STI: What are 3 bacterial?
What are 3 viral STI?
What is one protozoa?
What is one parasitic STI?
Why is chlamydia particularly dangerous?
- •Most common STI. Fast spreading.
- •Most dangerous because women are asymptomatic
- •If untreated = acute salpingitis or PID
- •Past chlamydia infections = increased risk of ectopic pregnancies and tubal factor infertility
- •Causes inflammation of the cervix = increases the risk of acquiring HIV if exposed
How would you treat newborn chlamydia?
(Other info of chlamydia to read about)
You treast it with erythromycin.
•Perinatal exposure to mothers’ cervix = conjunctivitis or pneumonia
•Most common infectious cause of opthalmia neonatorum
Prophylaxis with antibiotics
What are ways to screen Chlamydia? (2)
1. Cervical culture
2. Urine culture
CDC recommends who gets chlamydia testing? (6)
- •All pregnant women @ prenatal intake & 36 wks.
- •Sexually active adolescents
- •Women ages 20 – 25
- •Women > 25 not using barrier contraceptives
- •New partners
- •Multiple sexual partners
KNOW: What is used to treat Chlamydia?
Azithromycin 2 gm po 1
Doxycycline 100 mg po BID for 7 days. Doxycycline is contraindicated in pregnancy. It can cause yellowing of teeth in baby later in life.
What are clinical signs and symptoms of chlamydia?
Mucopurulent d/c from the cervical os, easily induced bleeding, edema in the area of ectopy.
What are clinilcal symptoms and signs of Gonorrhea?
Purulent vaginal d/c, dysuria, cervical motion tenderness, females may be asymptomatic in early stages up to 80%
Dx of Gonorrhea?
Direct culture from urethra, endocervix, throat, rectum the most sensitive for the detection of gonococcal infection, NAAT test.
KNOW: What is the treatment for gonorrhea?
Ceftriaxone 250 mg IM x1 plus azithromycin 1 g po in a single dose
Cefixime 400 mg po x1 plus azithromycin 1 g po in a single dose
KNOW: What does PID cause?
Infectious process commonly involving fallopian tubes and uterus
Most cases associated with >1 organism
Occurs with ascending spread of microorganisms at the end of or following menses (open cervical os, lack of cervical mucus barrier, blood is excellent medium for growth of bacteria)
Most frequent single infection in women. More than 1 million have at least one episode of PID (CDC 1977)
Can cause infertility.
What are some risk factors of PID? (4)
- Young age
- Multiple partners
- Hx of STIs
- IUDs, esp within first few months after insertion. So if a woman has gonorrhea, does it mean she doesn't get IUD? No, but if she has gonorrhea and chlamydia. Then they'll wait for it to be treated, then insert IUD.
What are some ways to screen and Dx PID?"
1. Important to do a detailed hx
The CDC criteria
1. positive history of STDs
2. Oral temp >38.3
3. Abnormal cervical/vaginal discharge
4. Elevated sed rate
5. +GC or chlamydia cultures
Woman who comes in with it has severe pain etc and is jumpy when you do examination
KNOW What are PID treatments?
First off, it varies depending on the infecting organisms, presenting symptoms and pt compliance.
For OUT patient treatment
Ceftriaxone 250 mg IM in a single dose
Doxycycline 100 mg orally 2x a day for 14 days with or without metronidazole
Metronidazole 500mg orally 2x a day for 14 days (taste like rust and sucks, not often used)
What are inpatient treatments of PID?
There are two sets.
Cefotetan 2 g IV every 12 hours and
Doxycycline 100 mg orally or IV every 12 hours
Cefoxitin 2 g IV every 6 hours and
Doxycycline 100 mg orally or IV every 12 hours
What are some prevention measures of PID? (2)
•Education of self-protective measures such as safe sex, barrier methods of contraception.
•Routine screening for STIs
How is it transmitted?
Transmitted by entry in SQ tissue through microscopic cervical abrasions.
Can be transmitted through kissing, biting, oral genital sex.
Transplacental transmission any time during pregnancy.
What are many cases of syphilis realted to?
Related to ilicit drug use, crack cocaine.
It's a serious systemic disease that can lead to death
KNOW: There are 3 phases of syphilis, what are they?
Primary, Secondary, Latent
KNOW: What S/S are in primary syphilis?
1. Painless chancre at site of inoculation, discreet enlarged, painless rgional lymph nodes.
2. Incubation period is 10~90 days
KNOW: Secondary syphilis S/S and appearance?
S/S Symmetric papillosquamous eruptions on palms, soles, mucous membranes and trunk
Appears 2~8 weeks after appearance of chancre
KNOW: S/S and Dx of Laten Syphilis
S/S: Positive serology w/o evidence of clinical disease. *evaluate for aortitis, neurosyphillis iritis.
Dx: Dark field examinations, VDRL, RPR
KNOW: How would you treat Primary and Secondary syphilis?
Benzathine penicillin G, 2.4 million units IM x1.
If allergic to penicillin, Doxycycline 100 mg po BID x 14 days or tetracycline 500 mg po QID x 14 days
KNOW: How would you treat latent syphilis?
Benzathine penicilllin G 7.2 million units total, admin as 3 doses of 2.4 milllion units IM each at 1 week intervals
HPV occurs most in what age range?
There's 6 million new cases each year, 74% of those cases occur in people 15~24 years old
HPV is presented in 90% of cervical cancers.
How does the risk of getting HPV increase?
Acquiring HPV increases with the number of lifetime sexual partners
It's not 100% preventable with condoms, and can be transmitted on body surfaces not covered by the condom
Most HPV infections are asymptomatic.
In women, the lesions are called what?
The lesions are called condylomata. They're soft papillary lesions that occurs in clusters. The lesions are typically painless.
HPV symptoms are more frequent in pregnant women, why?
Due to immunosuppresion present during pregnancy
How can HPV be treated?
Aldera can increase activity of immune system.
There are different strands of HPV.
6,11 causes lesions/warts,
16,18,31,33 have oncologic potential
What does Gardasil, an HPV vaccine help protect again?
2 types of HPV, 16&18, causes 90% of geneital wart cases
2 types of HPV that causes about 75% of cervical cancer cases
KNOW: What is the timeline of Gardasil administration?
How effective is Gardasil in vaginal and vulvar cancer cases?
3 injectsions, given at baseline, two months after, and then 6 months after baseline
Given IM (0.5 ml, in the deltoid)
Helps protect against 70% of vaginal cancer cases and up to 50% of vulvar cancer cases
Gardasil does not prevent cerivcal cancer in what age group?
27 to 45
Clinical S/S of HSV ( Genital Herpes)
Visible, painful lesions or grouped vesicles in the genital or anal area and regional lymphadenopathy.
First outbreak is typically the worst!
The dif bet HSV and Syphilis is that syphilis isn't as painful.
KNOW: Dx for HSV?
Viral culture (gold standard) Preferred test for patients with genital ulcers or other mucocutaneous lesions.
KNOW: How is HSV identified?
Identified through observation of painful, multiple vesicular ulcerative lesions.
•Incubation period is about 2-12 days
•Lesions are usually 1-2mm in size, erythematous, superficial, tender
A positive culture for HSV is necessary for definitive diagnosis
•HSV Viral Culture >99% specific
•Positive within 24-72 hours of submission
•Sensitivity decreases as lesions crust and resolve.
For 1st clinical episode: Acyclovir 400 mg po TID for 7~10 days
Episodic: Acyclovir 400 mg po TID for 5 days
Daily Suppressive therapy: Acyclovir 400 mg po BID for a year. We put a woman on it, and she'll never have outbreaks again, or it's less frequent.
Once HIV enters the body, seroconversion occurs within 6~12 weeks. It could occur with sx, what are they?
•Seroconversion is usually without sx, may have flu-like sx or fever, HA, night sweats, nausea, diarrhea, weight loss, sore throat and rash
What are clinical S/S of trichomoniasis?
Yellow or green vaginal discharge, vaginal wall inflammation, “strawberry cervix”.
can have frothy vaginal discharge, protozoa disease
KNOW: Tx of Trichomonoiasis, Dx or trichomoniasis?
Tx: Metronidazole 2 gm po x1 OR Tinidazole 2 gm pox 1
Dx. Wet prep and culture
What is Pediculosis Pubis?
Affects what region?
Affects mostly the groin, anus or abdomen
General symptoms include:
•Feeling run down
•Inflamed skin and small red or bluish irritations caused by lice bites and defecation
•Intense itchiness at the infected area, usually more intense at night (begins about 5 days after infestation)irritability
Dx of Pediculosis Pubis?
Tx of Pediculosis pubis?
Diagnosis is made with the naked eye, a magnifying glass, or under a microscope, from observation of the shape of the louse and/or eggs.
Treatment is with anti-parasite medication, the most effective treatments being shampoos and creams containing Lindane, Permethrin, or a related compound.
How can we prevent STDs? (3)
2. Early education
What are victims of sexual assault most likely to suffer from? (Laundry list, just read).
- 3 times more likely to suffer from depression.
- 6 times more likely to suffer from post-traumatic stress disorder.
- 13 times more likely to abuse alcohol.
- 26 times more likely to abuse drugs.
- 4 times more likely to contemplate suicide.
What are some medical management of sexual assault?
•Testing for N. gonorrhoeae (gonorrhea) and C. trachomatis (Chlamydia) from specimens collected from any sites of penetration or attempted penetration.
•Wet mount and culture of a vaginal swab specimen for T. vaginalis (trichomoniasis) infection.
•Collection of a serum sample for HIV, hepatitis B, and syphilis
Post-exposure hepatitis B vaccination (if not previously vaccinated)
•At time of report
•1–2 months and
•4–6 months after the first dose
Treatment regimen for chlamydia, gonorrhea, trichomonaisis.
Emergency contraception should be offered if pregnancy is possible for the victim.
What are drugs given in medical management of sexual assault? You're treating gonorrhea, chlamydia, trichomonoiasis, etc
Ceftriaxone 250 mg IM in a single dose
Metronidazole 2 g orally in a single dose
Azithromycin 1 g orally in a single dose
Doxycycline 100 mg orally twice a day for 7 days