Sexually Transmitted Infections (STIs)

Jimenez

Chlamydia

+pathogen, complications

Pathogen: Chlamydia trachomatis

complications:

• cervicitis

• urethritis

• PID, epididymitis, and rarely prostatitis

Chlamydia diagnosis

first catch urine or swab specimen

ask about exposures (genital, oral, anal)

• can catch positives in other than urine

Nucleic acid amplification test (NAAT)

• sensitive and specific

• can self collect

Chlamydia Treatment

+first line, alt., durations, counseling

first line: doxycycline PO x7 days

alt: Azithromycin PO x1

• pro: can give during pregancy

• con: inferior to first line

  • reset treatment to ensure cure

Expedited Partner Therapy (EPT)

treatment for patients even if not directly a patient to HCP

Gonorrhea

+pathogen, incubation, presentations in genders , complications

pathogen: Neisseria gonorrhoeae

Incubation: 3-7 days

Symptomatic

• men: urethritis and epididymitis

• women: urethritis and cervicitis

complications:

• pharyngitis

• Dissemnintated gonoccal infection

Gonorrhea Diagnosis

culture: surveillance, treat susceptibility

NAATs sensitive and specific

• first catch urine

• swabs multiple sites (important)

Gonorrhea Treatment

+for: uncomplicated infections, EPT, diagnosis not excluded by testing, pharyngeal infection, [gonococcal arthritis, meningitis, endocarditis], resistance treatment

Uncomplicated infections of cervix, urethra, rectum, and pharynx

• ceftriaxone IM x1

• gentamicin IM+ azithromycin PO

Gonococcal Arthritis, meningitis, endocarditis

• Ceftriazone high dose x> 7 days (arthritis) to >4 weeks(endocarditis)

EPT (partner)

• Cefixime PO

Chlamydia not excluded by testing

• doxycycline x 7day

  • azithromycin PO multiday

Pharyngeal Infection: test of cure recommended

Resistance: use ceftriaxone (high dose)

Pelvic Inflammatory Disease (PID)

+pathogen, diagnosis, complication

pathogen: C.trachomatis or N. gonorrhoeoe

diagnosis:

• young women and other women at risk STDs with:

  • pelvic or lower abdominal pain

  • no cause for illness other then PID can IDed

  • cervial motion, uterine, or adrenal tenderness on pelvic exam

complications:

• infertility

• chronic pelvic pain

Pelvic Inflammatory Disease (PID) Treatment

+duration

Ceftriaxone IM x1 dose + Doxycycline PO x 14 days + metronidazole PO BID x 14 days

Nongonococcal Urethritis

+pathogen, manifestations

“all you have to know”

Herpes Simplex Virus (HSV) genital recurrences and subclinical shedding

HSV 2 » HSV 1

Genital Herpes Treament

+first episode, reccurent episode, duration, severe

1st episode is treated for longer periods than recurrent episodes: > 5 days

Treat recurrent Episode

• acyclovir, famciclovir, valacyclovir

• dosing: 1-5 days

Severe disease requires IV therapy

• CNS complications

Syphilis Treatment

Penicillin (PCN)

• preferred for all stages

efficacious during pregnancy

Primary → early latent

Benzathine PCN G

PCN allergy:

• Doxycycline x14

Late latent syphilis or Tertiary Syphilis (not neurosyphilis) Treatment (symp: CV and gammas

• benzathine PCN G qwk x 3weeks

• PCN allergy: Doxycycline x28 days

Neurosyphilis (including ocular) Treatment

PCN G IV 18-24 million units per day

NO DOXY

Jarisch-Herxheimer Reaction

+def., when does it begin, prevention and treatment

resembles bacterial Sepsis

begins 6-8 hours after treatment and lasts 12-24 hours

• happens in early syphilis

prevention + treatment

• analgesics: aspirin, prednisone

Doxy PEP

+def., when to give, who to give

syphilis treatment prophylaxis

<72 hours of sex

Men who have sex with men and Transgender women