Therapeutics - STIs Part 1 Flashcards by amanda kastel

primary prevention of STIs includes…..

assessment of behavioral risk

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name 5 components of behavioral risk that should be assessed during primary prevention of STIs

partners
practices
protection
past history of STI
pregnancy intention

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4 things that are MOST EFFECTIVE as primary prevention of STIs

what is the “gold standard” for primary prevention

pre-exposure vaccination
condoms
HIV PREP
PEP

GOLD STANDARD = ABSTINENCE AND REDUCTION IN PARTNERS

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4 things that are NOT effective as primary prevention for STIs

diaphragms
topical spermicides/microbiocides
male circumcision
emergency contraception

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true or false

spermicides are effective at prevention of STIs

FALSE

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explain what partner services is

clinical evaluation, counseling, and testing and tretment to increase # of infected persons brought to treatment and REDUCE TRANSMISSIOn through sexual networks

EPT, PEP

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in partner services, is it normal practice to retest after treatment to detect any repeat infections?

YES

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what does EPT stand for

expedited partner therapy

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explain what EPT (expedited partner therapy) is

treating the partners of the person who receives gonorrhea or chlamydia diagnosis WITHOUT EVER BEING EXAMINED BY A HC PROVIDER

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EPT is available to partners of the diagnosed patient within the past ____ days

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on an EPT prescription, it has the medication and instructions, warnings, counseling, and a statement regarding what?

advising them to seek medical evaluation

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shared clinical decision making is done regarding EPT for _________ because of ______

MSM

high risk of coexisting infection

ideally, we want the partner to seek care THEMSELVES, but if they refuse, we can still give EPT

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true or false

EPT is only allowed in a few states

FALSE

majority of the US

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explain what PEP is

post exposure prophylaxis

taking a med prior to infection, AFTER a possible exposure to syphilis, chlamydia, or gonorrhea

provides the pt a prescription, allowing them to have DOXYCYCLINE for self treatment ASAP after sex to prevent syphilis, chlamydia, and gonorrhea

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target populations for PEP

gay, bi, trans women, and other MSM with history of at least 1 bacterial STI (syphilis, gonorrhea, or chlamydia) in the past 12 months

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true or false

the CDC recommends PEP for cisgender women

FALSE

only for gay, bi, other MSM, and transgender women with hostory of at least 1 bacterial STI (syphilis, gonorrhea, chlamydia) in the last 12 months

NO recommendation for cis men or women, trans men, and other queer/nonbinary

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medication for PEP - include dose, route, length, etc

any max dose?

doxycycline 200mg PO taken ASAP and within 24 hours or oral, vaginal, or anal sex

MAX DOSE of 200mg every 24 hrs

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in a doxy prescription for PEP, what should the quantity be

enough doses based on pt’s anticipated sexual activity until their next visit

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the ongoing need for doxyxyline PEP should be assessed every..

3-6 months

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as recap, differentiate between EPT and PEP

EPT - infected person gives to partners within 60 days of intercourse for prevention

PEP - person continues to be at risk after initial infection (ie - gay, bi, MSM, trans women). take doxy “on deman” after sex (within 24 hours

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gonorrhea is caused by what bacteria

neisseria gonorroeae

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neisseria gonorrhoeae is a gram ___ ____

negative diplococci

neisseria gonorrhoeae can infect which areas

cervix, urethra, rectum, and/or pharynx

explain the relationship between gonorrhea infection and chlamydia infection and what this means for treatment

if person is diagnosed with gonorrhea, need to rule out chlamydia because coinfection is common

if CANNOT rule out coinfection with chlamydia, must also give treatment for chlamydia

true or false routine annual screening is not recommended for gonorrhea

FALSE - it is recommended for sexually active ppl less than 25 years old

symptom onset from original infection of gonorrhea for: men/women

2-8 days from initial infection for men and within 10 days for women

compare and contrast the symptoms of gonorrhea in men vs women

men - purulent urethral or rectal discharge females - adnormal vaginal discharge or urethral bleeding BOTH - dysuria and urinary frequency

3 complications of gonorrhea infection

infertility ectopic pregnancy pelvic inflammatory disease

true or false symptoms are enough to differentiate between STIS

FALSE - they're not symptoms similar for all

true or false symptoms from gonorrhea infection are not common

FALSE they are - especially in males

1st line treatment for UNCOMPLICATED GONORRHEA of the cervix, urethra, or rectum in adults and adolescents include if chlamydia has NOT been ruled out

def no chlamydia: ceftriaxone 500mg IM in a single dose (<150kg)** chlamydia hasnt been ruled out: ceftriaxone 500mg IM x1 + doxyxline 100mg oral BID for 7 days **(if greater than 150kg, use 1g ceftriaxone IM)

if ceftriaxone is NOT available, what is alternative treatment for uncomplicated gonorrhea?

gentamicin 240mg IM x1 + Azithromycin 2g orally x1 OR cefixime 800mg PO x1 (again - if chlamydia not excluded - treat with doxy 100mg PO BID for 7 days)

how can treating gonorrhea become complicated?

by gonorrhea becoming resistant to antibiotics. this is becoming very common (CDC even said it's urgent), particularly to fluoroquinolones and cephalosporins drug-resistant gonorrhea may require treating with more than 1 antibiotic

patients who are being treated for gonorrhea should be instructed to what?

abstain from sex for 7 days after treatment AND until all sex partners have been adequately treated (you can get gonorrhea more than once!)

any person diagnosed with gonorrhea should be....

screened for other STIs

when IS/IS NOT test of cure recommended for gonorrhea infection?

test of cure NOT recommended for uncomplicated urogenital or rectal gonorrhea pts who receive appropriate treatment test of cure IS recommended for any person with pharyngeal gonorrhea

gonorrhea EPT should be offered to who?

all recent sex partners of the infected person within the past 60 days IF last sex partner was over 60 days ago, offer to the most recent

gonorrhea EPT treatment if: -chlamydia ruled out -chlamydia NOT ruled out -if adherence is a concern

chlamydia ruled out: Cefixime 800mg x1 ALONE chlamydia NOT ruled out: Cefixime 800mg x1 + doxy 100mg BID for 7 days IF ADHERENCE IS CONCERN - use azithromycin 1g as single dose instead of doxy (BUT less effective at rectal. if rectal infection is a concern, still give doxy)

chlamydia is caused by what bacteria

chlamydia trachomatis

chlamydia trachomatis is an obligate ____ organism

INTRACELLULAR thus, shares properties of both bacteria and viruses

___ are 3x more likely than ____ to be infected by chlamydia trachomatis

women 3x more likely than men

how is the clinical presentation of chlamydia different than that of gonorrhea

chlamydia infection is commonly asymptomatic, making annual screening very important -prompt treatment reduces the risk of complications!)

symptom onset of chlamydia for both men and women

7-21 days from initial infection

as mentioned, chlamydia is often asymptomatic, but if the patient does have symptoms, what are they?

SAME AS GONORRHEA male - purulent urethral or rectal discharge female - abnormal vaginal discharge or uterine bleeding BOTH - dysuria and urinary frequency THUS, CANNOT USE SYMPTOMS ALONE TO DIAGNOSE!!!

complications of chlamydia infection

SAME AS GONORRHEA pelvic inflamm disease, ectopic pregnancy, infertility

recommended treatment regimen for chlamydia infection alternative regimens (what is concern with these?)

recommended - doxycycline 100mg PO BID for 7 days alternatives: -azithromycin 1g as single dose -levofloxacin 500mg PO daily x 7 days ALTERNATIVES LESS EFFECTIVE AT TREATING RECTAL!!! if rectal infection or at risk for rectal infection, doxy is preferred

pts diagnosed and being treated for chlamydia should be instructed to....

abstain from sex for 7 days after single dose treatment OR completion of 7 day regimen, AND until all sex partners adequately treated

true or false anyone diagnosed with chlamydia should be screened for other STIs

TRUE

When is/is not test of cure for chlamydia advised?

NOT advised - non pregnant pts with recommended or alt regimens ONLY recommended for them if the symptoms persist or reinfection is suspected

chlamydia EPT should be offered to who?

sex partners within the last 60 days if greater than 60 days ago, offer to most recent partner

recommended/alternative treatment for chlamydia EPT

recommended - doxy 100mg PO BID 7 days alts: Azithromycin 1g x1 OR levof;oxacin 500mg PO daily for 7 days

true or false in a patient with a chlamydia infection, gonorrhea should be assumed unless specifically ruled out

FALSE only applies to gonorrhea infection - suspect chlamydia unless ruled out

pt is 22 year old female. feels well, no complaints. takes birth control with good adherence. STI screen is positive for chlamydia and pregnancy test is negative. what treatment regimen is appropriate for her?

SHE REPORTS GOOD ADHERENCE - DO NOT NEED ALT REGIMEN give doxycycline 100mg BID for 7 days