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Flashcards in STI/ PID Deck (89)
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1
Q

Gonorrhea treatment (New update CDC 2015):

A

treatment of uncomplicated gonorrhea:500 mg injection of ceftriaxone.
Single-Dose Treatment of Uncomplicated Gonococcal Infection of the Cervix, Urethra, or Rectum:
Recommended regimen: Ceftriaxone (Rocephin) 250 mg IM + Azithromycin (Zithromax) 1 g orally once
Alternative regimen: Cefixime (Suprax) 400 mg orally once +Azithromycin 1 g orally once
In cases of cephalosporin allergy, one potential option is single oral doses of gemifloxacin 320 mg plus azithromycin 2 g. Another is single doses of
gentamicin 240 mg IM plus oral azithromycin 2 g. For azithromycin allergy, ceftriaxone alone suffices. However, if the alternative regimen with cefixime
is used, then doxycycline, 100 mg orally twice daily for 7 days, replaces the azithromycin

2
Q

Diagnostic test for chlamydia and gonorrhea and trichomonas and M genitalium:

A

nucleic acid amplification test (NAATs)

after chlamydia, gonorrhea, and trichomonas, a three-month test post-therapy is no more recommended with single dose highly effective except for certain high-risk groups (pregnancy,
(ideally to repeat after 3 wks)

3
Q

Diagnostic method for genital herpes

A

Physical exam
herpes PCR from the lesions is the preferred diagnostic test.
Nucleic acid amplification test (NAAT) testing is many times more sensitive than culture and can detect HSV DNA shed from epithelia without vesicular lesions

4
Q

HIV screening and diagnosis

A

The recommended diagnostic algorithm for HIV infection consists of a laboratory-based immunoassay, which if repeatedly reactive is followed by a supplemental test (e.g., an HIV-1/HIV-2 antibody differentiation assay, Western blot, or indirect immunofluorescence assay).

5
Q

Acute retroviral syndrome is characterized by

A

is the first stage of infection with the human immunodeficiency virus (HIV). nonspecific symptoms, including fever, malaise, lymphadenopathy, and skin rash.

6
Q

Treatment of HSV

A

if First clinical episode:
Acyclovir 400 mg three times daily for 7–10 days
or Acyclovir 200 mg five times daily for 7–10 days
or Famciclovir (Famvir) 250 mg three times daily for 7–10 days
or Valacyclovir (Valtrex) 1 g twice daily for 7–10 days
(CDC-2015)

7
Q

HPV couliflower vs. Molluscum contagiousum

A

-

8
Q

Syphillis dx test

A

Syphillis specific Ab with clinical suspicion enough to diagnose

If not sure can be
Followed by (RPR) A rapid plasma reagin
If +ve > diagnostic

9
Q

the vaginal pH ranges between 4 and 4.5. This is due in part to

A

gram-positive aerobic Lactobacillus species producing lactic acid, fatty acids, and other organic acids.

10
Q

the most reliable indicators of BV

A

Clue cells

11
Q

whiff test

A

10-percent potassium hydroxide (KOH) to a fresh sample of vaginal secretions releases volatile amines that have a fishy odor in bacterial vaginosis.

12
Q

Pregnant patients with BV have an elevated risk of

A

preterm delivery and postpartum endometritis

13
Q

BV treatment options:

A

Recommended regimens:
Metronidazole (Flagyl) 500 mg PO BID dailyx7 days
Metronidazole gel 0.75% (Metrogel vaginal) 5 g (1 full applicator) intravaginally OD X5 days
Clindamycin cream 2% (Cleocin, Clindesse) 5 g (1 full applicator) intravaginally at bedtimeX 7 days
Alternative regimens:
Secnidazole (Solosec) 2 g orally once
Tinidazole (Tindamax) 2 g orally once daily for 2 days OR 1 g orally once daily for 5 days
Clindamycin 300 mg orally twice daily for 7 days
Clindamycin ovulesa (Cleocin) 100 mg intravaginally at bedtime for 3 days

14
Q

this virus enters sensory nerve endings and undergoes retrograde axonal transport to the dorsal root ganglion. Here, the virus develops lifelong latency.

A

Herpes Simplex Virus

15
Q

The three stages of HSV lesions are:

A

(1) vesicle with or without pustule formation, which lasts approximately a week; (2) ulceration; and (3) crusting. Virus is predictably shed during the first two phases.

16
Q

Episodic therapy for recurrent HSV disease

A

ideally initiated at least within 1 day of lesion outbreak or during the prodrome.
Acyclovir 400 mg three times daily for 5 days
or Acyclovir 800 mg twice daily for 5 days
or Acyclovir 800 mg three times daily for 2 days
or Famciclovir 125 mg twice daily for 5 days
or Famciclovir 1 g twice daily for 1 day
or Famciclovir 500 mg once, then 250 mg twice daily for 2 days
or Valacyclovir 500 mg twice daily for 3 days
or Valacyclovir 1 g once daily for 5 days
(CDC-2015)

17
Q

Suppressive therapy FOR HSV:
If episodes recur at frequent intervals, a woman may elect daily suppressive therapy, which reduces recurrences by 70 to 80 percent

A
Suppressive therapy
Acyclovir 400 mg twice daily
or Famciclovir 250 mg twice daily
or Valacyclovir 0.5 or 1 g once daily
(CDC-2015)
18
Q

Syphilis is caused by

A

the spirochete Treponema pallidum, which is a slender, spiral-shaped organism with tapered ends.

19
Q
  • primary syphilis Characteristics:
A

-primary syphilis: the hallmark lesion is the chancre (an isolated, nontender ulcer with raised, rounded borders and an uninfected base) it may become secondarily infected and painful. often found on the cervix, vagina, or vulva but may also form in the mouth or around the anus. The mean incubation period is 3 weeks, but lesions can develop 10 days to 3 months after exposure. Without treatment, lesions spontaneously heal within 6 weeks.

20
Q

The natural history of syphilis in untreated patients can be divided into four stages WHICH IS :

A

1-1RY: chancre lesions btw 10 d - 3 mon
2- 2ry: bacteremia with maculopapular rash btw 6 wks- 6 mon
3- LATENT PAHSE:
A- Early latent syphilis: resolved symptoms, diagnosed within 1 year of infection.
B- late latent syphilis: a period greater than 1 year after the initial infection.
4- Tertiary syphilis: appear up to 20 years after latency, CVS, CNS, MSK involvement become apparent.

21
Q

secondary syphilis Characteristics:

A

bacteremia develops 6 weeks to 6 months after a chancre appears. Its hallmark is a maculopapular rash that may involve the entire body and includes the palms, soles, and mucous membranes called mucous patches, actively shed spirochetes. In warm, moist body areas, this rash may produce broad, pink or gray-white, highly infectious plaques called condylomata lata. Because syphilis is a systemic infection, other manifestations may include fever and malaise. Less commonly, cranial nerve dysfunction, meningitis, hepatitis, nephrotic syndrome, and arthritis develop.

22
Q

Early latent syphilis:

A

Untreated, the manifestations of secondary syphilis resolve, and latent syphilis is diagnosed using serologic tests. During early latent syphilis, which is diagnosed within 1 year of infection, secondary signs and symptoms may recur.

23
Q

Tertiary syphilis is

A

the phase of untreated syphilis that may appear up to 20 years after latency. During this phase, cardiovascular, central nervous system, and musculoskeletal involvement become apparent. However, cardiovascular and neurosyphilis are half as common in females as in males.
((gumma)) characteristic lesion of tertiary syphilis

24
Q

A definitive diagnosis of syphilis by:

A

direct detection of spirochetes within a lesion sample.

but can be diagnosed presumptively using clinical assessment plus serologic testing. Serologic testing includes both nontreponemal and treponemal-specific tests. The two nontreponemal tests are the Venereal Disease Research Laboratory (VDRL) and the rapid plasma reagin (RPR) tests.
In a woman previously treated for syphilis, a fourfold (two dilution) rise in nontreponemal titer suggests reinfection, and retreatment is provided.

25
Q

a Jarisch-Herxheimer reaction

A

Within the first 24 hours after treatment of early syphilis disease, an acute, self-limited febrile response may develop and is associated with headache and myalgia, uterine contractions and fetal late decelations , they resolve in 24 hours.

26
Q

treatment of Primary, secondary, early latent (<1 year) syphilis

A

Recommended regimen:

  • Benzathine penicillin G, 2.4 million units IM once
  • Alternative oral regimens (penicillin-allergic, nonpregnant women): Doxycycline 100 mg orally twice daily for 2 weeks
27
Q

treatment of Late latent, tertiary, and cardiovascular syphilis

A

Recommended regimen:

  • Benzathine penicillin G, 2.4 million units IM weekly times 3 doses
  • Alternative oral regimen (penicillin-allergic, nonpregnant women): Doxycycline 100 mg orally twice daily for 4 weeks.
28
Q

Chancroid is caused by

A

Haemophilus ducreyi, and following exposure, incubation usually spans 3 to 10 days.
painful genital ulcers classically have soft irregular margins and friable bases. In addition, many patients develop tender inguinal lymphadenopathy. If large and fluctuant, these buboes may suppurate and form fistulas.

29
Q

standard method of diagnosis of Chancroid is

A

a NAAT

30
Q

Chancroid treatment, the CDC’s (2015) recommended regimens include

A

either a single dose of oral azithromycin (1 g) or of IM ceftriaxone (250 mg). Second-line, multidose options are ciprofloxacin or erythromycin base.

31
Q

Also known as donovanosis, granuloma inguinale is caused by

A

the gram-negative bacterium Klebsiella granulomatis. Incubation may last from days to weeks, and infection presents with painless inflammatory nodules that progress to highly vascular, nontender ulcers. These ulcers heal by fibrosis, which can result in scarring resembling keloids. Lymph nodes are usually uninvolved.

32
Q

granuloma inguinale diagnosis is confirmed by

A

identification of Donovan bodies, which appear as a “closed safety pin” during microscopic cytologic evaluation following Wright-Giemsa staining.

33
Q

granuloma inguinale Treatment recommended by the CDC (2015) is

A

azithromycin 1 g once weekly for at least 3 weeks and until lesions are completely healed. Alternative regimens include doxycycline, ciprofloxacin, trimethoprim-sulfamethoxazole, or erythromycin base.

34
Q

Lymphogranuloma Venereum

This ulcerative painless genital disease is caused by

A

C trachomatis serotypes L1, L2, and L3.

Incubation ranges from 3 days to 2 weeks.

35
Q

lymphogranuloma venereum (LGV) is divided into three stages:

A

(1) small painless papule, (2) regional lymphadenopathy, and (3) anogenitorectal fibrosis.

36
Q

lymphogranuloma venereum (LGV) treatment:

A

the CDC (2015) recommends doxycycline, 100 mg orally twice daily for 21 days. An alternative is erythromycin base.

37
Q

recurrent candidiasis disease definition

A

four or more candidal infections during a year.

38
Q

recurrent candidiasis disease treatment

A

For recurrent C albicans disease, local intravaginal therapy for 7-14 days is an option. or oral fluconazole (Diflucan) in 100-mg, 150-mg, or 200-mg strengths once every third day for a total of three doses
(day 1, 4, and 7). Suppressive maintenance for recurrence prevention is with oral fluconazole, 100 to 200 mg weekly for 6 months. Nonalbicans candidal species are less responsive to topical azole therapy. For non-albicans recurrent infection, a 600-mg boric acid gelatin capsule intravaginally at bedtime for 2 weeks may be successful.

39
Q

the most prevalent nonviral STD worldwide is

A

Trichomoniasis

40
Q

trichomoniasis Oral regimens recommended by the CDC (2015) are

A

metronidazole 2 g once or tinidazole (Tindamax) 2 g once.

41
Q

patients with trichomoniasis may have strains that are highly resistant to metronidazole, proper treatment ?

A

but these organisms are usually sensitive to tinidazole. If cure is not achieved by a single dose or then by a subsequent 7-day course of metronidazole, oral tinidazole 2 g daily for 7 days is considered. If treatment fails following adherence to multiple 1-week regimens and reinfection is excluded, culture and susceptibility testing is considered with the assistance of CDC (404-718-4141).

42
Q

Oral Treatments of Chlamydial Infection:

A

Recommended regimen
Azithromycin 1 g once
or Doxycycline 100 mg twice daily for 7 days
Alternative regimens
Erythromycin base 500 mg four times daily for 7 days
or Erythromycin ethyl succinate 800 mg four times daily for 7 days
or Levofloxacin (Levaquin) 500 mg once daily for 7 d
or Ofloxacin (Floxin) 300 mg twice daily for 7 days

43
Q

Mycoplasma Genitalium

A

recently been considered significant as a potential public health risk for its role in female reproductive tract pathology. Most female carriers are asymptomatic, but it has been linked in some studies to urethritis, cervicitis, PID, and tubalfactor infertilit. . Thus, in women with persistent or recurrent urethritis, cervicitis, or PID, M genitalium is considered.

44
Q

Acute PID, which is defined as

A

lasting <30 days, represents most cases.

45
Q

Chronic PID is generally associated with

A

Mycobacterium tuberculosis or Actinomyces species

46
Q

One or more of the following enhances diagnostic specificity of acute PID:

A

(1) oral temperature >38.3°C (101.6°F), (2) mucopurulent cervical discharge or cervical friability, (3) abundant WBCs on saline microscopy of cervical secretions, (4) elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), and (5) presence of cervical N gonorrhoeae or C trachomatis. Thus, a diagnosis of PID
is typically based on clinical findings.

47
Q

Fitz-Hugh-Curtis syndrome.

A

inflammation of the liver capsule, which can accompany PID, may lead to right upper quadrant pain Classically, symptoms of this perihepatitis include sharp, pleuritic right upper quadrant pain that accompanies pelvic pain. The upper abdominal pain may refer to the shoulder or upper arm. Importantly,
during examination, if all abdominal quadrants are involved, suspicion for a ruptured tuboovarian abscess (TOA) is heightened.

48
Q

US Characteristic acute PID findings include:

A

(1) distended, ovoid-shaped tube filled with anechoic or echogenic fluid, (2) fallopian tube wall thickening, (3) incomplete internal septa, and (4) a “cogwheel” appearance when inflamed tubes are imaged in cross section. If color or power Doppler is applied, marked vascularity with low impedance blood flow, which reflects hyperemia, is seen within thickened fallopian tube walls and septa.

49
Q

Tuboovarian complex Vs. Tuboovarian abscess in US

A

Sonographically, if both tube and ovary are recognizable, the term tuboovarian complex is used. If inflammation proceeds, tissue planes and distinction between the two is lost, and the term tuboovarian abscess is applied.

50
Q

Sonographic features of PID

A

the mass has thick irregular walls, areas of mixed echogenicity, septations, and internal echoes from debris.

51
Q

Periappendiceal abscess is a common mimic OF Tuboovarian abscess, how would be differentiated ?

A

the right ovarian vein entering the mass, the mass lying posterior to the mesovarium, contralateral pelvic fat stranding, and thickened uterosacral ligaments

52
Q

MRI for Tuboovarian abscess

A

MRI usually shows a complex pelvic mass
with low signal intensity on T1-weighted sequences and heterogeneously high signal intensity on T2-weighted sequences. MRI is not routinely
used for TOA diagnosis but may be helpful and shows greater accuracy than CT scanning for distinguishing TOAs from ovarian neoplasms.

53
Q

Tubal damage or occlusion resulting from infection may lead to infertility. Rates following one episode approximate – percent; two episodes, – percent; and three or more episodes, – percent

A

Tubal damage or occlusion resulting from infection may lead to infertility. Rates following one episode
approximate 10 percent; two episodes, 20 percent; and three or more episodes, 40 percent

54
Q

Suggested Indications for Parenteral Treatment of PID:

A
Pregnant
High fever
Suspected abscess
Uncertain diagnosis
Generalized peritonitis
Failed outpatient therapy
Noncompliant with medications
White blood cell count >15,000/mm3
Nausea/vomiting precluding oral therapy
55
Q

IUD AND PID

A

During the first 3 weeks after insertion, patients have an increased IUD associated PID risk. After this time, other PID risks are considered causative. In women with PID and an IUD, theoretical concerns are that the coexistent device might worsen the infection or delay resolution. Although a provider may choose to remove the device, evidence supports leaving an IUD during
treatment in those with mild or moderate PID (cdc 15)

56
Q

Outpatient Treatment of PID

A

Ceftriaxone (Rocephin) 250 mg IM oncea,b
PLUS
Doxycycline 100 mg orally twice daily for 14 days
with or without
Metronidazole (Flagyl) 500 mg orally twice daily for 14 days

57
Q

Chronic Pelvic Inflammatory Disease defined as

A

PID lasting longer than 30 days, and one cause is Actinomyces israelii.

58
Q

Acquired immunodeficiency syndrome (AIDS), also known as stage 3 infection, is the most advanced stage of HIV infection and is diagnosed in those meeting specific criteria. These
are

A

a CD4 count <200 cell/μL and AIDS-defining criteria that include Pneumocystis jirovecii pneumonia, Kaposi sarcoma, invasive cervical cancer, and others.

59
Q

The recommended initial screening test for HIV

A

fourth-generation antigen/antibody combination immunoassay that detects both HIV-1 and HIV-2 antibodies and HIV-1 p24 antigen. This antigen is produced before antibody formation in HIV-1 infection

60
Q

the gold standard for diagnosing PID and TOA

A

laparoscopy

61
Q

differential diagnosis for TOA

A

appendicitis, diverticulitis, inflammatory bowel disease, PID, ovarian torsion, ectopic pregnancy, ruptured ovarian cyst, pyelonephritis, and cystitis.

62
Q

Your patient who you diagnosed with PID, now starts to complain of sharp, pleuritic RUQ pain. What is your immediate mangement?

A

Fitz-Hugh-Curtis Syndrome
ABCs > Admission
LFTs, Abdominal US

63
Q

The most common site of genital TB, what is the least common?

A

Fallopian tube, least is ovaries

64
Q

The most widely accepted clinical criteria for BV diagnosis

A

‘Amsel’s criteria’. This clinical diagnosis requires that three of the following four criteria be met: first, a vaginal pH of greater than pH 4.5; second, the presence of clue cells in the vaginal fluid; third, a milky, homogeneous vaginal discharge; and finally, the release of an amine (fishy) odour afteraddition of 10% potassium hydroxide to the vaginal fluid

65
Q

VDRL is positive, Next step?

A

FTA-ABS test

Or Treponema pallidum particle agglutination assay (TPPA)

66
Q

the next most carcinogenic type of HPV and it is responsible for 10–15% of cases of cervical cancer.

A

Human papillomavirus 18

67
Q

Genital warts and mode or delivery

A

Congenital HPV infection from vertical transmission (mother to fetus/newborn) beyond common, transient skin colonization is rare. Conjunctival, laryngeal, vulvar, or perianal warts that are present at birth or that develop within 1 to 3 years of birth are most likely due to perinatal exposure to maternal HPV (Cohen, 1990). Infection is not linked to presence of maternal genital warts or route of delivery (Silverberg, 2003; Syrjanen, 2010). Accordingly, cesarean delivery is not recommended solely for maternal HPV infection. Exceptions include cases of large genital warts that could obstruct delivery or avulse and bleed with cervical dilation or vaginal delivery.

68
Q

Clinical HPV testing involves

A

the direct detection of HPV nucleic acids by in situ hybridization, nucleic acid amplification testing (NAAT), polymerase chain reaction (PCR), or other techniques (Molijn, 2005).
A negative HPV test result does not exclude genital HPV infection because only specific oncogenic HPVs are tested for, and sensitivities are set to detect cervical neoplasia.Therefore, these tests are not approved for routine STD screening.

69
Q

The indications to treat HPV-related LAGT disease are

A

symptomatic warts, high-grade neoplasia, or invasive cancer.

70
Q

Type of Laser used for pre-cancerous lower Genital tract changes (CIN) and condylomata (HPV)

A

CO2 laser

71
Q

Type of laser used in TTTS

A

Diode or ND:YAG

72
Q

patient who diagnosed with N.GONORRHEA she is allergic

to benzyle penicillin , what do you want to give her :

A

Spectonomycin

73
Q

Granuloma inguinale (donovanosis) is

A

genital ulcerative disease caused by the intracellular gram-negative bacterium Klebsiella granulomatis (formerly known as Calymmatobacterium granulomatis).
extremely rare, characterized as painless, slowly progressive ulcerative lesions on the genitals or perineum without regional lymphadenopathy; subcutaneous granulomas (pseudobuboes) also might occur. The lesions are highly vascular (i.e., beefy red appearance) and can bleed.

74
Q

Suggested Indications for Parenteral Treatment of PID

A
Pregnant 
High fever 
Suspected abscess 
Uncertain diagnosis 
Generalized peritonitis 
Failed outpatient therapy 
Noncompliant with medications 
White blood cell count > 15,OOO/mm3 
Nausea/vomiting precluding oral therapy
75
Q

One or more of the following enhances diagnostic specificity (signs and symptoms of PID):

A

(1) oral temperature >38.3°C (101.6°F),
(2) mucopurulent cervical discharge or cervical friability,
(3) abundant WBCs on saline microscopy of cervical secretions,
(4) elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), (5) presence of cervical N gonorrhoea or C trachomatis (Centers for Disease Control and Prevention, 2015). Thus, a diagnosis of PID is typically based on clinical findings.

76
Q

How to diagnose herpes simplex

A

Culture from vesicular fluid
PCR
Western blot test
Pap test multi-nucleated giant cell cytomegally
Inclusion bodies in the nucleus

77
Q

Treatment of herpes

A

acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex),

78
Q

Needle injury risk of transmission of HBV, HCV, HIV

A

HIV following a hollow needle NSI is about 0.3%, compared with 3% for HCV and 30% for HBV.

79
Q

The recommended initial screening test is

A

an FDA-approved, fourth-generation antigen/antibody combination immunoassay that detects both HIV-I and HIV-2 antibodies and HIV-I p24 antigen.

80
Q

If fourth-generation antigen/antibody combination immunoassay is reactive (“positive”)

A

If reactive (“positive”), specimens are tested with an FDA- approved antibody immunoassay that differentiates between HIV-I and HIV-2 antibodies (“differentiation assay”). In chronic infection, both the initial combination immunoas- say and the antibody differentiation assay for the specific HIV type are reactive. In acute infection, specimens may be reactive by fourth-generation combination assay but nonreactive or indeterminate on the differentiation assay. In this case, an FDA-approved HIV-I NAAT is performed, which identifies early HIV RNA production prior to antibody formation. Ifthe NAAT result is nonreactive (“negative”) , the possibility o f a false-positive combination immunoassay is considered

81
Q

Suggested Criteria for Admission of Women With Pelvic Inflammatory Disease

A

Surgical emergency (eg, appendicitis) Tubo-ovarian abscess
Pregnancy
Severe illness
Nausea and vomiting
High fever
Unable to follow or tolerate an outpatient oral regimen
No clinical response to oral antimicrobial therapy

82
Q

tubo-ovarian abscess management

A

can be treated surgically or with antibiotics based on the size of the abscess. Rupture of a tubo-ovarian abscess is a surgi- cal emergency, and mortality is high without prompt sur- gical intervention. Approximately 85% of abscesses that are 4 cm in size or smaller respond to parenteral broad- spectrum antibiotics, whereas only 40% of abscesses 10 cm in size or larger will respond to this treatment.

83
Q

Centers for Disease Control and Prevention’s Guidance on Human Immunodeficiency Virus Preexposure Prophylaxis

A

Before providing preexposure prophylaxis: • Document negative HIV-antibody status immediately before starting preexposure prophy-
laxis medication
• Confirm that patient currently is at very high risk of acquiring HIV infection
• Document the pregnancy intention of the patient
• Determine method of contraception • Prescribe no more than a 90-day supply of medication (preexposure prophylaxis medica-
tion, not contraception)
• Screen for hepatitis B infection, and vaccinate if susceptible
• Screen and treat for STls
Follow-up while patient is taking preexposure prophylaxis
• Perform an HIV-antibody test every 2-3 months
• Evaluate medication adherence at each follow-up visit
• Assess risk behaviors and provide risk-reduction counseling and condoms every
2-3 months
• Test for bacterial STIs and treat as indicated

84
Q

When to Discontinuing preexposure prophylaxis of HIV

A

• Discontinue preexposure prophylaxis at patient request, for safety concerns, or if HIV
infection is acquired
• Test for antiretroviral resistance and refer for HIV care, if HIV positive
• Continue risk-reduction counseling, if HIV negative

85
Q

The Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents recommends that women who are HIV-infected should have age-based cervical cancer screening as follows:

A

• In women and adolescents with HIV, initiation of cervical cancer screening with cytology alone should begin within 1 year of onset of sexual activity or, if already sexually active, within the first year after HIV diagnosis but no later than 21 years of age. • Cervical cancer screening in women who are infected with HIV should continue throughout a woman’s lifetime (ie, not stopping at age 65 years). • In women infected with HIV who are younger than 30 years, if the initial cytology screening result is normal, the next cytology screening should be in 12 months. If the results of three consecutive annual cervical cytology screenings are normal, follow-up cervical cytology screening should be every 3 years. Co-testing (cervical cytology and human papilloma- virus [HPV] screening) is not recommended for HIV-infected women younger than 30 years. • Women infected with HIV who are 30 years and older can be screened with cytology alone or co-testing. After women screened with cytology alone have had three consecutive annual test results that are normal, follow-up screening can be every 3 years. Women infected with HIV who have one negative co-test result (normal cytology and HPV negative) can have their next cervical cancer screening in 3 years.
• In women with HIV infection, co-testing results that are cytology negative but HPV positive are man- aged as in the general population.
• Women with HIV who have cervical cytology results of low-grade squamous intraepithelial lesions or worse should be referred for colposcopy. • For women with HIV infection who are 21 years or older and have atypical squamous cells of undetermined significance (ASC-US) test results, if reflex HPV testing results are positive, referral to colposcopy is recommended. If HPV testing is not available, repeat cervical cytology in 6–12 months is recommended, and for any result of ASC-US or worse on repeat cytology, referral to colposcopy is recom- mended. Repeat cytology in 6–12 months, but not HPV testing, is recommended for HIV-infected women younger than 21 years with ASC-US test results.

86
Q

How do diagnosis and treatment of sexually transmitted infections differ in HIV-infected women compared with non-HIV-infected women?

A

Women with HIV should be screened at entry to care and at least annually thereafter with nucleic acid amplification tests for Neisseria gonorrhoeae and Chlamydia trachomatis, serologic testing for syphilis, and testing for vaginal trichomoniasis . Screening for hepatitis C virus should be performed at entry to care.

87
Q

How is Women with HIV should be treated for trichomoniasis ?

A

If trichomoniasis is diagnosed, a longer duration of metronidazole treatment (versus the standard single-dose regimen) is recommended. Treated patients should be rescreened 3 months after treatment.
Trichomoniasis is found frequently in women with HIV, with a prevalence of 9.4–29.5% in the HIV Epidemiology Study (56) and up to 53% in a smaller study (57). Women infected with HIV and with trichomoniasis are at increased risk of pelvic inflammatory disease (58). Treatment of trichomoniasis decreases HIV viral load and shedding in the genital tract (59, 60) and may lead to decreased HIV transmission (24). A 1-week course of metronidazole is recommended because a randomized trial noted higher repeat infection rates in the group treated with a single dose

88
Q

What is preexposure prophylaxis of seronegative male partner of an HIV-infected woman should consider use of antiretroviral

A

should consider use of antiretroviral preexposure prophylaxis with a daily fixed dose of oral tenofovir disoproxil fumarate and emtricitabine to reduce the risk of HIV acquisition.

89
Q

Recommendation for Women with HIV and menopausal hormonal therapy

A

Women with HIV may use topical or systemic hormone therapy (HT) for the management of menopausal symptoms, although there are potential interactions with antiretroviral medications that may require higher systemic HT doses. Systemic HT should be avoided in women taking fosamprenavir.