Week 10 Flashcards

Question

Management of Gonorrhoea

Answer 1

Recommended regime: Ceftriaxone 250mg IM x1 + Azithromycin 1gram PO x1 OR Doxycycline 100mg PO BID x 7 days

Answer 2

Caused by the bacterium Treponema pallidum Has been nationally notifiable since 1924 Average onset of first symptoms is 21 days, however can range from 10-90 days If untreated, it progresses through primary, secondary, and early latent stages

Answer 3

Rates are increasing in Canada In 2018, 6,281 cases were reported nationally (16.9 cases per 100,000) Nunavut reported the highest rate in Canada every year since 2012 Males comprise the majority of reported cases every year (85%) Rates among women have been increasing over the past decade Highest rates were among the 25-29 and 30-29 year old groups (49% of cases!)

Answer 4

Chancre sore or proctitis Single sore or multiple are common Sores appear where the syphilis entered the body, are usually firm, round small and painless Chancres last 3-6 weeks and will heal without treatment

Answer 5

Begins with skin rash and mucous membrane lesions Rash is rough, red or reddish brown spots on palms of hands, soles of feet, and/or torso extremities, not usually itchy Can also include fever, swollen lymph glands, sore throat, patchy hair loss, muscle aches, fatigue, flu-like symptoms

Answer 6

No symptoms identified at the time of medical visit Infection has been identified to have occurred after the last 12 months (ie, no evidence of any of the above stages in the past year)

Answer 7

Chancre sores - are usually firm, round and painless. On occasion are open and wet Chancres can show up on your vulva, vagina, anus, penis, scrotum, lips or mouth They can be easy to mistake for an ingrown hair

Answer 8

Secondary Stage Rashes on the palms of your hands, soles of your feet or other body parts Not usually itchy May develop mild flu-like symptoms (slight fever, tired, sore throat, swollen glands, headache, muscle aches) Can also have sores in your mouth, vagina, or anus May note hair or weight loss Can last 2-6 weeks at a time and come and go for up to 2 years

Answer 9

Late stages Tumors Blindness Paralysis Damage the nervous system, brain and other organs May result in death

Answer 10

Recommended regime: Primary or Secondary syphilis: Penicillin G benzathine 2.4 million units IM x1 Neurosyphilis: 2.4 million units IM qWeek x3 Doxycycline, tetracycline, and possibly ceftriaxone can be used in patients with PCN allergy Pregnant women should only be treated with penicillin

Answer 11

Order: 2.4 million units of Penicillin G IM X1 now Available: 5 million units, to be diluted in 3.1 mL of sterile water for injection, yielding an approximate volume of 5mL total How many mL will you administer IM? Which IM site is the most appropriate + why?

Answer 12

Genital herpes simples virus (HSV) Human papilloma virus (HPV) Both are non-reportable Genital HSV and HPV are transmitted through intimate skin-skin sexual contact, can also be spread from mother to baby through childbirth (resulting in serious complications such as abnormal development or death) Untreated HSV 1 or 2 in the second half of pregnancy, carries a 30-50% risk of vertical transmission Neonatal herpes can cause serious morbidity (including long-term neurological damage ie cognitive dysfunction and learning disabilities) and high mortality

Answer 13

HSV type 1 and 2 (2 is most common) Either can cause genital infections, however HSV-2 rarely causes oral herpes Often appear as one or a group of painful, itchy, fluid filled blisters in or around the genitals, buttocks, and/or thighs May experiences burning while voiding, fever and flu-like symptoms, and swollen glands Transmission occurs when both symptomatic and asymptomatic

Answer 14

Viral identification “Nucleic Acid Amplification Test” (NAAT) or viral culture HSV serology may be useful if testing isn’t available

Answer 15

Oral acyclovir, famciclovir, valacyclovir within the first 3-4 days of symptom onset for maximum benefit Caesarean delivery is strongly recommended if a first episode of genital herpes occurs in the third trimester Suppressive therapy is recommended for those with frequent (>6/year) or highly symptomatic recurrences

Answer 16

Not required as a public health measure People are encouraged to inform their partners so that partners are aware of risk of infection

Answer 17

HPV is one of the most common STI’s in Canada + worldwide There are many types of HPV, some lead to cancer and others to skin lesions It is estimated that as many as 75% of sexually active people will have at least one HPV infection in their lifetime Most peoples immune systems will eventually clear the infection Only a small proportion of people will go on to develop cancer

Answer 18

There is no cure for HPV infections but many symptoms are treatable Routine Papanicolaou (Pap) exams are important screening tools for cervical cancer 3 vaccines are available to help prevent some types of HPV, including strains that cause 7-% of anal and genital cancers + 90% of anogenital warts HPV causes almost all cervical cancers, and is also linked to cancer of the throat, oral cavity, penis, anus, vagina or vulva

Answer 19

Many people are asymptomatic Anogenital warts are one sign, they look like small cauliflower or may be flat In women, warts may appear on the vulva, thigh, any, rectum, or in the vagina or urethra with the cervix being a common HPV site Active infection will demonstrate a change in cells and will either become normal again or the cells slowly progress to cervical cancer HPV DNA testing is available in Canada, but is not a part of women’s regular check-ups or Pap tests. It isn’t covered by provincial/territorial health programs

Answer 20

Health Canada has authorized 3 vaccines Gardasil, Gardasil 9 (for females and males), and Cervarix (for females only) Studies have found the vaccines to be safe Vaccines cannot cause disease as they contain no live biologicals or DNA Vaccines do not contain any preservatives, thimerosal, or mercury If you are infected with one type of HPV, you can still benefit from the vaccine None of the vaccines have an impact on existing infection

Answer 21

Protects against two high risk types of HPV (16 and 18) which cause approximately 70% of anal and genital cancers Also covers two low risk types of HPV (6 + 11) which cause 90% of anogenital warts Gardasil 9 prevents up to an additional 14% of anogenital cancers cause by HPV types 31, 33, 45, 52, 58 Vaccines are approved for females age 9-45 and in males 9-26 Involves one dose initially followed by one dose two months later, and another dose given 6 months after the first dose Not recommended for pregnant or lactating women

Answer 22

In 2018, 60% of Canadians reported never having been screened for STI’s STI screening provides an opportunity to discuss transmission, signs and symptoms, risk reduction, and preventative measures More frequent STI screening may be appropriate for individuals: Who have had a previous STI diagnosis New sexual partner Multiple or anonymous sexual partners Sexual partner(s) having a STI Condomless sex Sex while under the influence of alcohol or drugs

Answer 23

Includes HIV, Hepatitis B, and Hepatitis C Need special consideration as they are not solely transmitted by sexual activity Transmission can also occur by reusing drug, tattooing, or piercing equipment that has residual traces of infected blood Hep B + C can be transmitted through sharing razors or toothbrushes Can be transmitted from mother to neonate during pregnancy or birth HIV can be transmitted through breast milk

Answer 24

Virus that attacks the body’s immune system HIV is a manageable chronic condition If left untreated, it causes a weakened immune system or acquired immune deficiency syndrome (AIDS) In 2018 there was an estimated 62,050 people living with HIV in Canada - 85% being diagnosed and on treatment An estimated 2,242 new HIV infections occurred in Canada in 2018 HIV is not transmitted through: Kissing, hugging, toilet seats, sharing foods, shaking hands, or mosquito bites

Answer 25

Some people may not develop symptoms after contracting HIV, and could remain undiagnosed until symptoms of AIDS appear (this can be up to 10 years later) 50% or more of people living with HIV may develop the following within 2-4 weeks: Chills Fever Fatigue Joint Pain Headache Sore throat Muscle aches Swollen lymph nodes

Answer 26

Blood serum testing Some are not able to detect the virus during the first 2-4 weeks of HIV infection, however the individual is still infectious May repeat testing if it’s negative and there’s a possibility of having HIV Anonymous testing Rapid HIV testing (point of care) Online testing

Answer 27

Treatment is highly effective, and can prevent HIV transmission Client’s can be treated with antiretroviral medications as part of antiretroviral therapy (ART) Lower the level of HIV in the body (suppresses the viral load) Slows the spread of the virus in your body Helps the immune system fight off other infections

Answer 28

Highly effective HIV prevention strategy that HIV negative people can use to lower risk Involves taking antiretroviral (anti-HIV) drugs and having regular medical appointments, monitoring, and supporting When taken as prescribed, the risk of transmission is extremely low Generally safe and well tolerated Available by prescription Two PrEP pills approved by Health Canada, both contain emtricitabine + either tenofovir disoproxil or tenofovir alafenamide Only covered under OHIP for those 24 years or younger, otherwise costs $250-280/month in Ontario

Answer 29

Can be taken after HIV exposure to help prevent infection Should be started as soon as possible, up to a maximum of 72 hours afterwards Very effective but will not prevent 100% of HIV transmissions from occurring Must have high adherence to the full course of PEP drugs (4 weeks) and should have no further exposures to HIV while taking PEP PEP is a combination of three medications Tenofovir disoproxil fumarate, emtricitbine, raltegravir (or dolutegravir)

Answer 30

Reduce stigma by being respectful, compassionate and nonjudgemental Model this behaviour for others when you witness stigmatizing behaviours When talking about HIV, be thoughtful of the words you use Learn more about the facts of HIV: Treatment lowers the viral load, making it too low to be measured in blood tests and therefore undetectable People on HIV treatment who maintain an undetectable viral load have effectively no risk of transmitting HIV to their sexual partners

Answer 31

Is a liver disease spread by contact with infected body fluids, including blood, semen and vaginal fluid It is more infectious that HIV Following infection, 50% of people are asymptomatic 50% will develop symptoms of fatigue, nausea, vomiting, jaundice, decreased appetite, and arthralgia Approximately 95% of healthy people will clear the virus, the remaining will become chronic carriers Those Hepatitis B may eventually develop liver cancer, liver failure, or cirrhosis Diagnosis is confirmed by blood tests and can be treated using antiviral drugs

Answer 32

Four Hepatitis B-Containing Vaccines Available for Use in Canada Engerix-B + Engerix-B Pediatric Infanrix hexa, also contained diphtheria, tetanus toxoids, acellular pertussis, hep B, inactivated poliomyelitis, and conjugated Haemophilus influenza type B Recombivax HB, Recombinvax HB - Pediatric, Recombivax-HB Adult dialysis Twinrix + Twinrix Junior, combined Hepatitis A and B 3 vaccine series over 6 months Not covered under OHIP

Answer 33

Is a liver disease caused by the hepatitis C virus (HCV) Most commonly spread by percutaneous exposure with infected blood and less commonly by sexual activity or perinatal exposure Hepatitis C can progress to cause liver injury and eventually end-stage disease Following infection, most people are asymptomatic 30% of people may experience fatigue, jaundice, or arthralgia Approximately 45% of healthy people will spontaneously clear HCV 55-85% of people will develop chronic infection

Answer 34

Diagnosis is made through serum blood testing Treatment is highly effective and cures more than 95% of people of hepatitis C Medications used are called “direct-acting antivirals” (DAAs), which block the ability of the HCV to replicate Being cured of hepatitis C, or a sustained virological response (SVR) is achieved after a negative/ undetectable HCV RNA test 12 weeks after the end of their treatment Treatment is based on amount of liver injury, drug interactions, genotype/strain of the HCV, length of treatment, and previous treatment experience

Answer 35

Preventing STBBIs and risk factors from existing Creation of programs and policies that keep youth off the streets, or advocating for access to comprehensive sexual health education

Answer 36

Refers to preventing the start of disease with the goal of decreasing incidence Involves activities prior to any sign of disease, injury, or transmission of STBBIs Includes the use of penile or male condoms + vaginal or female condom *Remember condoms are not 100% effective in protecting against herpes or HPV Vaccination is very valuable

Answer 37

Refers to early detection Involves regular testing and screening for STBBIs, including blood testing, urine samples, genital examination, and sometimes swabs

Answer 38

Measures aimed at decreasing the progress of a disease and controlling long-term negative consequences Involves using medications to treat an infection Manage symptoms

Answer 39

Methods to avoid results of unnecessary or excessive intervention As new medications are developed for STBBIs, is it important to ensure patients are not placed in any harm - ensuring consent is obtained in trials, and having the ability to withdraw at any time

Week 10 Flashcards

(63 cards)