STIs Flashcards by joelle wasikowski

biggest risk factors for STIs

number of sexual partners
teens and 20s
MSM
African American and Hispanic
single, seperated, divorced
ED drug use

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what do condoms not protect from

STIs spread by skin to skin contact
genital herpes, HPV, syphilus

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HPV vaccine recommended for who

children 11-12 years
anyone under 26 without it
27-45 sometimes

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what does HPV vaccine help with

prevents new HPV infections before exposure, does not treat an active infection

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gonorrhea can present as what in adults

uncomplicated genital infection
anorectal infection
pharyngeal infection
(mostly asymptomatic)

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gonorrhea can present as what in newborns

opthalmia neonatorum
from birth canal or in utero

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diagnosis of gonorrhea

NAAT test
gram negative diplococci

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treatment for gonorrhea of cervix, urethra, rectum

<150 kg: ceftriaxone 500 mg IM x 1
> 150 kg: ceftriaxone 1 g IM x 1

if chlamydia not ruled out:
- doxycycline 100 mg PO BID x 7 days
- if pregnant: azithromycin 1 g PO x 1

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treatment for gonorrhea of cervix, urethra, rectum if ceftriaxone unavailable or allergy to cephalos

gentamicin 240 mg IM x 1
+ azithromycin 2 g PO x 1
OR
cefixime 800 mg PO x 1

if chlamydia not ruled out:
- doxycycline 100 mg PO BID x 7 days
- if pregnant: azithromycin 1 g PO x 1

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treatment for gonorrhea in pharynx

<150 kg: ceftriaxone 500 mg IM x 1
> 150 kg: ceftriaxone 1 g IM x 1

if chlamydia positive:
- doxycycline 100 mg PO BID x 7 days
- if pregnant: azithromycin 1 g PO x 1

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what if there is ceftriaxone unavailable or allergy in gonorrhea for pharynx

no other treatment options

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patient education for gonorrhea treatment

abstain from sex for 7 days after treatments and until 7 days after partner treated

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types of syphilus

primary
secondary
latent
tertiary (late)
neurosyphilis
congenital syphilis

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diagnosis of syphilis

2 types of serologic testing
1. nontreponemal - detect reagin
2. treponemal tests - confirmatory (more sensitive)
- must use both types of tests

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drug of choice for all types of syphilis

penicillin G (parenteral)

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treatment for primary and secondary syphilis

benzathine penicillin G 2.4 mil IM x 1 dose
if PCN allergy:
- doxycyline x 14 days
- tetracycline x 14 days
- azithromycin x 1 dose

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treatment for early latent sypphilis

benzathine penicillin G 2.4 mil IM x 1 dose
if PCN allergy:
- doxycyline x 14 days
- tetracycline x 14 days

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what is early latent syphilis

< 1 year duration

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treatment for late latent syphilis

benzathine penicillin G 2.4 mil IM x 3 weeks
if PCN allergy:
- doxycyline x 28 days
- tetracycline x 28 days

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treatment for tertiary syphilis

benzathine penicillin G 2.4 mil IM x 3 weeks
if PCN allergy:
- doxycyline x 28 days
- tetracycline x 28 days

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what is late latent syphilis

> 1 year or unknown duration

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treatment for neurosyphilis

aqueous crystalline penicillin G IV x 10-14 days
then benzathine penicillin IM x 3 weeks
OR
procaine penicillin IM daily +probenicid

if pcn allergy:
- ceftriaxone 2 g IM or IV daily x 10-14 days

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treatment considerations for syphilis if HIV +

same

treatment of syphilis in pregnancy

penicillin only agent
if allergic do desensitization

what is a Jarisc-Herxheimer reaction

happens 2-4 hours after PCN admin not to be confused with allergy treat with antipyretics

chlamydia presentation in females and males

dysuria, urinary frequency in males asymptomatic in females

chlamydia presentation in infants

most common cause of neonatal eye infections and afebriles interstitial pneumonia in infants < 6 months

diagnosis of chlamydia

NAAT test Giemsa stain (cell culture 100% specific)

chlamydia treatment

doxycycline 100 mg PO BID x 7 days OR azithromycin 1 g PO x 1 dose OR levofloxacin 500 mg PO q24h x 7 days

chlamydia treatment in pregnant women

azithromycin 500 mg PO x 1 dose amoxicillin 500 mg PO TID x 7 days

patient education in pts with chlamydia

abstain from sex for 7 days after completion of therapy and until partners are treated

mycoplasma shape

no cell wall

presentation of mycoplasma

asymptomatic

diagnosis of mycoplasma

no cell wall NAAT testing

treatment of mycoplasma based on what

macrolide suseptibility

mycoplasma treatment

macrolide suseptible: - doxycycline x 7 days then - azithromycin 1 g x 1 day then - azithromycin 500 mg x 3 days macrolide resistant or no testing: - doxycycline x 7 days then - moxifloxacin x 7 days

presentation of genital herpes simplex

flu like symptoms - long duration of symptoms largely asymptomatic high mortality and morbidity during pregancy and neonates

diagnosis of herpes

viral culture HSV NAAT serologic tets to detect HSV antibodies

initial treatment of genital herpes

acyclovir 400 mg PO TID famciclovir 250 mg PO TID valacyclovir 1 g PO BID x 7-10 days !

recurrent treatement of genital herpes

acyclovir 2 or 5 days famciclovir 1 or 5 days valacyclovir 3 or 5 days overall 1-5 days for recurrent

when to give recurrent treatment of herpes simplex

if prodromal symptoms or within 1 day of onset of lesions

treatment of severe herpes simplex

acyclovir 5-10 mg/kg/dose IV q8h for 2-7 days

suppressive treatment of herpes simplex

acyclovir 400 BID famciclovir 250 BID valacyclovir 500 mg daily valacyclovir 1 g daily

when to give suppressive treatment herpes simplex

if frequent occurences > 6 per year

treatment of herpes simplex in HIV patients

episodic: acyclovir famciclovir valacyclovir x 5-10 days daily suppressive: acyclovir famciclovir valacyclovir BID

treatment of herpes simplex in acyclovir resistant

foscarnet 40-80 mg/kg/dose IV q8h cidofovir 5 mg/kg/dose IV once weekly

treatment of herpes simplex in pregnant women

start supressive therapy at 36 weeks acyclovir valacyclovir

clinical presentation of trichomoniasis

asymptomatic

diagnosis of trichomoniasis

wet mount examination of discharge NAAT

treatment of trichomoniasis drug

metronidazole tinidazole

trichomoniasis treatment in women vs men

women metronidazole 500 BID x 7 days tinidazole 2 g x 1 dose men metronidazole 2 g x 1 dose tinidazole 2 g x 1 dose HIV metronidazole 500 BID x 7 days

can we use metronidazole gel

what if allergy to metronidazole in trichomoniasis

desensitization

when should women be retested for trichomoniasis

< 3 months after initial treatment

considerations with metronidazole

avoid alcohol 24 h w metro and 72 hours with tinidazole in breast milk, wait 12-24 hours after end of treatment treat the partner too

pelvic inflammatory disease treatment

ceftriaxone + doxycycline + metronidazole x 14 days OR ampicillin/sulbactam doxycycline x 14 days if PCN allergy: - clindamycin + gentamycin x 14 days

pelvic inflammatory disease IM/oral option

ceftriaxone x 1 dose doxycycline x 14 days metronidazole x 14 days