Peds Week 4 Sexually Transmitted Infections

part 1

Infection

transmitted from one person to another by intimate physical contact

STI prevention

A-C-S

• Abstinence

• Condoms (barrier method)

• Screening (lower risk, prevent spread)

Gonorrhea: transmisson

sexual contact (skin & fluids)

• genitalia

• rectal

• throat

birth conjunctivitis

Gonorrhea: S/Sx

most asymptomatic

• greenish yellow purulent discharge

• irregularities with mentation

• pelvic pain/abdominal pain

• rectal itching, pain

• blood in stool

Gonorrhea: Dx

• urine or swab sample

• gram stain

• culture (rectum, throat, cervix)

• co-infection common screen other STI

Gonorrhea: Tx

1 g Azithromycin + 250 mg Cefrtiaxone IM

• partner tx critical

Chlamydia: Transmission

sexual contact

• skin

• bodily fluids

• birth (conjunctivitis)

Chlamydia: S/Sx

most asymptomatic

• dysuria

• lower abdominal pain

• vaginal/penile discharge

• painful intercourse

• Bleeding between periods/after sex

• testicular pain

Chlamydia: Dx

• culture (most sensitive)

• NAATs (nucleic acid amplification test (urine, cervix, vaginal)

Chlamydia: tx

• 1 g azithromycin

• alternative Doxycycline BID for 10 days

• partener tx critical

• wait >1 month retest due to false positive

Gonorrhea & chlamydia: complications

P-E-I-H

• Pelvic inflammatory disease (PID)/ salpingitis (inflam fallopian tube)

• inc etopic pregancy & infertility

• increase HIV

• perineatal exposure ½ devleop conjunctivitis

Pelvic inflammatory disease (PID)

infection of upper genital tract (endometrium, fallopian tubes, ovaries)

Pelvic inflammatory disease (PID): cause

gonorrhea, trachomatis, other anaerobic bacteria

Pelvic inflammatory disease (PID): sx

• generalized lower abdominal pain

• UTI sx

• vague flu like sx

• malaise

• vomiting

• diarrhea

• constipation

Pelvic inflammatory disease (PID): long term effects

• infertility

• tubal scarring

• etopic pregnancy

• chronic abdominal pain

Pelvic inflammatory disease (PID): management

treat underlying infection (prevent sequelae

partner tx

Syphilis: primary sx

chancre sores (painless genital ulcer)

Syphilis: secondary sx

diffuse rash (symmetrical macular or papular eruption entire

• trunk

• extremities

• palms

• soles

Syphilis: secondary latent untreated

• latent phase often asymptomatic

• asymptomatic infection cause congenital syphilis

Syphilis: tertiary sx

• aortic insufficiency

• menigovascular disease

Syphilis: early latent

• asymptomatic acquired within last 12 months

• secondary symptoms relapse during early latent phase

Syphilis: late latent

• asymptomatic diagnose GREATER than 1 year form last negative blood test

• last for years/decades with no sx of disease

• >1 yr since last screening assume last latent syphillis

Syphilis: Tx

• cured if caught early stage

• Penicilin G for ALL stages

• tx can not undo damage infection already caused

Syphilis: Tx: latent (early)

• penicillin G benzathine 2.4 million units IM once

Syphilis: Tx latent (late)

• penicillin G benzathine 2.4 million units IM once weekly for three weeks

Congenital Syphilis: screening

• 1st prenatal visit

• late 3rd trimester

• time of birth

Congenital Syphilis: manifestation in newborns

• stillbirth

• prematurity

• wide range of clinical manifestations

HPV: types

>200 types

• cutaneous

• mucusal

HPV: cutaneous

• plantar warts

• common warts

• flat warts

HPV: mucosal

• common on scrotum, penis, anal canal, perineum are

• over 40 mucosal genotypes infect genital tract

• 6 & 11 HPV+ warts

• 16 & 18 = cervical cancer —> pap test q 3 years individual 21+ or annually if abnormal

HIV: targets

subset T lymphocytes

• CD 4 dysfunction and impair immunity

HIV: Transmission

• horizontal person to person (blood/bodily fluids)

• vertical: perinatal mom to infant through utero, intrapartum, breastfeeding (children <13 yrs) SCREEN AGE 13

• infants in perinatal HIV are smaller in length and weight for age

HIV: screening/dx

• RNA test

• rapid oral test

• anitbody test

HIV: tx

management antiretrovirals (lower viral load)

All STI done on pregnant women in early pregnancy?

yes, gonorrhea, chamydia syphilis, HIV