-
What is the recommended treatment of Chlamydia?
- Azithromycin once OR
- Doxycycline BID for 7 days
-
What is the alternative treatment : Chlamydia?
- Ofloxacin BID x 7 days
- levofloxacin once daily x 7 days
- erythromycin QID x 7 days
- erythromycin ethylsuccinate QID x 7days
-
Recommended chlamydia tx in pregnancy
- Azithromycin 1g once
- amoxicillin TID x 7 days
-
alternative chlamydia tx in pregnancy
- Erythromycin base QID x 7 days
- erythromycin ethylsuccinate QID x 7days
-
What is the clinical presentation for chlamydia in men/women?
- men: incubation 35 days, 50% asymptomatic, little to profuse mucoid to purulent discharge
- women: incubation 7-35 days, 60% aysmptomatic, little to profuse mocoid to purulent discharge, uterine bleeding
-
What are the complications of chlamydia?
Epididymitis Reiter syndrome, also in women PID
-
Chlamydia follow up for pregnant women, when?
3 weeks after completion of therapy
-
Sexual partner mgt. w/chlamydia
- treat if sexual contact was during 60 days preceding onset of sx/diagnosis
- abstinence for 7 days after single dose or after 7 treatment completed
-
Which STDs cross the placenta ?
- Chlamydia
- Gonorrhea
- syphilis after 12 wks gestation
-
Most common cause of nongonococcal urethritis?
Chlamydia
-
Chlamydia and gonorrhea infects?
- cervix
- upper genital tract in women
- urethra
- rectum
- conjuctiva
-
What is the age group reporting most infections with STDs?
-
What is the most commonly reported infectious disease? What is the 2nd most commonly reported STD?
-
60% of gonorrhea infections is accompanied by?
chlamydia
-
Symptom onset for Chlamydia?
for gonorrhea?
- chlamydia 7-21 days male and female
- gonorrhea: male 2-8 days, female 10 days
-
What is gonorrhea incubation period?
Men and women 1-14 days
-
What are the symptoms of gonorrhea infection in men/women?
- usually asymptomatic but both may experience dysuria and urinary frequency, rectal pain, pharyngitis
- cervical: usually asymptomatic to mild
-
What are the signs of infection for gonorrhea?
- men: purulent rectal, urethral discharge
- women: purulent rectal, urethral discharge, uterine bleeding
-
What are the diagnostic test for chlamydia?
- patient history exam
- edocervical or urethral cell scraping
- NAAT (nuceic acid amplification test)
- EIA (ezyme immunoassay)
- DNA hybridization probe
- DFA (direct fluorescent monoclonal antibody)
-
Diagnostic test for gonorrhea
- gram stain smears (low sensitivity in asymptomatic men
- culture
- nucleic acid hybridization test
- NAAT
-
Recommended Treatment for gonorrhea all routes of infxn, ie throat etc
- ceftriaxone IM once + azithromycin once OR
- doxycycline BID x 7 days
- azithromycin or doxycycline is added if chlamydia hasn't been ruled out
-
Alternate regimen for gonorrhea
- cefixime once + azithromycin once OR doxycycline BID x 7 days
- azithromycin 2g once or ceftriaxone
-
Gonorrhea treatment in pregnancy
same as regular treatment except substitute amoxicillin TID x 7 days instead of doxycycline b/c we don't use tertracyclines or FQs in pregnancy
-
What is the follow up treatment for Gonorrhea?
same as chlamydia. no test for cure unless patient still has symptoms
-
Transmission of Syphillis, how?
- contact w/infected mucous membrane or lesions
- mother to fetus after 12 weeks gestation
-
Clinical presentation of primary syphilis
appearance of a single sore or multiple sores
-
Clinical presentation of 2ndary syphilis
- skin rash and mucous membrane lesions
- develops in 2-8 wks
- pruritic or nonpruritic rash, mucocutaneous lesions, flu-like symptoms, lymphadenopathy
- disappear in 4-10 wks
- lesions can recur anytime w/in 4 years
-
Clinical presentation of latent syphilis
- Asymptomatic -noninfectious stage
- positive serologic test
- 2 phases: early latency up to 1 yr after exposure (can still transmit); late latency > 1yr after exposure
- ~25-30% progress to tertiary syphilis
-
Clinical presentation/manifestations of tertiary syphilis
- gummatous lesions
- aortic insufficiency
- neurosyphilis-meningitis, general paresis, dementia
-
What is the most common site of infection in tertiary syphilis and when does it develop?
- site of infxn: CNS, heart, eyes, bones, and joints
- ~develops in 30% of untreated or inadequately treated its 10-30 years after initial infxn
-
How is syphilis diagnosis by screening test, describe
- Screening test (non-treponemal test):
- Venereal disease research laboratory (VDRL) and rapid plasma reagin (RPR) -detect abs, high titer level correlates w/degree of the disease
-
Confirmatory syphilis test (treponema test), what is it?
- Fluorescent treponemal antibody absorption (FTA-ABS)
- measures specific IgG abs
-
Recommended:
Primary -early latent treatment
Late latent - tertiary treatment, unknown
- Primary: Benzathine pcn G 2.4 million units IM once
- Late: Benzathine pcn G 2.4 million units IM once weekly x 3
-
Alternate:
Primary - early latent treatment
Late latent - unknown treatment
- Primary: doxycycline BID x 14 days; Tetracycline QID x 14 days; ceftriaxone IM/IV once daily x 10-14 days; azithromycin 2g once
- Late latent: doxcycline BID x 28 days; tetracycline QID x 28 days
-
Pregnancy syphilis tx
Benzathine PCN G once then again 1 week later, depends on the provider
-
SE of PCN treatment in pregnant patient being treated for syphilis
Jarisch-Herxheimer -acute fever in 1st 24hrs, may induce labor or fetal distress
**allergic pts should be desensitized**
-
Syphilis follow up schedule:
primary:
late:
sexual partners:
- primary: non-treponemal test 6 & 12 months
- late: non-treponemal test 6,12, & 24 months
- sexual partners: contact if sex in previous 3 months; >3 months consider serologic test
-
BV risk factors:
- multiple sex partners
- new sex partners
- douching
- lack of vaginal lactobacilli
-
BV results from replacement of lactobacillus sp. by?
- gardenella vaginalis
- mycomplasma hominis
-
BV is most prevalent cause of and and is common among women of .
vaginal discharge and malodor, childbearing age
-
BV clinical presentation S/Sx:
- Thin white discharge
- fishy odor
- vulvar itching and irritation
-
BV diagnosis by gram stain or clinical criteria, what are the clinical criteria?
- Need at least 3 :
- Thin white discharge
- fishy odor (positive whiff test)
- presence of clue cells on microscopic exam
- pH of vaginal fluid >4.5
-
Which BV patients require treatment?
All symptomatic patients
-
A follow visit is necessary after patients are treated for BV? and sex partners must be treated?
False and false only treat if symptoms are unresolved...duh men can't get BV they don't have a vagina
-
BV treatment:
Recommended non-preggers:
- metronidazole BID x 7 days
- metronidazole vaginal gel once daily x 5 days
- clindamycin cream QHS x 7 days
-
BV non-preggers alternate treatment:
- Clindamycin BID x 7 days
- Clindamycin vaginal ovules QHS x 3 days
- Tinidazole PO daily x 3 days
- Tinidazole PO daily x 5 days
-
BV preggers treatment:
- metronidazole 25O mg TID or 500mg BID x 7 days
- Clindamycin BID x 7 days
-
Protozoal STD, trichomononas vaginalis only affects women
False, men and women
-
Trasmission method for trichomonas
- sexual contact
- direct exposure with contaminated surfaces (i.e. wet towels and toilet seats) SCARY!! don't sit hover like a UFO
- mother to newborn during birth
-
Incubation period for trichomoniasis:
men:
women:
same for both, 3 - 28 days
-
Trichomoniasis most common site of infection for:
men?
women?
- men: urethra
- women: endocervical canal
-
Trichomoniasis s/sx:
men?
women?
- men: usually asymptomatic or discharge
- women: malodorous yellow green/foamy vaginal discharge, dysuria, dsypareunia, vulvar irritation and pruritus, "strawberry spots" (erosion of cervix 90% of women)
- Everything is harder on a woman that's why we are the stronger sex!!!
-
Trichomoniasis diagnosis:
- elevated vaginal ph >5
- strawberry spots
- culture to confirm positive wet mount
- EIA or DNA probe technique
-
Trichomoniasis recommended treatment:
men/women?
pregnant?
treatment failure?
- men/women: metronidazole 1 dose or tinidazole 1 dose
- pregnant: metronidazole 1 dose
- treatment failure: metronidazole BID x 7 days
-
Patients treated for trichomoniasis must follow-up with provider
False
-
Trichomoniasis mgt of sexual partners:
- Treat partners
- avoid sex until cured/ therapy completed
-
Herpes is the most common cause of and affects ? Age grp? Women < men T/F?
- genital ulceration
- 1 in 6 americans
- 14-49 years old
- false, women affected more than men, 1 out of 5 women and 1 out 9 men
-
What are the 5 lovely stages of Herpes?
- primary mucocutaneous infection
- infection of ganglia
- establishment of latency
- reactivation
- recurrent infection
-
What is the incubation period for genital herpes primary infection?
2-14 days
-
Primary HSV clinical presentation
- painful small vesicular lesions on external genitalia
- itching, dysuria, vaginal discharge, tender inguinal adenopathy
- flu-like symptoms
-
How long is viral shedding for HSV?
11-12 days
-
Recurrent infections for HSV1 are more severe than HSV2 T/F? How long is viral shedding for recurrent infection?
-
HSV diagnosis
- virologic test:
- culture
- PCR assay
- specific serologic test
-
Treatment for HSV for 1st episode with:
Acyclovir
famciclovir
valacyclovir
- Acyclovir TID 7- 10 days also has a 200 mg 5 x day dose
- Famciclovir TID 7-10 days
- Valcyclovir BID 7-10 days
-
HSV recurrent episode treatment
Acyclovir
Famciclovir
Valcyclovir
see chart pg 11
-
Daily suppressive treatment HSV
- Acyclovir: BID
- Famciclovir: BID
- Valcyclovir: 500 mg QD (1g less effective if >10 episodes a year)
-
What is the HSV rate of transmission to neonates? Pregnant women can be treated with which medication?
- 30-50%
- Acyclovir -limited prenatal exposure
-
What is the HPV condylomata acuminata epidemiology (sounds fancy)
- HPV 6 & 11 most common causes genital warts
- associated with cancers of cervix, and oropharyngeal cancer in men
-
HPV risk factors
- multiple sex partners
- < 25 years of age
- sex at 16 or younger
- having a slut or ex-slut for a partner
- un-snipped man
-
Clinical presentation for HPV
- asymptomatic
- genital warts, look like cauliflower or flat
- painful /pruritic
- may appear within weeks or months after sexual intercourse
-
HPV health complications
- cervical cancer in > 20 years after infection
- vulvar malignancy
- penile malignancy
-
HPV diagnosis
- pap smear
- PCR detects HPV-DNA
-
HPV Provider applied treatment
- Cryotherapy
- Podophyllin resin 10 - 25%
- Trichoroacetic or bichloroacetic acid 80-90%
- Surgical removal (for large area)
-
HPV Patient applied treatment
- Podofilox 0.5% sol or gel, wait 4 days in b/t 3 day treatment cycles
- -BID x 3 days, can repeat for 4 cycles
- Imiquimod 5% cream-leave on 6hrs
- -3 times weekly for 6 weeks
- Sinecatechins 15% ointment
- -apply 0.5 cm strand to each wart TID (NTE 16wks)
-
Vaginal spermicides can
Vaginal sponge protects against
Diaphragm protects against cervical
- spermicide: induce lesions, increase risk of infections
- sponge: gonorrhea and chlamydia but increases risk of candidiasis
- diaphragm: gonorrhea, chlamydia, & trich, increase risk of UTI
-
Incubation period?
Chlamydia
Gonorrhea
syphilis
Trichomoniasis
HSV
- Chlamydia: men 35 days, women 7-35
- Gonorrhea: men/women 1-14 days
- syphilis: primary 10-90 days avg 21 days
- Trichomoniasis: men/women 3-28 days
- HSV: 2-14
-
Onset of symptoms:
Chlamydia
Gonorrhea
syphilis
HSV
- chlamydia: men/women 7-21 days
- gonorrhea: men 2-8 days, women 10 days
- syphilis: secondary 2-8 wks may take 4-10 wks to resolve
- HSV: 2-14, viral shedding 11-12 days, for recurrent infxn viral shed is ~ 4 days
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