STIs

Question 1

STIs are the most common ____

Answer 1

infection in the US

Question 2

Portal of entry for STIs

Answer 2

skin, mucosal linings of urethra, cervix, vagina, rectum, oropharynx

Question 3

_____ ____ is essential for prevention and effective treatment

Answer 3

community education

Question 4

Male and female condoms (what it is, reduction of, what is essential for best protection)

Answer 4

• 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

Question 5

STI issues with dx and disease control (4)

Answer 5

• 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

Question 6

What bacteria causes syphilis?

Answer 6

Treponema pallidum

Question 7

Primary syphilis

Answer 7

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

Question 8

Secondary syphilis

Answer 8

• 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

Question 9

Secondary syphilis s/s

Answer 9

lymphadenopathy, arthritis, fever, malaise, weight loss, hair loss

Question 10

What happens after secondary syphilis?

Answer 10

• latency period (no s/s)

- latency may be interrupted by recurrence of secondary stage

Question 11

tertiary syphilis

Answer 11

20-40% asymptomatic; slow progressive inflammatory disease

multiple organs infected

Question 12

Possible manifestations of tertiary syphilis

Answer 12

auoritits, neurosyphilis (dementia, psychosis, stroke, meningitis, paresis)

Question 13

Syphilis: assessment and diagnosis

Answer 13

• 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

Question 14

Treponemal tests

Answer 14

-FTA-ABS, MHA-TP, verification that screening not false positive; will not convert to negative after tx

Question 15

syphilis collaborative management: Antibiotics

Answer 15

single IM injection Penicillin G benzathine for early syphilis or early latent stage ( < 1 year)

Question 16

syphilis collaborative management: later stages or unknown duration

Answer 16

3x injections at 1 week interval

Question 17

How long to monitor pt after penicillin injection

Answer 17

30 min for possible reaction to PCN

Question 18

For syphilis, what antibiotic is used if someone is allergic to penicillin

Answer 18

doxycycline

Question 19

syphilis collaborative management: reporting and when to use gloves

Answer 19

• 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

Question 20

syphilis collaborative management: pt education (preventing spread of syphilis) (5)

Answer 20

• 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

Question 21

Chlamydia and Gonorrhea

Answer 21

• most commonly reported infection in the US

- coinfection with chlamydia frequent in patients with gonorrhea

Question 22

Chlamydia and Gonorrhea: female symptoms

Answer 22

usually asymptomatic; if symptoms present –> mucopurulent cervitis, UTI and vaginitis (gonorrhea)

Question 23

Chlamydia and Gonorrhea: male symptoms

Answer 23

may be asymptotic; if present burning urination, foul-smelling penile discharge, painful and swollen testicles (gonorrhea)

Question 24

Chlamydia and Gonorrhea: assessment and dx (assess for, how is gonorrhea diagnosed, how is chlamydia diagnosed, who to scan)

Answer 24

• 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

Question 25

Chlamydia and Gonorrhea: treatment (therapy for gonorrhea, therapy for both chlamydia and gonorrhea, CDC recommendations, what else to test if someone is positive)

Answer 25

• 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

Question 26

Chlamydia and Gonorrhea: treatment (must report, who to educate, prevention)

Answer 26

• 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