Lecture 28: STIs Flashcards by Emily Byford

What are some of the factors that can lead to STIs?

NUMBER OF SEXUAL PARTNERS
Teens and Twenites
African Americans or Hispanics
Men that have sex with Men
Higher rates in those with Erectile Dysfunction

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What is the etiologic agent and some of the epidemiology of Gonorrhea?

Neisseria Gonorrhoeae
Second MOST COMMON disease
50% are resistant to ONE antibiotic
Higher in those that have low socioeconmic status, urban living, unmarried, previous history

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What are the Clinical Manifestions of Genital infection in Menin Gonorrhea?

What is it? Symptoms? Resolution?

Acute Urethria inflammotion
Symptoms: Urethral discharge and dysuria
Can resolve on its now

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What are the Clinical Manifestions of Uncomplicated Gential Infections in womenin Gonorrhea?

Mainly in the Endocervix
80% are asymptomatic; leading to ~15% becoming infertile

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What are the Clinical Manifestions of Pharyngeal Infection in Gonorrhea?

Asymptomatic
Orogential Sexual Exposure

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What are the Clinical Manifestions of Gonococcal Infections in the Newborn in Gonorrhea?

From Passign through birth canal
Commonly –> Ophthalmia Neonatorum
NOT treated = ulceration and blindness

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What is the way we Diagnose for Gonorrhea?

Gram Stains [diplococci]
NAAT: Standard [urine, rectum, throat]
Swabs
Test other STIs if HIV -

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What is the Treatment for Gonorrhea when it is uncomplicated Gonococcal infection of the Cervix, Urethra and Rectum?

2021 guildlines

Ceftriaxone 500mg IM ONCE < 150kg [1g for > 150kg]
Has Chlamydia too: Doxycycline 100mg PO BID x 7d
Has Chlamydia & Pregnant: Azithromycin 1g ONCE

Alternative: Gentamicin 240mg IM ONCE + Azithromycin 2g PO ONCE [only when you cant get Ceftriaxone]

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What is the Treatment for Gonorrhea when it is Uncomplicated Gonococcal Infection of the Pharynx?

Ceftriaxone 500mg IM ONCE < 150kg [1g for > 150kg]
Has Chlamydia too: Doxycycline 100mg PO BID x 7d
Has Chlamydia & Pregnant: Azithromycin 1g ONCE

Test -of-cure: 7-14 days after start

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What are some of the important instructions to tell someone with Gonorrhea?

Abstain from sex for 7 days after treatment
Treat ALL sexual partners [Cefixime 800mg PO ONCE + Doxycycline 100mg PO BID x 7d]

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What is the etiologic agent and some of the epidemiology of Syphilis?

Treponema Pallidum
45% from Men having sex with Men
STRONG association with HIV and Syphilis

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What is the Clinical Presentation of Primary Syphilis in Syphilis?

Paineless lesions [like chancre sore] that HIGHLY infectious
Can dissappear without treatment (3-6w)

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What is the Clinical Presentation of Secondary Syphilis in Syphilis?

Develops 2-6w after primary onset
Lesion are anywhere [even palms and soles]
Can cause malaise, fever, pharyngitis, headache, anorexia, arthralgis…
May disappear in 4-10w

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What is the Clinical Presentation of Latent Syphilis in Syphilis?

Early or Late?

Positive Serologic test but no other signs
Early: Maybe infectious; 1 year from onset
Late: Not infection except during pregnancy

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What is the Clinical Presentation of Neurosyphilis in Syphilis?

MAY HAPPEN AT ANY STAGE
Causes headaches, meningismus, increased CSF
Looking for VDRL-CSF [very specfic for it]

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What is the Diagnosis for Syphilis?

Speices? Tests? Screens?

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Presence of T. Pallidum [primary]
Testing: VDRL, RPR, USR, TRUST [(+) means any stage]
Screening: fourfold change in titer [increase = treat]

What is the Treatment for Primary and Secondary Syphilis in Nonpregnant Adults?

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Penicillin G benzathine 2.4 mil unit ONCE IM
Doxycycline 100mg PO BID x14d [1st alt]
Ceftriaxone 1-2g QD IM or IV for 10-14d [2nd alt]

This includes HIV patients

What is the Treatment for Latent Syphilis in Nonpregnant Adults?

Early and Late

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Early: Penicillin G Benzathine 2.4 mil unti ONCE IM [Doxycyline 100mg PO BID for 14d]
Latent: Penicillin G Benzathine 7.2 unit; given 3 IM doses of 2.4 mil 1 week apart [Doxycycline 100mg PO BID x28d (alt)]

This includes HIV patinets

What is the Treatment for Late Syphilis?

not neuro?

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Penicillin G Benzathine 7.2 mil units; given 3 IM dose of 2.4 mil 1 week apart

What is the Treatment for Neurosyphilis and Ocular Syphilis?

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Penicillin G 18-24 mil units per day; continuous IV for 10-14d
Penicillin G Procaine [alt]

What is the Treatment for Primary and Secondary Syphilis in Pregnant Adults?

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Penicillin G Benzathine 2.4 mil unit ONCE IM

Pencillin is the ONLY thing that will help mother and baby

What is the Treatment for Latent Syphilis in Pregnant Adults?

Early and Late?

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Early: Pencillin G Benzathine 2.4 mil unit ONCE IM
Late: Pencillin G Benzathine 7.2 mil unit; 3 doses of 2.4 mil unit IM 1 week apart

What is Jarish-Herxheimer Reaction?

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Flu-like reaction of headache, fever, chills, malaise, arthralgia, myalgia, tachycardia…
May start 2-4 hours; DO NOT confuse with Penicillin allergy

What is the etiologic agent and some of the epidemiology of Chlamydia?

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Chlamydia Trachomatis
The MOST COMMON infectious disease
Highest among African Americans
Untreated in women –> Infertility

What is the **clinical presentations** in **Male, Females, Infants** for **Chlamydia**?

- Males: dysuria, urinary frequency, mucoio urethral discharge [asymptomatic] - Females: Most are asymtompatic; IF symptomatic [endocervicitis] - Infants: transmitted via cervicovaginal secretion; commonly causes eye infections

What is the **diagnosis** for **Chlamydia**?

- NAAT - Giemas Stain of Cells - Immunofluorescence - Cell Culture ~100% specific

What is the **Treatment** for **Chlamydia**? ## Footnote Teens & adults? Pregnacy?

- Teens and adults: **Doxycycline 100 mg PO BID x 7d** [Alt: Azithromycin 1g PO ONCE or Levofloxiacin 500mg PO q24h x7d] - Pregnancy: **Azithromycin 1g PO ONCE** [Alt: amoxicillin 500mg PO TID x 7d] ## Footnote **Abstain from sex for 7 days** and **have all sex partners tested**

What is the **Etiology and Epidemiology** of **Gential Herpes Simplex Virus Infections**? ## Footnote HSV 1 & 2?

- HSV 1: anogenital [mainly in young women & MSM] - HSV 2: MOST genital herps

What is the **Clinical Presentations** for **Primary HSV Infections**?

- First-Episode: prolonged duration [Fever, headache, malasie, gential pain, discharge]

What is the **Treatment** for the **First Clinical Episode** of **HSV**?

- Acyclovir 400mg PO TID - Famciclovir 250mg PO TID - Valacyclovir 1g PO BID ## Footnote **Treat for 7-10 days** Same thing for those that have HIV

What is the **Treatment** for **Recurrent HSV** infections?

- Acyclovir 800mg PO BID x 5d or 800mg PO TID x 2d - Famciclovir 125mg pO BID x 5d or 1g PO BID x1d - Valacyclovir 500mg PO BID x 3d or 1g PO QD x 5d ## Footnote Same thing for those with HIV

What is the **Treatment** for Trichomoniasis?

- **Metronidazole**

Lecture 28: STIs Flashcards

(32 cards)