIs?

A

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

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5
Q

T or F
a person treated for an STI in the past is unable to be re-infected with the same STI

A

False

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6
Q

What are the SK communicable disease control management guidelines?

A

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

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7
Q

what are the PHAC sexually transmitted and blood born infection guidelines?

A

guidelines for health professionals
screening recommended specific to STI
offer in the course of route with special attention to those with risk factors

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8
Q

Which STIs are nationally notifiable?

A

chlamydia, gonorrhea, syphilis, hepatitis, HIV, chancroid

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9
Q

what are the goals of therapy for treating STIs?

A

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

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10
Q

When should pregnant women be tested for STIs?

A

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

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11
Q

what does vaginal discharge look like when infected with candidiasis?

A

pruritis, white, clumpy, curdy discharge

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12
Q

what does vaginal discharge look like when infected with trichomoniasis?

A

pruritis, odour, off white or yellow frothy discharge

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13
Q

what does vaginal discharge look like when infected with bacterial vaginosis?

A

fishy odour, grey or milky, thin copious discharge

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14
Q

what is the treatment of bacterial vaginosis?

A

metronidazole PO or metronidazole or clindamycin PV

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15
Q

is it necessary to treat asymptomatic BV?

A

no
only if undergoing procedure or high risk pregnancy

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16
Q

which STIs discussed in class are spread through skin to skin contact?

A

HSV, HPV, syphilis

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17
Q

which STIs discussed in class are vertically transmitted to baby?

A

all
chlamydia, HSV, gonorrhea, HPV, syphilis

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18
Q

which STIs discussed in class are curable?

A

chlamydia, gonorrhea, syphilis

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19
Q

which STIs discussed in class affect fertility?

A

chlamydia, gonorrhea, syphilis

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20
Q

what causes chlamydia?

A

chlamydia trachomatis (gram negative)

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21
Q

what are the common symptoms of chlamydia?

A

most people are asymptomatic

dysuria
urethritis
cervicitis
proctitis
conjunctivitis (if in eye)

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22
Q

what are the symptoms of chlamydia in women?

A

cervicitis, vaginal discharge, lower abdominal pain, dysuria, abnormal vaginal bleeding, painful intercourse, conjunctivitis, proctitis

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23
Q

what are the symptoms of chlamydia in men?

A

urethritis (discharge, pain), urethral itch, dysuria, testicular pain, conjunctivitis, proctitis

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24
Q

what are the symptoms of chlamydia in infants/children?

A

conjunctivitis, pneumonia

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25
Q

what are the complications of chlamydia in women?

A

pelvic inflammatory disease
ectopic pregnancy
infertility
chronic pelvic pain
Reiter syndrome

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26
Q

what are the complications of chlamydia in men?

A

epididyo-orchitis
Reiter syndrome

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27
Q

what is Reiter syndrome?

A

reactive arthritis that affects joints, eyes, urethra, skin

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28
Q

what is the preferred treatment of chlamydia?

A

doxycycline 100mg PO BID x 7d
or
azithromycin 500mg PO QD x 7d

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29
Q

what is the alternative treatment of chlamydia?

A

levofloxacin 500mg PO QID x7d

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30
Q

what is the treatment of chlamydia in pregnancy?

A

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

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31
Q

what are some counselling points for pts taking doxycylcine?

A

take with food
take with iron or calcium may decrease absorption
photosensitivity

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32
Q

what are some counselling points for pts taking azithromycin?

A

GI upset
may need prophylactic antiemetics

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33
Q

what do you tell a pt being treated for chlamydia about sexual activity?

A

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

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34
Q

what is the follow up for patients being treated for chlamydia?

A

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

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35
Q

what is lymphogranuloma venereum (LGV)?

A

chlamydia trachomatis genotypes L1, L2, L3 which are more invasive than non-LGV genotypes
preferentially affect the lymph tissue

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36
Q

what is the timeline and symptoms of the 3 stages of LGV?

A

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

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37
Q

what is the preferred and alternative treatment of LGV?

A

preferred:
doxycycline 100mg PO BID x 21d

alternative:
azithromycin 1g PO once weekly x 3w

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38
Q

what causes gonorrhea?

A

Neisseria gonorrhoeae

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39
Q

why do we treat chlamydia and gonorrhea together?

A

high rates of concomitant infection

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40
Q

what are the symptoms of gonorrhea in females?

A

vaginal discharge
lower abdominal pain
dysuria
cervical discharge
Bartholinitis
dyspareuria
rectal pain
discharge with proctitis

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41
Q

what are the symptoms of gonorrhea in men?

A

urethral discharge
dysuria
urethral itch
testicular pain
epididymitis
rectal pain
discharge with proctitis

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42
Q

what are the complications of gonorrhea in females?

A

pelvic inflammatory disease –> infertility and risk of ectopic pregnancy
chronic pelvic pain
disseminated genital infection (DGI)
reactive arthritis
perihepatitis

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43
Q

what are the complications of gonorrhea in males?

A

epididymo-orchitis
disseminated genital infection (DGI)
reactive arthritis
perihepatitis

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44
Q

what is disseminated genital infection (DGI)?

A

spectrum including arthritis, tenosynovitis, dermatitis, endocarditis, meningitis

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45
Q

why do we treat gonococcal infections with combination therapy?

A

improves efficacy and potentially delays resistance

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46
Q

T or F
there is an issue with resistance in the treatment of chlamydia?

A

False

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47
Q

T or F
there is an issue with resistance in the treatment of gonorrhea

A

True

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48
Q

What is the preferred treatment of anogenital gonorrhea?

A

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

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49
Q

what is the alternative treatment of anogenital gonorrhea?

A

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

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50
Q

when is doxycycline CI?

A

in pregnant and breastfeeding women

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51
Q

what is the preferred treatment for pharyngeal gonorrhea?

A

ceftriaxone 250mg IM in a single dose PLUS azithromycin 1g PO in a single dose

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52
Q

what is the alternative treatment of pharyngeal gonorrhea?

A

cefixime 800mg PO in a single dose PLUS azithromycin 1g PO in a single dose

53
Q

what do you tell a pt being treated for gonorrhea about sexual activity?

A

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

54
Q

how long after taking single dose azithromycin will you have to retake the dose if you vomit?

A

within 1 hour

55
Q

what is the follow up for gonorrhea?

A

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

56
Q

what causes syphilis?

A

treponema pallidum (spirochete)

57
Q

how is syphilis transmitted?

A

via contact with chancres

58
Q

what tends to happen in concurrent infections of syphilis and HIV?

A

more rapid progression to neurosyphilis and more aggressive and atypical signs of infection

59
Q

what is the timeline and symptoms of primary syphilis?

A

3-90 days

painless lesion (chancre), regional lymphadenopathy (swollen lymph nodes in genital area)

60
Q

what is the timeline and symptoms of secondary syphilis?

A

2 wks to 6 months

rash, fever, malaise, lymphadenopathy, mucous lesions, condyloma lata, alopecia, meningitis, headaches, uveitis, retinitis

61
Q

what is the timeline and symptoms of early latent syphilis?

A

asymptomatic syphilis for less than 1 year

62
Q

what is the timeline and symptoms of late latent syphilis?

A

asymptomatic syphilis for more than 1 year

63
Q

what stages of syphilis are infectious?

A

primary, secondary, and early latent

64
Q

what is the timeline and symptoms of tertiary syphilis?

A

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

65
Q

when can neurosyphilis occur?

A

at any stage
early: within 1st year
late: 1-20 years

66
Q

what are the symptoms of neurosyphilis?

A

ranges from asymptomatic to headaches, vertigo, personality changes, dementia, ataxia, Argyll Robertson pupil, otic and ocular symptoms

67
Q

in what group of people is neurosyphilis typically asymptomatic?

A

immunocompromised

68
Q

what is the test for diagnosising neurosyphilis?

A

lumbar puncture

69
Q

what is the timeline and symptoms of early congenital syphilis?

A

onset < 2 years

2/3 may be asymptomatic

anemia, neurosyphilis, rhinitis, osteochondritis, hepatosplenomegaly, mucocutaneous lesions, fulminant disseminated infection

70
Q

what is the timeline and symptoms of late congenital syphilis?

A

persistence > 2 years after birth

anemia, neurosyphilis, interstitial keratitis, lymphadenopathy, hepatosplenomegaly, bone involvement, anemia, Hutchinson’s teeth

71
Q

what is the preferred treatment for primary, secondary and early latent syphilis?

A

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

72
Q

what is the treatment for primary, secondary, and early latent syphilis in penicillin allergy?

A

doxycycline 100mg PO BID x 14 d

73
Q

what is the alternative treatment for primary, secondary and early latent syphilis and when can it be used?

A

ceftriaxone 1g IV or IM daily x 10d

only used in exceptional circumstances and when close follow up is assured

74
Q

what is the preferred treatment for late, late latent, CV syphilis, gumma?

A

Benzathine penicillin G-LA 2.4 million U IM weekly for 3 doses

75
Q

when would you give 3 doses of benzathine penicillin G-LA empirically?

A

when we do not know what stage/when infection was acquired

76
Q

what is the alternative treatment for late, late latent, CV syphilis, gumma and when can it be used?

A

ceftriaxone 1g IV or IM x 10 d

can be used in exceptional circumstances and when close follow up is assured

77
Q

what is the treatment for late, late latent, CV syphilis, gumma in penicillin allergy?

A

doxycycline 100mg PO BID x 28 d

strongly consider penicillin desensitization

78
Q

what is the treatment for neurosyphilis?

A

refer to neurologist or infectious disease specialist

IV antibiotics x 14d

79
Q

what is the treatment of syphilis in pregnancy?

A

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

80
Q

what do you tell a pt being treated for syphilis about sexual activity?

A

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

81
Q

when is follow up recommended for syphilis?

A

primary, secondary, early latent: 3, 6, and 12 months

late latent and tertiary (not neurosyphilis): 12 and 24 months

82
Q

when is follow up recommended for syphilis in people who have HIV?

A

3, 6, 12 and 24 months post treatment

83
Q

when is follow up screening done for syphilis in pregnant women?

A

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

84
Q

what is Jarisch-Herxheimer reaction?

A

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

85
Q

what is the problem with Jarisch-Herxheimer reaction in pregnancy?

A

it may induce early labour or cause fetal distress

86
Q

what is the most common STI worldwide?

A

HPV

87
Q

what are the symptoms of genital warts?

A

asymptomatic
itchiness
discomfort during intercourse
bleeding with intercourse or shaving
warts of penis or vulva (cauliflower like)

88
Q

what are the symptoms of cervical cancer?

A

often causes little to no discomfort
lesions can bleed, itch, cause pain wherever located

89
Q

what is the topcial treatment of anogenital warts?

A

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

90
Q

what are the ablative treatment of anogenital warts?

A

cryotherapy
CO2 laser
electrosurgery
surgical excision

91
Q

what are some counselling points for treating anogenital warts?

A

avoid contact with healthy skin

refrain from sexual activity while undergoing treatment

92
Q

what are some side effects of anogenital wart treatment?

A

itching, tenderness, erythema, ulceration

93
Q

which HPV types cause cervical cancer?

A

16 and 18 cause 70%

31, 33, 45, 52 and 58 cause 20%

94
Q

which HPV types cause anal cancers?

A

16 and 18 cause 90%

95
Q

which HPV types cause anogenital warts?

A

6 and 11

96
Q

what types of HPV does Gardisil-9 protect agaisnt?

A

6, 11, 16, 18, 31, 33, 45, 52, 58

97
Q

who is approved for Gardasil-9?

A

all individuals aged 9-45

98
Q

what is the dosing for Gardasil-9?

A

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

99
Q

what are some adverse effects of Gardasil-9?

A

local injection site reaction, headache, fever, nausea, dizziness, fatigue, diarrhea, oropharyngeal pain, upper abdominal pain

100
Q

which types of HPV did Gardasil cover?

A

6, 11, 16, 18
not available anymore

101
Q

what types of HPV does ceravix cover?

A

16 and 18

102
Q

what is the difference between HSV-1 and HSV-2

A

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)

103
Q

T or F
genital herpes increases the risk of acquisition of HIV?

A

True
increases the risk two-fold

104
Q

what are the symptoms and duration of a primary HSV infection?

A

extensive, painful, bilateral, vesiculo-ulcerative genital or anal lesions
fever, malaise, myalgia, headache (67%)
tender inguinal lymphadenopathy (80%)

duration: 17-20 days

105
Q

what are the symptoms and duration of a non-primary HSV infection?

A

doesnt last as long and is less severe and extensive

duration: 16 days

106
Q

what are the symptoms and duration of recurrent HSV infection?

A

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

107
Q

what are some complications of genital HSV?

A

meningitis, extragenital lesions

108
Q

what is the treatment of primary HSV infection?

A

acyclovir 200mg PO five times per day x 5-10 days
or
famicyclovir 250mg TID x 5d
or
valacyclovir 1000mg PO BID x 10d

109
Q

T or F
topical treatments can be used for HSV?

A

False

110
Q

what is the treatment for primary HSV in pregnancy?

A

acyclovir 200mg PO QID x 5-10d

111
Q

what is the treatment for severe primary HSV infection?

A

IV acyclovir 5mg/kg infused over 60 minutes q8h, convert to oral therapy once significantly improvedwh

112
Q

what is the treatment of recurrent HSV infections?

A

valacyclovir 500mg PO BID or 1g PO daily x 3d
or
famicylovir 125mg PO BID x 5d
or
acyclovir 200mg PO 5x/d

113
Q

when is it best to start therapy for a recurrent HSV infection?

A

within 6-12 hours to reduce severity and duration

114
Q

who is eligible for suppression therapy of HSV?

A

anyone who has 6 or more recurrences a year, has significant complications, or have partners without herpes

115
Q

what can be used for suppression therapy of HSV?

A

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)

116
Q

what can be used for suppression therapy of HSV in pregnancy?

A

acyclovir 200mg PO QID or 400mg PO TID
or
valacyclovir 500mg PO BID

117
Q

how does neonatal herpes occur?

A

when baby is deliver through an infected vagina (active infeciton)

118
Q

when does neonatal herpes present itself?

A

around 4 wks of age

119
Q

what are the complications of neonatal herpes?

A

generalized systemic infection involving liver, other organs, CNS and skin

mortality in nearly 60% of cases, 70% will experience severe or fatal complications

120
Q

what is the treatment for neonatal herpes?

A

acyclovir 45-60mg/kg/d IV in 3 equal 8 hourly infusions, each over 60 mins for 14-21 days

121
Q

what are some counselling points for HSV treatment?

A

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

122
Q

what is monkey pox (MPOX)?

A

viral zoonotic disease caused by orthopoxvirus

123
Q

how is Mpox transmitted?

A

any form of direct contact with lesion, body fluids, mucosal surfaces or respiratory secretions of infected person or shared contaminated objects

124
Q

what is the management of mpox?

A

supportive care
small pox antiviral

125
Q

what is the vaccine for mpox?

A

imvamune (smallpox) vaccine
PEP and PrEP

126
Q

what is the incubation period of mpox?

A

3-21 days

127
Q

what are the symptoms of mpox?

A

rash: more prominent on fact and extremities – macules –> papules –> pustules –> crusting
lymphadenopathy
may be preceded by systematic symptoms (fever, myalgia, fatigue)

128
Q

how long does mpox infection last?

A

self resolving within 2-4 weeks

PHAR 253 (6 decks)

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