STI's

Bacterial infection, Haemophilus ducreui

saliva, air, cough, fecal-oral route, surfaces, blood, needles, blood transf., sexual contact, mother-to-fetus

rare in N.A.

Males > female

• Papule to pustule 7-10 day incubation
•           - erodes into nonindurated, PAINFUL, ulcer w/ purulent base and ragged, undermined borders

Single or mult.ulcers confined to genitals

Unilateral tender adenopathy can rupture

Def. lab dx rarely available

PCR by CDC only

Serology can't determine old vs. new infection

Culture possible

azithromycin 1gm PO x 1 dose

ceftriaxone 250mg IM x 1

ciprofloxacin 500mg PO BID x 3d

eryth. 500mg PO 3xdaily for 7 days

Fungus Candida albicans, a normal skin flora

Not considered sexually transmitted

frequently seen with increased sexual activity

vulvar itching, burning, soreness

painful intercourse and/or urination

THICK, CURDY WHITE vaginal discharge

erythema, irritation

Diflucan (fluconazole) 150mg PO x 1

If oral candida, 100mg PO x1

Topical: 

clotrimazole, miconazole, terconazole

CDC, USPSTF yearly for all sexually active females < 25y.o., or older at risk females.

Most frequently reported STD in U.S.

Women 3x> men

Bacterial infection - chlamydia trachomatis

Infects genitals, throat, eyes, rectum

>50% asymptomatic, untreated

7-21 days of incubation

vaginal, oral, anal sex w/ infected person

cross-contamination from fingers

Meatal itching/discomfort

mucopurulent endocervical discharge

edematous cervix w/ erythema and friability

pyuria, dysuria, urinary frequency

WOMEN

• increased discharge
• abnl bleeding
• lower abd.pain
• coital pain
• endocerv. bleeding
• ectopy

Can cause PID in women

Can lead to: ectopic pregnancy, blocked fallopian tubes, long term pelvic pain, early miscarriage or premature birth

painful inf. of testes, can result in reduced fertility or sterility

occasionally leads to Reiter's syndrome (infl.of joints, urethra, eyes)

NAAT's (nucleic acid amplification test) 80-95%

Direct fluorescent antibody 70-85%

Tissue culture 70-85%

Enzyme immunoassay 50-75%

azithromycin 1gm orally in one dose

OR 

doxycycline 100mg PO BID x 7d


Alternative: 

• erythro.500mg 4xday x 7d
• levaquin 500mg PO BID x 7d
• ofloxacin 300mg PO BID x7d

genital warts & condyloma acuminata

most common symptomatic viral infection, chronic

Types 6 & 11 most common

Cancerous: 16, 18, 31, 33, 35

80% of sexually active women infected

May present as laryngeal papillomatosis (JORRP)

from vertical transmission

Possibly sexual abuse

Single or multiple soft, fleshy painless, keratinized growths

Flesh-colored or red, may be flat & difficult to detect

vaginal walls or cervix, penis, anus, oral cavity (occasionally)

Smooth: dome-shaped and skin colored

Flat: macular to slightly raised, flesh-colored w/ smooth surface, more commonly found on internal structures

Keratotic: thick horny layer can resemble common warts or seborrhea keratosis

biopsy

Pap smear, cervical anal

eradicate visible lesions

May not be practical to eliminate all lesions

Most pts will develop a spontaneous immune response and eliminate the wart virus by the age of 30

Pt. applies: 

Podofilox 0.5% sol. or gel to visible warts BID for 3 days, rest 4 days, 4 cycles max.

Imiquimod 5% cream, QHS x 16 weeks.

NEW:

Veregen (extract of green tea), FDA-approved, TID < 16 weeks.

Cryotherapy

Surgical removal

Podophylin resin 10-25%

Laser surgery, intralesional interferon

Ages 11-12 (prior to sexual contact)

9-26 y.o.

Approved for males

"The Drip"

Bacterial

Male symptoms:

• Yellow, purulent urethral discharge, may be clear or cloudy
• Dysuria
• Itching & burning
• Epididymitis (unilateral testicular pain & swelling)

Females:

• burning on urination
• yellowish vaginal discharge, redness, & swelling of the genitals

bleeding

Abd./coital pain

Untreated can lead to severe pelvic infections & even sterility

Babies: eye infections

Accessory gland infection (Bartholin's, skene's)

PID

Perihepatitis (fitz-hugh-curtis syndrome)

gram-stain: gram (-) diplococci

95%/98%

CULTURE GOLD STANDARD

NAAT's: noninvasive, quick results, co-identify chlamydia, high sensitivity-high specificity

• Ceftriaxone 250mg IM x 1
•  
• & 

• Azithromycin 1gm PO x1
• doxycycline 100mg PO BID X 7d

ceftriaxone 250mg IM x1 

& 

azithromycin 1mg PO in single dose

OR 

doxycycline 100mg BID x 7d

Multiple severe lesions, last longer

Papules -> vesicles -> pustules -> ulcers -> crusts ->healed

Illness lasts 2-4 weeks

Can have: 

fever, HA, malaise, myalgia

pain, itching, dysuria, vaginal discharge, tender inguinal adenopathy, numerous, bilateral painful genital lesions; last 11-12 days.

genital itching

small sore blisters

lymph node enlargement

HA, fever after the blisters break out

weakness, lethargy, body aches

acyclovir 400mg PO 3xdaily 7-10d (200mg 5xdaily for 7-10days)

famciclovir 250mg 3xdaily for 7-10 days

valacyclovir 1mg PO 2xdaily for 7-10 days

• acyclovir 400mg PO 3xdaily for 5 days
•              800mg PO 2xdaily for 5 days
•              800mg PO 3xdaily for 2 days

valacyclovir 500mg 2xdaily for 3 days

Acyclovir 400mg PO 2xdaily

famciclovir 250mg PO 2xdaily

valacyclovir 500mg (or 1g) PO QD

complication of BV and or chlamydia/gonorrhea

Women 15-25, sexually active, highest risk

Major cause for infertility

gonorrhea, chlamydia

• Male partners w/ infection
• mult. partners

current douching

IUD insertion

BV

abd. pain

uterine or adnexal pain

cervical motion tenderness

abd. vaginal bleeding

discharge

painful intercourse

fever

cervicitis

enometritis

salpingitis/oophoritis/tuboovarian abscess

peritonitis

Ceftriaxone 250mg IM x 1

& 

doxycycline 100mg PO BID x 14d

with/without

metronidazole 500mg orally BID x 14d

Bacteria - treponema pallidum

sexual contact - passed through open cut or wound

mother-child

3-staged disease

Primary

10-90 days of initial exposure

Tiny hard red spots at the initial site of contact: progresses from macule to papule to ulcer. Painless, indurated, w/ clean base.

Highly infectious

Heals spontaneously in 1-6 weeks

Lymphadenopathy

Resolves 7-14d

Secondary

90-180 days

Flu-like sx, sore throat, fever, itching, general.rash. Lesions occur 3-6 weeks after primary chancre appears, may persist for weeks to months. Mucocutaneous lesions most common

Sx may abate and return for final stage

Latent

gummatous lesions

Affects the brain, spinal cord, heart w/o tx.

FATAL

Presumptive dx possible

Serology: 

RPR, VDRL (non-treponemal) - titers may correlate w/ disease activity.

FTA-ABS (treponemal)

Rash (75-100%)

Lymphadenopathy (50-86%)

Malaise

Mucous patches (6-30%)

Condylomata (10-20%)

Invasion of CNS can occur at any stage

Can be asymptomatic

PCN G IM/IV (all stages of syphilis)

Primary/Secondary/early latent: 2.4 million units IM in a single dose

Late latent: 7.2 million units in 3 divided doses, IM, qweek

Parasitic infection

Cannot survive in mouth or rectum

Passed through sexual contact

Frequently no symptoms

Men: discharge from penis, mild discomfort & Swelling of genitalia

Women: frothy green to yellow discharge with bad odor, vaginal itching, cervical petechiae (strawberry cervix), painful urination, inflammation in genitals, sometimes lower abdomen.

Metronidazole 500mg , 4 tabs as one dose 

OR

Metronidazole 500mg PO BID x 7d

NO ALCOHOL

Itch mite burrows into skin producing pimple-like irritations or burrows transferred by direct skin-skin contact. 

Intense itching particularly at night.

Webs and sides of fingers, wrists, elbows/armpits, waist, thighs, nipples, breasts & lower buttocks.

Permetrin 5% cream, apply to all areas of body from neck down, wash off after 8-14hrs

Ivermectin 200mcg/kg PO, repeat in 2 weeks

Parasites live in hair around genitals

Trans. through close physical contact (EXTREMELY CONTAGIOUS)

Symptoms: itching

Wash all contaminated clothing, bedding, etc. in hot water or dry clean

permethrin 1% cream rinse - apply to area, wash after 10 min.

Ivermectin 250mcg/kg PO, repeat in 2 weeks