STIs Flashcards
symptoms of urethritis (ngonorrheae, ctrachomatis)
dysuria
frequency
purulent or mucopurulent discharge
minimal or asymptomatic
symptoms of cervicitis (ngonoorheae, ctrachomatis)
purulent discharge
endocervical bleeding
asymptomatic
symptoms of genital ulcer disease
ulcer on genitalia
prostatitis (prostate gland infection) symptoms
dysuria
bloody urine
lower back pain
pain testes/penis
what is pelvic inflammatory disease
ascending spread of pathogens from vagina to upper female genital tract
symptoms of PID
abd/pelvic pain cervical motion tenderness vaginal discharge fever elevated WBC intermenstrual bleeding
define serology
measures/detects antibodies to pathogen
most common STIs
gonorrhea
chlamydia
syphilis
trichmoniasis
which STIs are reportable to MB health
gonorrhea chlamydia syphilis hep b hep c HIV
people wiht gonorrhea may be co infected with
chlamydia
NAAT
nucleic acid amplification test PCR detects specific DNA sequence of pathogen
DFA
diract fluorescent antigen
serology
measures/detects antibodies to pathogen
patients with syphillis may be coinfected with what
HIV
name some risk factors for stis
unprotected sex MSM age geographic sex worker gender unaware anonymous sex
some impact of stis
complications PID dmage to reporductive tract transmission antibiotic resistance economic congenital infections
which is the only sti greater in males
syphilis
sti patient education
risks of untreated infection/reinfection abstain from sex 3 days after treatment barrier protection return to care if symptoms not improved get tested reduce risks of sexual activity
most common infection of gon
urethrutus
cervicitis
other tyoes of gon infection
oropharyanx
ocular
diffeminated gonococcal infection
neonatal conjunctivitis
incubation of gon
1-14 day
male symptoms of gon
symptomatic common
urethral - dysuria, frequency
anorectal - pain
pharyngeal - pharyngitis
female symptoms of gon
asymptomatic or min symptomatic
urethral: dysuria, frequency
anorectal pain
pharyngeal- pharyngitis
signs of gon
urethral, rectal, or vaginal discharge
adnormal vag discharge or uterine bleeding
male complications of gon
epidiymitis prostatitis urethral stricture inguinal lymphadenopathy DGI
female complication of gon
PID
ectopic pregnancy
infertility
what is disseminated gon infection
ngon bacteremia seeds sites outside reproductive tract
fever, chills, joint pain, skin rash
if go to other organs ex. meningitis
symptoms of neonatal conjunctivitis
infection may lead to blindness
prevention of neonatal conjunctivits
erythromycin 0.5% eye ointment applied to newborns as prophylaxis
labs for gon
gram stain - gram negative diplococci
culture
NAAT
major concern for gon
antibiotic resistance
which antibiotics is gon completely resistant to
penicillin
ampicillin
fluoroquinolones - only use if local resistance <5%
what do you also treat for in gon
chlamydia due to high rate of concomitant infection
treatment of uncomplicated gon
ceftriaxone and azithromycin single dose
alternative treatment for uncomplicated gon
azithromycin single dose
cefixime and azithro
what should you do when monotherapy with azithromycin is use
test of cure
anogenital infection gon infection in <9yoa
cefixime and azithromycin
ceftriaxone and azithro
no alternative
pharyngeal infection treatment for <9yoa
ceftriaxone and azithro
alternative: cefixime and azithro
why dont we use macrolide in children under 1 month
pyloric stenosis
treatment of gon opthalmia and disseminated infection
ceftriaxone and azithro
what gon infections require hospitalization
meningitis and disseminated
any disseminated infection if under 9
treatment for ophthalmia neonatorum
ceftriaxone
irrigate eyes hourly
test for chlamydia (no prophylaxis)
hospitalization and consult with expert
anogenital gon alternative treatment if contraindication to cephalosporins and macrolide resistance
gentimicin iv or im plus azithromycin or doxy
when should you repeat screening in someone with a gon infection
6months after treatment
when do you test for cure for ngon
pharyngeal infections presistant symptoms alternative treatment reexposure pregnancy disseminated child abortion AM resistant
symptoms of PID
lower ab pain
irregular menstrual bleeding
fever
pain with intercourse and urination
complications of PID
tuboovaria abscess
infertility
extopic pregnancy
chronic pelvic pain
chlamydia pathogen
gram negative obligate intracellular pathogen
chlamydia incubation
35 days
chlamydia onset
7-21 days
sites of chlamydia infection
endocervical canal urethra oropharynx rectum eye
chlamydia sigs in symptoms in men
often asymptomatic dysuria discharge pharyngitis rectal pain discharge bleeding
chlamydia signs and symptoms in women
subclinical
pharyngitis
discharge
uterine bleeding
male complications of chlamydia
epididymitis
reiters syndrome
female complications of chlamydia
PID
ectopic pregnancy
infertility
reiters
newborn exposure to chlamydia can result in
neonatal conjunctivitis
pneumonia
diagnosis of chlamydia
NAAT
DFA
culture if treatment failure
symptoms and history
treatment options for uncomplicated urethral endocervical rectal and conjunctival infections in >9yoa
azithromycin one dose
doxy 7 days
treatment option for chlamydia in children
azithro
erythromycin
treatment option for chlamydia in pregnant women
azithro - weigh risk ad benefit
erythro
amox if cant tolerate either
pathogen in syphilis
treponema pallidum spirochete
invades humans only through mucous membranes or open lesions
co infection of syphilis and ____ is common
HIV
consult with specialist
describe primary syphiliis
genitalia, perianal, mouth, throat
chancre, regional lymphadenopathy
incubation 3 weeks
describe secondary syphilis
multisystem
rash, fever, malaise, mucous lesions, alopecia, meningitis..
incubation 2-12 weeks
describe latent syphilis
multisystem dormant
asymptomatic
describe tertiary syphilis
cardiovascular - aortic aneurysm, coronary artery stenosis, 10-30years
neurosyphilis - vertigo, personality changes, 2-20 years
gumma - tissue destruction of any organ, 15 years
syphilis in newborns
tpallidum can cross placenta, highest risk when mom in primary/secondary
screen for signs of early congenital syphilis
diagnosis of syphilis
history and cliinical presentation
dark field microscopy
NAAT
serologic - treponemal, non treponemal
treatment of primary, secondary, and early latent <1 yr duration syphilis
benzathine penicillin IM single dose
alternative: doxycycline PO 14 days
ceftriaxone IV 10 days
treatment of late latent or unknow duration latent and tertiary (not involving CNS) syphilis
benzathine penicillin IM 3 doses
alternative: penicillin desensitization, doxy for 28 days, ceftriaxone IV for 10 days
treatment of neurosyphilis
pen G x10-14 days
alternative: penicillin desensitization followed by penicillin, ceftriaxone IV x 10-14d
treatment of sexual contacts in prior 90 days to syphilis
pen G single dose IM
treatment of syphilis in pregnant women
pen G IM
consider pen desensitization followed by treatment with pen
trichomonas pathogen
trichomonas vaginalis
flagellated motile protozoan
humans only host
incubation time for trichmonas
3-28 days
detectable 48hr after exposure
sites of trichomonas infection
urethra endocervical canal rectum oropharynx eye
signs and symptoms of trichomonas in males
asymptomatic (more common than in females)
urethral discharge
dysuria, pruritis
signs and symptoms of trichomonas in women
asymptomatic malodorous vag discharge and pruiritis dysuria, dyspareunia vag ph 4.5-6 inflammation of vulva/vagina/cervix urethritis
male complication of trichomonas
epididymitis and chronic prostatitis
male infertility
female complications in trichomonas
PID
premature labor
premature rupture of membranes, low birth weight infants
cervical neoplasia
diagnosis of trichomonas
history
presentation
NAAT
microscopy
treatment of trichomonas
metronidazole single dose of 7 days
intravaginal metronidazole is not effective
metronidazole not CI in pregnancy or breast feeding
efficacy of trichamonas treatment
88% increase to 95% if partner also treated
infection sites of HPV
moist mucose of anogenital tract, oral cavity and oropharynx
non mucosal causes warts on hands and feet k
describe hov type 6 and 11
low risk
cause anogenital warts
describe HPV 16 and 18
high risk
cause cervical cancer
prevention of HPV
condoms
counselling
screening
HOV vaccination
describe gardisal
approved for females 9-45 and males 9-26
3 doses at 0,2,6 months
describe gardisil 9
4 HPV types added
describe ceravix
used for females 9-45
3 doses at 0, 1, 6 months
treatment of HPV
see specialist
difference between HSV 1 and 2
1 - oropharyngeal and genital disease
2- genital disease
5 stages of HPVinfection
primary mucocutaneous ganglia latency reactivation recurrent infection
difference between 1st episode primary and non primary
primary - HSV antibody negative individual
non primary - HSV + antibody, prior exposure
diagnosis of HSVC
history presentation electron microscopy tissue culture NAAT immunoflourescence assay
treatment of HSV
no cure
antivirals acyclovir, famciclovir, valacyclovir modify course
first episode antiviral reduce shedding and duration
recurrent can treat when prodrome or continuously suppressive to reduce frequency
HSV incubation
2-14 days
1st episode of HSV signs and symptoms
usualy asymptomatic
multiple painful lesions of external genitalia develop in a week and heal in 2-4 weeks
flu like symptoms
itching, pain, discomfort, discharge
how long does shedding of HSV occur for
primary 11-12 days, nonprimary 7 days
recurrent 4 days
in which people are HSV symptoms more severe
females
IC
primary infection
sings and symptoms of recurrent HSV
prodrome - itching, burning, tingling
fewer lesions, milder
asymptomatic viral shedding during first year of infection
complications of HSV
secondary infection of lesions extragenital infection because of autoinoculation disseminated meningitis encephalitis neonatal transmission
