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PHAR253 > STIs > Flashcards

STIs Flashcards

1
Q

Describe some ways to provide good care for a patient with an STI.

A

have a safe, private, and respectful environment
-safety is subjective
-check your assumptions and personal values/beliefs
-ensure confidentiality
-build rapport and trust
encourage questions and and revisit information as needed
use concise, plain language
use inclusive and non-stigmatizing language

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2
Q

What is an STI?

A

infection passed from one person to another through sexual activity, including vaginal, oral or anal sex as well as genital skin-to-skin contact
some are passed through blood

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3
Q

What are the three categories of STIs?

A

viral: HPV, HIV, hepatitis B, HSV
bacterial: chlamydia, gonorrhea, syphilis
parasitic/fungal: trichomoniasis

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4
Q

What does STBBI stand for?

A

sexually transmitted and blood borne infection

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5
Q

What are the risk factors for STIs?

A

multiple partners (concurrently or over time)
anonymous or casual sex partners
sex without the use of barrier protection
sex with person(s) with an STI
previous STI
substance use (drug, alcohol or both)
use of medications for ED
history of intimate partner or sexual violence
social environments

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6
Q

Which populations are disproportionally affected by STIs?

A

Indigenous people
gbMSM
transgender
youth and young adults
people who use drugs
incarcerated or previously incarcerated people
people engaged in the sale or purchase of sex

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7
Q

True or false: STIs do not affect people in the same way

A

true

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8
Q

How can health care providers incorporate STI prevention into practice?

A

assessing and discussing risk
educating ppl about signs and symptoms and the asymptomatic nature of many infections
helping individuals recognize and minimize their risk
offering vaccination where indicated
offering screening and testing, as appropriate
providing treatment, follow up and counselling to individuals and their partner(s)

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9
Q

Discuss the importance of screening and testing for STIs.

A

many STIs are asymptomatic
even if no symptoms are present, the infection can still be passed to other people
a person treated for an STI in the past can be still be re-infected
test for one - test for all

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10
Q

Who can perform STI testing?

A

primary care provider, public health, or hospital
sexual health clinics in Saskatchewan

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11
Q

What are the barriers to seeking testing?

A

underestimate personal risk
perception that STIs are not serious
fearful of procedures
self-conscious about genital exam
perceived and anticipated attitudes of HCPs and clinic staff
stigma

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12
Q

Describe reporting of STIs.

A

STIs are reportable communicable disease
HCPs report to MHO who reports to Chief Medical Health Officer
reports available on Sask government website

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13
Q

Which STIs are nationally notifiable?

A

chlamydia
gonorrhea
syphilis
hepatitis
HIV
chancroid

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14
Q

What is the importance of partner notification?

A

critical to prevention and control
goal: assist individuals to inform partners about risk and honour their right to make informed health care decisions
confidential
individual, HCP, MHO may notify partner

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15
Q

What are examples of barrier protection?

A

external condoms
internal condoms
dental dams

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16
Q

What is the importance of barrier protection?

A

decrease risk of acquiring and transmitting the majority of STIs, including HIV, HBV, chlamydia, gonorrhea

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17
Q

Which STIs do barrier protection not provide protection against?

A

syphilis, HPV, HSV
lesions and asymptomatic shedding can occur in areas not covered

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18
Q

Which condoms are not recommended as barrier protection?

A

spermicidal lubricated condoms containing nonoxynol-9

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19
Q

What are the goals of therapy for STIs?

A
  1. treat the infection
  2. abolish symptoms
  3. decrease spread to sexual partners
  4. decrease vertical transmission to newborns
  5. reduce transmission of HIV
  6. decrease probability of complications, such as infertility, chronic pain, sepsis
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20
Q

Which antibiotics are provided free of charge by Sask Health for STIs?

A

amoxicillin
azithromycin
cefixime
doxycycline

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21
Q

How are STIs spread?

A

from person to person through:
-contact with semen, vaginal fluid or other bodily fluids during vaginal, anal or oral sex with a condom
-skin to skin contact during sexual activity
-sharing toys
some can be passed through blood transfusions and transplants
some can be transmitted vertically during pregnancy and labour
HIV can be transmitted through breastfeeding

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22
Q

What are the complications of chlamydia, gonorrhea, and syphilis in babies?

A

chlamydia:
-preterm birth, conjunctivitis, pneumonia in newborn
gonorrhea:
-endometritis and pelvic sepsis, ophthalmia neonatorum and systemic infection in newborn
syphilis:
-systemic symptoms, fetal loss

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23
Q

When should pregnant women be tested for STIs?

A

early in pregnancy and again in 3rd trimester if ongoing risk and treated before giving birth

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24
Q

What are the STI-associated syndromes?

A

cervicitis
epididymitis
pelvic inflammatory disease
proctitis
urethritis
vaginitis
anogenital ulcers

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25
Q

What is the cause of vulvovaginal candidiasis? What are the symptoms?

A

cause: candida albicans
symptoms: pruritis, white, clumpy, curdy discharge

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26
Q

What is the cause of trichomoniasis? What are the symptoms?

A

cause: trichomonas vaginalis
symptoms: pruritis, odour, off-white or yellow, frothy discharge

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27
Q

What is the cause of bacterial vaginosis? What are the symptoms?

A

cause: mycoplasma and gardnerella vaginalis
symptoms: fishy odour, grey or milky, thin copious discharge

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28
Q

What is the treatment of vulvovaginal candidiasis?

A

fluconazole 150mg po x single dose
topical azole antifungals: clotrimazole, miconazole, terconazole
not necessary to treat asymptomatic patients

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29
Q

What is the treatment of trichomoniasis?

A

metronidazole 2g po x single dose OR 500mg po BID x 7d
treat sexual partners

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30
Q

What is the treatment of bacterial vaginosis?

A

metronidazole 500mg po BID x 7d OR 2g po x single dose
metronidazole 0.75% 5g PV x 5d
clindamycin 2% 5g PV x 7d
not necessary to treat asymptomatic patients unless undergoing procedure or high risk pregnancy

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31
Q

Which infections are anogenital ulcers often caused by?

A

HSV
lymphogranuloma venereum
syphilis

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32
Q

Which infection usually causes anogenital warts?

A

HPV types 6 and 11

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33
Q

What is the etiology of chlamydia?

A

chlamydia trachomatis
-most common nationally reportable STI in Canada
-may be under-detected because majority of people with infection asymptomatic

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34
Q

True or false: you cannot give empiric therapy for chlamydia, lab testing is required

A

false
empiric treatment may be given without lab testing

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35
Q

What are the symptoms of chlamydia?

A

most individuals are asymptomatic
most common:
-dysuria
-urethritis (dysuria, dyspareunia)
-cervicitis (abnormal bleeding, abnormal discharge, dyspareunia)
-proctitis (pain, diarrhea, bleeding, discharge)
-conjunctivitis (tearing, discharge, inflammation, swelling/redness of eye)

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36
Q

What are the symptoms of chlamydia in children?

A

conjunctivitis
pneumonia

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37
Q

What are the complications of chlamydia?

A

female genitalia:
-pelvic inflammatory disease
-ectopic pregnancy
-infertility
-chronic pelvis pain
-Reiter syndrome
male genitalia:
-epididymoorchitis
-Reiter syndrome

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38
Q

What is Reiter syndrome?

A

reactive arthritis that affects joints, eyes, urethra, skin

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39
Q

What is the preferred treatment for chlamydia?

A

doxycycline 100mg po BID x 7d
or
azithromycin 1g po single dose

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40
Q

What is the alternative treatment for chlamydia?

A

levofloxacin 500mg po OD x 7d

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41
Q

What is the treatment of chlamydia if pregnant or lactating?

A

options:
-azithromycin 1g po single dose
-amoxicillin 500mg po TID x 7d
-erythromycin 2g/d po in divided doses x 7d
-erythromycin 1g/d po in divided doses x 14d

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42
Q

What are some points to provide regarding doxycycline, azithromycin and sexual activity during a chlamydia counsel?

A

doxycycline:
-take with food, Fe or Ca may decrease absorption, photosensitive
azithromycin:
-GI upset
abstain from sexual activity with or without barrier protection until treatment of person and partners is complete (7d after one dose therapy) and symptoms have resolved

43
Q

Describe follow-up for chlamydia.

A

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 3-4wks following + and repeat annually, every 3-6 months, or after any new partner

44
Q

What is the etiology of lymphogranuloma venereum (LGV)?

A

chlamydia trachomatis genotypes L1, L2, L3 which are more invasive than non-LGV genotypes
-relatively rare, some outbreaks reported in Canada

45
Q

Which tissue does LGV preferentially affect?

A

lymph

46
Q

Differentiate between the stages of LGV.

A

primary:
-3 to 30d incubation
-small painless papules at site of inoculation
secondary:
-2 to 6wks after primary lesion
-swollen lymph nodes, proctocolitis, systemic symptoms
-cardiac involvement, meningitis, ocular inflammatory disease
tertiary:
-chronic inflammatory lesions leading to scarring
-lymphatic obstruction
-genital and rectal strictures and fistulae
-possible extensive destruction of genitalia

47
Q

What is the preferred treatment for LGV?

A

doxycycline 100mg po BID x 21d
possible treatment: azithromycin 1g po once weekly x 3wks

48
Q

What is the etiology of gonorrhea?

A

neisseria gonnorrheae
-2nd most common nationally reportable STI in Canada

49
Q

What occurs if gonorrhea is left untreated?

A

infections become chronic
reinfections are common with gonorrhea

50
Q

Which STI has a high rate of concomitant infection with gonorrhea?

A

chlamydia
treat for both

51
Q

What are the symptoms of gonorrhea?

A

female genitalia:
-vaginal discharge
-lower abdominal pain
-abnormal vaginal bleeding
-dysuria
-cervical discharge
-bartholinitis
-dyspareunia
-proctitis
male genitalia:
-urethral discharge
-dysuria
-urethral itch
-testicular pain, epididymitis
-proctitis

52
Q

What are the complications of gonorrhea?

A

female genitalia:
-pelvic inflammatory disease (infertility and risk of ectopic pregnancy)
-chronic pelvic pain
male genitalia:
-epididymoorchitis
both:
-disseminated gonococcal infection
-reactive arthritis
-perihepatitis

53
Q

What does therapy of gonorrhea depend on?

A

site of infection and probability of resistance

54
Q

Why do we treat gonococcal infections with combination therapy?

A

improve efficacy and potentially delay resistance
resistance is an issue with gonorrhea

55
Q

What is the recommended combination therapy for gonorrhea?

A

3rd gen cephalosporin with either azith or doxy

56
Q

What is the treatment of gonorrhea if the primary site of infection is anogenital?

A

ceftriaxone 250mg IM single dose + azithromycin 1g po single dose
OR
cefixime 800mg po single dose + azithromycin 1g po single dose

57
Q

What is the treatment of gonorrhea if the primary site of infection is pharyngeal?

A

ceftriaxone 250mg IM single dose + azithromycin 1g po single dose

58
Q

What is the alternative treatment for gonorrhea if the primary site of infection is anogenital?

A

ceftriaxone 250mg IM single dose + doxycycline 100mg po BID x 7d
OR
cefixime 800mg po single dose + doxycycline 100mg po BID x 7d

59
Q

What is the alternative treatment for gonorrhea if the primary site of infection is pharyngeal?

A

cefixime 800mg po single dose + azithromycin 1g po single dose

60
Q

True or false: cross-sensitivity between penicillin’s and 2nd or 3rd gen cephalosporins is high

A

false

61
Q

When should someone repeat a dose of azithromycin?

A

if they vomit within an hour of dose

62
Q

What are the recommendations for sexual activity after being treated for gonorrhea?

A

abstain from sexual activity without barrier protection until treatment of person and partners is complete (7d after one dose therapy) and symptoms have resolved

63
Q

Describe follow-up for gonorrhea.

A

TOC cultures recommended within a week for all + sites or NAAT 2-3wks after treatment completed
repeat screening recommended 6 months post-treatment
SK: TOC 3-4wks following + and repeat annually, every 3-6months or after any new partner

64
Q

What is the etiology of syphilis?

A

treponema pallidum
-3rd most common nationally notifiable STI in Canada
-rates of infection increasing rapidly (females, gbMSM, congenital)
-SK among highest rates in Canada

65
Q

How is syphilis transmitted?

A

contact with chancres

66
Q

Which STI has universal screening recommended in pregnancy?

A

syphilis

67
Q

Which patients experience more rapid progression to neurosyphilis and more aggressive and atypical signs of infection?

A

those with HIV

68
Q

List the stages of syphilis and their clinical manifestations.

A

primary
-painless lesion (chancre), regional lymphadenopathy
-time: 3 weeks (3-90 days)
secondary
-rash, fever, malaise, lymphadenopathy, mucous lesions, condyloma lata, alopecia, meningitis, headaches, uveitis, retinits
-time: 2-12wks (2wks-6mo)
early latent
-asymptomatic (+ serology)
-time:<1yr
late latent
-asymptomatic (+ serology)
-time: >1yr
tertiary:
-cardiovascular syphilis, gumma
neurosyphilis and ocular syphilis can occur at any stage

69
Q

What is the preferred treatment for primary, secondary, and early latent syphilis?

A

benzathine penicillin G-LA 2.4 million U IM single dose

70
Q

What is the preferred treatment for cardiovascular syphilis, gumma, late latent syphilis?

A

benzathine penicillin G-LA 2.4 million U IM weekly for 3 doses

71
Q

What is the alternative treatment (penicillin allergy) for primary, secondary, early latent syphilis?

A

doxycycline 100mg po BID x 14d
exceptional circumstances and when close follow-up is assured:
-ceftriaxone 1g IV or IM daily x 10d

72
Q

What is the alternative treatment for cardiovascular syphilis, gumma, and late latent syphilis?

A

consider penicillin desensitization
doxycycline 100mg po BID x 28d
in exceptional circumstances and when close follow-up is assured:
-ceftriaxone 1g IV or IM daily x 10d

73
Q

Which form of syphilis should be referred to a neurologist or ID specialist?

A

neurosyphilis

74
Q

What is the treatment of syphilis during pregnancy?

A

benzathine penicillin G-LA 2.4 million U IM single dose

75
Q

What are the recommendations for sexual activity after being treated for syphilis?

A

abstain from sexual contact until the lesions are completely healed and it has been 7d since they received their final dose of treatment
condoms advised for all sexual encounters

76
Q

Describe follow-up for syphilis.

A

no TOC
treatment response based on clinical picture and nontreponemal test titre change (4 fold decrease by 6 months)

77
Q

What is the Jarisch-Herxheimer reaction?

A

acute febrile reaction accompanied by headache, myalgia, chills, and rigors
occurs within 1st 24hrs after initiation of any syphilis therapy
NOT an allergic reaction, but rather reaction to therapy
manage with NSAIDs

78
Q

What is the most common STI in the world?

A

HPV
-over 200 types
-atleast 40 types known to infect mucosa of the anogenital tract and oropharynx
-infections with multiple types possible

79
Q

Infections with which type of HPV are associated with low/no cancer risk?

A

6 and 11
-may lead to anogenital warts, cervical lesions, and rare conditions such as recurrent respiratory papillomatosis

80
Q

Infections with which type of HPV may lead to cancer?

A

16 and 18
-cervical, oropharyngeal, cancer of vulva, vagina, penis, anus
virtually all cases of cervical cancer are attributable to HPV

81
Q

What are the genital wart symptoms of HPV?

A

asymptomatic
itchiness
discomfort during intercourse
bleeding with intercourse or shaving
warts on penis or vulva

82
Q

What are the cancer symptoms of HPV?

A

cervical cancer causes little to no discomfort , hence regular screening (pap test)
lesions can bleed, itch, cause pain wherever located

83
Q

What is the treatment of HPV?

A

treatment of anogenital warts: topical and ablative
-imiquimod cream 3.75% daily and wash off after 8h or 5% cream 3x/wk apply and wash off after 6-10h
-sinecatechins 10% ointment apply 0.5cm strand TID, washing off not needed

84
Q

What are some tips to provide for HPV treatment?

A

avoid contact with healthy skin
refrain from sexual activity while undergoing treatment
pain reduction: lidocaine/prilocaine, injectable lidocaine

85
Q

Which types of HPV does Gardasil 9 protect against?

A

6, 11,16, 18
PLUS 31, 33, 45, 52, 58

86
Q

Describe Gardasil 9.

A

approved for individuals aged 9-45yrs
IM injection (deltoid preferred)
dose:
-0.5ml x 3 doses (0, 2, 6 months)
-9-14yo: 0.5ml x 2 doses (0, 6 months)
-immunocompromised: 3 dose series
97% vaccine efficacy for preventing CIN or more severe disease in HPV naive 16-26 yos

87
Q

What are the adverse effects of Gardasil 9?

A

local injection site reaction
headache
fever
nausea
dizziness
fatigue
diarrhea
oropharyngeal pain
upper abdominal pain

88
Q

True or false: Gardasil 9 is not publicly funded in Sask

A

false

89
Q

What is the etiology of HSV?

A

herpes simplex virus type 1 and 2
-HSV 1 is primarily associated with oral infections but may cause genital herpes
-HSV 2 is primarily associated with genital infection but may also present orally as a result of oro-genital transmission

90
Q

How is HSV transmitted?

A

unprotected sex and via delivery of baby
higher risk with open sores, also asymptomatic viral shedding
common in adolescents and adults, women>men

91
Q

Is HSV curable?

A

virus establishes itself intracellularly within host cell ganglia for life

92
Q

What are the symptoms of a primary HSV infection?

A

extensive, painful, bilateral vesiculo-ulcerative genital or anal lesions
fever, malaise, myalgia, headache
tender inguinal lymphadenopathy
duration: 17-20d

93
Q

What are the symptoms of HSV recurrences?

A

prodromal symptoms for 1-2d
unilateral localized small patch painful genital vesicles and ulcers
systemic symptoms: 5-12%
duration: 9-11 days

94
Q

What are the symptoms of a non-primary HSV infection?

A

dont last as long
less severe
less extensive
duration: 16d

95
Q

What are the complications of HSV?

A

meningitis
extragenital lesions

96
Q

What is the treatment for primary genital herpes?

A

acyclovir 200mg po 5x per day for 5-10d
famciclovir 250mg po TID for 5d
valacyclovir 1000mg po BID for 10d
pregnancy: acyclovir 200mg po QID x 5-10d
severe: IV acyclovir 5mg/kg infused over 1h q8h
topicals not effective

97
Q

What is the treatment for recurrent genital herpes?

A

valacyclovir 500mg po BID or 1g po daily x 3d
famciclovir 125mg po BID x 5d
acyclovir 200mg po 5x/d for 5d
start within hours

98
Q

What are the treatment options for genital herpes suppressive therapy?

A

acyclovir 200mg po TID-5x/d or 400mg po BID
famciclovir 250mg po BID
valacyclovir 500mg po daily (<9 recurrences/yr) 1000mg daily (>9)
pregnancy: acyclovir 200mg po QID or 400mg po TID or valacyclovir 500mg po BID

99
Q

How does neonatal herpes occur?

A

when baby is delivered through an infected vagina
initial symptoms ~4wks of age
results in generalized systemic infection involving liver, other organs, CNS and skin

100
Q

What is the treatment of neonatal herpes?

A

acyclovir 45-60mg/kg/d IV in three equal 8-hourly infusions, each over 60 minutes for 14-21d

101
Q

List some counselling points to discuss during an HSV counsel.

A

antivirals will decrease severity and duration of symptoms, but not prevent recurrences
use as early as possible (preferably <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 may occur (may not eliminate risk of transmission when lesions not limited to genital area)
lifelong infection

102
Q

What is monkeypox?

A

viral zoonotic disease caused by orthopoxvirus
transmission: any form of direct contact with lesions, bodily fluids, mucosal surfaces or respiratory secretions of infected person or shared contaminated objects
management: supportive care, smallpox antiviral

103
Q

What are the symptoms of mpox?

A

incubation: 3-21 days
symptoms:
-rash (more prominent on face and extremities)
-lymphadenopathy
-may be preceded by systemic symptoms (fever, myalgia, fatigue)
-self resolving within 2-4wks

104
Q

Which stages of syphilis are infectious?

A

primary
secondary
early latent

PHAR253 (16 decks)

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