STIs and UITs Flashcards
Which STIs are reportable?
- chlamydia
- gonorrhoea
- syphilis
Untreated HPV is associated with what condition later on in life?
cervical cancer
What can untreated congenital syphilis lead to?
birth defects
Chronic pain is a result of what untreated STIs?
gonorrhoea and chlamydia
What is the most prevalent bacterial STI in Canada?
Chlamydia
What are the long-term sequelae of Chlamydia?
Females: pelvic inflammatory disease (PID), infertility (due to PID), ectopic pregnancy, chronic pelvic pain (due to PID), Reiter’s syndrome (sterile arthritis at joints)
Males: Epididymo-orchitis (inflammation of testicle), Reiter’s syndrome
Newborn: trachoma, pneumonia
What are the treatment options for Chlamydia?
Azithromycin single dose OR Doxycycline for 7 days, people should abstain from having sex for 7 days post-treatment
Are most females symptomatic or asymptomatic when they are infected with Chlamydia?
asymptomatic
What is Pelvic Inflammatory disease?
It is infection and inflammation of the upper genital tract caused by either Chlamydia trachomatis or Neisseria gonorrhoeae
What are symptoms of PID?
- fever, abdominal pain, abnormal discharge
- adnexal (painful palpation of ovaries) and cervical motion tenderness (painful palpation of the cervix)
How is the diagnosis of PID made?
based on symptoms, microbiology and diagnostic imaging
What is the outpatient treatment regimen for treating PID?
Ceftriaxone 250 mg IM + Doxycycline 100 mg x 2day for 14 days + Metronidazole 500 mg x 2 day for 14 days
What is key in the treatment of PID?
Catching it early and then treating it promptly to preserve fertility
What are long-term sequelae of PID?
ectopic pregnancy, sterility, chronic pelvic pain
What type of bacterial infection is Gonorrhea?
Neisseria gonorrhoeae is gram negative facultative intracellular bacteria
What is the second most commonly reported bacterial STI in Canada?
Gonorrhea
What STI afflicts more males than females?
Gonorrhea
What is the common long-term sequelae in both males and females?
disseminated infection
What is the long-term sequelae in neonates?
ophthalmia neonatorum, sepsis
Why is there an even higher risk of developing PID from gonorrhea?
Because N. gonorrhoeae have fimbriae that attach to sperm cells, once ejaculated they can travel up and cause PID in females
How are N. gonorrhoeae able to reach joints, meninges and the heart??
Phagocytized bacteria can survive and multiply in neutrophils, traveling t distal sites in the body
T/F: most women who contract gonorrhea are asymptomatic
True
Female vaginal bleeding and Male urethral discharge are symptoms of _
gonorrhea
What is the treatment for Gonorrhea?
Ceftriaxone 250 mg IM (to treat the gon) + Azithromycin 1g PO (to treat the clam)
What is the incubation period of Gonorrhea?
2-7 days
Who should be screened for Chlamydia and Gonorrhea regardless if symptomatic?
All sexually active females under 25 years of age and all pregnant women (significant reduction in perinatal mortality)
For Chlamydia and Gonorrhea culture testing, what areas need to be swabbed for sampling?
- endocervical or vaginal & urethral
- pharyngeal and rectal (if applicable)
What is a pro and con of using Nucleic Acid Amplification Tests (NAATs)?
PRO: can use urine: easier sample to collect from men
CON: impedes tracking of AMR and not approved for use in pharyngeal and rectal diagnosis
How have Gonorrhea rates changed between 2009 and 2017?
increased by 109%
What bacteria causes Syphilis?
Treponema pallidum
How have rates of syphilis changed since 2009?
They have increased by 259%
What gender (between ages of 25-39) account for 93% of cases?
males
How is congenital syphilis contracted?
Infectious syphilis can be transmitted from mother to fetus during pregnancy or delivery
What is the risk of transmission from mother to fetus of primary and secondary syphilis?
> 70%
What is the risk of transmission from mother to fetus of early latent syphilis?
> 40%
What are fetal complications that can arise if syphilis is contracted?
fetal death (40%), cerebral palsy, mental disability, organ malfunction
Screening of pregnant females in the first trimester is required for the mothers when they have what STI?
syphilis
What are signs of primary syphilis?
small, heard, painless ulcers (chancres) occuring at site of infection, regional lymphadenopathy (cervix, vulva, vaginal wall, penis, anus, mouth)
What is the treatment of primary syphilis?
Symptoms manifest ~21 days post-exposure and resolve within 3-6 weeks without treatment
How is primary and secondary syphilis diagnosed?
symptoms, serologic testing and samples from lesions (except oral and anal)
How is primary syphilis treated?
Benzathine penicillin G (IM, single dose)
What is the difference between primary and secondary syphilis?
In secondary we being to see systemic signs
What are the symptoms associated with secondary syphilis?
rash (palms of the hands and soles of the feet). fever, malaise, lymphadenopathy, headache, mucous membrane lesions, patchy alopecia, meningitis
How is secondary syphilis treated?
Benzathine penicillin G (IM, single dose)
What is the early latent infection of syphilis?
Take the last time they had a symptom of secondary infection (ex.rash), from that day to about a year they are at risk for another episode
- asymptomatic phase (<1 year post-secondary phase)
What is the late latent infection of syphilis?
- asymptomatic (>1 year post-secondary stage)
- patient may never develop any long-term complications
- no longer have symptoms, no longer infectious
What is the tertiary infection of syphilis?
this occurs 10-30 years after initial infection, increased occurence in HIV(+) patients, associated with inflammation and severe hyperimmune responses
- (cardiovascular syphilis)
- neurosyphilis
- gumma (skin and soft tissue lesions)
What is the treatment for the early latent phase?
Benzathine penicillin G (IM, single dose)
What is the course of treatment for late latent and tertiary phase of syphilis?
longer therapy of the Benzathine
How is the diagnosis of latent and tertiary syphilis made?
CSF, chest x-ray, physical and neurological exams, serology (may come out negative because not as sensitive in this stage)
What strain are most cases of genital herpes associated with?
HSV2
“Asymptomatic shedding and rate of recurrence greater with HSV_”
HSV2
What is the incubation period of Herpes simplex virus?
~ 6 days, but can be weeks, months or years
What is the estimated amount of 14-59 year olds that are infected with HSV?
14%
What facilitates transmission of HSV?
Asymptomatic “silent”shedding of the virus facilitates transmission, direct skin to skin contact
What are the primary manifestations of HSV?
clear, straw-coloured fluid-filled vesicles appear first and then develop into painful, burning ulcers as they rupture
What are complications (20%) of the primary manifestations of HSV?
meningitis and encephalitis
What is the course of treatment for primary HSV?
Acyclovir 200 mg PO x 5 per day for 5-10 days
What triggers secondary manifestations of HSV?
stress
- fever, menstrual cycle, skin irritation, fatigue, coitus, immunosuppression
What are the prodromal or “preceding” symptoms that occur where the new vesicles will form in secondary HSV?
pain, tingling, burning, itching and skin sensitivity
What is the duration of secondary HSV?
mean duration of 9.3 -10.6 days
What treatment can we give for HSV episodes?
Valacyclovir 500 mg PO bid for 3 days (start within 12 hours of symptom appearance)
What can we offer for people who have 6 episodes/ year of HSV?
daily suppressive antiviral therapy, Valacyclovir 500 mg, PO daily, decreases the frequency/ severity of symptoms and reduces transmission by 48%
(HSV) What is given as suppressive therapy for pregnant women; initiated at 36 weeks and continued until delivery?
Valacyclovir 500 mg, PO twice daily
What is the most common STI in Canada?
Human Papillomavirus (HPV) 75% of sexually active adults with acquire a genital tract HPV infection during their lifetime, majority of these infections resolve within 18 months
How many HPV genotypes exist and how many are associated with genitals?
200, 40
How many of the HPV genotypes are associated with cancers?
15 high risk (oncogenic) genotypes including 16 &18
What are the low-risk HPV genotypes?
non-oncogenic including 6 & 11, presents with genital warts; painful lesions that typically present 3-4 months post-exposure
What is the typical treatment for genital warts?
treatment is topical and patient applied, TCA (trichloroacetic acid)
What is HPV a predisposing factor of?
cervical cancer; types 16&18 are responsible for 70% of all cervical cancers
What is the screening procedure of HPV?
- screening programs to detect cervical abnormalities, precancerous lesions and cervical cancer due to HPV infection in women
- begin screening at 21 years (if sexually active); if cytology is normal, then every 3 years, if abnormal, annually
What are cofactors of developing HPV?
smoking, long term use of oral contraceptives (> 5years), higher number of pregnancies, other STIs, poor nutrition, multiple sex partners, sex at a young age, immunosuppression, genetic factors
What prevention is out there for HPV?
Immunization - Gardasil
- targets genotypes 6,11,16,18
- 3 doses over a 6 month period, for males in females in grade 7
- Gardasil is NOT effective in females with abnormal cytology or HPV infection
What are 3 examples of UTIs?
- Urethritis
- Cystitis
- Prostatitis
What is an upper UTI?
acute pyelonephritis (infection has spread to the kidneys)
What is a common cause of illness in hospitalized and elderly patients?
UTIs
What are common symptoms of someone who has a UTI?
fever, dysuria, frequency, urgency, incontinence, abdominal pain, flank tenderness (show its reached the kidneys), sepsis
Who is at risk of developing a UTI?
- females, pregnancy, sexual activity, catheters, obstruction/ neurogenic bladder
When diagnosis of UTI what is looked for in the urinalysis?
- leukocyte esterase (active infection)
- WBCs
- Bacteria (1000 bacteria/ml) 90% pyelonephritogenic E. coli
- Nitrites
- Protein levels
What are some complications associated with UTIs (in relation to pyelonephritis)?
- ascending infection
- severe abdominal, flank and back pain
- fever (>39), that persists for more than 2 days
- chills, n&v, fatigue
- pyuria
- sepsis & kidney damage
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