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Flashcards in STIs Deck (109):
1

RF for STIs

Number of sexual partners
Men who have sex with men
Prostitution
Illicit drug use

2

Prevention methods for STIs

Male condoms
Female condoms
Diaphragm

3

Male condoms

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

Female condoms

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

Diaphragm

Limited protection
Least preferred, good for trich, gonorrhea, chlamydia

6

Neisserie gonorrhoeae

Gram neg diplococcus

7

GU presentation of gonorrhea

Vaginal d/c
Uterine bleeding
Dysuria
Urinary frequency
PID

8

Throat presentation of gonorrhea

Pharyngitis

9

Anorectal presentation of gonorrhea

Rectal pain
Pruritis
Mucopurulent d/c
Bleeding

10

Tx for uncomplicated gonorrhea

Ceftriaxone 250 mg IM x1 +
(Azithromycin 1 g PO x 1 OR
Doxycycline 100 mg PO BID x 7 days)

11

Tx for disseminated gonococcal infection

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

Tx for infants born to mother with infection

Erythromycin 0.5% ophthalmic ointment x 1
Mandated by law

13

Counselling for gonorrhea

Avoid intercourse x 7 days after completing abx
Sex partners should be treated

14

MOA of ceftriaxone

3rd gen cephalosporin
Inhibits cell wall synthesis

15

AEs of ceftriaxone

Injection site reaction
Diarrhea
Pregnancy category B

16

MOA of azithromycin

Macrolide
Inhibits RNA-dependent protein synthesis

17

AEs of azithromycin

N/V
Diarrhea
Abd pain
SJS (rare)
Avoid if QT prolonged
Pregnancy category B

18

Syphilis

Treponema pallidum
Spirochete
Transmitted via sexual contact with lesion

19

Incubation period of primary syphilis

10-90 days

20

Presentation of primary syphilis

Single, painless lesion
Erodes, ulcerates, heals within 1-8 wks

21

Sites of primary syphilis infection

External genitalia
Perianal region
Mouth
Throat

22

When does secondary syphilis develop?

2-8 wks after initial infection

23

Site of secondary syphilis infection?

Hematogenous
Lymphatic

24

Presentation of secondary syphilis

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