DS: Infection of reproductive organs/STD

Question 1

Chlamydia: linical manifestations

Answer 1

Incubation time is from 1 weeks -3 weeks
Asymptomatic male and female
Clinical syndromes: urethritis in males and females, cervicitis, proctitis, conjunctivitis in both adults and neonates, PNA in neonates

Question 2

Chlamydia in infants and children

Answer 2

Rare, most common presentation in conjunctivitis, but can also cause PNA usually occurs in 4-12 weeks after birth

Question 3

Complication of chlamydia infections

Answer 3

Question 4

Non genital Chlamydia clinical manifestation

Answer 4

Question 5

Chlamydia screening recommendations

Answer 5

Question 6

Chlamydia - repeat testing

Answer 6

Test of cure is only recommended in pregnant patients → should have test of cure 3-4 weeks after chlamydia treatment and repeat for re-infection approximately 3 months after completing treatment.

All patient diagnosed and treated should have a repeat test in 3 months to detect re-infection due to substantial risk for reinfection during the 3-months period following initial diagnosis

Question 7

Chlamydia - Patient Education

Answer 7

Abstain from sexual intercourse x 7 days after one time dose of azithromycin or until completion of 7 days course regimen of doxycycline
DDi of doxycycline with polyvalent cations
Retest 3 month for re-infection

Question 8

Gonorrhea - Clinical Manifestation

Answer 8

Question 9

Gonorrhea - Non genital Gonococcal Clinical Manifestation

Answer 9

Question 10

Gonorrhea - Screening Recommendation

Answer 10

NAAT Assays are recommended for detection of urogenital infection in both men / women with or without symptoms, however, NAATs do not yield live organisms → Now used GISP to detect and see if there any growing resistance of drug class

Question 11

Gonorrhea - Treatment

Answer 11

Question 12

Gonorrhea - Treatment Key points

Answer 12

Question 13

Gonorrhea - allergies consideration

Answer 13

If serious anaphylactic allergy to cephalosporin → DUAL TREATMENT of one time dose of IM gentamicin 240 mg + oral azithromycin 2 gram

Question 14

Gonorrhea - Why ceftriaxone?

Answer 14

Other oral cephalosporin have been investigated but have inferior efficacy
Vantin was inferior to cefixime
Cefixime will probably be effective - however, wise use of cefixime may increase N gonnorrhea MIC and cross resistance to CTX.

Question 15

Disseminated gonococcal infection (DGI)

Answer 15

Question 16

Other non genital gonococcal treatment

Answer 16

Question 17

Gonococcal neonate conjunctivitis treatment

Answer 17

Question 18

Gonorrhea test of cure

Answer 18

Test of cure is recommended for any person with pharyngeal gonorrhea regardless of the treatment regimen
7-14 days after the treatment should do a test of cure
Using culture +/- NAAT

• If NAAT is positive, confirmatory culture needed before treatment

Question 19

Gonorrhea treatment failure

Answer 19

Question 20

Gonorrhea sex partners treatment and referrals:

Answer 20

Highly contagious, highly transmissible,
All sexual partners within the preceding 60 days should be referred for treatment
Or most recent partner if this contact occurred >60 days ago.

Providers should use Expedite partner therapy (EPT)
EPT: Cefixime 800 mg x 1 oral dose and if chlamydia co-infection not excluded ADD doxycycline 100 mg BID x 7 days

Question 21

Gonorrhea patient education

Answer 21

Should be abstaining for 7 days after treatment and until all sex partners are adequately treated (7 days after receiving treatment and resolution of symptoms)
Person who receive diagnosis of gonorrhea should be tested for other STDs including chlamydia, syphilis and HIV

Question 22

Syphillis

Answer 22

Caused by bacterium called Treponema pallidum
Transmitted via sexual contact, human bites, mother-to child across placenta, blood transfusion

Question 23

Staging of syphillis

Answer 23

Nuerosyphillis - can occurs at any stages
Secondary syphilis skin rash - can be present on palms and bottom of feed

Question 24

Congenital Syphillis

Answer 24

Question 25

Screening of Syphilis

Answer 25

Question 26

Syphilis testing

Answer 26

Question 27

Syphilis Treatment

Answer 27

Question 28

Syphillis Alternative treatment

Answer 28

Question 29

Consideration syphilis treatment in pregnancy

Answer 29

Should have additional quantitative non treponemal testing because titers are essential in monitoring treatment course Pregnant women who miss any dose, must repeat full course therapy due to potential congenital syphilis

Question 30

Consideration syphillis tretament in allergies

Answer 30

Question 31

Jarish-Herxheimer Reaction (JHR)

Answer 31

Question 32

Syphilis Treatment Failure

Answer 32

Question 33

Syphillis patient education

Answer 33

Patient should be informed about JHR and how to manage it - need to explain that it is not a reaction to medication, rather response to treatment Abstinence, mutual monogamy with an uninfected partner, use condom and limiting the number of sex partners Develop individualized risk reduction plan

Question 34

Pelvic inflammatory disease (PID)

Answer 34

Studies suggest that the proportion of PID cases attributable to N gonorrhea or C trachomatis is declising No single diagnostic test for PID, difficult to diagnose, provides maintain a lowe threshold for the diagnosis of PID due to potential damage to reproductive health of women Comprises a spectrum of inflammatory disorders of the upper female genital tract, including any combination of endometritis, salpingitis, tubo-ovarian abscess and pelvic peritonitis

Question 35

Fitz-Hugh- Curtis Syndrome of PID

Answer 35

Question 36

PID Treatment

Answer 36

Question 37

PID Alternative regimen

Answer 37

Question 38

PID other consideration

Answer 38

All women who received a diagnosis of acute PID should be tested for HIV, gonorrhea and chlamydia Clinical improvement should be seen within 3 days If no improved after 72 hours - hospitalization, assessment of abx regimen and additional diagnostic should be done. Pregnant - high risk for morbidity and preterm delivery → need to be hospitalized and treat with IV

Question 38

PID recommended IM/Oral regimen

Answer 38

In women with PID of mild/moderate clinical severity → IV and PO regimens appears to have similar efficacy Anaerobic coverage should be considered due to lack of data on regimens without anaerobic coverage, and bacterial vaginosis is frequently associated with PID When Tubo-ovarian abscess is present, either clindamycin or flagyl should be included for at least 14 days

Question 39

Epididymitis

Answer 39

Inflammation of the epididymis due to infectious and non infectious etiology Most frequently caused by C trachomatis or N. gonorrhea Men age >35 years (STI less common) usually infected as secondary infection to bacteriuria and obstruction (BPH)

Question 40

Epididymitis: Clinical Presentation

Answer 40

Question 41

Epididymitis: Treatment recommendation

Answer 41

Question 42

Human papillomavirus (HPV)

Answer 42

Most common sexually transmitted infection in teh US

Question 43

Recommend treatment for HPV - external anogenital warts

Answer 43

Question 44

Herpes Simplex Virus (1&2)

Answer 44

Genital herpes is chronic, lifelong viral infection usually caused for HSV-2 and sometimes Hs1b Recurrence and subclinical shedding most common in HSV2 HSV is not a national reportable condition

Question 45

HSV screening recommendation

Answer 45

Does not support routine HSV screening amont asymptomatic pregnancy women Should be considered for persons presenting for an STD evaluation Does not support screening in the general population

Question 46

HSV Diagnostic testing

Answer 46

Question 47

HSV Initial Therapy

Answer 47

Question 48

HSV Recurrent episodes

Answer 48

Question 49

HSV Suppressive treatment

Answer 49

Question 50

HSV Antiviral Resistance

Answer 50

Low, but it is more commonly seen in immunocompromised patients Most HSV acyclovir resistance is due to decreased or absent in production of viral thymidine kinase (TK) High dose oral acyclovir and valacyclovir cannot overcome this resistance mechanism Famciclovir and penciclovir not recommended - similar to acyclovir Alternative option is IV foscarnet