STIs and HIV Notes

Pelvic Inflammatory Disease and STIs

Lower abdominal pain can indicate pelvic inflammatory disease, especially if related to the uterus or bloating.
Rectal infections may require discharge and can lead to sterility due to scarring in the spermatic ducts.

Chlamydia can lead to sterility by causing scarring in the spermatic ducts.
Treatment typically involves a course of antibiotics like doxycycline for seven days or other antibiotics for ten days.
Patients should refrain from sexual contact during antibiotic treatment due to continued infectiousness.
If patients are non-compliant with abstinence, advise the use of male latex condoms.
Multiple STIs can occur simultaneously; Gonorrhea is often found with chlamydia or syphilis.
Post-treatment, patients should return in three to three months for retesting to ensure eradication and check for re-infection.

Caused by direct sexual contact with Neisseria gonorrhoeae.
Drug-resistant strains exist, thus necessitating patient education.
Can infect various body parts, including the pharynx, urethra, prostate, epididymis, and fallopian tubes.
Infection of spermatic ducts or fallopian tubes can lead to future sterility.
Disseminated gonorrhea can affect the heart, joints, skin, and meninges; thus, early and aggressive treatment is crucial.
Treatment usually involves a single injection of ceftriaxone.
Many women with gonorrhea are asymptomatic; if symptoms occur, they typically appear two to ten days post-exposure.
Asymptomatic individuals remain highly infectious.
Erythromycin ophthalmic ointment is administered to newborns to prevent gonorrheal infection during delivery.
Pregnant women are screened for STIs, including gonorrhea, toward the end of pregnancy.
Patients should avoid sexual contact until cured; if not, advise latex condoms.

Caused by the bacteria Treponema pallidum and has been prevalent throughout history.
Transmitted through sexual contact in stages one and two, and via bloodborne transmission in latency and stage three. Extremely contagious during rash.
Can cross the placenta, affecting the fetus.

Characterized by a painless sore (chancre) that starts as a blister and turns into an ulcer at the site of bacterial entry.
Often goes unnoticed or mistaken for minor skin irritations.

Involves a rash on the palms and soles, a characteristic symptom of syphilis.
Painless red ulcer (chancre) that can last one to five weeks and then disappears, after which the infection moves into the bloodstream.
Occurs one to six months after contact and presents with a rash on the chest, back, palms, and soles.

Occurs around three years after initial contact.
Symptoms include headaches, arthritis, numbness in extremities, skin and internal organ lesions, heart and aorta damage, and nervous system symptoms.
Historically, mercury was used as a treatment, evidenced by mercury traces at historical sites like those of the Lewis and Clark expedition.

Herpes type one is often associated with infections above the waist, while herpes type two is typically below the waist, though this distinction isn't absolute.
Transmitted through contact with lesions.
A viral infection with no cure; the virus remains inactive for long periods.
Patients should dry themselves with a hairdryer or gently with a towel to avoid contact with lesions.
Most patients are asymptomatic.
The first outbreak is usually the most severe, characterized by small blisters that ulcerate, causing itching and pain.
Symptoms appear two to twelve days after exposure, with the first outbreak lasting two to three weeks.
Some individuals experience prodromal symptoms like pain and itching before outbreaks.
Antiviral drugs (ending in "-vir") can shorten the length and severity of outbreaks if started within one day of the outbreak.
Episodic therapy: Antiviral drugs used when symptoms appear.
Chronic suppressive therapy: Daily antiviral drugs to prevent outbreaks in individuals with frequent or severe occurrences.
Topical anesthetics can be used for pain relief.

Very common with over 200 strains.
Includes genital warts, which are associated with high-risk strains linked to cervical cancer.
Incubation periods can vary significantly.
HPV hides from the immune system, which may cause warts to disappear and reappear over time, as the immune system recognizes and combats the virus.
Individuals with HPV should use latex barriers during sexual activity.

Gardasil: protects against four strains, including types six and eleven (ninety percent of genital warts) and types sixteen and eighteen (seventy percent of cervical cancers).
Gardasil 9: Protects against all four strains and additional strains.
Cervarix: Protects against strains sixteen and eighteen only.
CDC recommends two doses for children between nine and fourteen and three doses for those between fifteen and twenty-six or who are immunocompromised.

Screen for cervical cancer if the patient has warts.
HPV testing can identify the specific strain to guide monitoring and management.
Warts may resolve spontaneously.
Treatments include topical medications, surgical removal, cryotherapy, acids, podophyllin resin, or injections.

Emerged in the early 1980s, with initial cases showing unusual conditions in young, healthy men, such as Candida infections, herpes, Pneumocystis pneumonia, and Kaposi's sarcoma.
Screening involves asking patients if they are men who have sex with men, without inquiring about sexual orientation.

Male-to-male sexual contact, injection drug use, female-to-mother transmission (including through breast milk), and blood transfusions.

HIV is a retrovirus (RNA virus) that infects macrophages and T helper cells (CD4 cells).
The virus injects itself into these cells, hijacking their replication processes.
The immune system can initially keep up with the destruction of CD4 cells, but eventually, it becomes overwhelmed, leading to symptoms.
HIV integrates itself into the host's DNA, making eradication difficult.

Present in blood, semen, vaginal secretions, and breast milk.
Not present in sweat or tears; very low amounts in saliva are not considered infectious.

Lasts for a few weeks and may present with flu-like symptoms.
Diagnosis may be overlooked because symptoms mimic the flu.
High amount of HIV in the blood.
Seroconversion occurs as the body produces antibodies and cytotoxic lymphocytes.
CD4 cell count is normal (500 to 1,500 cells per cubic millimeter).
Swollen lymph nodes may be present as the infection's only symptom, apart from initial flu-like indications.

Typically lasts around ten years.
Generally, no major symptoms but can include swollen lymph nodes and other clinical manifestations.
Individuals remain infectious, and HIV antibodies are detectable in the blood.
CD4 cell count is around 500 cells per cubic millimeter or higher.
Symptoms can include moderate weight loss, recurrent respiratory tract infections, herpes zoster virus infection, angular cheilitis, oral ulcerations, seborrheic dermatitis, and fungal nail infections.