STI's Flashcards

Question

Chlamydia SX

Answer 1

dysuria → painful to pee urethritis = inflammation of urethra → dysuria, dyspareunia cervicitis = inflammation of cervix → abnormal bleeding, abnormal discharge, dyspareunia proctitis = inflammation of lining of rectum → pain, diarrhea, bleeding, discharge conjunctivitis → excessive tearing, discharge, inflammation, swelling or redness of eye Clinical presentation reflects site of infection

Answer 2

Take with food Taking with iron or calcium may decrease absorption Photosensitivity

Answer 3

GI upset - prophylactic antiemetics

Answer 4

Counselling: abstain from sexual activity without barrier protection until treatment of person and partners is complete (7 days after one dose therapy, end of multiple dose therapy) and symptoms have resolved --> preferably abstinence

Answer 5

Test of cure (TOC) recommended when symptoms persist, compliance is suboptimal, preferred treatment not used, prepubertal, pregnancy Repeat screening recommended 3 months post-treatment due to risk of reinfection SK – TOC 3-4 weeks following positive. Repeat testing in all individuals 6 months post as re-infection risk high.

Answer 6

Etiology: Chlamydia trachomatis genotypes L1, L2, L3 which are more invasive than non-LGV genotypes Relatively rare, some outbreaks reported in Canada Preferentially affect the lymph tissue Divided into three stages: primary, secondary, tertiary

Answer 7

Etiology: Neisseria gonorrhoeae Second most common nationally reportable STI in Canada Frequently asymptomatic When left untreated, infections become chronic Reinfections common High rates of concomitant infection with chlamydia → treat for both

Answer 8

Treat gonococcal infections with combination therapy →improve efficacy and potentially delay resistance Therapy depends on site of infection and probability of resistance Recommended combination includes a third-generation cephalosporin with either azithromycin or doxycycline

Answer 9

Penicillin allergy Cross-sensitivity between penicillins and second- or third-generation cephalosporins is low. Resistance is a concern – encourage adherence, treating all partners, other sexual health education Azithromycin can be taken with food to minimize nausea (vomit within 1 hour, repeat dose) or anti-emetics Abstain from sexual activity without barrier protection until treatment of person and partners is complete (7 days after one dose therapy, end of multiple dose therapy) and symptoms have resolved

Answer 10

Test of cure (TOC) cultures recommended within a week for all positive sites or NAAT 2-3 weeks after treatment completed Repeat screening recommended 6 months post-treatment SK – follow up TOC cultures 4-5 days following treatment in certain circumstances. NAAT not recommended but if needed, at least 4 weeks following positive. Repeat testing in all individuals 6 months post as re-infection risk high

Answer 11

Etiology: Treponema pallidum Third most common nationally notifiable STI in Canada Rates of infection increasing rapidly Transmission via contact with chancres Untreated syphilis has many complications Universal screening recommended in pregnancy HIV → more rapid progression to neurosyphilis and more aggressive and atypical signs of infection

Answer 12

Neurosphyllis is not tertiary syphillis

Answer 13

National comitte SSTBI --> screening in all sexually active persons with multiple sexual partners or upon the patients request New or multiple partners regardless sof risk factors Screen every 3-6 months in people with risk factors In patient at high risk, should be the norm to test high risk individuals. The norm should be that you “opt-out” rather than “opt-in”

Answer 14

Abstain from sexual contact until the lesions are completely healed and it has been 7 days since they received their final dose of treatment Condoms should be advised and encouraged for all sexual encounters PHAC: Advise all people with potentially infectious lesions such as chancres, condylomata lata and/or rash of secondary syphilis to abstain from sexual contact until symptoms have resolved and for 7 days after treatment

Answer 15

No test of cure – treatment response based on clinical picture (symptom resolution) and nontreponemal test (NTT) titre change (ie: four-fold change at 6 months)

Answer 16

Acute febrile reaction accompanied by headache, myalgia, chills and rigors Occurs within 1st 24 hours after initiation of any syphilis therapy NOT an allergic reaction, but rather reaction to therapy Manage with antipyretics (NSAID), but not proven to prevent reaction May induce early labour or cause fetal distress in pregnancy

Answer 17

HPV is everywhere –over 200 types have been identified Most common STI in the world At least 40 types of HPV known to infect mucosa of the anogenital tract and oropharynx Majority of infections are self-limited, asymptomatic, unrecognized Infection with multiple types possible

Answer 18

Infection with low-risk types (6, 11) associated with low/no cancer risk but may lead to anogenital warts, cervical lesions, and rare conditions such as recurrent respiratory papillomatosis Persistent infection with oncogenic, high-risk types (16, 18) may lead to cancer – cervical, oropharyngeal, cancer of vulva, vagina, penis, anus Virtually all cases of cervical cancer are attributable to HPV Can lead to cancer

Answer 19

Avoid contact with healthy skin Refrain from sexual activity while undergoing treatment Skin reactions: itching, tenderness, erythema, ulceration Pain reduction – lidocaine/prilocaine, injectable lidocaine

Answer 20

Gardasil 9 – HPV types 6, 11, 16, 18, PLUS 31, 33, 45, 52, 58 Cervarix – HPV types 16 and 18

Answer 21

Approved for Individuals aged 9-45 years IM injection (deltoid preferred) Dose: >15 years old: 0.5 ml x 3 doses – 0, 2, 6 months 9-14 yo: 0.5 ml x 2 doses – 0, 6 months (5-13 months) Immunocompromised (no matter age): 3 dose series 97% vaccine efficacy for preventing CIN (cervical intraepithelial neoplasia, abnormal cervical cells) or more severe disease in HPV naïve 16-26 yos Adverse effects: local injection site reaction, headache (7-20%), fever (2-10%), nausea, dizziness, fatigue, diarrhea, oropharyngeal pain, upper abdominal pain

Answer 22

Females and males in Grade 6 Those that did not receive vaccine in Grade 6 until they are 26 years old Immunocompromised females and males aged 9-26 years

Answer 23

Etiology: herpes simplex virus type 1 and 2 HSV-1 is primarily associated with ORAL infection but may cause genital herpes refer to Herpes Labialis management (guidelines on medSask) HSV-2 is primarily associated with genital infection but may also present orally as a result of oro-genital transmission (rare)

Answer 24

Transmitted by unprotected sex and via delivery of baby Higher risk with open sores, also asymptomatic viral shedding Common in adolescents and adults, women > men – but true incidence is not known since not reported Virus establishes itself intracellularly within host cell ganglia for life Genital herpes increases the risk of acquisition of HIV twofold

Answer 25

Acyclovir 200mg PO five times per day for 5-10 days OR Famciclovir 250mg PO TID for 5 days OR Valacyclovir 1000mg PO BID for 10 days Topicals not effective Pregnancy Acyclovir 200 mg PO qid for 5-10 days Severe: IV acyclovir 5mg/kg infused over 60 minutes every 8 hours, convert to oral therapy once significantly improved

Answer 26

Valacyclovir 500 mg PO bid OR 1 g PO daily for 3 days OR Famciclovir 125 mg PO bid for 5 days OR Acyclovir 200 mg PO 5 times/day for 5 days 800 mg PO TID x 2 days also shows efficacy

Answer 27

Occurs when baby is delivered through an infected vagina Initial symptoms ~4 weeks of age Results in generalized systemic infection involving liver, other organs, CNS and skin Mortality in nearly 60% of cases, 70% will experience severe or fatal complications Acyclovir 45–60 mg/kg/day IV in three equal 8-hourly infusions, each over 60 minutes for 14 to 21 days

Answer 28

Antivirals will decrease severity and duration of symptoms, but not prevent recurrences Use as early as possible (preferably fewer than 6h) and until lesions are healed Abstain from sexual contact during symptomatic episodes until lesions are completely healed Always use a condom as asymptomatic viral shedding can occur May not eliminate risk of transmission when lesions not limited to genital area Lifelong infection – encourage patient to seek support

STI's Flashcards

(65 cards)