Sexually Transmitted Diseases: Schoenwald Flashcards
(164 cards)
1
Q
1 in __ people in the US have an STI
-___ million new STIs in 2018
A
5
- 26 million*
- HALF of new STIs were among youth aged 15-24 in the US
- New STIs total nearly $16 billion in direct medical costs
2
Q
STD Prevention and Control:
-Education/ counseling?
A
- Education and counseling to reduce risk of STD acquisition
- Detection of asymptomatic and/or symptomatic persons unlikely to seek evaluation
- Effective dx and tx
- Evaluation, tx, and counseling of infected persons and sexual partners
3
Q
STD Prevention and Control:
describe preexposure vaccination
A
**hepatitis A, B and HPV
4
Q
Medical Interview Important:
-The 5 P’s
A
Partners Prevention of Pregnancy Protection from STDs Practices Past History of STDs
5
Q
Prevention Messages
A
-Tailor to personal risk(patient)
Interactive counseling
- Don’t forget about adolescents
- Specific about actions needed for prevention or acquisition of STD
- Inform about specific tests performed
6
Q
Preexposure vaccines:
-Hepatitis B vaccine is recommended for:
A
ALL sexually active persons
7
Q
Preexposure vaccines:
-Hep A vaccine recommended for:
A
MSM
8
Q
Preexposure vaccines:
-HPV vaccine recommended for–>
A
ACIP recommendation ages 9-26
-**Males and females
9
Q
Prevention Methods:Male Condoms
-Consistent/correct use of latex condoms are effective in preventing:
A
sexual transmission of HIV infection and can reduce risk of other STDs
-*80% less likely to transmit HIV when condoms utilized
10
Q
Prevention Methods:Male Condoms
-Likely to be more effective in prevention of infections transmitted by ______
A
fluids from mucosal surfaces (GC,CT, trichomonas, HIV) than those transmitted by skin-skin contact (HSV,HPV, syphilis, chancroid) up to 70% risk reduction for HPV
11
Q
Male condoms:
___% breakage rate
A
-2%
12
Q
T/F: Non latex available-higher breakage and slippage rate
A
True!
ie:
–Synthetic and lambskin
–Lambskin-larger pores (10 times the diameter of HIV viral particle, 25 times the size of HBV)
13
Q
Female condoms provide an effective mechanical barrier to ______
A
viruses
14
Q
Prevention Methods: Spermicides
-N-9 vaginal spermicides are NOT effective in preventing :
A
CT, GC, or HIV infection
15
Q
Frequent use of spermicides/N-9 have been associated with _____
A
genital lesions
16
Q
Spermicides alone are NOT recommended for:
A
STD/HIV prevention
17
Q
N-9 should NOT be used as microbicide or lubricant during ____ intercourse
A
anal
18
Q
MSM=
A
males who have sex with males
19
Q
for all MSM, what must occur? (i.e. screening and counseling)
A
-STD/HIV sexual risk assessment and client-centered prevention counseling
- **Annual STD screening for MSM at risk
- -HIV and syphilis serology
- Pharyngeal NAAT, GC (oro-genital)
- Rectal NAAT, GC/CT (receptive anal IC)
20
Q
About ___ of the cases of syphilis are in MSM in the US
A
2/3
21
Q
____ preferred testing for GC/CT
A
**NAAT
GC=gonoccocal, NAAT=nucleic acid amplification test
22
Q
MSM annual screening:
-includes 3 tests
A
- HPV screening-anal pap smear
- HBsAg testing
- Hepatitis C Ab testing
23
Q
WSW=
A
women having sex w women
24
Q
WSW:
-HPV risk up to __% in those reporting never having sex with men
A
30%
25
WSW:
| -also are a higher concern for ____
- HIV
- GC/Chlamydia
- Trichomonas and BV a concern
26
HIV testing is ____
IMPORTANT
27
HIV:
| -opt out testing--
testing-notifying patient that test will be performed unless they decline
28
HIV testing should be included for ALL Pts in which demographic?
Pregnant women**
29
STDs of Concern
- Actually, all of them
- “Sores” (ulcers):
- -Syphilis
- -Genital herpes (HSV-2, HSV-1)
- Others UNCOMMON in the U.S.
30
In US, ____ and syphilis majority of cases of ulcers in young
HSV
31
List 3 Ex's of other STDS of concern that are uncommon in the US (KNOW FOR BOARD EXAMS)
- -Lymphogranuloma venereum
- -Chancroid
- -Granuloma inguinale
32
Non infectious etiology of ulcers (list Ex's)
```
Carcinoma
Trauma
Psoriasis
Fixed drug eruption
Yeast
```
33
STDs of concern Cont.
| -Describe "Drips" (aka discharges)
- Gonorrhea
- Chlamydia
- Nongonococcal urethritis / mucopurulent cervicitis
- Trichomonas vaginitis / urethritis
- Candidiasis (vulvovaginal, less problems in men)
34
Other MAJOR STD concerns: that is it's own category
| -hint: genital HPV
Genital HPV (especially type 16, 18) and Cervical Cancer
35
Genital Ulcer Diseases – Does It Hurt?
| -Painful (list ex's)
- Chancroid
| - Genital herpes simplex
36
Genital Ulcer Diseases – Does It Hurt?
| -Painless (list Ex's)
- Syphilis
- Lymphogranuloma venereum
- Granuloma inguinale
37
Genital Ulcers: Herpes Virus (HSV1/HSV2)
- How common ?
- ___% of adults in the US infected
- MC infectious etiology of genital ulcerations
| - **32-50% of adults in US infected(50 million)
38
Genital Ulcers: Herpes Virus (HSV1/HSV2)
- often transmitted ______
- HSV1 or HSV 2 is the most frequent cause of genital herpes?
- **unknowingly-asymptomatic viral shedding
| - **HSV 2 most frequent
39
Herpes (HSV1/HSV2)
| -Sx/clinical presentation
**Multiple painful vesicles on erythematous base, persist 7-10 days
40
Herpes can last how long?
- Chronic, lifelong infection
| - Majority of cases undiagnosed
41
Herpes:
| -serological testing?
*Serological testing high rate of false negative
42
Herpes Testing:
- viral studies:
- what is the test of choice??
culture and PCR preferred methods of testing
-**PCR is test of choice for CSF
(herpes simplex can cause a meningeal infection, so we add in the PCR of CSF to make sure it hasnt infected the brain)
43
Herpes:
| -primary lesions are associated with fever and ______
bilateral adenopathy
44
Herpes:
| Recurrent lesions-->
no fever or adenopathy
45
Herpes:
| -Describe the prodrome
Prodrome= tingling or burning 18-36 hours prior lesion
46
Gold standard dx test for Herpes lesion
**Tzank smear
| KNOW
47
Other dx tests for herpes
culture, serologies (many false negatives)
48
Tzanc smear=
| --positive if _____
=**Gold standard test for HSV
| -Positive if reported as presence of multinucleated giant cells
49
Genital HerpesFirst Clinical Episode: tx?
- **Acyclovir 400 mg tid or
- Acyclovir 200 mg 5 times daily or
- Famciclovir 250 mg tid - OR Valacyclovir 1000 mg bid
-**Duration of Therapy 7-10 days
(just remember acyclovir and famciclovir are primary ones)
50
Genital Herpes Episodic Therapy: tx?
```
-Acyclovir 400 mg 3x daily x 5 days
OR
-Acyclovir 800 mf BID x 5 days
OR
-Acyclovir 800 mg TID x 2 days
OR
-Famiciclovir 125 mg BID x 5 days
OR
-Famciclovir 1000 mg BID x 1 day
OR
-Valacylcovir 500 mg BID x 3 days
OR
Valacyclovir 1 gm PO daily x 5 days
```
51
Genital Herpes: supression
| -Reduces frequency by ____% in frequent recurrence (>6/yr)
70-80%
| supression= someone on an antiviral every day of the yr-- IF they have 6 or more episodes during a year
52
Genital HerpesDaily Suppression: tx regimen
```
Acyclovir 400 mg bid
or
Famciclovir 250 mg bid
or
Valacyclovir 500-1000 mg daily
```
53
Genital Herpes: Treatment in Pregnancy
- Available data do not indicate an increased risk of major birth defects (first trimester)
- Limited experience on pregnancy outcomes with prenatal exposure to valacyclovir or famciclovir
- Acyclovir may be used with first episode or severe recurrent disease
54
Genital Herpes: Treatment in Pregnancy
| --Risk of transmission to the neonate is ___% among women who acquire HSV near delivery
30-50%
55
Genital Herpes: Counseling
- Natural history of infection, recurrences, asymptomatic shedding, transmission risk
- *Individualize use of episodic or suppressive therapy
- **Abstain from sexual activity when lesions or prodromal symptoms present
- Inform partners
- **Risk of neonatal infection
56
Genital Herpes: Counseling
| -describe the risk of neonatal infection (ie pregnant women giving birth)
Women without symptoms can deliver vaginally, IF ulcer present-->c section
57
Genital Ulcers: Syphilis
| -describe the increasing incidence
- **Incidence increasing esp in HIV + men and MSM, also in IV drug usage
- 71% increase in numbers in US since 2014
58
Syphilis:
- etiology? (what organism)
- Describe the "Chancre"
- **Caused by Treponema pallidum
| - Chancre-papule that ulcerates-painless
59
Genital Ulcers:
- active infection classified as:
- -Primary=
- -Secondary=
- -Tertiary=
- Primary (ulcer)
- Secondary(skin rash, lymphadenopathy), neurologic(altered mental status, stroke, meningitis)
- Tertiary (cardiac or gummatous lesions)
60
Syphilis staging:
| -Describe Early Latent
Reactive testing within 1 year of infection-no symptoms
61
Syphilis staging:
| -Describe Late Latent
- Reactive testing greater than 1 year after onset of infection or timing cannot be determined
- No symptoms
62
Syphilis testing:
| -what is the Gold standard test?
**Darkfield examination of exudate/tissue =gold standard
63
Syphilis testing:
| -other dx tests: Serologic tests (describe the 2 types)
- Nontreponemal tests-RPR,VDRL
- -Reactivity fades over time
- Treponemal tests-fluorescent trepenemal ab(FTA-AB)
- ->Once positive, usually stays positive
64
Primary Syphilis - Clinical Manifestations
| -Incubation period=
10-90 days (Average of 3 weeks)
65
Primary Syphilis - Clinical Manifestations
| -describe the Chancre:
-Early: macule/papule --> erodes
Late: clean based, painless, indurated ulcer with smooth firm borders
- Unnoticed in 15-30% of patients
- Resolves in 1-5 weeks
- *****HIGHLY INFECTIOUS
66
Secondary Syphilis --> represents ________ dissemination of spirochetes
hematogenous
67
Secondary Syphilis - Clinical Manifestations
| -Usually ___ weeks after chancre appears
2-8
68
Secondary Syphilis - Clinical Manifestations
| -Findings?
- rash - whole body (includes palms/soles)
- mucous patches
- **condylomata lata (=anal/rectal syphilis)--> THIS IS HIGHLY INFECTIOUS
- constitutional symptoms (ie fever/chills)
69
Secondary Syphilis - Clinical Manifestations
| -S/Sx resolve in ____ weeks
2-10 (note: sx may resolve, BUT they are still infectious)
70
Tertiary syphilis:
- Gumma=
- Associated with _____ syphilis
soft,tumor like growth of tissues
| -cardiac syphilis
71
Tertiary syphilis:
| -Gumma tx
Penicillin G 2.4 million units IM q week x 3 weeks (Bicillin LA)
72
Neurosyphilis:
| -To make a Dx: MUST perform which exam?
CSF exam (CSF fluid by doing a VDRL test*)
| it takes month-yrs to develop neurosyphilis after exposure
73
Neurosyphilis:
| -can cause ____ disease
EYE disease --> uveitis, optic neuritis
74
With Syphilis, describe and important differentiator b/w the RPR test vs Treponemal test
When you treat them, repeat the RPR after about 6 months of tx, and you want the RPR to go down, and even to non reactive levels
VS
Treponemal test: this will always be + if the Pt ever tests positive
(KNOW FOR BOARDS)
75
Neurosyphilis: tx?
** Aqueous Penicillin G 18-24 million units/day for 10-14 days
76
Jarisch-Herxheimer Rxn=
- Sx=
- occurs when?
=Acute febrile rxn
- Headache, myalgia, fever
- Occurs within 24 hours of initiation of Syphilis treatment
77
Jarisch-Herxheimer Rxn:
| -how serious is this rxn?
Most of the time controlled with antipyretics but can be a **life threatening reaction
(antipyretics: ie NSAIDs, tylenol, sometimes albuterol is used)
78
SyphilisPrimary, Secondary, Early Latent: Recommended tx regimen
**Benzathine Penicillin G, 2.4 million units IM
79
SyphilisPrimary, Secondary, Early Latent:
| Recommended tx regimen for PCN allergy
- **Doxycycline 100 mg twice daily x 14 days or
- Ceftriaxone 1 gm IM/IV daily x 8-10 days (limited studies) or
- Azithromycin 2 gm single oral dose (preliminary data)
-NOTE: for these alternative agents in the setting of HIV, their use in HIV-infection has not been studied
80
SyphilisManagement of Sex Partners:
| -Exposure to primary, secondary, or early latent within 90 days: tx=
tx presumptively
81
SyphilisManagement of Sex Partners:
| Exposure to primary, secondary, or early latent > 90 days, tx=
presumptively if serology not available
82
SyphilisManagement of Sex Partners:
| -Exposure to latent syphilis who have high nontreponemal titers > 1:32, consider _______
presumptive tx for early syphilis
83
Syphilis:Treatment in Pregnancy
- Screen for syphilis at first prenatal visit; repeat RPR third trimester/delivery for those at high risk or high prevalence areas
- Treat for the appropriate stage of syphilis
- Some experts recommend additional benzathine penicillin 2.4 mu IM after the initial dose for primary, secondary, or early latent syphilis
- Management and counseling may be facilitated by sonographic fetal evaluation for congenital syphilis in the second half of pregnancy
84
Congenital syphilis:
| ___% of babies die or are stillborn
40%
85
Congenital syphilis:
| -Describe nerve damage
**vision and hearing
86
Syphilis PEARLS
- Highly contagious
- Test for HIV in newly diagnosed syphilis patients and vice versa
- Jarisch-Herxheimer reaction
87
Chancroid:
| T/F: Declining cases in the US, but is risk factor for HIV transmission
True!
88
Chancroid:
- Describe this condition
- **Painful or Painless?
- Vesicle or papule to pustule or ulcer, soft
| - Not indurated, **VERY painful
89
Chancroid:
| caused by ____________
* *Haemophilus ducreyi
| - Difficult to test, **culture <80% sensitivity
90
Pearl:
| A combination of **painful ulcer with **tender inguinal adenopathy suggests _____
****chancroid
KNOW
91
Chancroid:
| -contagious?
VERY
| -Sx: regional adenopathy is pathoneumonic
92
Chancroid: tx?
-which med is contraindicated in pregnancy?
```
Azithromycin 1 gm orally
or
Ceftriaxone 250 mg IM in a single dose
or
Ciprofloxacin 500 mg twice daily x 3 days
or
Erythromycin base 500 mg tid x 7 days
```
**Ciprofloxacin contraindicated in pregnancy
93
ChancroidManagement:
- re-examination ____ days after tx
- time required for complete healing is related to ulcer ____
- Lack of improvement indicates _____
- 3-7 days
- size
- incorrect diagnosis, co-infection, non-compliance, antimicrobial resistance
94
ChancroidManagement Considerations:
| -Resolution of lymphadenopathy may require _______
-drainage
95
Chancroid: Management of Sex Partners
Examine and treat partner whether symptomatic or not if partner contact < 10 days prior to onset
96
Lymphogranuloma venereum:
- organism?
- Incubation period=
- Chlamydia trachomatis
| - **5-21 day incubation
97
Lymphogranuloma venereum:
- describe this condition
- painless or painful?
- Lymphadenopathy is unilateral or bilateral?
- **Painless papule, vesicle or ulcer
| - Tender regional lymphadenopathy usually **unilateral
98
Genital elephantiasis=
think Chronic lymphogranuloma venereum
99
Lymphogranuloma Venereum:
| -1st line tx=
**Doxycycline 100 mg BID for 21 days
100
Lymphogranuloma Venereum:
| -alternative regimen=
Erythromycin base 500 mg four times daily for 21 days
101
Granuloma inguinale:
- organism?
- How common in the US?
- incubation=
* *Klebsiella (Calymmatobacterium) granulomatis
- Rare in US
- 9-50 day incubation
102
calcium makes which antibiotic ineffective?
**doxy
103
Granuloma inguinale:
- Painless or Painful?
- Lymph node involvement?
* *Painless papule that eventually ulcerates
| - No regional lymph nodes
104
**Granuloma inguinale can occur with ________
**donovanosis (donovan bodies present)
| KNOW this term
105
Granuloma inguinale: tx?
-minimum tx duration=
Doxycycline 100 mg twice daily x 3 weeks
or
Azithromycin 1 gram once per week x 3 weeks
or
Cipro 750 mg bid x 3 weeks
or
Trimethoprim-sulfamethoxazole 800 mg/160 mg BID
**Minimum treatment duration three weeks
106
Donovan bodies=
THINK Granuloma inguinale**
107
Condyloma acuminatum=
genital warts
108
Condyloma acuminatum:
| -etiology?
**HPV virus
109
Genital UlcerEvaluation:
| -Dx based on medical hx and PE is often ______
*inaccurate
110
Genital UlcerEvaluation: _____ test for syphilis
*serologic
| once that syphilis antibody is positive, they will be positive. BUT RPR can go back down to non reactive levels
111
Genital UlcerEvaluation:
| ______ test for HSV
*Culture/antigen test
112
Condylomata lata=
**anal rectal warts
113
Genital UlcerEvaluation:
| **Haemophilus ducreyi culture in settings where ______ is prevalent
chancroid**
114
Genital UlcerEvaluation:
| ____ may be useful
biopsy
115
“Drips”-Urethritis/Cervicitis:
| -organism
- Gonorrhea
| - Nongonococcal urethritis-
116
“Drips”: Urethritis/Cervicitis
- organisms?
- List Ex's of "Drips"
- Gonorrhea
- Nongonococcal urethritis
- Mucopurulent Cervicitis
- Trichomonas vaginitis and urethritis
- Candidiasis
117
Gonorrhea: is the _____ MC reported infection yearly in the US
2nd MC**
- 820,000 new cases/yr
- 92% increase in infections since 2009 (low point of infection)
- Complications
118
Gonorrhea- cases reported by states
Dark blue= higher risk states (ie Alaska, NM, Oklahoma, North Dakota)
119
Gonorrhea — Proportion of STD Clinic Patients Testing Positive by Age Group, Sex, and Sex of Sex Partners, STD Surveillance Network (SSuN), 2019
just know--> Men who have sex w men (MSM) have the highest rates for Gonorrhea , women have the lowest
120
Urethritis-- in males:
| -List clinical manifestations & Sx
- Urethral inflammation
| - Sx: Dysuria and urethral discharge (5% asymptomatic)
121
Urethritis-- in males:
- incubation=
- Dx? (test of choice=)
- 1-14 d (usually 2-5 d)
- Dx: **NAAT (urine)= 1st line, Gram stain, culture
*NAAT= nucleic acid amplification test
122
Gonorrhea Cervicitis:
| Describe this urogenital infection in females-->
- Endocervical canal primary site
- 70-90% also colonize urethra
- Incubation period is unclear; sx usually in l0 d
123
Gonorrhea Cervicitis:
| Describe this urogenital infection in females-->
- Endocervical canal primary site (note: VERY contagious)
- 70-90% also colonize urethra
- Incubation period is unclear; sx usually in l0 d
124
Gonorrhea Cervicitis:
| Dx?
- *NAAT, Gram stain smear , culture
| - complications
125
Gonorrhea Cervicitis:
| Dx?
- NAAT, **Gram stain smear , culture
| - complications
126
Gonorrhea Cervicitis:
| -gold standard test= ?
= **Gram stain
-**Gram stain shows gram negative diplococci intracellular (KNOW for boards!)
-BUT, MC utilized is NAAT in clinic
127
Bartholin’s abscess- tx?
sitz baths
128
Disseminated gonorrhea is indicated by _____
skin lesion
129
Neisseria gonorrhea: Involving the Cervix, Urethra, Rectum,Pharynx
**What is the OLD specific Tx (2015 Guideline) ?
Ceftriaxone 250 mg IM single dose
PLUS
Azithromycin 1 gram po single dose
130
* *Gonorrhoeae Guideline Update: Dec 17, 2020 Guideline change
- what is the new tx regimen?
-ceftriaxone 500 mg IM x single dose** (azithromycin dropped)
(need to know the latest update, AND the old tx regimen)
131
Neisseria gonorrhoeae Pharyngitis:
| -Tx regimen?
Ceftriaxone 250 mg IM in a single dose
Plus
Azithromycin 1 gram po single dose
132
* *Gonorrhoeae Guideline Update: Dec 17, 2020 Guideline change
- -What about concurrent treatment of Chlamydia?
-doxycycline for 7 days
133
Neisseria gonorrhoeae:
| -resistance to ______ has developed
*azithromycin. this is why it was dropped
134
Disseminated Gonococcal Infection:
- Recommended tx Regimen=
- alternate regimen= (dont memorize alternative)
**Ceftriaxone 1 gm IM or IV q 24 hr
-Cefotaxime or Ceftizoxime 1 gm IV q8 hr
135
Neisseria gonorrhoeae Antimicrobial Resistance:
- Geographic variation in resistance to ____ and tetracycline
- No significant resistance to ______
- _______ resistance worldwide!
- penicillin
- ceftriaxone
- **fluoroquinolone
**Surveillance is crucial for guiding therapy recommendations
136
Nongonococcal Urethritis
| -etiology:
- 20-40% C. trachomatis (chlamydia)***
- 20-30% genital mycoplasmas** (Ureaplasma urealyticum, Mycoplasma genitalium)
- Occasional Trichomonas vaginalis, HSV
- **Unknown in ~50% cases
137
Nongonococcal Urethritis:
| -Sx?
Mild dysuria, mucoid discharge
138
Nongonococcal Urethritis: dx
- Urethral smear:
- Urine microscopic:
- Urethral smear ≥ 5 PMNs (usually ≥ 15)/OI field
| - Urine microscopic: ≥10 PMNs/HPFand (+) Leukocyte esterase
139
Nongonococcal Urethritis:
| -historical tx=
**Azithromycin 1 gm in a single dose
OR
Doxy 100 mg bid x 7 days
140
Chlamydia trachomatis:
| -how common?
- More than three million new cases annually
- *Most frequently reported infectious disease in the USA
- Direct and indirect cost of chlamydial infections run into billions of dollars
- Infections mostly asymptomatic (more likely to be symptomatic in males)
- **Prevalence highest in those less than 24 years of age
141
Chlamydia trachomatis:
| -screen women ____ yo
<25
142
Chlamydia trachomatis infection is responsible for causing cervicitis, urethritis, ______, _________, and _____
proctitis, lymphogranuloma venereum, and ***PID in women!!
143
Chlamydia trachomatis:
| -Potential to transmit to _____
**newborn during delivery
144
Chlamydia trachomatis:
| -list some Ex's of significant problems that can occur if infection is transmitted to the newborn
**Conjunctivitis, pneumonia
| chlaymdia PNA or Conjuncivitis (SIGNIFICANT problem in newborn)
145
Predominant Chlamydia infection Population groups:
-<19 men who have sex w women, Women <19
146
Lab Tests for Chlamydia: dx
-**Urine (NAAT) MC used or cervical/urethral swabs
Other tests:
- Enzyme Immunoassay (EIA), e.g. Chlamydiazyme
- Nucleic Acid Hybridization (NA Probe), e.g. Gen- Probe Pace-2
- DNA amplification assays: polymerase chain reaction (PCR) and ligase chain reaction (LCR)
147
Chlamydia tests:
| T/F: Sensitivities with PCR and LCR 95% and 85-98% respectively; specificity approaches 100%
True! LCR also has the ability to detect chlamydia in first void urine
148
Chlamydia trachomatis:
-Annual screening of sexually active women ≤ ____ years
- Annual screening of sexually active women >____ yrs with risk factors
- Sexual risk assessment may indicate ______ screening for some women
- Rescreen women ____ months after treatment due to high prevalence of repeat infection
- 25 years
- 25 years
- **more frequent screening for some women
- 3-4 months
149
Chlamydia trachomatis: tx?
**Azithromycin 1 gm single dose
or
Doxycycline 100 mg bid x 7d
150
Chlamydia trachomatis Treatment in Pregnancy
| -recommended tx?
**Azithromycin 1 gram orally
or
Amoxicillin 500 mg three times daily for 7 days
-Need test of cure if treating in pregnancy
151
____% women with GC develop PID
10-20% **
152
In Europe and North America, higher proportion of C. trachomatis than ______ in women with symptoms of PID
N. gonorrhoeae
| so C. trachomatis Infection (PID) are more common
153
PID:
| -CDC minimal criteria for dx=
**uterine adnexal tenderness, cervical motion tenderness
(KNOW!) this requires pelvic exam
154
PID:
| -other Sx include:
endocervical discharge, fever, lower abd. pain
155
(+) cervical motion tenderness sign=
**Chandelier sign
| KNOW
156
PID:
| -complications ?
- **Infertility: 15%-24% with 1 episode of PID 2/2 GC or chlamydia
- **7X risk of ectopic pregnancy with 1 episode of PID
- chronic pelvic pain in 18%
(Normal human fallopian tube is ciliated to help move the egg along through the fallopian tube, BUT w/ PID, it attacks the cilia. So less ciliary movement, and this can cause the egg to get stuck (predisposes to ectopic)
157
Pelvic Inflammatory Disease:
| -Additional Diagnostic Criteria (list)
- Oral temp >101 F(38.3 C) -Elevated ESR
- Cervical CT or GC -Elevated CRP
- WBCs/saline microscopy -Cervical discharge
158
Pelvic Inflammatory Disease:
| -admit or no?
-many cases the Pt is Hospitalized**
159
PID:
| -list circumstances when the Pt must be hospitalized
- Surgical emergencies not excluded
- **Pregnancy
- Clinical failure of oral antimicrobials
- Inability to follow or tolerate oral regimen
- Severe illness, N/V, high fever
- Tubo-ovarian abscess
160
PID:
| -Parenteral vs oral regimens
-No efficacy data compare parenteral with oral regimens
- Clinical experience should guide decisions regarding transition to oral therapy
- **Until regimens that do NOT adequately cover anaerobes have been demonstrated to prevent sequelae as successfully as regimens active against these microbes, regimens should provide anaerobic coverage
161
PID:Parenteral Regimen A
```
**Cefotetan 2 g IV q 12 hours
or
***Cefoxitin 2 g IV q 6 hours
PLUS
Doxycycline 100 mg orally/IV
q 12 hrs
```
(cefotetan and cefoxitin covers GC)
162
PID: Parenteral Regimen B
Clindamycin 900 mg IV q8 hrs
PLUS
Gentamicin loading dose IV/IM (2 mg/kg) followed by maintenance dose (1.5 mg/kg) q 8 hours.
Single daily dosing may be substituted
163
PID: oral regimen
```
**Ceftriaxone 250 mg IM in a single dose
PLUS
Doxycycline 100 mg PO BID for 14 days
WITH or WITHOUT
Metronidazole 500 mg twice daily for 14 days
```
(KNOW)
164
PID: Management of Sex Partners
- Male sex partners of women with PID should be:
- Sex partners should be treated empirically with:
- examined and treated for sexual contact 60 days preceding pt’s onset of symptoms
- regimens effective against CT and GC (ie ceftriaxone plus azith or doxy)
