STI's

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STI's
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2013-04-22 22:33:47
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  1. Chancroid, cause of
    Bacterial infection, Haemophilus ducreui
  2. Transmission routes of chancroid
    saliva, air, cough, fecal-oral route, surfaces, blood, needles, blood transf., sexual contact, mother-to-fetus
  3. Symptoms of chancroid
    rare in N.A.

    Males > female

    • Papule to pustule 7-10 day incubation
    •           - erodes into nonindurated, PAINFUL, ulcer w/ purulent base and ragged, undermined borders

    Single or mult.ulcers confined to genitals

    Unilateral tender adenopathy can rupture
  4. Chancroid testing
    Def. lab dx rarely available

    PCR by CDC only

    Serology can't determine old vs. new infection

    Culture possible
  5. Treatment of chancroid
    azithromycin 1gm PO x 1 dose

    ceftriaxone 250mg IM x 1

    ciprofloxacin 500mg PO BID x 3d

    eryth. 500mg PO 3xdaily for 7 days
  6. Causes of candidiasis
    Fungus Candida albicans, a normal skin flora

    Not considered sexually transmitted
  7. Symptoms of candidiasis
    frequently seen with increased sexual activity

    vulvar itching, burning, soreness

    painful intercourse and/or urination

    THICK, CURDY WHITE vaginal discharge

    erythema, irritation
  8. Treatment of candidiasis
    Diflucan (fluconazole) 150mg PO x 1

    If oral candida, 100mg PO x1

    Topical: 

    clotrimazole, miconazole, terconazole
  9. Chlamydia screening
    CDC, USPSTF yearly for all sexually active females < 25y.o., or older at risk females.

    Most frequently reported STD in U.S.

    Women 3x> men
  10. Chlamydia
    Bacterial infection - chlamydia trachomatis

    Infects genitals, throat, eyes, rectum

    >50% asymptomatic, untreated

    7-21 days of incubation
  11. Transmission of chlamydia
    vaginal, oral, anal sex w/ infected person

    cross-contamination from fingers
  12. Chlamydia symptoms
    Meatal itching/discomfort

    mucopurulent endocervical discharge

    edematous cervix w/ erythema and friability

    pyuria, dysuria, urinary frequency

    WOMEN

    • increased discharge
    • abnl bleeding
    • lower abd.pain
    • coital pain
    • endocerv. bleeding
    • ectopy
  13. Complications of chlamydia
    Can cause PID in women

    Can lead to: ectopic pregnancy, blocked fallopian tubes, long term pelvic pain, early miscarriage or premature birth
  14. Chlamydia in men
    painful inf. of testes, can result in reduced fertility or sterility

    occasionally leads to Reiter's syndrome (infl.of joints, urethra, eyes)
  15. Testing for chlamydia
    NAAT's (nucleic acid amplification test) 80-95%

    Direct fluorescent antibody 70-85%

    Tissue culture 70-85%

    Enzyme immunoassay 50-75%
  16. Treatment of chlamydia
    azithromycin 1gm orally in one dose

    OR 

    doxycycline 100mg PO BID x 7d


    Alternative: 

    • erythro.500mg 4xday x 7d
    • levaquin 500mg PO BID x 7d
    • ofloxacin 300mg PO BID x7d
  17. HPV (Human papilloma virus)
    genital warts & condyloma acuminata

    most common symptomatic viral infection, chronic

    Types 6 & 11 most common

    Cancerous: 16, 18, 31, 33, 35

    80% of sexually active women infected
  18. HPV in infants
    May present as laryngeal papillomatosis (JORRP)

    from vertical transmission

    Possibly sexual abuse
  19. P.E. for HPV
    Single or multiple soft, fleshy painless, keratinized growths

    Flesh-colored or red, may be flat & difficult to detect

    vaginal walls or cervix, penis, anus, oral cavity (occasionally)
  20. Types of HPV
    Smooth: dome-shaped and skin colored

    Flat: macular to slightly raised, flesh-colored w/ smooth surface, more commonly found on internal structures

    Keratotic: thick horny layer can resemble common warts or seborrhea keratosis
  21. Testing for HPV
    biopsy

    Pap smear, cervical anal
  22. Treatment goals of HPV
    eradicate visible lesions

    May not be practical to eliminate all lesions

    Most pts will develop a spontaneous immune response and eliminate the wart virus by the age of 30
  23. Treatment of HPV
    Pt. applies: 

    Podofilox 0.5% sol. or gel to visible warts BID for 3 days, rest 4 days, 4 cycles max.

    Imiquimod 5% cream, QHS x 16 weeks.

    NEW:

    Veregen (extract of green tea), FDA-approved, TID < 16 weeks.
  24. Tx of HPV, Provider administered
    Cryotherapy

    Surgical removal

    Podophylin resin 10-25%

    Laser surgery, intralesional interferon
  25. HPV vaccine
    Ages 11-12 (prior to sexual contact)

    9-26 y.o.

    Approved for males
  26. Gonococcal Infection
    "The Drip"

    Bacterial

    Male symptoms:

    • Yellow, purulent urethral discharge, may be clear or cloudy
    • Dysuria
    • Itching & burning
    • Epididymitis (unilateral testicular pain & swelling)

    Females:

    • burning on urination
    • yellowish vaginal discharge, redness, & swelling of the genitals

    bleeding

    Abd./coital pain

    Untreated can lead to severe pelvic infections & even sterility

    Babies: eye infections
  27. Female complications of Gonorrhea
    Accessory gland infection (Bartholin's, skene's)

    PID

    Perihepatitis (fitz-hugh-curtis syndrome)
  28. Testing for gonorrhea
    gram-stain: gram (-) diplococci

    95%/98%

    CULTURE GOLD STANDARD

    NAAT's: noninvasive, quick results, co-identify chlamydia, high sensitivity-high specificity
  29. Treatment of Gonorrhea
    • Ceftriaxone 250mg IM x 1
    •  

    • Azithromycin 1gm PO x1
    • doxycycline 100mg PO BID X 7d
  30. Tx of pharyngeal gonorrhea
    ceftriaxone 250mg IM x1 



    azithromycin 1mg PO in single dose

    OR 

    doxycycline 100mg BID x 7d
  31. Herpes: Primary Infection
    Multiple severe lesions, last longer

    Papules -> vesicles -> pustules -> ulcers -> crusts ->healed

    Illness lasts 2-4 weeks

    Can have: 

    fever, HA, malaise, myalgia
  32. Female Herpes Symptoms
    pain, itching, dysuria, vaginal discharge, tender inguinal adenopathy, numerous, bilateral painful genital lesions; last 11-12 days.
  33. Male herpes symptoms
    genital itching

    small sore blisters

    lymph node enlargement

    HA, fever after the blisters break out

    weakness, lethargy, body aches
  34. Treatment of Herpes
    acyclovir 400mg PO 3xdaily 7-10d (200mg 5xdaily for 7-10days)

    famciclovir 250mg 3xdaily for 7-10 days

    valacyclovir 1mg PO 2xdaily for 7-10 days
  35. Episodic herpes treatment
    • acyclovir 400mg PO 3xdaily for 5 days
    •              800mg PO 2xdaily for 5 days
    •              800mg PO 3xdaily for 2 days

    valacyclovir 500mg 2xdaily for 3 days
  36. Suppressive herpes tx
    Acyclovir 400mg PO 2xdaily

    famciclovir 250mg PO 2xdaily

    valacyclovir 500mg (or 1g) PO QD
  37. PID
    complication of BV and or chlamydia/gonorrhea

    Women 15-25, sexually active, highest risk

    Major cause for infertility
  38. PID Risks
    gonorrhea, chlamydia

    • Male partners w/ infection
    • mult. partners

    current douching

    IUD insertion

    BV
  39. Symptoms of PID
    abd. pain

    uterine or adnexal pain

    cervical motion tenderness

    abd. vaginal bleeding

    discharge

    painful intercourse

    fever
  40. Ascending infection pathway to PID
    cervicitis

    enometritis

    salpingitis/oophoritis/tuboovarian abscess

    peritonitis
  41. Treatment of PID
    Ceftriaxone 250mg IM x 1



    doxycycline 100mg PO BID x 14d

    with/without

    metronidazole 500mg orally BID x 14d
  42. Syphilis
    Bacteria - treponema pallidum

    sexual contact - passed through open cut or wound

    mother-child

    3-staged disease
  43. Stage I Syphilis
    Primary

    10-90 days of initial exposure

    Tiny hard red spots at the initial site of contact: progresses from macule to papule to ulcer. Painless, indurated, w/ clean base.

    Highly infectious

    Heals spontaneously in 1-6 weeks

    Lymphadenopathy

    Resolves 7-14d
  44. Stage II Syphilis
    Secondary

    90-180 days

    Flu-like sx, sore throat, fever, itching, general.rash. Lesions occur 3-6 weeks after primary chancre appears, may persist for weeks to months. Mucocutaneous lesions most common

    Sx may abate and return for final stage
  45. Stage III Syphilis
    Latent

    gummatous lesions

    Affects the brain, spinal cord, heart w/o tx.

    FATAL
  46. Syphilis testing
    Presumptive dx possible

    Serology: 

    RPR, VDRL (non-treponemal) - titers may correlate w/ disease activity.

    FTA-ABS (treponemal)
  47. Manifestations of Syphilis, Secondary
    Rash (75-100%)

    Lymphadenopathy (50-86%)

    Malaise

    Mucous patches (6-30%)

    Condylomata (10-20%)
  48. Neurosyphilis
    Invasion of CNS can occur at any stage

    Can be asymptomatic
  49. Treatment of Syphilis
    PCN G IM/IV (all stages of syphilis)

    Primary/Secondary/early latent: 2.4 million units IM in a single dose

    Late latent: 7.2 million units in 3 divided doses, IM, qweek
  50. Trichomonias
    Parasitic infection

    Cannot survive in mouth or rectum

    Passed through sexual contact

    Frequently no symptoms
  51. Symptoms of Trichomoniasis
    Men: discharge from penis, mild discomfort & Swelling of genitalia

    Women: frothy green to yellow discharge with bad odor, vaginal itching, cervical petechiae (strawberry cervix), painful urination, inflammation in genitals, sometimes lower abdomen.
  52. Treatment of trichomoniasis
    Metronidazole 500mg , 4 tabs as one dose 

    OR

    Metronidazole 500mg PO BID x 7d

    NO ALCOHOL
  53. Scabies
    Itch mite burrows into skin producing pimple-like irritations or burrows transferred by direct skin-skin contact. 

    Intense itching particularly at night.

    Webs and sides of fingers, wrists, elbows/armpits, waist, thighs, nipples, breasts & lower buttocks.
  54. Scabies treatment
    Permetrin 5% cream, apply to all areas of body from neck down, wash off after 8-14hrs

    Ivermectin 200mcg/kg PO, repeat in 2 weeks
  55. Lice
    Parasites live in hair around genitals

    Trans. through close physical contact (EXTREMELY CONTAGIOUS)

    Symptoms: itching
  56. Lice treatment
    Wash all contaminated clothing, bedding, etc. in hot water or dry clean

    permethrin 1% cream rinse - apply to area, wash after 10 min.

    Ivermectin 250mcg/kg PO, repeat in 2 weeks

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