Sexually transmitted infections

causative agent of syphilis

treponema pallidum (a spirochete)

how is syphilis transmitted

direct mucocutaneous contact

what occurs in the primary stage of syphilis

chancre at site of inoculation (penis, vagina, anus, in the rectum, lips, in the mouth) - can be symptomatic or completely asymptomatic

what occurs in the secondary stage of syphillis

hematogenous dissemination, rash, fatigue, malaise, sore throat, lymphadenopathy, fever, organ involvement

when does stage 2 of syphilis occur

within 6 months

what is early latency syphilis

occurs within 1 year (CDC) or 2 years (WHO) and is symptomatic

what is late latency (formerly tertiary)?

progressive organ involvement - CV complications, gummoatous lesions, neurosyphilis of brain and spinal cord

when should asymptomatic patients be screened for syphilis

if high risk (factors for acquisition or factors for transmission)

testing for symptomatic syphilis

presumptive diagnosis includes two tests: nontreponemal test and a treponemal test

what is treponemal test

fluorescent treponemal antibody and T. pallidum particle agglutination

what is the nontreponemal test

venereal disease research laboratory (VDRL) or rapid plasma reagin (RPR) - also used for disease monitoring

when does neurosyphilis and ocular syphilis occur?

any stage

T/F: ocular manifestations can be associated with neurosyphilis

true

patients with suspected neurosyphilis (ncluding tertiary syphilis or HIV infection) with late latent syphilis should have:

LP, CSF tests, CBC, and VDRL

medications used for primary and secondary syphilis

benzathine penicillin G 2.4 million units IM single dose

medications used for early latentent syphilis

benzathine penicillin G 2.4 million units IM single dose

medications used for neurosyphilis and ocular syphilis

aqueous crystalline penicillin G 18-24 million units IV daily (3-4 million units Q4H or continuous infusion) for 10-14 days OR

aqueous procaine penicillin G 2.4 million units IM QD plus probenecid 500 mg PO QID both for 10-14 days

medications for late latent or tertiary with normal CSF

benzathine penicillin G 2.4 million units IM once a week for 3 successive weeks

medications for children with primary, secondary, or latent infection and normal CSF

dose of benzathine penicillin G is 50,000 units/kg

T/F: Jarisch-Herxheimer reactions are specific allergies to benzathine penicillin

fallse

what is Jarisch-Herxheimer reactions

acute febrile reaction within a few hours of first dose (50% in primary and (0% in secondary) - presentation for everal days then self-limits

pregnancy complications associated with Jarisch-Herxheimer reactions

early labor and fetal distress

treatment for Jarisch-Herxheimer reactions

supportive unless severe

pathogen of chamydia

C. trachomatis

In women, where does C. trachomatis commonly effect

the cervix

signs and symptoms of cervicitis

vaginal discharge, abnormal vaginal bleeding, and purulent endocervical discharge, pain, minor bleeding

what does C. trachomatis common cause in men?

nongonococcal urethritis

what is nongonococcal urethritis

majority asymptomatic, if symptoms (mucoid or watery urethral discharge and dysuria), possible cause of epididymis or prostatitis

how to diagnose chlamydia

NAATs (nucleic acid amplification tests) from infection site or presence of WBC in vaginal fluid without trichomonas

how are NAATs done for chlamydia?

first-catch urine or collecting swab specimens from the endocervix or urethra (men), rectal and oropharyngeal

which bacteria causes similar clinical symptoms as C. trachomatis

N. gonorrhoeae

any testing for C. trachomatis should also prompt testing for ______ as they coexist in a significant proportion of patients

N. gonorrhoeae

recommended chlamydia treatment

Doxycycline 100 mg PO BID x 7days

alternative treatments for chlamydia

macrolides or quinolones - azithromycin 1 gram PO x1 or levofloxacin 500 mg PO QD x 7days

considerations for treatment of chlamydia

concurrent gonorrhea, formulation, pregnancy, adherence, monitoring, re-infection

antibiotics for pregnant women with chlamydia

azithromycin 1 gram PO x1 or amoxicillin 500 mg PO TID x 7 days

how long does it take for symptoms to appear for gonorrhea

within 10 days

presentation of gonorrhea

urethritis, cervicitis, pharyngitis, PID

if gonorrhea is left untreated what can occur?

bacteremia, arthritis (tenosynovitis or purulent arthritis), or meningitis

how to diagnose gonorrhea

culture and NAAT

how is NAAT done for gonorrhea

endocervical swabs, vaginal swabs, urethral swabs (men), and urine (from men and women) - collection methods and specimen types vary

what cultures should be done for gonorrhea

culture for severe infection and/or treatment failure (susceptibility testing),, culture for rectal, oropharyngeal, and conjunctival

recommended treatment of uncomplicated gonococcal infections (cervix, urethra, rectum)

ceftriaxone 250 mg IM x1

alternative treatments for uncomplicated gonococcal infections (cervix, urethra, rectum)

cefotaxime 500 mg IM + azithromycin 1 gram orally once

cefoxitin 2 grams IM + azithromycin 1 gram orally once

alternative oral agents for uncomplicated gonococcal infections (cervix, urethra, rectum) of ceftriaxone is unavailble

cefixime 800 mg PO x1

pregnancy treatment for uncomplicated gonococcal infections (cervix, urethra, rectum)

ceftriaxone 250 mg IM x1 + azithromycin

what to give for disseminated infection of gonorrhea

ceftriaxone 1 gram IM or IV Q24H > 7 days then PO cefixime 400 mg BID + PO azithromycin 1 gram x1

treatment for uncomplicated gonococcal infections (cervix, urethra, rectum) with a PCN allergy

azithromycin 2 gram PO x1 + gentamicin 240 mg IM x1

inpatient pelvic inflammatory disease treatment

cefotetan IV or cefoxitin IV + doxycycline PO

clindamycin IV + gentamycin

outpatient pelvic inflammatory disease treatment

ceftriaxone IM x1 or cefoxitin IM (add probenecid) x1 + doxycycline PO

duration of therapy for PID

total of 14 days

when should metronidazole be added to PID treatment regimens

for abscesses

what is expedited partner therapy

a practice that allows health care providers to provide a patient with either antibiotics or a written prescription, intended for the patients’ sexual partners

T/F: EPTs can only be used for chlamydia infections not other STDs in NYS

true

what is the preferred EPT treatment?

azithromycin 1 gram orally (250 mg x 4)

recommended drug regimens for EPT for sexual partners of patients with chlamydia but not gonorrhea

azithromycin 1 gram orally in a single dose

recommended drug regimens for EPT for sexual partners of patients with gonorrhea, regardless of the chlamydia test result

cefixime 400 mg orally in a single dose + azithromycin 1 gram orally in a single dose

how to prevent STDs

practice abstinence, have fewer partners, talk with your partner, use condoms, get vaccinated, get tested