STIs Flashcards
Potentially cause chronic pelvic pain and infertility
chlamydia
ELISA is used as a screening test
HIV
Screening test may be negative during initial acute flu-like illness
HIV
If HIV is suspected during acute flu-like illness, what test should be ordered?
NAAT: RNA qualitative assay
(2) produces malodorous vaginal discharge
- trichimoniasis
- BV
Frothy yellow discharge
may be asymptomatic especially in >40yo
Trichomoniasis
NAAT used for screening
GC/CG
Who should be screened yearly for STIs
<25 year olds
Term for initial painless lesion associated with syphilis
Chancre
organism associated with syphillis
Treponema pallidum
Positive whiff-amine test
BV
Birth control to increase BV cure rates
condoms
HIV confirmatory test
Western blot
Treated with metronidazole 500 mg BID for 7 days
- BV
- trich
Are metronidazole and clindamycin safe in pregnancy
yes, but avoid in 1st trimester
STI that causes cervical cancer
HPV
white, adherent, malodorous discharge
BV
Serology test to differentiate HSV1 and 2
IgG
positive “chandelier test” indicates
PID
Patient group at highest risk for HIV
Hispanic MSM
__% with HIV report no high-risk behaviors
25%
screen everyone
If HIV 1/2 antigen/antibody assay is positive (ELISA) what do you order
HIV 1/2 antibody differentiation immunoassay (replaces western blot)
- (+) refer
- (-) order NAT (HIV1 RNA qualitative assay)
Initial HIV infection duration
<14 days
Initial HIV infection presentation
- fever
- pharyngitis
- nonpruritic macular skin rash
- malaise
- headache
- lymphadenopathy
When is HIV most infectious
acute retroviral stage
2-4 weeks postinfection
What is a significant risk factor for reactivation of latent TB
HIV
What should never be given to HIV infected patients
live attenuated vaccines
When are HIV antibodies typically developed
within 3 months of exposure
AIDs definition
CD4 cell count <200
infection with opportunistic infections and malignancies
s/sx of AIDs
- oral thrush
- fever
- weight loss
- diarrhea
- cough
- SOB
- purple to bluish red bumps on skin
What causes the most deaths in patients with HIV
-infection with Pneumocystis jirovecii
Which HIV strain is most common in US
HIV 1
Step 1 with suspected HIV
- HIV-1/HIV-2 antibodies and P24 antigen with reflex
- detects if strain 1 or 2
Step 2 if HIV1/2 antibodies are positive
- lab performs HIV1/2 antibody differentiation immunoassay
- if results indeterminate, order HIV RNA test
HIV RNA PCR can detect HIV infection as early as
7-28 days
Pneumocystis carinii prophylaxis
Bactrim DS one tab daily
MOnitoring viral load on ART frequency
every 1-2 months until viral load is undetectable
then q 3-4 months
Tenofovir lab monitoring
-UA every 6 months
nephrotoxic
Zodovudine lab monitoring
-CBC with diff
BM suppression
HIV education what to avoid
- cat litter
- undercooked meat
- turtles, snakes, other amphibians
- bird stool
Preventing HIV transmission
- condom every sexual encounter
- do not share needles
- do not share toothbrush, razer, or any blood item
HIV infected mothers and breastfeeding
do NOT breastfeed
Who should take PrEP
- ongoing sexual relationship with HIV (+) partner
- LGBT who do not use condoms/high risk sexual behaviors
PrEP HIV checks
check for HIV before starting
-then every 3 months
PEP
postexposure prophylaxis
Outer limit of PEP
72 hours postexposure
When to start prophylaxis for Pneumocystis carinii
when CD4 is <200
When to start antiretroviral therapy in HIV infected pregnant women
ASAP
Which HIV drug is safest for HIV infected pregnant women
-Zodivudine
What to do if HIV+ patient is unwilling to notify partners
-health department will try to locate them
Why does BV occur
-replacement of normal vaginal flora with high concentrations of anaerobic bacteria
Risks of BV
- multiple sex partners
- new partners
- douching
- IUCs
BV increases risk for
STI
UTI
post-gynecologic surgery infections
preterm labor
BV organisms
- Prevotella
- Mobiluncus
- G.vaginalis
BV Amsel criteria
- requires 3 for diagnosis
- white discharge coating vulva/vagina
- vaginal pH of >4.7
- fishy odor before or after addition of KOH (whiff test)
- clue cells on microscopy
BV management
- screen for other STIs
- Metronidazole 500 mg PO BID x 7 days (cream available)
- Clindamycin 300 mg PO BID x 7 days
Patient teaching with metronidazole
-no alcohol until 24 hours after last dose
With recurrent BV, what must you rule out
HIV
Pregnant women treated with GC/CG should have test-of-cure when
3-4 weeks after treatment
Pregnant women who were treated should be tested again for GC/CT when
at 3 months
Most chlamydial infections are symptomatic
false
Which STD is most common in US
chlamydia
Lab testing for GCCT
NAAT
-swabs or urine sample
Treatment for uncomplicated chlamydia
- Azithromycin 1 g PO single dose
- OR doxycyline 100 mg BID x 7 days
Is a test-of-cure necessary for uncomplicated chlamydia
no
Chlamydia treatment for sexual partners
- azithromycin 1 g PO
- abstain from sex for 7 days
Expedited Partner Therapy
practice of treating sexual partner of a patient diagnosed with STD without evaluating them
-Allowed in 41 states
Treatment for PID
- Ceftriaxone (Rocephin) 250 mg IM x one dose
- PLUS doxycycline PO BID x 14 days
- with or without metronidazole PO BID x 14 days
What can happen with gonorrhea infection if not treated
-can become systemic or disseminated
Treatment for gonorrhea
-treat for both chlamydia and gonorrhea d/t high rates of coinfection
Gonorrhea presentation
- purulent green-colored vaginal discharge
- shuffling gait to avoid abdominal pain
- cervix friable
- males can have penile discharge
- new onset sex partner or multiple sex partners
- inconsistent condom use
Proctitis presentation
- pruritus
- rectal pain
- tenesmus (cramping of rectum)
- feeling urge to defecate even if rectum is empty
- avoiding defecation due to pain
Gonorrhea presentation in men
- may be asymptomatic
- dysuria
- discharge
- testicular pain
Trichomoniasis presentation
- asymptomatic for decades
- frothy yellow green discharge
- vulvar irritation
- dysuria
- cervical petechiae
Diagnosis of trichomoniasis
- wet prep –> flagellated motile cells
- NAAT
Trichomoniasis management
- Metronidazole 2 g single dose
- abstinence from sex until treatment completion
- treat sexual partners
- avoid alcohol x 72 hours after dose
Trichomoniasis organism
trichomoniasis vaginalis
Primary syphilis findings
- chancre
- indurated and painless, well demarcated
- persists for 1-5 weeks and heals spontaneously
- regional lymphadenopathy
Secondary syphilis findings
- symmetrical bilateral rash
- frequently on palms and soles
- 2-6 weeks and resolves
- condyloma lata: moist, pink, warty lesions
Condyloma lata indicates which stage of syphilis
secondary
Latent syphilis findings
asymptomatic
Tertiary syphilis findings
- CVD: aortic valve disease, aneurysms
- Neuro: meningitis, encephalitis, tabes dorsalis, dementia
- Skin: gummas
- Ortho: Charcot joints, osteomyelitis
Syphilis organism
treponema pallidum
Syphilis management
Benzathine PCN G (Bicillin) 2.4 million units IM
First labs to order with syphilis
- nontreponemal tests: RPR or VDRL
- if positive: order confirmatory tests
Confirmatory test for syphilis
Treponemal tests
-FTA-ABS
What is diagnostic for syphilis
+RPR and +FTA-ABS
What to monitor for treatment response in syphilis
- sequential RPR
- four fold or higher decrease means responding well to treatment
Treatment for primary, secondary, or early latent syphilis (<1 year)
-Benzathine PCN G (Bicillin L-A) 2.4 million units IM x one dose
Syphilis follow up
RPR or VDRL at 6 and 12 months of treatment
When to refer syphilis to infectious disease specialist
- suspected neurosyphilis
- poor response to treatment
- PCN allergy
- or if not familiar with management
Proctitis patho
Lining of inner rectum becomes inflamed
-can be due to STI’s
Complicated gonococcal infections include…
- PID
- acute epididymitis
- acute prostatitis
- acute proctitis
Risks for PID
- history of PID (25% recurrence)
- Multiple partners
- Age <25
Urine specimen is best collected with
first urine of the day
STI’s requiring serum
- HIV
- Hep B and C
- syphilis
- HSV type 2
Sexual assault after care
- Hep B immunization
- HPV vaccination
- GC/CT treatment: Rocephin +Azithromycin
- Trich and BV treatment: Metronidazole 2 g
- consider PEP for HIV with zidovudine
Complication of PID due to chlamydia or gonorrhea infection
Fitz-Hugh-Curtis syndrome
Jarisch-Herxheimer reaction
- acute febrile reaction during first 24 hours of syphilis treatment and other spirochetes
- resolves spontaneously within 24 hours
Reiter’s syndrome
- more in males
- joint pain and swelling
- conjunctivitis
- urethritis
- immune-mediated reaction secondary to infection with certain bacteria that resolves spontaneously
- supportive treatment
Reiter’s syndrome mnemonic
cant see
cant pee
cant climb a tree
Follow up for PID treatment
- within 72 hours
- retest for adnexal tenderness or cervical motion tenderness
Condyloma acuminata
genital warts
HPV vaccine is given at age
- 9-14: 2 doses 6-12 months apart
- 15-45, IC: 0, 1-2, 6
Genital warts treatment
- Podofilox (Condylox) 0.5% gel or cream x 3 days, hold for 4 days, repeat up to 4 times
- Imiquimod or Zyclara, thin layer three times a week
- Sinecatechins
- electrocautery
HSV prodrome
-itching, burning, tingling on site
HSV diagnostic test
- herpes viral culture
- RPR assay for HSV 1/2 DNA –> more sensitive
First herpes outbreak treatment
- Acyclovir 400 mg TID 7-10 days or 200 mg five x/day
- Famciclovir 1 g BID 7-10 days
- Valacyclovir TID 7-10 days
Episodic HSV treatment
- best if started within 1 day of lesion onset
- Famciclovir 125 mg BID x 5 days
- Acyclovir x 5 days
- Valacyclovir x 5 days
HSV suppressive treatment
-Acyclovir 400 BID or famciclovir 250 mg BID
Imiquimod
- immune modulator
- patient can use at home
Genital warts treatment C/I in pregnancy
- podofilox
- podophylla
- imiquimod
Genital warts treatment for pregnancy
- manual removal by HCP
- cryo, laser, excision
Which strains of HPV are oncogenic
- 16
- 18
Screening test for HIV
-combination HIV-1 and HIV-2 antibody immunoassay with p24 antigen
ELISA and Western Blot test for HIV tests what
HIV antibody
