STIs Flashcards
(109 cards)
1
Q
RF for STIs
A
Number of sexual partners
Men who have sex with men
Prostitution
Illicit drug use
2
Q
Prevention methods for STIs
A
Male condoms
Female condoms
Diaphragm
3
Q
Male condoms
A
Latex is more effective than lambskin
Discourage lambskin in latex allergies- use polyurethane synthetic instead
Use a water-based lubricant because petroleum and oil-based lubes can degrade integrity of condom
4
Q
Female condoms
A
Can be inserted up to 8 hrs prior
Discourage male and female condom use at the same time- one of them will break
Polyurethane synthetic, diaphragm-like ring
Limited data on viral protection
5
Q
Diaphragm
A
Limited protection
Least preferred, good for trich, gonorrhea, chlamydia
6
Q
Neisserie gonorrhoeae
A
Gram neg diplococcus
7
Q
GU presentation of gonorrhea
A
Vaginal d/c Uterine bleeding Dysuria Urinary frequency PID
8
Q
Throat presentation of gonorrhea
A
Pharyngitis
9
Q
Anorectal presentation of gonorrhea
A
Rectal pain
Pruritis
Mucopurulent d/c
Bleeding
10
Q
Tx for uncomplicated gonorrhea
A
Ceftriaxone 250 mg IM x1 +
(Azithromycin 1 g PO x 1 OR
Doxycycline 100 mg PO BID x 7 days)
11
Q
Tx for disseminated gonococcal infection
A
Ceftriaxone 1 g IV/IM q24h for at least seven days or until sx have resolved for 24 hrs + Azithromycin 1 g PO x 1
12
Q
Tx for infants born to mother with infection
A
Erythromycin 0.5% ophthalmic ointment x 1
Mandated by law
13
Q
Counselling for gonorrhea
A
Avoid intercourse x 7 days after completing abx
Sex partners should be treated
14
Q
MOA of ceftriaxone
A
3rd gen cephalosporin
Inhibits cell wall synthesis
15
Q
AEs of ceftriaxone
A
Injection site reaction
Diarrhea
Pregnancy category B
16
Q
MOA of azithromycin
A
Macrolide
Inhibits RNA-dependent protein synthesis
17
Q
AEs of azithromycin
A
N/V Diarrhea Abd pain SJS (rare) Avoid if QT prolonged Pregnancy category B
18
Q
Syphilis
A
Treponema pallidum
Spirochete
Transmitted via sexual contact with lesion
19
Q
Incubation period of primary syphilis
A
10-90 days
20
Q
Presentation of primary syphilis
A
Single, painless lesion
Erodes, ulcerates, heals within 1-8 wks
21
Q
Sites of primary syphilis infection
A
External genitalia
Perianal region
Mouth
Throat
22
Q
When does secondary syphilis develop?
A
2-8 wks after initial infection
23
Q
Site of secondary syphilis infection?
A
Hematogenous
Lymphatic
24
Q
Presentation of secondary syphilis
A
Pruritic or nonpruritic rash
Mucocutaneous lesions
Flulike sx
Lymphadenopathy
25
When does secondary syphilis subside?
Within 4-10 wks if untreated
| Lesions can recur at any time x 4 yrs
26
When does latent syphilis develop?
4-10 wks after secondary stage
| Pos serologic test, no other evidence of dz
27
What are the latency stages of latent syphilis?
Early and late latency
28
Early latency- latent syphilis
1 yr from onset of infection
| Potentially infectious d/t risk of mucocutaneous relapse
29
Late latency- latent syphilis
Noninfectious
| Exception: transmission from mother to infant
30
When does tertiary syphilis develop?
Develops in 30% of untreated pts 10-30 yrs after initial infection
31
What are the sites of tertiary syphilis infection?
```
CNS
Heart
Eyes
Bones
Joints
```
32
CV presentation of tertiary syphilis
Aortitis
| Aortic insufficiency
33
Neurosyphilis presentation of tertiary syphilis
```
Meningitis
Paresis
Dementia
Blindness
Hearing loss
Tabes dorsalis
```
34
Congenital syphilis
Transplacental transmission
| Greatest risk with primary and secondary infection
35
Presentation of congenital syphilis
Low birth weight
Prematurity
Stillborn
Congenital syphilis
36
Complications of congenital syphilis
Cataracts
Deafness
Seizures
Death
37
Tx for congenital syphilis
Aqueous crystalline PCN G IV
38
Primary, secondary, early latent syphilis tx
Benzathine PCN G 2.4 mil units IM x 1
PCN allergy:
Doxycycline
Tetracycline
F/u at 6 and 12 mos
-Additionally, at 24 mos for early latent dz
Pregnant pts need to go through PCN desensitization
39
Counselling for primary, secondary, early latent syphilis
Avoid intercourse x 7 days for early latent dz
| Treat sex partners within 90 days dx
40
Late latent and tertiary syphilis tx
```
Benzathin PCN G 2.4 mil units IM once weekly x 3 wks
-If dose >2 days late, must restart tx
PCN allergy:
Doxycyline
Tetracycline
F/u at 6, 12, 24 mos
```
41
Neurosyphilis and ocular syphilis tx
Aqueous crystalline PCN G 3-4 mil units IV q4h x 10-14 days
Alternative:
-Procaine penicillin 2.4 mil units IM daily PLUS probenecid 500 mg PO QID x 10-14 days
-PCN allergy: desensitize
42
F/u to neurosyphilis and ocular syphilis tx
CSF exam q6 mos until cell count nl
43
PCNs MOA
Beta-lactam
| Inhibits cell wall synthesis
44
AEs of PCNs
Injecton site reaction
N/V
Diarrhea
Pregnancy category B
45
MOA of doxycyline
A tetracycline
| Bind with 30s and 50s ribosomal subunits- inhibit protein synthesis
46
AEs of doxycycline
N/V
Diarrhea
Photosensitivity
Pregnancy category D
47
Chlamydia
Chlamydia trachomatis
Atypical
Symptom onset 7-21 days
48
GU presentation of chlamydia in men
Dysuria
Urinary frequency
Urethral d/c
49
GU presentation of chlamydia in women
Vaginal d/c
Uterine bleeding
Dysuria
Urinary frequency
50
Throat presentation of chlamydia
Pharyngitis
51
Anorectal presentation of chlamydia
Rectal pain
Pruritis
Mucopurulent d/c
Bleeding
52
Complications of chlamydia
Epididymitis
Reiter's syndrome
PID
53
Tx of uncomplicated chlamydia
Azithromycin 1 g PO x 1
| Alternative: Doxycycline 100 mg PO BID x 7 days
54
Tx of chlamydia in pregnancy
Azithromycin 1 g PO x 1
| Alternative: Amoxicillin 500 mg PO TID x 7 days
55
Counselling for chlamydia
Avoid intercourse x 7 days after completing abx
| Sex partners should be treated
56
Genital herpes
HSV-1, HSV-2
57
Presentation of genital herpes
Multiple painful pustular or ulcerative lesions on external genitalia, flulike sx
58
Lesions at extragenital sites- genital herpes
Eye
Rectum
Pharynx
Fingers
59
CNS presentation of genital herpes
Meningitis
Transverse myelitis
Sacral radiculopathy syndrome
60
Presentation of 1st episode of genital herpes
Multiple painful pustular or ulcerative lesions on external genitalia
-Develop over 7-10 days
-Heal in 2-4 wks
Flulike sx during first few days after appearance of lesions
Pruritis, vaginal or urethral d/c, paresthesias, urinary retention
61
What occurs after a primary genital herpes infection
Virus establishes latency in neurons
| Viral shedding x 7-12 days
62
Recurrent genital herpes
```
Prodrome
-50% of pts
--Mild burning, itching, tingling
Compared to primary infections
-Fewer lesions, more localized
-Shorter duration of active infection
-Milder sx
Viral shedding x 4 days
```
63
Tx for 1st episode of genital herpes
```
Treat 7-10 days with:
Acyclovir
-400 mg PO TID
-200 mg PO 5x/day
Famciclovir
-250 mg PO TID
Valacyclovir
-1 g PO BID
```
64
Tx for recurrent genital herpes
```
Episodic therapy
-Initiated early during recurrence
-Acyclovir, Famciclovir, Valacyclovir
-Treat 1-5 days
Suppressive therapy
-Acyclovir, Famciclovir, Valacyclovir
-Treat daily or twice daily x 1 yr
Severe complicated dz
-Acyclovir IV
```
65
MOA of acyclovir, famciclovir, valacyclovir
Antiviral
| Inhibits DNA synthesis and viral replication
66
AEs of acyclovir, famciclovir,, valacyclovir
```
Malaise
HA
N/V
Diarrhea
Pregnancy category B
```
67
Trichomoniasis
Trichomonas vaginalis
-Pear-shaped, motile, flagellated protozoan parasite
Trichomonads gather in clusters and cause damage to underlying epithelium
Can survive up to 45 mins on moist surfaces
-Transmission via contact with infected bath or toilet articles, communal bathing
68
Presentation of trichomoniasis in men
Urethral d/c
Dysuria
Burning
Pruritis
69
Presentation of trichomoniasis in women
```
Malodorous greyish-yellow vaginal d/c
Dysuria
Pruritis
Painful intercourse
Inflammation/erythema
```
70
Tx for trichomoniasis
Metronidazole 2 g PO x 1
Tinidazole 2 g PO x 1
If sx remain:
Metronidazole 500 mg PO BID x 7 days
71
Counselling for trichomoniasis
Avoid intercourse x 7 days after completing abx
Sex partners should be treated
Do not drink alcohol while taking the meds and 24 hrs after last dose of metro, 72 hrs after last dose of tinidazole
72
MOA of metronidazole and tinidazole
Antiprotozoal
| Penetrates organism, inhibits protein synthesis, produces cell death
73
AEs of metronidazole and tinidazole
```
N/V
Metallic taste
SJS (rare)
Disulfiram-like rxn
Metro= pregnancy category B
Tinidazole= pregnancy category C
```
74
HPV
Most common viral STD in US
Over 100 types
Papillomaviruses use the skin or mucosal linings to replicate
-Oral, genital, anal or respiratory
75
Prevention of HPV
Gardasil quadrivalent vaccine
Gardasil 9 nonavalent vaccine
Indications: females and males 9-26 y/o
-Prevents cervical precancers, cervical cancer, genital warts, anal cancer
76
What strains does Gardasil cover?
6
11
16
18
77
What strains does Gardasil 9 cover?
```
Gardasil quadrivalent in addition to:
31
33
45
52
58
```
78
What is a bivalent vaccine that helps prevent HPV?
Cervarix
Protects against 16 and 18
Indications: Females 9-26 y/o for prevention of cervical precancers and cervical cancer
79
HPV tx- general concepts
Symptomatic tx
- No tx of virus available
Pt administered and provider administered therapies
Tx varies based on site of infection
80
What are the options for external tx for genital/perianal warts?
Podofilox
Imiquimod
Sinecatechins
81
Podofilox MOA
Keratolytic drug
| Inhibits cell division, necrosis occurs, tissues erode
82
Dose of Podofilox and instructions
0.5% solution or gel
| Treat x 3 days, wait 4 days, repeat if sx persist x 4 cycles
83
AE of podofilox
Localized burning
Inflammation
Itching
Pregnancy category C
84
Imiquimod MOA
Stimulates production of interferon and cytokines
85
Administration of imiquimod
5% cream
Wash area 6-10 hrs after application
Treat 3x/wk up to 16 wks
86
AE of imiquimod
```
Local inflammatory reactions
Ulceration
Vesicles
Hypopigmentation
May degrade integrity of condoms and diaphragms
Pregnancy category C
```
87
Sinecatechins MOA
Antioxidant
88
Sinecatechins dosing and application
15% ointment
Apply with finger TID up to 16 wks
Avoid sexual contact while on skin
89
When to avoid sinecatechins
HIV +
IC
Pts with genital herpes
90
AE of sinecatechins
```
Local inflammatory rxns
Burning
Itching
Ulceration
Vesicles
May degrade integrity of condoms and diaphragms
Pregnancy category C
```
91
What are provider administered external therapies for genital/perianal warts?
```
Cryotherapy
-Liquid nitrogen or cryoprobe
Podophyllin resin
Trichloroacetic acid (TCA)
Surgical removal
-Not for vaginal or urethral meatus warts
```
92
Tx protocol for vaginal, urethral meatus, and anal warts
Require provider administered therapies
| Those therapies are the same as the ones for genital/perianal warts
93
MOA of podophyllin resin
Binds to microtubules, induces cell death
94
Directions of podophyllin resin
Apply to lesion, cleanse area after tx
- First administration: leave on for 30-40 mins
- -Monitor for extreme burning or discomfort
- Repeat administration: leave on for 1-4 hrs
95
AE of podophyllin resin?
```
Local rxns
Fever
Leukopenia
Thrombocytopenia
Avoid in pregnancy
```
96
MOA of trichloroacetic acid (TCA)
Destroys proteins of cells
97
Directions for trichloroacetic acid (TCA)
Apply to lesion, allow white frost to form, cleanse after tx
98
AE of trichloroacetic acid (TCA)
Local reactions
| Burning
99
Bacterial vaginosis
Polymicrobial
Results from replacement of nl flora with anaerobic bacteria
May affect women who are not sexually active
100
Presentation of bacterial vaginosis
Malodorous vaginal d/c or asymptomatic
101
1st line tx for bacterial vaginosis
Metronidazole PO
Metronidazole gel intravaginal
Clindamycin cream intravaginal
102
Alternative tx for bacterial vaginosis
Tinidazole PO, Clindamycin PO, clindamycin ovules
103
Counselling for bacterial vaginosis
Avoid intercourse x 7 days after completing abx
104
Doses for metronidazole PO
ER 750 mg PO qd x 7 days
105
Metronidazole intravaginal cream dose and AE
1 applicator full daily-BID x 1-5 days
AE: itching, vaginal candidiasis, disulfiram-like rxn
Pregnancy category B
106
MOA of intravaginal clindamycin
Lincosamide
| Binds to 50s ribosomal subunit, inhibits bacterial protein synthesis
107
Directions of intravaginal clindamycin
Insert 1 applicator full or ovule intravaginally once daily x 1-7 day
108
AE of intravaginal clindamycin
Skin rxns
Itching
Pregnancy category B
109
Counselling for intravaginal clindamycin
Oil based: may degrade integrity of condoms and diaphragms x 5 days after use
Remove foil from ovules, cleanse applicators between uses
