Term
age: 15-24 yo account for 1/2 of STIs
# of sexual partners
prostitution
illicit drug use
sexual preference |
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Definition
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Term
incubation period: 1-14 days
women are usually asymptomatic
urethral infection: dysuria and urinary frequency; purulent discharge
anorectal infection: severe rectal pain, pruritus, bleeding
pharyngeal infection: mild pharyngitis
abnormal vaginal discharge; uterine bleeding
complications: PID, disseminated gonorrhea
complications if untreated during pregnancy: ophthalmia neonatorum (ophthalmic infection leading to blindness) |
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Definition
| clinical presentation of gonorrhea |
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Term
uncomplicated gonorrhea:
Ceftriaxone 125 mg IM x 1 dose
OR
Cefixime PO x 1 dose
PLUS
Azithromycin 1 g x 1 dose (for Chlamydia)
if allergic to beta lactams - Azithromycin 2 g (emerging resistance)
OR
Ciprofloxacin/Levofloxacin (quinolone resistant gonorrhea)
disseminated gonorrhea:
Ceftriaxone 1 g IM or IV q 24 hours until improvement begins, then switch to oral regimen x 7 days
pregnancy DOC = ceftriaxone or if allergic 2 g azithromycin |
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Definition
| treatment of uncomplicated and disseminated gonorrhea and gonorrhea during pregnancy |
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Term
strong association between HIV and syphilis
diagnosis with RPR (rapid plasma reagent)
primary stage: 10-90 days, chancre sore, regional lymphadenopathy
secondary stage: 2-8 weeks, pruritic or non-pruritic rash (usually on hands), mucocutaneous lesions, flu-like symptoms
latent stage: 4-10 weeks after secondary stage, asymptomatic
tertiary stage: 10-30 years after secondary stage, cardiovascular syphilis, gumma lesions present, neurosyphilis (dementia, auditory hallucinations, deafness, blindness) |
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Definition
| clinical presentation of syphilis |
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Term
primary, secondary, early latent:
PCN G 2.4 million units IM
follow up: RPR at 6 and 12 months
late latent and neurosyphilis:
PCN G 2.4 million units IM weekly x 3 weeks OR aqueous crystalline PCN G 18-24 million units IV infusion x 10-14 days
follow up: RPR at 6, 12, and 24 months, CSF examination q 6 months until clear |
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Definition
treatment of syphilis in the primary, secondary, and early latent phases
treatment of syphilis in the late latent and neurosyphilis stages |
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Term
| Jarisch-Herxheimer Reaction |
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Definition
acute febrile reaction of unknown MOA (but may be due to release of toxins of the syphilis bacteria)
NOT an allergic reaction
flu-like symptoms: HA, myalgia, tachypnea, malaise
develops 2-24 hours post PCN dose
treatment: antipyretics, analgesics, and rest |
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Term
primary, secondary, early latent syphilis:
doxycycline 100 mg PO BID x 14 days
OR
tetracycline 500 mg PO QID x 14 days
OR
ceftriaxone 1 g IM x 14 days
latent or unknown duration syphilis:
doxycycline 100 mg PO BID x 28 days
OR
tetracycline 500 mg PO QID x 28 days |
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Definition
PCN allergic patients
treatment of primary, secondary, and early latent syphilis
treatment of latent or unknown duration syphilis |
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Term
transmission: sexual activity, mother to fetus (birth canal)
symptom onset 7-21 days
sites of infection: urethra, endocervical canal, rectum, oropharynx, eye
usually asymptomatic
urethral discharge (watery)
abnormal vaginal discharge
dysuria
mild pharyngitis
complications: PID, infertility, Reiter syndrom (rare, autoimmune response to infection that presents like arthritis) |
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Definition
| clinical presentation of chlamydia |
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Term
uncomplicated infections:
azithromycin 1 g PO x 1 dose
OR
doxycycline 100 mg PO BID x 7 days
abstain from sexual intercourse x 7 days post treatment (applies to all STIs)
Chlamydia in Pregnancy:
azithromycin 1 g PO x 1 dose |
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Definition
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Term
upper genital tract infection in women resulting from the spread of bacteria that have colonized in the endocervical area
risk factors: young age, use of IUD
pelvic pain: lower abdominal tenderness, cervical motion tenderness
cervical discharge
fever
elevated erythrocyte sedimentation rate and C-reactive protein
lab verification of infection with gonorrhea or chlamydia |
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Definition
| clinical presentation of pelvic inflammatory disease |
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Term
oral outpatient regimens:
ceftriaxone 250 mg IM x 1 dose PLUS doxycyline 100 mg BID x 14 days
parenteral inpatient regimen:
cefoxitin 2 g IV q 6 h PLUS doxycycline 100 mg IV q 12 h |
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Definition
| treatment of pelvic inflammatory disease |
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Term
incubation period: 2-14 days
HSV1 = oropharyngeal disease
HSV2 = genital disease
transmission: from infected secretions onto mucosal surfaces
HSV cycle: primary mucocutaneous infection, infection of the ganglia, establishment of latency, reactivation (through physical/emotional stress), recurrent infection
asymptomatic (primary infection)
prodrome: mild burning, itching, tingling
multiple painful pustular or ulcerative lesions (usually heal in 2-4 weeks)
flu-like symptoms (fever, HA, malaise)
complications:
lesions at extragenital sites - eye, rectum, pharynx
CNS involvement - meningitis, encephalitis
neonatal exposure (in birth canal) - high morbidity (permanent neurological damage) and mortality (50%) |
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Definition
| clinical presentation of herpes simplex virus |
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Term
goals: relieve symptoms, shorten duration of clinical course, prevent recurrences, decrease disease transmission
treatment is palliative, not curative
first clinical episode:
acyclovir 400 mg PO TID x 7-10 days
famciclovir 250 mg PO TID x 7-10 days
valacyclovir 1 g PO BID x 7-10 days
recurrent infections: chronic suppressive therapy (> 6 episodes/year)
acyclovir 400 mg PO BID
famiciclovir 250 mg PO BID
valacyclovir 500 mg or 1000 mg PO q day
episodic treatment:
acyclovir 400 mg PO TID x 5 d
acyclovir 800 mg PO BID x 5 d
acyclovir 800 mg PO TID x 2 d
famiciclovir 125 mg PO TID x 5 d
valacyclovir 500 mg PO BID x 5 d
valacyclovir 1 g PO q d x 5 d |
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Definition
| treatment of genital herpes |
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Term
counsel regarding the disease and its transmission
abstain from sexual activity when lesions or prodromal symptoms are present
episodic recurrent treatment: begin your antiviral during prodromal phase or 1 day after lesion onset
topical acyclovir is INEFFECTIVE treatment for genital herpes |
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Definition
| patient counseling on herpes infection |
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Term
females > males
incubation period: 3-28 days
transmission: sexual contact, contamination of inanimate objects
females: scant to copious, malodorous vaginal discharge and pruitus
males: often asymptomatic, urethral discharge (clear to mucopurulent)
complications: PID, premature labor, infertility (male and female), cervical neoplasia |
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Definition
| clinical presentation of Trichomoniasis |
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Term
metronidazole 2 g PO x 1 dose
OR
metronidazole 500 mg PO x 7 d
OR
tinidazole 2 g PO x 1 dose |
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Definition
| treatment of trichomoniasis |
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Term
may take with food to decrease GI upset
use 7 day course in those with severe GI complaints
treat sexual partners simultaneously
pregnancy Category B (better to wait until 2nd or 3rd trimester to treat)
ADRs: diarrhea, N/V, dry mouth, metallic taste, abdominal pain, HA, dizziness
AVOID ALCOHOL: during treatment and 3 days after treatment, disulfiram like reaction |
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Definition
| patient education on metronidazole |
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Term
most common viral STI in the US
6 and 11 are associated with the development of genital warts
16 and 18 increases risk of cerival neoplasia
treatment: cryotherapy with liquid nitrogen or surgial removal of external warts |
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Definition
| clinical presentation of human papillomavirus |
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Term
stimulates antibody production against 4 types of HPV
provides protection against cervical cancer from 16 and 18
provides protection against genital warts from 6 and 11 |
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Definition
| the HPV vaccine, gardasil protects against what strains of HPV? |
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Term
| antibody protection against 16 and 18 (cervical cancer) |
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Definition
| Cervarix provides protection against what strains of HPV? |
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Term
injection site reaction (pain and swelling)
HA, fever, fatigue
post marketing surveillance: fainting and VTE
VTE risk factors: OC, genetic predispostion to blood clots
CDC recommendations: benefits outweigh risks |
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Definition
| gardasil tolerability and concerns |
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