Flashcards in STIs Deck (44)
When you touch each other...
you will get pregnant, and you will die.
Risk factors for STIs
residence in an urban area
new sex partners
multiple sex partners
history of a prior STI
illicit drug use
contact with sex workers
young age (15-24)
admission to correctional facility or juvenile detention center
meeting partners on the internet
What are the potential etiologies for a patient with a genital ulcer?
STI- HSV, syphilis, chancroid, LGV
noninfectious- Behcet's disease, fixed drug reactions and trauma
Herpes Simplex Virus (HSV)
types of infection
HSV-1 and HSV-2
-Primary: infection in a patient without antibodies to HSV1 or HSV-2 (has lesions but not abys)
-Nonprimary: first episode infection due to acquiring genital HSV-1 w/ preexisting antibodies to HSV-2 or vice versa
-Recurrent: reactivation of genital herpes in which the HSV type recovered in the lesion is the same type as the antibodies recovered in the serum
-highly variable from symptomatic to asymptomatic
-sx tend to be more severe in women
-systemic sx, local pain/itching, dysuria (d/t urinary retention or more rarely to lumbosacral radiculomyelitis), lymphadenopathy
-less symptomatic than first episode
-less severe/shorter duration
HIGHLY transmittable via the oral-genital route
-remember, any break in the skin gives you an increased chance of HIV
-viral cultrue if active lesions present
-PCR: more sensitive
-serology: type-specific antibody testing of serum, helps determine if the pt is at risk of acquisition, determines if a patient has had evidence of prior infection
-CAN do screening for HSV
therapy for primary genital infections
therapy for recurrent disease
-should be treated within 72 hours
-decreases duration of sx, increases healing of lesions, decreases viral shedding
-analgesics may be required/ sitz baths helpful
-chronic suppressive therapy: expensive and may not be covered by all insurance carriers
-episodic therapy: start at the first sign of prodromal sx, usually take for three days
What is the most common mode of transmission of HSV?
From direct contact of the fetus with infected vaginal secretions during delivery
What is used to treat HSV in pregnancy?
When do we do a prophylactic C-section?
If the mother has active HSV lesions in the birth canal.
Do NOT do if infected mother has:
-no active lesions
-lesions that have crusted
-active nongenital HSV lesions (cold sores)
**Maternal immunity is important
Does HSV always appear right away?
No, it could take years to show up.
-pts need to be educated that they may not have acquired the infection recently and that there had not necessarily been infidelity in a monogamous partner
Serological tests available
who to screen?
Cannot be cultured! Can be seen with DARKFIELD microscopy. Instead, do serological test.
Nontreponemal: VDRL, RPR, TRUST/ reported as titers
Treponemal: (reported as reactive or nonreactive)
-patient with suspected disease
-high risk populations (pts with other STIs, multiple sex partners)
-routine screening of pregnant women
-commercial sex workers
-all sexually active HIV- infected patients at least annually; more frequent screening for those w/ multiple sex partners and unprotected intercourse
What do you do when you diagnose a pt with syphilis?
offer HIV testing and counseling
It is a reportable infection in the US
Primary and secondary syphilis produce chancres, mucous patches, and condyloma lata
spread by kissing or touching a person who had active lesions on the lips, oral cavity, breasts, or genitals
can be passed through the placenta
incubation period of 2-3 weeks from inoculation- a papule forms and soon ulcerates to the chancre
chancre is usually painless, they heal spontaneously 3-6 weeks even without treatment
Usually bilateral lymphadenopathy
-Weeks to a few months later 25% of people w/ untreated infections will develop systemic illness
-rash: any form BUT vesicular, INCLUDES THE PALMS/SOLES
-grey/white lesions in warm moist areas- condyloma lata
-musculoskeletal and renal abnormallities
1-25 years after secondary syphillis:
-early tertiaty syphilis presents = 1 year
-Late tertiary syphilis presents > 1 year from initial infection
-subcutaneous tissues (gumma)- granuloma
-CV: ascending thoracic aorta becomes dilated aortic valve regurgitation occurs
-CNS: (most common)
--early: meningitis, meningiovascular disease
--late: general paresis, tabes dorsalis, ocular, otosyphilis
What do you do when you suspect Neurospyhilis?
a Lumbar puncture!
+ a serological test like CSF-VDRL, and or FTA-ABS
**need to follow CSF during treatment to make sure there is a response
Treatment for early syphilis
For primary, secondary syphilis and early latent:
2.4 million units of PEN G
-for pcn allergy pts, preferred drug is doxy 100mg BID for 14 days
Treatment for late syphilis
-pts with gummas or CV invlvment need to have an LP to r/o neurosyphilis before treatment
if they have localized disease:
-2.4 million units of PEN G IM weekly for 3 weeks
-Gumma will resolve
-it will only halt progession of CV disease and some prefer to treat CV disease like neurosyphilis
tx of neurosyphilis
-IV PEN G
-pts who are allergic to PCN should undergo PCN desensitization since PCN G is the DOC for treating neurosyphilis and an allergist should be consulted
-non-penicillin regimens are not recommended for pts with neurosyphilis
-pts need to be reexamined at 6 weeks and 12 months after tx
-a titer should be drawn just prior to starting tx and the same test and lab should be used for follow up
Human Papillomavirus (HPV)
Double-stranded DNA viruses Papillomavirus genus
-genital warts (condyloma acuminatum)
-bowenoid papules and Bowen's disease
-giant condyloma (Buschke-Lowenstein tumors) (huge genital warts)
-Intraepithelial neoplasia and/or carcinoma of the vagina, vulva, cervix, anus, or penis
-Plays a role in squamous cell carcinomas of the head and neck particularly the oral cavity
What HPV strains cause cancer? warts?
HPV 16 and HPV 18 account for 70% of all cervical cancers worldwide
HPV 6 and HPV 11 cause about 90% of genital warts
Paradigm of cervical carcinogenesis
*most HPV infections usually resolve within 6-12 months (including the carcinogenic HPV genotypes)
-progression of persisting infection to precancerous lesion
What is the most common viral sexually transmitted disease in the US?
Anogenital warts (HPV)
-persistent infections especially with other risk factors (such as HIV) can result in the development of squamous cell carcinoma
large condylomata can interfere w/ defecation, intercourse, and vaginal delivery
lesions in the proximal anal canal may cause strictures
-dx made by visual inspection
-document extent of involvement by PE,, anoscopy, sigmoidoscopy, colposcopy, and or vaginal speculum exam
-5% acetic acid (vinegar) causes lesions to turn white
*consider bx when dx is uncertain or presence of atypical features or lesions that do not respond to tx
-spontaneous regression occurs 20-30% cases
-all therapies have a 30-70% recurrence rate
-podophylliin (contraindicated in pregnancy)
-imiguimod (aldara)- also used for IEN vulva/anus
-Trichloroacetic acid (applied by provider)
-5-fluoruracil (5-FU) (applied by provider)
-Intralesional injected alpha interferon
-laser therapy: requires anesthesia/risk of scarring
-with knife or scissors: requires anesthesia, risk of infection and hemorrhage, need to send specimen to path
What are the three main causes of urethritis in males?
-usually can get discharge w/milking the urethra
-Urethral swab will be positive for WBCs and GRAM NEGATIVE INTRACELLULAR DIPLOCOCCI
-the cause of "nongonococcal urethritis" (NGU)