STIs Flashcards
What is pelvic inflammatory disease?
- ascending spread of pathogens from the vagina/cervix to upper female genital tract (endometrium, fallopian tubes, other structures). May present as a combination of endometriosis, salpingitis, turbo-ovarian abscess and pelvic peritonitis)
What are the common symptoms of mild-severe symptoms of PID?
- abdominal tenderness (abdominal/pelvic pain)
- cervical motion tenderness
- vaginal/urethral discharge
What are the most common STIs?
- gonorrhea
- chlamydia
- syphilis
- trichomoniasis
What are the reportable STIs?
- gonorrhea
- chlamydia
- syphilis
- hep B
- hep C
- HIV
People with gonorrhoea is often co-infected with _____
chlamydia
Patients with syphilis may be co-infected with _____
HIV
What are the contributing risk factors to STI infection?
- unaware, lack of knowledge
- gender (female > male)
- unprotected sex
- sexual contact with infected person
- number of sexual partners
- anonymous sex
- MSM
- host susceptibility ( e.g.. HIV)
- age
- socioeconomic
- sex worker and contacts
- societal stigma
- co-infection
- unreported infections
- asymptomatic patients
- missed sx
- geographic
What STIs are attributed to PID?
- gonorrhea and chlamydia
What are the other impacts of STIs?
- complications in reproduction
- PID
- risk of cervical cancer
- damage to reproductive tract
- transmission to others
- congenital/perinatal infections
- social stigma
- economic
- antibiotic resistance
- spread of other infectious diseases (HIV)
Chlamydia- highest rates are found in _____ cases
female
What age groups have the highest prevalence of STIs?
Females: 15-19 or 20-24
Males: 20-24 and 25-29 age groups
What STI have the majority of STIs in men?
- syphilis (highest rates in men 20-24 and in 30-39)
- female rates of syphilis lower than that for males
- however the female rate increased nearly four fold between 2013 and 2014
Sex must be abstained from for at least ______ after treatment completed
3 days
What is the test used to diagnose gonorrhoea?
- called the NAP - nucleic acid plasma test- to determine and test for gonorrhea
Humans are the only host for _____
gonorrhea
What are the risk factors of gonorrhea in females?
- can lead to scarring of the reproductive tract in females
What is the main risk factor for gonorrhoea in people?
- anonymous sex is risk factor here
What are the signs and symptoms of gonorrhea?
- milky discharge from the penis and scarring of the uterus are the main effects of gonorrhoea
How are patients that have both chlamydia and gonorrhea treated?
- they are both treated with zithromax and cefixime combinations
What other kinds of infections can be caused by N. gonorrhoea?
- oropharyanx
- ocular
- disseminated gonoccal infection
- neonatal conjunctivitis (ophthalmia neonatorum)
How does n. gonorrhoea attach to the mucosal membrane?
- attach to the mucosal surfaces (columnar, cuboidal or non-cornified squamous epithelial cells)
- N. gonorrheae cell proteins (virulence factors) contribute to the acquisition, spread and response to infection
What are the male complications of gonorrhoea?
- rare complications of gonorrhoea in men (prostatitis, inguinal lymphadenopathy)
What are the complications of gonorrhea in females?
- PID, ectopic pregnancy, infertility
What are the signs of gonorrhea in females?
- asymptomatic originally
- dysuria, frequency of urination increases
- abnormal vaginal discharge or uterine bleeding, purulent urethral or rectal discharge can be scant to profuse
What are the signs of gonorrhea in males?
- symptomatic more common- dysuria and frequency increased of urination, purulent urethral or rectal discharge can be scant to profuse, pruritus of anus, bleeding
What are the signs of disseminated gonorrhoea infections?
(when gonorrhoea seeds outside of the reproductive tract)
- fever, chills, joint pain, joint swelling, skin rash red spots
- can disseminate to other organ sites (meningitis, endocarditis)
How can neonates get gonorrhea?
- newborns can acquire gonorrhea during delivery - infection can lead to blindness
What is done in MB to prevent newborns from getting gonorrhea?
- erythromycin 0.5% eye ointment applied to newborns as GC prophylaxis
What gives a positive diagnosis of gonorrhoea?
- gram stain of gram negative diplococci
- culture of N. gonorrhoea from the urine, cervix or urethra
What are the treatment issues associated with gonorrhoea infections?
- emergency of antibiotic resistance form sulphonamides to ceftiaxone
- increased gonorrhoea treatment failure, concern with superbug
- increasing antibiotic resistance in Canada
39% of gonorrhoea is resistant to_____
ciprofloxacin
What are the antibiotics is gonorrhoea staring to become resistant to?
- ciprofloxacin
- azithromycin
- decreased cefixime and ceftriaxone susceptibilities
- tetracycline resistance
(complete loss of penicillin, ampilicillin, and FQ use over the decades)
What is the indication of anogenital infections used in adults and youths in 9 years of age (gonorrhoea)
ceftriaxone 250 mg IM in a single dose PLUS azithromycin 1 g po in a single dose (also used for MSM)
OR
ceftiaxone 800 mg IM in a single dose PLUS azithromycin 1 g po in a single dose
What is the indication for pharyngeal infections used in adults?
- ceftriaxone 250 mg IM in a single dose PLUS azithromycin 1 g po in a single dose
What is used for anogenital infections of gonorrhoea in children under the age of 9?
- cefixime 8 mg/kg po bid for 2 doses (max 400 mg per dose) plus azithromycin 20 mg/kg
OR
ceftriaxone 50 mg/kg OM plus azithromycin 20 mg/kg in a single dose
What is used to treat pharyngeal infections of gonorrhoea in those under 9?
- ceftriaxone 50 mg/kg plus azithromycin 20 mg/kg
What is used to treat pharyngeal infections of gonorrhoea in those under 9?
- ceftriaxone 50 mg/kg plus azithromycin 20 mg/kg
What is the preferred initial treatment for ALL disseminated infections in adults?
- ceftriaxone and azithromycin
What is the duration of ceftiaxone treatment in treating disseminated arthritis?
-7 days
What is the duration of ceftriaxone treatment in meningitis?
14 days
What is the duration of ceftriaxone treatment in endocarditis?
- 28 days
What is the duration of treatment in gonorreal ophthalmia?
- single dose! as well as azithromycin in a single dose
What is the preferred treatment for ophalmia neonatorum?
- ceftriaxone in a single dose
- irrigate eyes immediately with sterile normal saline and at lease hourly as long as necessary to eliminate discharge wh
What is the preferred treatment for neonates with disseminated gonococcal arthritis, meningitis or endocarditis?
- cefotaxime for 10-14 days
- hospitalization and consultation with an expert in infectious diseases should be initiated as soon as possible
- prophylactic treatment for possible chlamydial infection is not recommended unless follow-up can be assured
- testing should be done for chlamydia and if results are positive, treatment should be provided as per chlamydia protocol
What is the treatment regimen for those with cephalosporin resistant N. gonorrhoeae or a history of anaphylactic reaction to penicillin or an allergy to cephalosporins?
- azithromycin 2 g (single oral dose) plus gentamicin 240 mg IM (as 2 separate 3 mL injections of 40 mg/mL)
OR
can fuse gentamicin 240 mg IV infused over 30 minutes if IV is not feasible
What is the treatment regiment for those with macrolide resistant N. gonorrhoeae or a history of anaphylactic reaction to macrolides
- gentamicin IM (as 2 separate injections of 3 mL) OR
gentamicin240 mg IV infused over 30 minutes when the IM route is not feasible
plus azithromycin 2 g x 1 or doxycycline 100 mg x 7 days recommended
What is the quinolone treatment regimen for treating gonorrhoea?
- azithromycin 2 g (single oral dose) plus ciprofloxacin 500 mg (single oral dose)
What is PID disease?
- ascending pathogens from the cervix or vagina to the upper genital tract
- 1/3 PID cases attributed to gonorrhoea/chlamydia
- other causes included : mycoplasma, gram positives, gram negatives and anaerobes
- presents as endometriosis, salpingitis, tubo-ovarian abscess and pelvic peritonitis
What are the symptoms typically of PID?
- lower abdominal pain/mild pelvic pain
- increased vaginal discharge
- irregular menstrual bleeding
- fever (> 38 degrees)
- pain with intercourse
- painfull and frequent urination
- abdominal tenderness
- pelvic organ tenderness
- uterine tenderness
- adnexal tenderness
- cervical motion tenderness
- inflammation
What are the complications of PID?
- tubo-ovarian abscess, infertility, ectopic pregnancy, chronic pelvic pain
What is the inpatient treatment of PID?
- ## cefoxitin and oral doxycyclin OR clindamycin IV and gentamicin (ceftriaxone and doxycycline and metronidazole)
What is the outpatient treatment of PID?
- ceftriaxone 250 mg IM x1 + oral doxycycline (azithromycin alternative) + oral metronidazole
What is chlamydia caused by? (what bacteria?)
- chlamydia trachomatis
What are the characteristics of chlamydia trachomatis?
- gram negative, obligate intracellular pathogen
- less virulent than gonorrhoea
What are the characteristics of chlamydia compared to gonorrhoea?
- infection is less acute than gonorrhea
- many patients are asymptomatic
- C. trachomatic serovars D to K responsible for genital/perianal infections
- asymptomatic in up to 70% of women and 50% men- males are the largest reservoir
- urethritis may be hard to differentiate from gonorrhoea
- similar to GC, untreated disease may lead to PID, chronic pelvic pain, ectopic pregnancy
- increased risk of acquiring HIV
What are the main signs and symptoms of gonorrhoea in males?
- symptomatic gonorrhea is common
- urethral: mild dysuria, discharge
Pharyngeal: asymptomatic to mild pharyngitis - discharge scant to purulent urethral/rectal discharge
- recta; pain, discharge, bleeding
What are the main signs of symptoms of gonorrhoea in females?
- symptomatic gonorrhea is subclinical, dysuria/frequency is uncommon
- anorectal and pharyndeal symptoms are the same as for men
- can have abnormal vaginal discharge and uterine bleeding
- purulent urethral or rectal discharge can be scant to profuse
What are the main complications of gonorrhea in females?
- PID, ectopic pregnancy, infertility
What are the effects of a pregnant mother birthing a child with chlamydia?
- neonatal conjunctivitis
- pneumonia - generally mild but can be severe
What is the bacteria that can cause syphilis?
treponema pallidum (spirochete)
Can syphilis affect anyone but humans?
- no!
how many stages of syphilis are there is left untreated?
- 3
co-infection of ____ and syphilis is common
HIV
syphilis can enhance the acquisition of HIV
What is the site and clinical presentation associated with primary syphilis?
- genitalia, penianal, mouth, throat
- clinical presentation: chacre, regional lymphadenopathy
Incubation: 3 weeks
What is the site and clinical presentation associated with secondary syphilis?
- multisystem site
- clinical presentation: rash, fever, malaise, generalized lymphadenopathy, mucosal lesions, condylomata lata, alopecia, meningitis, headaches, uveitis, retinitis
Incubation: 2-12 weeks
What is the site and clinical presentation associated with tertiary syphilis?
- cardiovascular, neurosyphilis (CNS, eyes), gumma
- clinical presentation: aortic aneurysm, aortic regurgitation, coronary artery ostial stenosis
- ranges from asymptomatic to symptomatic with headaches, vertigo, personality changes, dementia, ataxia, presence of argyll robertson pupil
- tissue destruction of any organ, manifestations depend on site involved
What is the risk of syphilis to a newborn?
- T. pallidum can cross the placenta, fetal risk is highest when mom primary/secondary syphilis
- screen newborn early is there are signs and symptoms of early congenital syphilis
- congenital syphilis early (<2 years) vs late (>2 years)
What is the primary treatment for primary and secondary syphilis in adults? (non pregnant)
- benzahtine penicillin G 2.4 million units IM as a single dose
What is the alternative treatment for pen allergic patients?
- doxycycline 100 mg po bid for 14 days
- alternative agents (to be used in exceptional circumstances)
- ceftriaxone 1 g IV or IM daily for 10 days
What is the primary treatment for latent syphilis (>1 year duration)
Latent syphilis of unknown duration. Cardiovascular syphilis and other tertiary syphilis not involving the central nervous system?
- benzathine penicillin G 2.4 million units IM weekly for 3 doses
What is the alternative treatment for penicillin allergic patients?
- consider penicillin desensitization
- doxycycline 100 mg po bid for 28 days
- alternative agents (to be used in exceptional circumstances)
- ceftriaxone 1 g IV or IM daily for 10 days
What is the treatment for neurosyphilis?
- penicillin G 3-4 million units IV q4h (16-24 million units/day) for 10-14 days
What is the cause of trichomonas infection?
- trichomonas vaginalis (flagellated , motile protozoan)
- humans are the only host and it is spread through sexual contact
What is the treatment for trichomoniasis?
- metronidazole 2 g as a single dose OR metronidazole 500 mg bid for 7 days
What is trich infections associated with in pregnancy?
- premature rupture of the membranes, preterm birth and low birth weight
- symptomatic women: treat as above- metronidazole is used in pregnancy and breastfeeding
What are the characteristics of HPV?
- common viral STI
- HPV infects the moist mucosa of the anogenital tract, oral cavity and oropharynx
- non-mucosal HPV causes warts on hands/feet
- HPV can occur in both males and females, higher in females < 25years old, males across all ages
What HPV strains account for most of anogenital warts?
- 6 and 11
What HPV strains account for cervical cancers?
- 16 and 18 (high risk)
