STI tutorial Flashcards
(13 cards)
Jenny is a 19 year old university student who is seeking STI screening
She is taking a course in human sexuality and was prompted to seek testing
She recently had unprotected instercourse with a new partner
She has had 2 other lifetime partners
She wants to be tested for everything
- What tests should be done and what else do you need to know
- Tests to consider - Chlamydia, gonorrhea, syphilis, HIV, and hepatitis
- How do we do those tests?
- Getting a good sexual history is important - non-judgemental, sexual orientation and identity
- Hasn’t shared there hasn’t been trauma and consent issues
USE THE 5 Ps approach
1. Partners - we want to know the last 90s days of same, gender
2. Past history - Previous STIs (Usually should be screened in 6 months since last one)
3. Protection - vaccines, condom, vaccines, and HIV PrEP
4. Practices - Sites of contact, and substance use
5. Pregnancies - is pregnancy a relavent discussion, intercourse, oral sex, body parts, taking que from what they say - contraception
What is the difference between screening and testing
- Screening refers to initial identification of unrecognized disease or infection
- Used to identify STIS in asymptomatic patients. Vs. Testing symptomatic patients to establish a diagnosis
What are Routine testing for females
- GC and CT urine or vaginal swab for NAAT - swab for NAAT preferred over 1st void urine in patients with vagina
- Swab other exposed sites (pharynx and/or rectal) as indicated
- Urine or vaginal swab for trichomonas
- RPR or VDRL for syphilis
- HIV antibody
- Hep B if no immunized prior to sexual debut
- Hep A and C
- Pap smear (cervical +/- anal) for HPV
24 year old patient MSM
3 day history of acute dysuria and urethral discharge
Exam - purulent urethral disrcharge
Gram stain - Full field PMNs with gram-negative intracellular diplococci
A presumptive diagnosis of Gonorrhea.
- What other STIs should he be tested for?
- Should he receive presumptive treatment while awaiting urine NAAT?
- What treatment should he receive
- TEST for
HIV Antibody
RPR or VDRL for syphilis
GC and CT urine NAAT
GC culture +/- NAAT from other exposed sites (pharynx and/or rectal)
Hepatitis B if not immunized prior to sexual debute
Hep A and C - YES WE SHOULD DO PRESUMPTIVE TREATMENT - Make sure to cover CT and NG
MSM should get Ceftriaxone 250mg IM in a single dose plus Azithromycin 1g PO in a single dose due to increased resistance in MSM to cefixime
What the 24 year old patient who MSM what advice for him should we give?
Partner tracing/treatment?
What follow-up is required?
- Counselling - How to take, split the dose. Abstain for sexual contact for 7 days after you have been treated, and after 7 days from partner been treatment
- Partner tracing - 60 days. Public health follow-up with individual for contact tracing
- Follow-up - Test of cure for Gonorrhea - because of potential Resistance
22 year old female comes in for possible UTI symptoms
- C/o mild dysuria for 3 days, no urgency, frequency or hematuria. No fever or back pain
- What other history is important to obtain
- What labs should be ordered
- Would you treat emperically at this point?
Has had 2 male partners in the past 3 months, unprotected, both are asymptomatic
No prior STI or UTI hx
- What other hx is important - History of UTIs, history of STI, other partners, other symptoms, other medical conditions
- What labs should be ordered - Urine for both STI and UA (UTI is midstream, but STI use 1st void is best. Tricky
- 1 NAAT, Swab possibly, refer for further investigation, sample before giving
- Would you treat emperically at this point - No.
- azithromycin as a single dose
- Partners - contact tracing and have public health contact them
- No test of cure required in her case as she is not pregnant, an could likely take the treatment
COuld consider test for reinfection at 6 months
Preventing re-infection - Abstaining from sexual activity until completion of treatment (self and partners) or 7 days after 1 day therapy
44 year old male, newly divorces from female 9 months ago.
Recently started having sex with men and comes to primary care clinic for routine STI screening
He is concerned about a cut near his anus and wonders if it is a hemorrhoid
He has had receptive anal intercourse only a few times, most recently about 1 month ago. No other symptoms or concerns.
Has 1 cm fizzure noted near anus, not tender, firm edges
Labs HSV PCR swab of lesion and routine STI screening (GC, CT< RPR, HIV)
PLan: reassurance and self care recommended
Labs HSV PCR was negative, but RPR was reactive at 1:64 and has a positive TP-PA confirmatory test
a. Diagnosis - Syphilis - active infection - because TP-PA confirmatory and 1:64 is active. Primary stage - only exposure since recent intercourse in the
B. Benzathine Pen G injection 2.4 million units IM as a single dose
C. Follow-up - Repeat RPR titres at 1, 3, 6, 12 months. TARGET is a 4-fold drop at 6 months
When is Routine syphilis screening important
MSM, IDU, and pregnant women - Strong association with HIV infection (~50%)
Chameleon of STIs - keep a high index of suspicion when unusual rashes or suspisious lesions are present or other unusual SXs
Dysuria doesn’t always mean UTI - Common symptom of chlamydia, gonorrhea, and herpes in both men and women
Other STIS not discussed - Mpox, ureaplasma, mycoplasma, trichomonas - As well as unusual presentations (HSV), LGV, PID) - importance of routine screening
What are the pros and cons of using doxycycline for PEP?
PROS -
Cons -
What clinical situations would we use doxycycline for PEP
- MSM who have had STI in the past year, who are on HIV PREP
- and transgender women who are either on HIV prep, or who are living with HIV
Poeple who are on HIV prep it is very easy to follow-up with Doxy pep as follow-up is similar - should be getting treatment every 3 month - STI in the past year
- CDC in states has some more guidence on this
What is the difference between doxy prep and PEP?
What is the efficacy of doxy PEP for how well it works?
- Works well for syphilis, and Chlamydia
- Other STIS - shouldn’t replace condom use and screening
