Sexually Transmitted and other Infections

What is the most important type of STI prevention?

Primary prevention through education.

What is primary prevention?

Preventing STI before infection occurs.

What is secondary prevention?

Prompt diagnosis and treatment to prevent complications and transmission.

What are the 5 P's of sexual risk assessment?

Partners, Practices, Prevention of pregnancy, Protection from STIs, Past history of STIs.

What is the only 100% effective STI prevention method?

Mutual monogamy with tested partner or complete abstinence.

Are spermicides protective against STIs?

No.

Why is nonoxynol-9 discouraged?

It increases HIV transmission risk due to mucosal irritation.

What barrier methods prevent STI?

Latex or plastic male condoms, polyurethane female condoms.

What is reproductive coercion?

Interference with a woman's autonomous reproductive decisions.

Most common reportable STI?

Chlamydia trachomatis.

Who has highest rates of chlamydia?

Sexually active women ages 15-24 (highest 18-20).

Why is chlamydia dangerous in pregnancy?

Often silent but destructive to mother and baby.

Common chlamydia symptoms?

Spotting, postcoital bleeding, purulent discharge, dysuria.

How is chlamydia transmitted?

Genital-genital, oral-genital, anal-genital, vagina-rectum.

When screen pregnant women for chlamydia?

First trimester and at 36 weeks.

Diagnostic tests for chlamydia?

Culture, DNA probe, enzyme immunoassay, NAAT urine specimen.

First-line treatment for chlamydia?

Azithromycin 1g PO single dose.

Second-line treatment?

Doxycycline for 7 days.

What must partners do?

Be treated and use condoms to prevent reinfection.

Neonatal complication?

Ophthalmia neonatorum and pneumonia.

Neonatal prevention treatment?

Erythromycin ophthalmic ointment.

Causative organism of gonorrhea?

Neisseria gonorrhoeae (aerobic gram-negative diplococcus).

Ranking of gonorrhea among STIs?

Second most common reportable STI.

Are women usually symptomatic?

Often asymptomatic.

Diagnostic culture media?

Thayer Martin culture (endocervix, rectum, throat).

First-line treatment?

Ceftriaxone IM single dose.

Why treat for chlamydia too?

They commonly occur together.

Perinatal complications of gonorrhea?

Salpingitis, PROM, preterm birth, chorioamnionitis, neonatal sepsis.

Must test for what co-infection?

HIV.

Is gonorrhea reportable?

Yes.

Causative organism?

Treponema pallidum (motile spirochete).

What is syphilis known as?

"The Great Pretender."

Primary stage sign?

Painless chancre 5-90 days after exposure.

Secondary stage sign?

Maculopapular rash on palms and soles.

What is condylomata lata?

Wart-like lesions in secondary syphilis.

Tertiary stage effects?

Neurologic, cardiovascular, multiorgan devastation.

Screening tests?

RPR and VDRL (nontreponemal).

Diagnostic confirmatory tests?

FTA-ABS and TP-PA (treponemal).

False positives seen in?

Autoimmune disorders, pregnancy, malignancy, immunizations.

ONLY treatment?

Penicillin G.

Early syphilis dose?

2.4 million units IM once.

Late syphilis dose?

2.4 million units IM ×3 doses (7.2 million total).

What reaction may occur after treatment?

Jarisch-Herxheimer reaction.

Pregnancy transmission?

Transplacental at any time.

PID patho?

Ascending infection of uterus, fallopian tubes, ovaries.

Most common cause?

Untreated chlamydia or gonorrhea.

Why worse at end of menses?

Cervix open; menstrual blood medium for infection.

Major complication?

Tubal scarring → infertility & ectopic pregnancy.

Classic diagnostic exam finding?

Cervical motion tenderness.

Acute PID pain?

Severe, persistent abdominal pain.

Chronic PID pain?

Persistent cramping with discharge.

Severe PID treatment?

Hospitalization + IV antibiotics.

Prevention?

STI prevention and partner treatment.

Most prevalent viral STI?

HPV.

Oncogenic types?

Types 16 and 18.

Vaccine available?

Gardasil (3-shot series).

HPV lesion name?

Condyloma acuminata.

Pap smear may show what?

HPV infection even if asymptomatic.

Can HPV resolve spontaneously?

Yes, most cases resolve.

Cryotherapy used for?

Wart removal.

Medication safe if not pregnant?

Podophyllin.

HSV-1 transmission?

Non-sexual.

HSV-2 transmission?

Sexual.

Primary infection symptoms?

Painful lesions, fever, dysuria, vulvar edema.

Outbreak frequency?

Periodic recurrences lasting 5-7 days.

Is HSV curable?

No.

Medications?

Acyclovir, valacyclovir, famciclovir.

When is transmission highest?

Prodromal period until lesions heal.

Delivery if active lesions?

MUST perform C-section.

Can vaginal birth occur?

Yes, if no lesions or prodromal symptoms.

Most severe neonatal complication?

Neonatal herpes.

HAV transmission?

Fecal-oral.

HAV prevention?

Vaccination.

HBV most dangerous to?

Fetus & neonate.

HBV transmitted how?

Parenteral, perinatal, intimate contact.

HBV vaccine?

3-shot series.

HBV neonatal prevention?

Vaccine + immunoglobulin at birth if mom positive.

HCV transmission?

Blood-borne.

HCV pregnancy risk factor?

IV drug use.

HIV primarily transmitted via?

Exchange of body fluids.

Can HIV be transmitted to fetus?

Yes, via placenta, blood, breast milk.

Should HIV+ women breastfeed in US?

No.

Screening test?

Enzyme immunoassay + Western Blot confirmation.

Perinatal transmission rate with treatment?

Reduced to 1-2%.

Delivery recommendation?

Cesarean if high viral load.

Vaginal delivery allowed if viral load?

<1000 copies at 36 weeks.

Avoid during labor?

FSE, AROM, scalp sampling.

Intrapartum drug given?

Zidovudine.

Vulvovaginitis definition?

Inflammation of vulva and vagina.

BV cause?

Replacement of lactobacilli with anaerobes.

BV discharge description?

Thin, white/gray, fishy odor.

BV pregnancy risk?

Preterm labor & birth.

BV treatment?

Metronidazole.

Yeast discharge?

Thick, white, lumpy.

Yeast symptoms?

Intense pruritus, redness.

Yeast treatment OTC?

Azole creams (miconazole, clotrimazole).

Trichomonas discharge?

Green, frothy mucopurulent.

Strawberry cervix indicates?

Trichomoniasis.

Trichomonas treatment?

Metronidazole single dose (pregnancy safe).

GBS screening timing?

36-37 weeks.