STDs

Most common STD in U.S.

HPV

Chlamydia cause

Bacterial

Chlamydia symp

Often asymptomatic

• Spotting, menstrual abnormalities

• Postcoital (after intercourse) or abnormal bleeding

• Mucoid or purulent cervical discharge

• Dysuria, frequent urination, pyuria

• Abdominal pain, N&V, fever, malaise, chronic pelvic pain, infertility

Chlamydia women complications 

• Salpingitis (inflammation/infection of fallopian tubes)

• PID: Increased ectopic pregnancies and infertility- Cervical inflammation and ulcerations

• Increased HIV transmission

Clamida neotnatal complications 

Conjunctivitis and Pneumonia- Leading cause of ophthalmia neonatorum

Does Prophylactic antibiotic eye ointment prevent infection of chlamydia?

No

Chlamydia dx

• Culture, DNA probe, enzyme immunoassay, or NAAT- Often done with just a urine test

• Test for other STDs- chlamydia often sticks together

Chlamydia tx

• Doxycycline 100 mg BID x 7 days

• Azithromycin 1 g single dose

• Alternatives: Erythromycin, Ofloxacin, Levofloxacin

Chlamydia patient education

• Abstain from sex for 7 days after treatment

• Treat all partners

• Retest in 3–4 months (especially in pregnancy)

• Encourage condom use

Oldest communicable STD

Gonorrhea

Gonorrhea women symp

1/3 asymptomatic- undiagnosed

• Purulent endocervical discharge

• Menstrual irregularities, dysuria

• Pelvic/lower abdominal pain

• Low backache, painful menses

• Vaginitis, vulvitis, red swollen labia

Gonorrhea male symp

• Dysuria, urethral discharge (white/yellow/green)

• May infect mouth, throat, eyes, anus

• Testicular/scrotal pain, epididymitis → infertility

• Symptoms appear 1–14 days post-infection

Gonorrhea maternal complications

• PID

• Salpingitis

• Chorioamnionitis

• Amniotic infection syndrome

Gonorrhea infant complications

PROM, preterm birth, neonatal sepsis, IUGR, postpartum sepsis,ophthalmia neonatorum

Gonorrhea dx 

• Screen all at-risk and pregnant women (esp. at 36 weeks)

• Culture (endocervical or urethral swabs)

• NAAT (urine, urethral, or endocervical)-> more common

• If positive, also test for chlamydia and syphilis

Untreated Gonorrhea 

↑ HIV transmission risk

Gonorrhea tx

Dual therapy: Ceftriaxone (IM) + Azithromycin or Doxycycline

Treat all partners

Syphilis transmission 

Through skin/mucous membrane breaks (abrsaidons) during sex; transplacental possible

Syphilis primary stage

Chancre 5–90 days post-infection (lasts 3–6 weeks)

Secondary Syphilis stage 

6 weeks–6 months after chancre

Maculopapular rash, fever, HA, malaise

Condylomata lata (broad, painless, pink/grey, wart-like lesions)

Syphilis tertiary stage

significant mortality and morbidity rates

Neurologic, cardiovascular, musculoskeletal, multi-organ involvement

Neurosyphilis

Gummas-Destructive skin, bone, soft tissue nodular lesion

Syphilis screening 

Screen if + with other STD

All pregnant women

High risk in 3rd trimester

Syphilis dx

Microscope of lesion tissue

Blood tests:Serology- Nontreponemal: VDRL, RPR (done when Latent and late infection

Treponemal: FTA-ABS, TP-PA, EIA, chemiluminescence assays- For more specific

Syphilis tx

Monthly follow-up

Treat all partners

2–5× increase in HIV transmission if syphilis present

HPV

Also called: Genital warts (Condylomata acuminata)

Lesions: Small → cauliflower-like, fingerlike projections

HPV symp

Profuse irritating vaginal discharge

Itching, dyspareunia, postcoital bleeding

Bumps on labia

HPV dx

Visual inspection

Pap smear and HPV DNA testing

Biopsy to remove warts and monitor for cervical cance

HSV patho

Virus enters peripheral nerves → dormant in ganglia (have forever) → recurs periodically (in times of stress)- INCURABLE VIRAL INFECTION

HSV initial infection

Fever, chills, malaise, dysuria

Itching, inguinal tenderness, lymphadenopathy

Vaginal discharge, multiple painful vesicular lesions, burning or tingling @site

Primary infection in first trimester ↑ miscarriage rik

HSV complications

↑ miscarriage risk

Autoinoculation (lips, breasts, fingers, eyes)

Keratitis → ulcers → blindness

HSV dx

History, physical, culture of lesion

Antibody assay for viral type

HSV tx

• No cure; manage symptoms

• Antivirals: Acyclovir, Valtrex, Famvir

• C-section if active outbreak during delivery

HIV

blood borne pathogen

Acute retroviral syndrome

1-6wks post exposure

fever, rash, joint pain, lymph node enlargement

HIV Stage 1

Asymptomatic or lymph node swelling

HIV Stage 2

Minor weight loss, mucocutaneous issues, recurrent URI

HIV Stage 3

Chronic diarrhea, fever, oral candidiasis, severe bacterial infections, pulmonary TB

HIV Stage 4

22 AIDS-related opportunistic infections or cancers

HIV dx

• Plasma HIV RNA (viral load), antibody test (blood, urine, mouth swab)- Higher viral load the higher chance of passing to baby

• Two positives for a diagnosis → confirmed by Western blot

HIV tx

• No cure

• ART: ≥3 antiretroviral drugs from ≥2 classes to prevent viral replication

HIV pregnancy tx

Keep viral load low → 2% mother-to-child transmission (US/Europe)

Treat/test infant, no breastfeeding

Trich symp

Often asymptomatic

• Yellow-green frothy, mucopurulent discharge, malodor

• Vulvar/vaginal irritation and itching

• Dysuria, dyspareunia

Trich pregnancy effects

Preterm, low birth wt

Trich dx

Wet prep slide, Pap smear, pH > 4.5

Trich tx

Metronidazole or Tinidazole (flagel)

Treat partner

Untreated → ↑ HIV risk

BV symp 

Fishy odor (especially after sex)

Profuse thin, milky white/gray discharge

Vaginal irritation and pruritis

BV dx

Microscopic exam of vaginal secretions

• 20% clue cells on saline slide

• KOH “whiff test” positive for fishy odor

• pH > 4.5

BV tx

Metronidazole (Flagyl) or Clindamycin

Candidiasis (Yeast Infection) symp

• Pruritus (itchness), dryness, dysuria

• Excoriations

• Thick white “cottage cheese” discharge

• Erythematous vulva, labia, vagina, cervix

Candidiasis risk factors

• Antibiotics, diabetes, pregnancy, obesity

• High-sugar diet, corticosteroids, hormones, immunosuppression

• Tight/non-breathable clothing

Candidiasis dx

• Physical exam

• Normal vaginal pH

• Wet prep: pseudohyphae on saline slide

Candidiasis tx

• Antifungal agents

• Sitz baths, comfort measures

• Avoid intercourse; use condoms

• Some use of lactobacilli (yogurt) or garlic (limited evidence)