STIs: Gonorrhea and Chlamydia (L35)

STIs are caused by bacteria, parasites, and viruses… but not ___________

fungi (fungal)

________ is the single most important demographic factor contributing to incidence of STIs

age (mainly 15-25 y/o)

greatest risk factor of STIs is ___________________ (for both men and women)

number of sexual partners

Neisseria gonorrhea is the second most common STI in the US and is caused by gram negative diplococci bacterium

it/s caused by oral, anal, and vaginal sexual contact, and infants can get it during birth

co-infection with ___________ is very common

chlamydia

Neisseria gonorrhea is the second most common STI in the US and is caused by gram negative diplococci bacterium

it/s caused by oral, anal, and vaginal sexual contact, and infants can get it during birth

predominantly seen in patients __________ years old and ________ common in women than it is in men

race and ethnicity: _____________ communities see the highest rates

15-25, less (men get it more commonly cuz of MSM)

black/AA

Neisseria gonorrhea is more common in men than in women d/t MSM

NG can cause infection in the _________, _________, or _________

genitals, rectum, throat (any part of the body you can use for sex lol)

Neisseria gonorrhea: ___________ typically have signs and symptoms, while ________ are often asymptomatic

males, females (females therefore are often left untreated and can progress to PID, tube scaring, infertility)

Neisseria gonorrhea: males typically have signs and symptoms, while females are often asymptomatic

in urethritis, >90% of males will have symptoms of _________ or urethral discharge

incubation period is 1-10 days; >90% of males will have symptoms by day ____

dysuria, 5

Neisseria gonorrhea: males typically have signs and symptoms, while females are often asymptomatic

females are asymptomatic ~50% of the time; if left untreated, NG can progress to _________, tubal scaring, or ___________

PID, infertility (negatively impacts reproductive organs)

Neisseria gonorrhea is an invasion of mucosal cells (which can sometimes disseminate, but usually stays localized)

the preferred diagnostic tool is __________ (from urine for a genital infection or swab from anatomical site)

NAAT (Nucleic Acid Amplification Test) (looking for gonnarheal DNA; results in ~48hrs)

treatment of Neisseria gonorrhea is complicated by the ability of NG to develop drug-resistance (ex: quinolone resistance is widespread in the US)

____________ (class) have the greatest activity, although resistance is expected to increase here too☹

Cephalosporins

treatment of Neisseria gonorrhea is complicated by the ability of NG to develop drug-resistance (ex: quinolone resistance is widespread in the US)

Cephalosporins (class) have the greatest activity, although resistance is expected to increase here too☹

_____ Cephalosporins provide the high and sustained bactericidal levels at anatomical sites compared to _____

IM, PO (IM much preferred)

there is increasing resistance to Azithromycin for treating Neisseria gonorrhea

the new preferred treatment recommendation is a single-drug treatment with _________ ____mg given _____ as a single dose (for pts <150kg) (double the dose for pts >150kg)

Ceftriaxone 500mg IM

the new preferred treatment for Neisseria gonorrhea is Ceftriaxone 500mg given IM as a single dose (for pts <150kg) (double the dose for pts >150kg)

if a pt has a severe cephalosporin allergy (anaphylaxis), we must give two-drug therapy instead (cuz of resistance)

this is _____________ given ____ + ____________ given ____, both just a single dose

Gentamycin IM, Azithromycin 2g PO

Neisseria gonorrhea is often seen as a co-infection with Chlamydia

if we suspect someone could have either one, we treat empirically for ________

both

Neisseria gonorrhea is often seen as a co-infection with Chlamydia

if we suspect someone could have either one, we treat empirically for both

____________ ____mg given ____ as a single dose PLUS __________ ____mg BID given _____ for 7 days

Ceftriaxone 500mg IM (for pts <150kg; covered gonorrhea)

Doxycycline 100mg BID PO (covers chlamydia)

Neisseria gonorrhea is often seen as a co-infection with Chlamydia

if we suspect someone could have either one, we treat empirically for both

Ceftriaxone 500mg given IM for _________ (how long) PLUS Doxycycline 100mg for _________ (how long)

single dose, BID for 7 days

Neisseria gonorrhea is often seen as a co-infection with Chlamydia

if we suspect someone could have either one, we treat empirically for both

in pregnant patients we would give Ceftriaxone 500mg given IM as a single dose PLUS __________ 1g as a single dose instead of the Doxycycline

Azithromycin (Doxy has toxicity to fetal bone development)

patient counseling for Neisseria gonorrhea includes partner _________

notification (goal is to refer for evaluation, testing, and treatment of all sexual partners in the last 60 days)

patient counseling for Neisseria gonorrhea includes partner notification

the goal is to refer for evaluation, testing, and treatment of all sexual partners in the last _________

60 days

patient counseling for Neisseria gonorrhea: avoid sexual activity for _________ after treatment and (hopefully) after their sexual partners have been treated

7 days

patient counseling for Neisseria gonorrhea: patient should be re-tested __________ post-treatment (reinfection from the same partner is very high)

3 months (or 1-2 weeks for pharyngeal NG)

patient counseling for Neisseria gonorrhea: it is very important that patients use ___________!!!

condoms

Chlamydia trachomatis is the most common reported STI in the US

it is transmitted via anal, vaginal, or oral sexual contact or vertical transmission to an infant during birth (important to treat pregnant women!!)

predominantly seen in patients ________ years old and in _________ communities

15-25, black/AA (same as gonorrhea)

Chlamydia trachomatis is the most common reported STI in the US

untreated disease can lead to long-term complications and damage to the female’s _____________ (occurs in approximately 10% of untreated women)

reproductive system (PID, chronic pelvic pain, infertility, ectopic pregnancy, etc.)

Chlamydia trachomatis is the most common reported STI in the US

a majority of infections in both men and women are __________ (even through females are still slightly more likely to be _________)

asymptomatic

Chlamydia trachomatis is the most common reported STI in the US

infection is ______ common in females than in males

more (and females are more often asymptomatic)

Chlamydia trachomatis is the most common reported STI in the US

CDC recommends all sexually active females <25 years old, all MSM, and all sexually active HIV patients should be screened ___________

annually

Chlamydia trachomatis is the most common reported STI in the US

although majority of cases are asymptomatic, symptoms can occur _________ (how long) after sexual contact with an infected partner (i.e. incubation period)

1-3 weeks (more delayed than gonorrhea)

Chlamydia trachomatis is the most common reported STI in the US

the s/sx of Chlamydia are similar to those of __________ infections

UTI (urinary tract)

a patient who has s/sx of either ____________ and/or __________ will be treated empirically for both

gonorrhea, chlamydia

diagnosis of Chlamydia trachomatis uses molecular based techniques, with the preferred method being _____________ (urine sample collected for both men or women)

NAAT (Nucleic Acid Amplification Test) (looking for presence of chlamydia DNA; results in ~48hrs)

Chlamydia trachomatis is easy to cure, but re-infection is very common

the CDC-updated recommendations lists the first-line treatment as __________ ___mg BID given _____ for 7 days

Doxycycline 100mg BID PO

Chlamydia trachomatis is easy to cure, but re-infection is very common

the CDC-updated recommendations lists the first-line treatment as Doxycycline 100mg PO BID for ____________ (how long)

7 days

Chlamydia trachomatis is easy to cure, but re-infection is very common

the CDC-updated recommendations lists the first-line treatment as Doxycycline 100mg PO BID for 7 days

if the patient is pregnant or has an allergy to Doxy, the alternative tx is ____________ ____mg in one single dose

Azithromycin 1000mg (Doxy is CI in pregnancy)

Chlamydia trachomatis is easy to cure, but re-infection is very common

after treating a pregnant woman, we should repeat NAAT ________ post-tx to confirm eradication

4 weeks

Chlamydia trachomatis is easy to cure, but re-infection is very common

after treating a pregnant woman, we should repeat __________ 4 weeks post-tx to confirm eradication

NAAT

for both Chlamydia and Gonorrhea we should be screening all sexually active women <25 y/o ___________

annually

for both Chlamydia and Gonorrhea we should be screening all sexually active women >25 y/o who are considered at high risk (ex: multiple partners) ___________

annually

for both Chlamydia and Gonorrhea we should be screening all pregnant women, and if positive we should re-test _________ after treatment

4 weeks

for both Chlamydia and Gonorrhea we should be screening all sexually active MSM or men considered at high risk __________

annually

_________________________ is a public health policy for treating sexual partners who are unable to or unlikely to seek treatment

Expedited Partner Therapy (EPT)

Expedited Partner Therapy (EPT) is a public health policy for treating sexual partners who are unable to or unlikely to seek treatment

for heterosexual partners of known positive tests, their partners can receive treatment without needing a ______________

medical evaluation

Expedited Partner Therapy (EPT) is a public health policy for treating sexual partners who are unable to or unlikely to seek treatment

for heterosexual partners of known positive tests, their partners can receive treatment without needing a medical evaluation

for _________ patients, we would prefer they come in to be tested for others things and educated more

MSM

Expedited Partner Therapy (EPT) is a public health policy for treating sexual partners who are unable to or unlikely to seek treatment

for heterosexual partners (in the last ________) of known positive tests, their partners can receive treatment without needing a medical evaluation

60 days

Expedited Partner Therapy (EPT) is a public health policy for treating sexual partners who are unable to or unlikely to seek treatment

for heterosexual partners of known positive tests, their partners can receive treatment without needing a medical evaluation

we will treat them with __________ ____mg PO as a single dose PLUS __________ _____mg BID for 7 days

Cefixime 800mg (yeah it’s not quite as good, but we can’t give out IM so this is the next best thing), Doxycycline 100mg