STDs

Which of following is the most prevalent STD in the United States?

A. Gonorrhea

B. HPV

C. HIV

D. Syphilis

B

CHLAMYDIA

1. Transmission is …

2. ______ is common

3. Perinatal transmission results in ______ in 30-50%

1. sexual OR vertical

2. re infxn

3. neonatal conjunctivitis

GONORRHEA

1. Transmission is …

2. M or F more likely to be symptomatic?

3. Associated w +transmission and susceptibility to …

1. sexual OR vertical

2. M

3. HIV infxn

CLINICAL SYNDROMES - MEN

1. _________ → urethral discharge (clear or cloudy) w dysuria & frequency

2. _________ → unilateral testicular pain & swelling

1. urethritis

2. epididymitis

CLINICAL SYNDROMES - WOMEN

1. _________ → mucopurulent endocervical discharge, edematous

2. _________ → dysuria, freq, pyruria

1. cervicitis

2. urethritis

GONORRHEA CLINICAL SYNDROMES - MEN & WOMEN → 4

1. proctitis

2. pharyngeal infxn

3. conjunctivitis

4. disseminated gonococcal infxn (DGI)

CHLAMYDIA MICROBIO →

atypical gram neg

GONORRHEA MICROBIO →

gram neg diplococcal

CHLAMYDIA & GONORRHEA

1. Diagnosis =

2. ______________ swab

3. Tests for _____ in the same specimen

4. CHALMYDIA treatment →

5. GONORRHEA treatment →

6. Management → 4

7. FOLLOW UP (REPEAT TESTING)

8. TEST OF CURE → ___ days after treatment → Gonorrhea if ALT regimen or pharyngeal infxn → chlamydia not rec

1. NAATs (nucleic acid amplification tests)

2. urine, vaginal, rectal, oral

3. G&C trich

4. doxycycline 100 mg BID x 7d

5. ceftriaxone 500 mg IM x 1 → 1g if >/= 150 kg

6. test for other STDs, abstinence x 7d, EPT partners w/in last 60d, report to health dpt

7. 3m → 3 weeks if pregnant

8. 14d

C

What other antibiotic choice for chlamydia?

azithromycin

Trichomoniasis is classified as what type of pathogen?

A. Bacterial

B. Fungal

C. Viral

D. Protozoal

D

TRICHOMONIASIS

1. Transmission is …

2. ~70% _____

3. Common co-infection with …

4. Diagnosis

5. Treatment → WOMEN

6. Treatment → MEN

7. Treat partners within the last ____ w EPT

8. FOLLOW-UP

1. sexual penile-vaginal

2. asymptomatic

3. BV (vaginal candidiasis)

4. NAATs

5. metronidazole 500 mg BID x 7d

6. metronidazole 2g x 1

7. 60d

8. 3m → 3 weeks pregnant

Which of the following is/are important patient counseling points for Metronidazole treatment?

A. Abstain from ETOH for 48-72 hrs

B. May experience bitter, metallic taste

C. Take with food to minimize GI upset

D. All of the above

D

BACTERIAL VAGINOSIS (BV)

1. ___________ (disruption to microbiome)

2. Producing Lactobacillus with high concentrations of _______ bacteria

3. Diagnosis → NAATs, gram stain → AMSEL’S CRITERIA (4)

4. Treatment options →

5. _______ during treatment!

6. Follow up →

1. vagina dysbiosis

2. anaerobic

3. discharge, clue cells, pH >4.5, fishy odor

4. metronidazole 500 mg BID x 7d, metronidazole gel 0.75% 1 app x 5d, clindamycin cream 2% 1 app x 7d

5. abstinence

6. rec for recurring symptoms, may consider long term tx

Which of the following is TRUE concerning BV?

A. Treatment includes Doxycycline & abstinence

B. Caused by disruption of microbiome due to overgrowth of aerobic bacteria

C. Not an STI, but increases the risk of STI acquisition

D. s/s include thick white discharge and pH <4.5

C

PELVIC INFLAMMATORY DISEASE

1. Microbio →

2. Diagnosis →

3. Symptoms that indicate INPATIENT treatment → 5

4. Reassess in ______

5. REPEAT TESTING →

1. polymicrobial

2. abd pain, chandelier sign, clinical hx

3. tubo-ovarian abscess, pregnancy, sev illness, unable to follow/tolerate PO, no response to PO

4. 72h

5. 3m

PELVIC INFLAMMATORY DISEASE

INPATIENT TREATMENT →

1. ceftriaxone 1g IV q 24h

2. +doxycycline 100 mg IV/PO q 12h

3. +metronidazole 500 mg IV/PO q 12h

PELVIC INFLAMMATORY DISEASE

OUTPATIENT TREATMENT →

1. ceftriaxone 500 mg IM x 1

2. +doxycycline 100 mg BID x 14d

3. +metronidazole 500 mg BID x 14d

SYPHILIS

1. Transmission is …

2. Most contagious →

3. →

4. Serologic tests for syphilis are usually HIGHEST in _____ stage

5. Categories: EARLY LATENT

6. LATE LATENT

1. sexual OR vertical

2. primary stage → chancre (primary lesion), ± lymphadenopathy

3. secondary → lesions, rash

4. secondary

5. <1 yr

6. >/= 1 yr

Manifestations of tertiary (late) syphilis → 2

1. gummatous lesions

2. Cardiovascular syphilis

____________ may occur at ANY stage of syphilis → involves HOSPITAL TX

neurosyphilis

SYPHIILIS

1. Microbio →

2. Serologic testing →

3. Primary, Secondary, & Early Latent TX → +alt

4. Tertiary & Late Latent TX → +alt

5. Neurosyphilis, ocular syphilis, otosyphilis TX →

6. Congenital syphilis →

1. gram neg spirochete

2. blood test → nontreponemal/treponemal antibodies

3. Pen G benzathine (Bicillin LA) x1 → doxycycline x 14d

4. Pen G benzathine x3 → doxycycline x 28d

5. Aq crystalline Pen G daily x 10-14d

6. Aq crystalline pen G

Late Latent Syphilis is defined by ≥ ___ year(s) duration of infection (vs. early latent)

1

A 38 y/o patient has Cardiovascular syphilis. Classify his syphilis stage

tertiary

A 66 y/o patient has Neurosyphilis. Choose the most appropriate treatment.

A. Pen G Benzathine IM x 1

B. Pen G IM Benzathine x 3

C. Aqueous Pen G IV

D. Doxycycline

C

T or F:

Penicillin G Benzathine (Bicillin L-A) and Penicillin G Procaine + Penicillin G Procaine (Bicillin C-R) may be used interchangeably for the treatment of Syphilis.

F

Which antibiotic is NOT to be used in pregnancy?

doxycycline

T or F:

HSV-1 more commonly causes genital herpes compared to HSV-2.

F

GENITAL HERPES

1. Transmission is …

   Most persons are UNAWARE of their infxn or asymptomatic

2. PRIMARY infection → (1st ever infxn)

3. Subsequent infection → virus remains ___________, reactivation w or w/o lesions, sx often MILDER

4. Diagnosis →

5. TREATMENT →

6. RESISTANT HSV →

1. sexual OR vertical

2. no AB, more severe, flu like

3. latent indefinitely

4. viral culture (gold standard), AB testing, NAATs

5. PO acyclovir, famciclovir, or valacyclovir

6. IV foscarnet or cidofovir

HERPES MANAGEMENT -PREGNANCY

1. Begin treatment at ____ weeks gestation

2. TX →

3. TX FOR NEONATES →

1. 36

2. acyclovir or valacyclovir

3. IV acyclovir

Which of the following is/are recommended for uncomplicated HSV Infection?

A. Acyclovir (oral)

B. Acyclovir (topical)

C. Acyclovir (IV)

D. Valacyclovir (oral)

A, D

T or F:

Patients with genital warts are more likely to develop HPV-related cancers.

F

GENITAL WARTS

1. microbio →

2. Low-risk (nononcogenic) →

3. High-risk (oncogenic) →

4. Transmission

5. Diagnosis →

6. TREATMENT →

7. Follow up →

8. Patient Applied Treatment (all 3 not safe in HIV/HSV co-infected) →

9. ^ which one is NOT safe in pregnancy?

10. PROVIDER Applied Treatment → 3

1. DNA virus

2. HPV types 6, 11

3. HPV types 16, 18

4. sexual, oral, skin-skin

5. PAP smear, HPV DNA test >/= 25 yo

6. removal of warts, HPV vax

7. +PAP = yearly, -PAP = q 3y

8. Podofilox 0.5% soln/gel, imiquimod 5% cream, sinecatechins 15% oint

9. sinecatechins

10. Cryotherapy q 1-2 weeks, TCA/BCA, surgery

1. HPV VACCINATION →

2. How many doses needed?

3. Pregnancy?

1. Gardasil 9-valent

2. 9-14 = 2 doses, 15+ = 3 doses

3. not rec until after