STIs Flashcards
Most commonly diagnosed bacterial STI
Chlamydia
Chlamydia/gonorrhoea primarily affect individuals of what age?
Women 15-24
Men 20-29
Syphilis most affects
MSM
Sex workers/clients
Peope in endemic regions
70% of adults will have at least one genital __ infection in their life
HPV
Relationship between spermicidal lubricated condoms and STIs?
Nonoxynol-9 distrupts mucosal lining –> increased infection/transmission of STIs. NEVER use rectally
List reportable STIs in Canada (6)
Chlamydia & Gonorrhea Chancroid Syphilis Hepatitis B HIV
Some jurisdictions
Why shouldn’t cervical specimens be taken from prepubertal girls?
STIs involve VAGINA not cervix
Endocervical samples used for which 2 common STIs?
Exocervical samples used for which 2 common STIs?
Endo: Chlamydia, gonorrhoea
Exo: HSV, HPV
Full names for chlamydia & gonorrhea
Chlamydia trachomatis, Neisseria gonorrhoeae
What less-invasive exams are available for Chlamydia & gonorrhea
First-catch urine (ideally haven’t peed 2 hours before)
Vaginal specimen can be SELF-administered
List 6 types of tests that can be done for C & G
Endocervical sample Vaginal sample / urethral sample (women/men) First-catch urine Rectal Pharyngeal
Chlamydia & gonorrhea are associated with what 6 “syndromes”?
Asymptomatic Urethritis Cervicitis Epididymitis PID Intestinal/enteric syndromes
4 symptoms of PID
Lower abdominal pain
Deep dyspareunia
Abnormal bleeding
Fever
3 bimanual exam findings of PID
Cervical motion tenderness
Adenexal tenderness
Adenexal masses
HPV can cause precancerous/cancerous lesions in what areas?
Mouth/oropharynx/larynx
Cervix/vagina/vulva
Penis
Anus
Tranmission modes of HPV
Receptive/penetrative vaginal/anal/oral sex
Also non-penetrative sexual activity
Nonsexual behaviour that increases risk of HPV?
Smoking
What 2 types of HPV are linked to 70% of cervical cancers?
Type 16 (50%) Type 18 (20%)
Which HPV types are “low-risk”, associated w/ 90% of anogenital warts?
Types 6 & 11
What 3 HPV vaccines are approved in Canada?
Cervarix: protect against Type 16/18
Gardasil: Types 16/18 & 6/11
Gardasil 9: same as above but additonal 5 cancer-causing types (31, 33, 45, 52, 58)
Do you need to perform C/S if active HPV warts during delivery?
No, unless significant bleeding risk or obstructing birth canal
Goal of HPV treatment
Topic, for symptom relief (does NOT prevent transmission/recurrence), pt may forgo treatment
How can internal HPV warts be treated?
Trichloroacetic acid
Cryotherapy
Electrosurgery
Surgical excision
Clinian-performed HPV treatments
Podophyllin (not as good as patient-applied phodophyllotoxin)
TCA
Cryotherapy
Surgical excision or electrosurgery
What is the only HPV treatment safe during pregnancy
Trichloroacetic acid
What is a significant public health issue wrt treating gonnorhoea, and what do we do because of this?
AB resistance
Do NOT use penicillin/tetracyclines/quinolones
Notify PH after treatment failures
Patients treated for gonorrhoea should abstain from sex for __ days after completion of treatment & asymptomatic
3 days
Gonnorrhea infections incubate for ___ days and are often ____
2-7
Often asymptomatic
What is disseminated gonococcal infection?
Gonorrhea can spread tematogenously (<1% of cases) –> arthritis, dermatitis; pericarditis/endocarditis/meningitis/perihepatitis rare
Major sequelae of gonorrhea in women (6)
PID
Infertility, ectopic pregnancy, chronic pelvic pain
Reactive arthritis, disseminated gonococcal infection
Major sequelae of gonorrhea in men (4)
Epididymo-orchitis
Reactive arthritis
Disseminated gonococcal infection
(infertility rare but can occur)
What is reactive arthritis? 2 other names?
AKA Reiter Syndrome, oculo-urethro-synovial syndrome
“can’t see, can’t pee, can’t bend my knee”
Postinfectious autoimmune process after STIs, postenteric infection (e.g. traveller’s diarrhea)
General treatment for gonorrhea
Combo therapy (AB resistance + co-infection with chlamydia common) Cephalosporin (cefixime, ceftriaxone) + Azithromycin
What type of AB therapy for gonorrhea preferred?
Directly observed single-dose therapy
How would you treat Neonates born to mother w/ untreated gonorrhea OR with symptoms
Cephalosporine (don’t co-treat for chlamydia w/out positive test)
Trace-back period for reporting chlamydia/Gonorrhea
60 days (or last partner if no partner in last 60 days)
Nucleic acid tests need to wait how long after treatment before testing again? Why?
2-3 weeks (false-positives from dead organisms)
What is lymphogranuloma vereneum? (LGV)
Disease caused by L1/L2/L3 serotype of C trachomatis
Invades lymph –> chronic swelling –> scarring, systemic symptoms
Transmission of Chlamydia
Vaginal, anal ,oral
Vertical transmission
Incubation period of Chlamydia
usualky 2-3 wks, up to 6 weeks
50% of males and 70% of females with chlamydia are…
Asymptomatic
Pregnant women are routinely screened at initial prenatal visit for…
HIV, HBV, syphilis, and (if <25 or risk factors) chlamydia & gonorrhea
Chlamydia may cause cervicitis characterized by
Friability of the os
Complications of untreated chlamydia
PID, ectopic pregnancy, infertility, CPP
Epididymo-orchitis
Reactive arthritis
Annual screening for C trachomatic recommended in..
<25 yo
gbMSM, transgender populations
Testing for asymptomatic chlamydia in males and females?
First-void urine in either
Female: also vaginal swab (can be self-admin) or cervical swab are options
Additional tests for chlamydia that can be done in patients with symptoms?
Swabs: urethral, rectal, pharyngeal, conjunctival, lesion (in addition to vaginal/cervical/FVU)
Treatment indications for chlamydia
1) Positive test for chlamydia
2) Positive test for gonorrhea
3) Suspected if compatible syndrome or partner has STI
After chlamydia treatment, how long do you need to wait before you can have unprotected sex again?
End of multi-dose treatment
7 days after single-dose treatment
When do you need to test for cures for C/G?
Persistent symptoms, non-ideal treatment regime, prepubertal/pregnant, suspected non-adherence
Preferred treatment for non-pregnant/non-lactating adults with chlamydia?
Doxycycline (BID for 7 days) = tetracycline
Azithromyzin (single dose, more compliance) = macrolide
Paps:
Benign-appearing endometrial cells are only reported in women ___ and require evaluation in ____
45+ yo
Postmenopausal women
Types of glandular cell abnormalities on Pap
Atypical glandular cells
AGC, favor neoplastic (suggestive but not specific of adenocarcinoma)
Endocervical adenocarcinoma in situ
Adenocarcinoma
What is the current Ontario recommended Pap schedule?
25+ yo, every 3 years (if negative)
Stop at 70yo if negative cytology for previous 10 years
Squamous cervical cytologic abnormalities on Paps are called ____. 2 types?
CSIL = cervical squamous intraepithelial lesions
LSIS (low grade) or HSIL (high-grade)
LSIS on Pap, especially in young women, is usually ____
a transient HPV infection
LSIL cervical cytologic specimens that contain a few cells that are suspicious for but not diagnostic of
HSIL are reported as
atypical squamous cells, cannot exclude a high-grade squamous intraepithelial
lesion (ASC-H)
LSIL (Bethesda system) corresponds to Cervical Intraepithelial Neoplasia (CIN) what?
CIN I
HSIL = CIN ?
CIN II/III
What is the next stage after HSIL/CIN III?
Invasive squamous cell carcinoma
Cytologic abnormalities must be further evaluated using…
Colposcopy, potentially biopsy
For ASCUS or LSIS, the next step is
Repeat cytology in 6 months (if same or worse then refer to colposcopy)
