STIs Flashcards
biggest risk factors for STIs
number of sexual partners
teens and 20s
MSM
African American and Hispanic
single, seperated, divorced
ED drug use
what do condoms not protect from
STIs spread by skin to skin contact
genital herpes, HPV, syphilus
HPV vaccine recommended for who
children 11-12 years
anyone under 26 without it
27-45 sometimes
what does HPV vaccine help with
prevents new HPV infections before exposure, does not treat an active infection
gonorrhea can present as what in adults
uncomplicated genital infection
anorectal infection
pharyngeal infection
(mostly asymptomatic)
gonorrhea can present as what in newborns
opthalmia neonatorum
from birth canal or in utero
diagnosis of gonorrhea
NAAT test
gram negative diplococci
treatment for gonorrhea of cervix, urethra, rectum
<150 kg: ceftriaxone 500 mg IM x 1
> 150 kg: ceftriaxone 1 g IM x 1
if chlamydia not ruled out:
- doxycycline 100 mg PO BID x 7 days
- if pregnant: azithromycin 1 g PO x 1
treatment for gonorrhea of cervix, urethra, rectum if ceftriaxone unavailable or allergy to cephalos
gentamicin 240 mg IM x 1
+ azithromycin 2 g PO x 1
OR
cefixime 800 mg PO x 1
if chlamydia not ruled out:
- doxycycline 100 mg PO BID x 7 days
- if pregnant: azithromycin 1 g PO x 1
treatment for gonorrhea in pharynx
<150 kg: ceftriaxone 500 mg IM x 1
> 150 kg: ceftriaxone 1 g IM x 1
if chlamydia positive:
- doxycycline 100 mg PO BID x 7 days
- if pregnant: azithromycin 1 g PO x 1
what if there is ceftriaxone unavailable or allergy in gonorrhea for pharynx
no other treatment options
patient education for gonorrhea treatment
abstain from sex for 7 days after treatments and until 7 days after partner treated
types of syphilus
primary
secondary
latent
tertiary (late)
neurosyphilis
congenital syphilis
diagnosis of syphilis
2 types of serologic testing
1. nontreponemal - detect reagin
2. treponemal tests - confirmatory (more sensitive)
- must use both types of tests
drug of choice for all types of syphilis
penicillin G (parenteral)
treatment for primary and secondary syphilis
benzathine penicillin G 2.4 mil IM x 1 dose
if PCN allergy:
- doxycyline x 14 days
- tetracycline x 14 days
- azithromycin x 1 dose
treatment for early latent sypphilis
benzathine penicillin G 2.4 mil IM x 1 dose
if PCN allergy:
- doxycyline x 14 days
- tetracycline x 14 days
what is early latent syphilis
< 1 year duration
treatment for late latent syphilis
benzathine penicillin G 2.4 mil IM x 3 weeks
if PCN allergy:
- doxycyline x 28 days
- tetracycline x 28 days
treatment for tertiary syphilis
benzathine penicillin G 2.4 mil IM x 3 weeks
if PCN allergy:
- doxycyline x 28 days
- tetracycline x 28 days
what is late latent syphilis
> 1 year or unknown duration
treatment for neurosyphilis
aqueous crystalline penicillin G IV x 10-14 days
then benzathine penicillin IM x 3 weeks
OR
procaine penicillin IM daily +probenicid
if pcn allergy:
- ceftriaxone 2 g IM or IV daily x 10-14 days
treatment considerations for syphilis if HIV +
same
treatment of syphilis in pregnancy
penicillin only agent
if allergic do desensitization
what is a Jarisc-Herxheimer reaction
happens 2-4 hours after PCN admin
not to be confused with allergy
treat with antipyretics
chlamydia presentation in females and males
dysuria, urinary frequency in males
asymptomatic in females
chlamydia presentation in infants
most common cause of neonatal eye infections and afebriles interstitial pneumonia in infants < 6 months
diagnosis of chlamydia
NAAT test
Giemsa stain
(cell culture 100% specific)
chlamydia treatment
doxycycline 100 mg PO BID x 7 days
OR
azithromycin 1 g PO x 1 dose
OR
levofloxacin 500 mg PO q24h x 7 days
chlamydia treatment in pregnant women
azithromycin 500 mg PO x 1 dose
amoxicillin 500 mg PO TID x 7 days
patient education in pts with chlamydia
abstain from sex for 7 days after completion of therapy and until partners are treated
mycoplasma shape
no cell wall
presentation of mycoplasma
asymptomatic
diagnosis of mycoplasma
no cell wall
NAAT testing
treatment of mycoplasma based on what
macrolide suseptibility
mycoplasma treatment
macrolide suseptible:
- doxycycline x 7 days then
- azithromycin 1 g x 1 day then
- azithromycin 500 mg x 3 days
macrolide resistant or no testing:
- doxycycline x 7 days then
- moxifloxacin x 7 days
presentation of genital herpes simplex
flu like symptoms - long duration of symptoms
largely asymptomatic
high mortality and morbidity during pregancy and neonates
diagnosis of herpes
viral culture
HSV NAAT
serologic tets to detect HSV antibodies
initial treatment of genital herpes
acyclovir 400 mg PO TID
famciclovir 250 mg PO TID
valacyclovir 1 g PO BID
x 7-10 days !
recurrent treatement of genital herpes
acyclovir 2 or 5 days
famciclovir 1 or 5 days
valacyclovir 3 or 5 days
overall 1-5 days for recurrent
when to give recurrent treatment of herpes simplex
if prodromal symptoms or within 1 day of onset of lesions
treatment of severe herpes simplex
acyclovir 5-10 mg/kg/dose IV q8h for 2-7 days
suppressive treatment of herpes simplex
acyclovir 400 BID
famciclovir 250 BID
valacyclovir 500 mg daily
valacyclovir 1 g daily
when to give suppressive treatment herpes simplex
if frequent occurences > 6 per year
treatment of herpes simplex in HIV patients
episodic:
acyclovir
famciclovir
valacyclovir
x 5-10 days
daily suppressive:
acyclovir
famciclovir
valacyclovir
BID
treatment of herpes simplex in acyclovir resistant
foscarnet 40-80 mg/kg/dose IV q8h
cidofovir 5 mg/kg/dose IV once weekly
treatment of herpes simplex in pregnant women
start supressive therapy at 36 weeks
acyclovir
valacyclovir
clinical presentation of trichomoniasis
asymptomatic
diagnosis of trichomoniasis
wet mount examination of discharge
NAAT
treatment of trichomoniasis drug
metronidazole
tinidazole
trichomoniasis treatment in women vs men
women
metronidazole 500 BID x 7 days
tinidazole 2 g x 1 dose
men
metronidazole 2 g x 1 dose
tinidazole 2 g x 1 dose
HIV
metronidazole 500 BID x 7 days
can we use metronidazole gel
no
what if allergy to metronidazole in trichomoniasis
desensitization
when should women be retested for trichomoniasis
< 3 months after initial treatment
considerations with metronidazole
avoid alcohol 24 h w metro and 72 hours with tinidazole
in breast milk, wait 12-24 hours after end of treatment
treat the partner too
pelvic inflammatory disease treatment
ceftriaxone
+ doxycycline
+ metronidazole
x 14 days
OR
ampicillin/sulbactam
doxycycline
x 14 days
if PCN allergy:
- clindamycin + gentamycin x 14 days
pelvic inflammatory disease IM/oral option
ceftriaxone x 1 dose
doxycycline x 14 days
metronidazole x 14 days
