Therapeutics - STIs Part 1 Flashcards
primary prevention of STIs includes…..
assessment of behavioral risk
name 5 components of behavioral risk that should be assessed during primary prevention of STIs
partners
practices
protection
past history of STI
pregnancy intention
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
4 things that are NOT effective as primary prevention for STIs
diaphragms
topical spermicides/microbiocides
male circumcision
emergency contraception
true or false
spermicides are effective at prevention of STIs
FALSE
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
in partner services, is it normal practice to retest after treatment to detect any repeat infections?
YES
what does EPT stand for
expedited partner therapy
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
EPT is available to partners of the diagnosed patient within the past ____ days
60
on an EPT prescription, it has the medication and instructions, warnings, counseling, and a statement regarding what?
advising them to seek medical evaluation
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
true or false
EPT is only allowed in a few states
FALSE
majority of the US
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
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
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
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
in a doxy prescription for PEP, what should the quantity be
enough doses based on pt’s anticipated sexual activity until their next visit
the ongoing need for doxyxyline PEP should be assessed every..
3-6 months
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
gonorrhea is caused by what bacteria
neisseria gonorroeae
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
