STIs Flashcards
STIs are the most common ____
infection in the US
Portal of entry for STIs
skin, mucosal linings of urethra, cervix, vagina, rectum, oropharynx
_____ ____ is essential for prevention and effective treatment
community education
Male and female condoms (what it is, reduction of, what is essential for best protection)
- protective barrier against STI transmission: safer sex
- reduction (not elimination) of transmission of HIV and other STIs (SAFER not Safe sex)
- correct placement and use are essential for best protection
STI issues with dx and disease control (4)
- reluctance to seek timely health care
- STIs may progress without symptoms
- easy transmission during asymptomatic stage
- If one STI is diagnosed, must test for others
What bacteria causes syphilis?
Treponema pallidum
Primary syphilis
2-3 weeks after initial infection; development of chancre (painless lesion) on mouth, anus, vagina or penis
chancre lesions resolve spontaneously in 3-12 weeks
Secondary syphilis
- generalized infection (spread from chancres)
- rashes 1 week to 6 months after chancre, on trunk, extremities, including palms of hand and soles of feet
- transmission may occur with contact with lesions
Secondary syphilis s/s
lymphadenopathy, arthritis, fever, malaise, weight loss, hair loss
What happens after secondary syphilis?
- latency period (no s/s)
- latency may be interrupted by recurrence of secondary stage
tertiary syphilis
20-40% asymptomatic; slow progressive inflammatory disease
multiple organs infected
Possible manifestations of tertiary syphilis
auoritits, neurosyphilis (dementia, psychosis, stroke, meningitis, paresis)
Syphilis: assessment and diagnosis
- primary syphilis: direct microscopic view of bacteria from change
- serologic tests for diagnosis during secondary and tertiary stages
- nontreponemal or reagin tests: VRDL, RPR-CT; results will convert to negative after tx
- treponemal tests
Treponemal tests
-FTA-ABS, MHA-TP, verification that screening not false positive; will not convert to negative after tx
syphilis collaborative management: Antibiotics
single IM injection Penicillin G benzathine for early syphilis or early latent stage ( < 1 year)
syphilis collaborative management: later stages or unknown duration
3x injections at 1 week interval
How long to monitor pt after penicillin injection
30 min for possible reaction to PCN
For syphilis, what antibiotic is used if someone is allergic to penicillin
doxycycline
syphilis collaborative management: reporting and when to use gloves
- must report to state or local healthcare agencies for community follow up
- public health department will identify and screen potential sexual contacts
-gloves for skin contact with primary and secondary syphilis lesions
syphilis collaborative management: pt education (preventing spread of syphilis) (5)
- complete the full course of therapy if multiple injections required
- refrain from sexual contact with previous or current partners until partners have been treated
- be aware that if you have primary or secondary syphilis, skin lesions and other sequelae of infection will improve with proper tx and serology will reflect cure
- recognize that condoms significantly reduce the risk of transmission of syphilis and other STIs
- be aware that having multiple sexual partners increases the risk of acquiring syphilis and other STIs
Chlamydia and Gonorrhea
- most commonly reported infection in the US
- coinfection with chlamydia frequent in patients with gonorrhea
Chlamydia and Gonorrhea: female symptoms
usually asymptomatic; if symptoms present –> mucopurulent cervitis, UTI and vaginitis (gonorrhea)
Chlamydia and Gonorrhea: male symptoms
may be asymptotic; if present burning urination, foul-smelling penile discharge, painful and swollen testicles (gonorrhea)
Chlamydia and Gonorrhea: assessment and dx (assess for, how is gonorrhea diagnosed, how is chlamydia diagnosed, who to scan)
- assess for fever and discharge
- gonorrhea: gram stain (male urethral samples), culture, NAATs
- chlamydia: gram stain, direct fluorescent antibody tests, NAATs
- 70% chlamydial infections asymptomatic: annual chlamydia screening for all sexual active females < 25 yo, older females with new sexual partners, or multiple partners, and all pregnant patients
Chlamydia and Gonorrhea: treatment (therapy for gonorrhea, therapy for both chlamydia and gonorrhea, CDC recommendations, what else to test if someone is positive)
- dual therapy if only diagnosed with gonorrhea
- combination therapy: tx for both chlamydia and gonorrhea
- CDC 2017 recommended tx: single IM ceftriaxone 250 mg plus single PO azithromycin 1g
- test infected pt for HIV and syphilis
Chlamydia and Gonorrhea: treatment (must report, who to educate, prevention)
- must report to local or state healthcare agencies for ID sexual contacts and follow up
- preventative community education: adolescents, young adults
- abstinence, postponing first sexual contact, limiting number of sexual partners, use of condoms for barrier protection
