Sexually Transmitted Diseases

Chlamydia is caused by

chlamydia trachomatis- intracellular pathogen **it is the most commonly reported notifiable disease in the US**

HPV Gardasil 9

covers 9 HPV types 6, 11, 16, 18, 31, 33, 45, 52, 58 approved for females 9-26 and males 9-15 3 dose vaccine with the 2nd and 3rd given at 2 and 6 months after the 1st

Clinical Presentation of Chlamydia- Females

incubation period of 7 -21 days -Endocervical infection most common Asymptomatic- 75% Dysuria Urinary frequency Odorless clear discharge Burning/pain with intercourse Abnormal menstrual bleeding Pelvic pain fever nausea

PID

infection and inflammation of the upper genital tract- chronic pain and infertility

Transmission of syphilis only occurs when

mucocutaneous lesions are present

Latent syphilis

usually asymptomatic but risk of mucocutaneous relapse

The clinical course of HSV

you are contagious from prodrome through the complete healing of blisters/ulcers

Treatment of uncomplicated gonorrhea?

#1. Ceftriaxone 250 mg IM x 1 dose PLUS Azithromycin 1 g PO x 1 dose OR doxycycline 100 mg PO BID x 7 days

Gonorrhea (AKA the clap) is the 2nd most common STD. What is the clinical presentation of this STD? (6)

**Asymptomatic** >50% -Cervicitis most common -Symptoms usually occur w/in 10 days of infection -odorless vaginal discharge -Dysuria -Vaginal bleeding or pain

Treatment of Chlamydia "AEDL"

**Azithromycin 1 gm PO x 1 dose** Erythromycin base 500 mg PO QID x 7 days doxycycline 100 mg PO BID x 7 days Levofloxacin 500 mg PO QD x 7 days

HSV in pregnancy

Neonatal herpes is associated with a high mortality and morbidity (CNS toxicity and blindness) -if mother has active genital herpes at time of delivery c-section should be done

HPV Vaccines Gardasil

Quadrivalent- 6, 11, 16, 18 protect against cervical/vaginal cancer and genital warts CDC recommends it for girls 11-26 May be administered to males to prevent genital warts ages 11-26

Screening and diagnosis of gonorrhea

Routine screening is recommended for all high risk sexually active women < 26 years of age CDC preferred tests: NAAT Cervical swab, vaginal swab or urine

Link between HIV and other STDs

STD treatment reduces the ability to transmit HIV STD treatment reduces the spread of HIV infection -treatment of one STD reduces the risk of other STDs including HIV

STDs are more common in men or women? Who accounts for more serious complications between the two?

STDs are more common in women than in men and women account for more serious complications then men as well

Clinical presentation of syphilis

Skin lesion often on palms and soles rash mucocutaneous lesions Malaise Fever

True or false: Complications caused by STDs are more common in women?

True

True or false: STDs Affect all Backgrounds and economic levels

True

True or false: When diagnosed and treated early many STDs can be treated?

True

True/False: A majority of the time STDs cause no symptoms

True

There is the potential for co-infection with gonorrhea what is the other STD? and what should be recommended?

Co-infection with Chlamydia. All patients receiving treatment for gonorrhea should receive concomitant therapy against Chlamydia Also may con-infect with trichomoniasis

Tertiary syphilis and site of infection

-Occurs 10-30 years after initial infection- if untreated can produce an inflammatory reaction anywhere in the body. site of infection- CNS skin heart bones eyes and joints

Primary syphilis Incubation period? Site of infection? Clinical Presentation:

-incubation period 10-90 days -Site of infection: Genitalia (external or internal) perianal region, mouth or throat Clinical Presentation: -chancre- painless sore

What are the complications of Chlamydia? If untreated?

1. "Reiter Syndrome"- If untreated -Conjunctivitis, arthritis 2. Pelvic Inflammatory Disease Infertility Chronic pelvic pain Ectopic pregnancy Tubal pregnancy

Goals of therapy for HSV

1. shorten the clinical course- heal and resolve symptoms 2. Prevent complications 3. Prevent the development of reoccurances 4. Decrease transmission

STD prevention

Abstinence Know your partner Condoms Spermacides Screening Education

Treatment of first clinical episode of HSV

Acyclovir 400 mg TID Acyclovir 200 mg 5x/d Famciclovir 250 mg TID Valacyclovir 1g BID Rx is usually for 7-10 or until clinically resolved Severe disease: acyclovir 5-10mg/kg IV Q8hr then PO to complete at least 10 days of therapy

Treatment of HSV2 Recurrent episodes

Acyclovir 400 mg TID x 5 days Acyclovir 800 mg TID x 2 days Acyclovir 800 mg BID x 5 days Famciclovir Valacyclovir **treatment should be initiated during the prodrome or within 1 day of onset of lesions**

Who is most affected by gonorrhea

African American aged 15-19 followed by 20-24 Hispanics have high rates 20-24

Patient has a severe cephalosporin allergy what can you give them to treat for gonorrhea

Azithromycin 2g PO x 1 dose PLUS return 1 week after treatment to test for cure

Treatment of Chlamydia in pregnancy "AEA"

Azithromycin x 1 dose Erythromycin x 7 days Amoxicillin x 7 days Doxycycline and quinolones should not be given -retardation of skeletal development -permanent tooth discoloration

Screening and Diagnosis

CDC recommends annual screening on women > 26 years of age TESTS: NAAT- nucleic acid amplification test -urine -vaginal swab

Treatment of syphilis latent tertiary or unknown

Benazthine Pen G x 3 weeks -Doxy x 28 days -Tetra x 28 days

Treatment of syphilis Primary & Secondary, Early latent

Benazthine Penicillin G x 1 dose 1st line -Doxy x 14 days -Tetracycline x 14 days -Ceftriaxone x 8-10 days

What is the Jarisch-Herxheimer Reaction

Benign self-limiting reaction common in primary, secondary syphilis treatment -Flu-like symptoms fever, HA, chills -exacerbation of syphilis rash/lesions -the reaction usually begins within 24 hrs after initiation of therapy and subsides spontaneously -Rx with antipyretics/analgesics/rest

HPV Vaccine Cervarix

Bivalent HPV types 16, 18 protects against cervical cancer CDC recommends for females 11-25 years

If ceftriaxone is unavailable for the treatment of gonorrhea use:

Cefixime 400 mg PO x 1 dose PLUS Azithromycin 1g PO x 1 dose OR doxycycline 100 mg PO BID x 7 days PLUS return 1 week after treatment to test for cure

Genital Warts is a ______ What are the two types?

DNA virus HSV1- cold sores HSV2- genital warts This is a recurrent incurable disease First episode is non-primary

Diagnosis of syphilis

Dark-Field-Exam

Secondary syphilis Site of infection

Develops 2-8 weeks after initial infection in untreated patients Site of infection- widespread due to hematogenous and lymphatic spread ** resolves spontaneously in 4-10 weeks if untreated**

One of the complications of gonorrhea is disseminated disease which means? Other Complications that can occur in untreated?

If it is untreated it can cause -arthritis -bacteremia -meningitis Other complications: 1. PID 2. Ectopic pregnancy 3. Infertility 4. Can facilitate HIV transmission

Transmission of syphilis

Mucocutaneous contact with a sore (chancre) or during pregnancy

Gonorrhea is characterized by what bacteria

Neisseria gonorrheae- small, gram- diplococcus

Monitoring

Patients being treated with ceftriaxone regimen do not require routine follow up. All other regimens require a return 1 week after treatment to test for cure Treat recent (60 days) partners