STIs - Block 1 Flashcards
What is the pathogen associated with gonorrhea?
Neisseria gonorrhoeae infects mucous membranes of GUT -> purulent exudates
S/s of gonorrhea?
Foul-smeeling vaginal discharge is NOT a sx
* Typically odorless
Who chould be screened for gonorrhea?
- Women sexually active <25YO
- > 25YO: multiple partners, partners with STI, no condoms, transactional sex, hx of STIs
- Pregnancy: first prenatal and 3rd trimester visits
- MSM -> annually
How do we diagnosis gonorrhea?
Nucleic Acid Amplifications Test (NAATs) -> combined test for GC and chlamydia
* Disad: no resistance data
How do you treat uncomplicated gono in pharynx?
Ceftriaxone
How do you treat uncomplicated gono in GUT?
Ceftriaxone 500 mg IM
* >150 kg -> 1 g
* Ceph allergy: Gentamicin + azithromycin
How do you treat gonococcal conjunctivitis?
Ceftriaxone 1g
Saline solution lavage in infected eye
How do you treat DGI?
Ceftriaxone 1-2 g Q12-24H
What supplemental tx is given in those with gonorrhea?
Tx for chlamydia: Doxycycline 100mg BID for 7 days
Gonorrhea and chlamydia interventions for partners?
- Tests with 60 days of sx onset or diagnosis
- Most recent partner should be treated even after 60 days
- Abstain from unprotected sex for 7 days or until resolution
What are the causes of chlamydia?
- Nongonococcal urethritis (NGU)
- Coinfection with gonorrhea
- Ocular infection
- Phrayngeal and rectal infection
Chlamydia increases the risk of acquiring ____?
HIV
What is the pathogen that causes chlamydia?
Chlamydia trachomatis
How does chlammydia differ from gonorrhea?
Genital tract infections are typically asymptomatic
* Urethral discharge is less profuse and more mucoid or watery
Who should be screened for chlamydia?
- MSM annually
- Pregant (first prenatal and 3rd trimester)
- Sexually active women <25YO annually
How is chlamydia dianosed?
NAATs
Cell culture (3-7 days)
Tx for uncomplicated chlamydia infection?
Doxycycline 100 mg BID for 7 days
* Non-adherence: azithromycin
* levofloxacin (7 days)
Tx for urogenital infections from chlamydia during pregnancy?
Azithromycin 1g PO once
Alt: amoxicillin 500mg TID for 7 days
Doxy and FQ are CI in pregnancy
Tx for conjunctivitis from chlamydia in newborns?
Erythromycin base or ethysuccinate 50mg/kg/d PO in 4 divided doses for 14 days
What is PID?
Inflammatory disorder of upper femal genital tract -> long term reproductive damage and caused by STI
Pathogen associated with PID?
Mycoplasma genitalium
How do you diagnosis PID?
Hallmark sign: sudden onset pelvic and lower ab pain, notable after menses
* Abnormal vag discharge. intermenstrual or postcoital bleeding, dyspareunia, dysuria
Screening for gono and chlamydia with NAAT
Tx for PID (hospitalization)
Ceftriaxibe 1g Q24H
+
Doxycycline (PO or IV)
+
Metronidazole (PO or IV)
Tx for mild-moderate PID?
Ceftriaxibe 1g IM
+
Doxycycline PO x 14 days
WITH
Metronidazole PO x 14 days
How often should you follow up with PID?
Pts who tested positive with GC and Chla -> 3 months
Pathogen that causes trichomoniasis?
Trichomonas vaginalis
Presnetations of trichomoniasis?
- Malodours Vaginal discharge (pH 4-5.6)
- Both genders: urethral discharge and dysuria
- Common in women (endocervical canal), men is asymtomatic (urethra)
Vaginal signs of tricohminosis>
- elevated pH (>5)
- Strawberry spots
- Malodours
- White, yellow, green discharge
- Thick/thin, frothy
Who should be screeened for trichomoniasis?
- HIV women -> annually
- High prevalence for infection: STI clinic, MSP, transactional sex, STI hx
- Symptomatic preganant women
How do you diagnosis trichomoniasis?
- Wet mount of vaginal discharge
- Culture (gold standard) -> long time
- NAAT
Tx for standard trichomoniasis infection?
Women: metronidazole 500mg BID for 7 days
* Alt: Tinidazole 2 g once
Men: Metronidazole 2 g once
Patients who fail should get a second course of Flagyl 500mg BID for another 7 days
Tx for persistent, recurrent trichomoniasis infection?
Metronidazole 2 g QD for 7 days
OR
Tinidazole 2g QD for 7 days (alt)
Tx for trichomoniasis in pregnancy?
Metronidazole (cat B) 500mg BID for 7 days
Avoid tinidazole (Cat C)
How often do you follow up with trichomiasis tx?
3 months if sexually active
* avoid retesting in 3 weeks -> false positive
What is the pathogen for syphilis?
Treponema pallidum -> transmission through intercouse and intacts itself to mucous membrane
What are the sx of primary syphilis?
10-90 days: Single, painless indurated lesion (chancre) that erodes, ulcerates, and typically heals
What are the presentations of secondary syphilis?
2-8 weeks: Pruritic or non rash that starts on the trunk and proximal arms spreading bilaterraly involving palms and soles
What is latent syphilis
4-10 weeks: risk for secondary relapse within the first years
* asymptommatic
What are the presentations of tertiary syphillis?
- CV syphilis
- Gummatous lessions of organs and tissues
What is meurosyphillis?
Neuroinvasion of any stage -> neurological complications
What is congenital syphillis?
Cross the placenta during pregnancy
Early: first 3 weeks of life resembling secondary syphillis
Late: >2YO revaling saddle nose and anterior bowing
What is the tx choice for all syphillis stages?
IV penicillin G (first line)
Pen G benzathine (IM, not IV)
Pen G procaine IM
Doxycycline
tetracycline
Counseling point with Bicillin LA?
Not for IV use -> cardiorespiratory arrest and death
* Not the same as Biccillin CR which is not for STIs
What is caused by trepnemal endotoxins and considered an acute reaction during tx of primary and secondary syphillis?
Jarisch-Herxheimer Reaction
* Not a penicillin allergy
* Supportivcare: analgesic, antipyretics, rest
Tx for primary, secondary, and early latent (<1Y) syphillis?
Penicillin benzathin G 2.4u IM once
Alt for allergy:
* Non pregnant: doxycycline or tetracycline for 14 days
* Pregnancy: desensitization then penicillin
Tx for late latent (>1yr) and unknown syphilis?
Penicillin benzathin G 2.4u IM 3 times
Alt for pen allergy:
* Non pregnant: doxycycline or tetracycline for 14 days
* Pregnancy: desensitization then penicillin
Tx for tertiary or retreatment after failure syphilis?
Penicillin benzathin G 2.4mu IM 3 times
Alt for pen allergy:
* see ID specialist
What is desensitization?
Process of giving med in a controlled and gradual manner so patient can tolerate allergc rx
Tx for neurosyphillis?
Aqueous crystallin penicillin 3-4million Q4H or continuous infusion for 10-14 days
ALt: 10-14 days Aqueous procaine penicillin G 2.4 million units IM daily PLUS probenecid
Preffered dosage forms for neurosyphillis?
IV infusion
Bicillin LA doesnt get into the CSF -> tx failure
Txx for congenital syphillis?
Aqueous crystalline penicillin G
OR
Procain Pen G
Both for 10 days
Those who have HPV are more at risk for getting ___?
Cervical cancer and genital warts
Pathology of HPV
- dsDNA virus breaks through epithelium
- Replicates in basal cells
- Differentiates
- Virus is shed with dead keratinocytes
- Infection is transmited with dead keratinocytes
Who do you diagnoses HPV?
Pap smear
HPV specific tests:
* Approved in women >30 with abnormal pap smears
* Not for men
* Not for screening
How often should someone be screened for HPV?
routine cervical cancer screening every 3 years for ages 21-65 regardless of vaccination status
Tx for HPV warts?
- Cyrotherapy w/ liquid nitrogen
- Surgery
- TCA
- BCA
How do we prevent HPV?
Gardasil 9 (9vHPV)
