ID Lecture 33-34: Sexually Transmitted Infections | Quizlet

True or false: The incidence of STIs is increasing.

True

What are the most common STIs?

Chlamydia

Gonorrhea

Genital herpes

Syphilis

Trichomoniasis

When should Doxycycline be used as postexposure prophylaxis (PEP) for STI prevention?

Men who have sex with men

Transgender women

HIV or plan to thave HIV PrEP

What is the treatment recommendation of Doxycycline PEP?

200mg once within 72 hours

What causes Gonorrhea?

Neisseria gonorrhoeae

How do females present with Gonorrhea?

Vaginal d/c

dysuria

cervicitis/urethritis

Intermenstrual bleeding

may also be asymptomatic or have minimal s/sx

How do males present with Gonorrhea?

Purulent d/c

dysuria

epididymitis

prostatitis

May also be asymptomatic

What are the complications of Gonorrhea?

Pelvic inflammatory disease (PID)

Ectopic pregnancy

Infertility

HIV transmission

What is the mechanism of resistance with Gonorrhea?

Penicillinase producing

Tetracycline resistance

Quinolone resistance

decreased susceptibility to azithromycin and cephalosporins

What is the recommended treatment for Gonorrhea?

Ceftriaxone 500mg IM for 1 dose

if >150kg then 1g IM for 1 dose

Alternatives:

Gentamicin

Azithromycin

Cefixime

What should be added to the treatment of Gonorrhea if chlamydia has NOT been ruled out?

Doxycycline 100mg BID x7 days

What is important when treating a patient for an STI?

Treat their recent partners (w/i 4 weeks)

Chlamydia is caused by what?

Chlamydia trachomatis

What is the clinical presentation of chlamydia in males and females?

Asymptomatic

Dysuria

Urinary frequency

Mucopurulent d/c

What is the recommended treatment for Chlamydia?

Doxycycline 100mg PO BID x7 days

Alternatives:

Azithromycin

Levofloxacin

What is the recommended treatment for Chlamydia in pregnancy?

Azithromycin OR Amoxicillin

What are the complications that can arise from Chalmydia?

Pelvic inflammatory disease

Neonatal conjunctivitis

Neonatal pneumonia

What causes Syphilis?

Treponema pallidum

How is Syphilis transmitted?

direct contact with a sore or during pregnancy

What is the progression of syphilis that is left untreated?

Primary syphilis presentation

Chancre (painless)

Lymphadenopathy

How long does it take for primary syphilis to resolve?

2-6 weeks

What are the infection sites of primary syphilis?

External genitalia

Perianal region

Mouth

Throat

Secondary syphilis

widespread infection that develops 2-8 weeks after initial infection due to hematogenous and lymphatic spread

What is the clinical presentation of secondary syphilis?

Skin lesions (palms and soles)

Rash

Mucocutaneous lesions

Alopecia

Latent syphilis

the third stage of syphilis (early or late), which may last for years, during which symptoms disappear although the person is still infected

Early latent syphilis

infectious due to spontaneous relapses during the 1st year of infection

Late latent syphilis

noninfectious but remains a host - can progress to neurosyphilis or tertiary syphilis

When does tertiary syphilis develop?

10-30 years after initial infection

Tertiary syphilis

the third phase of syphilis, marked by multiple organ damage

How can tertiary syphilis present?

Neurosyphilis

Cardiovascular

Gumma

Gumma syphilis

chronic, destructive lections on the skin, bone, soft tissue, liver, heart, and/or brain

*tertiary*

Cardiovascular syphilis

weakens the aorta

*tertiary*

Neurosyphilis

a variation of syphilis that infects the nervous system

*tertiary*

How is Syphilis diagnosed?

Nontrepomenal tests (screening):

- VDRL

- RPR

If above are positive, then Trepomenal tests for confirmation:

- FTA-Abs

- TPHA

- MHATP

What is the treatment recommendation for late latent or latent syphilis of an unknown duration?

Benzathine Penicillin G 2.4 million units IM weekly for 3 weeks

What is the treatment recommendation for primary, secondary, and early latent syphilis?

Benzathine Penicillin G 2.4 million units IM for 1 dose

What is the treatment recommendation for tertiary syphilis with a normal CSF exam (NOT neurosyphilis)?

Benzathine Penicillin G 2.4 million units IM once weekly for 3 weeks

What is the recommended treatment for neurosyphilis?

Penicillin G 18-24 MU IV for 10-14 days

THEN, follow up with Benzathine Penicillin G 2.4 MU weekly for 1-3 weeks

What is the recommended treatment for neurosyphilis in pregnancy?

Penicillin regimen appropriate for their stage of infection

What is the Jarisch-Herxheimer Reaction?

a benign, self-limiting reaction that is common during primary and/or secondary syphilis treatment

*NOT an allergy rxn*

With what STIs should the partners of the infected person also be treated?

Gonorrhea

Chlamydia

Trichomoniasis

What is genital herpes?

HSV 2

How is genital herpes transmitted?

direct contact with lesions or shedding virus from host

What are the treatment options for first clinical episodes of HSV 2?

Acyclovir

Famicyclovir

Valacyclovir

What are the treatment options for recurrent HSV 2 episodes?

Acyclovir

Valacyclovir

Famiciclovir

When should treatment be started for recurrent HSV 2 episodes?

during prodrome phase or within 1 day of symptom onset

When should patients with HSV 2 recieve suppressive therapy?

if they experience 6 or more reactivation episodes per year

What agents are recommended for HSV 2 suppressive therapy?

Acyclovir

Famiciclovir

Valacyclovir

What is the treatment option for HSV 2 in pregnancy?

Acyclovir

What causes Trichomoniasis?

Trichomonas vaginalis

What is the female presentation of trichomoniasis?

Asymptomatic

Vaginal d/c

Vulvar pruritis

Dysuria

Inguinal LA

Strawberry cervic

Gonorrhea co-infection

What is the male presentation of trichomoniasis?

Asymptomatic

Urethral discharge

Pruritis

Dysuria

Gonorrhea co-infection

What is the recommended treatment for females with trichomoniasis?

Metronidazole 500mg PO BID for 7 days

What is the recommended treatment for males with trichomoniasis?

Metronidazole 2g PO for 1 dose

What is recommended for HPV prevention in ages 9-26 y/o?

Gardasil 9 (2-3 dose series)

Monkeypox virus course

Incubation (3-17 days)

Prodrome

Rash (2-4 weeks)

How is monkeypox transmitted?

Contact with mpox rash/scabs

Contact with contaminated objects

Contact with respiratory secretions

Pregnancy

What vaccine is recommended for mpox prevention?

Jynneos vaccine (2 doses)

What are the recommended treatments for mpox?

Antivirals

Skin topicals

Stool softeners

Pain management

Tecoviramat (TPOXX)

treatment that is FDA approved for smallpox but also used in Mpox

Who should recieve TPOXX?

Severe disease

Mpox in anatomic areas that can result in serious sequeale

Immunocompromised

Kids <8 y/o

Pregnant/breastfeeding

Skin conditions

MOA of Tecovirimat

inhibits formation of virions necesary for virus dissemination

ADRs of TPOXX

HA

Nausea

Abdominal pain

What are the treatment options for Mpox besides TPOXX?

Cidofovir

Brincidofovir

VIVIG