Podcast
Questions and Answers
What is the typical clinical presentation of gonorrhea in women?
What is the typical clinical presentation of gonorrhea in women?
Which screening recommendation is specific to sexually active women under 25?
Which screening recommendation is specific to sexually active women under 25?
What is the recommended treatment regimen for a patient weighing less than 150 kg with gonorrhea?
What is the recommended treatment regimen for a patient weighing less than 150 kg with gonorrhea?
Which of the following groups should have annual gonorrhea testing regardless of condom use?
Which of the following groups should have annual gonorrhea testing regardless of condom use?
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What is a crucial consideration when selecting a treatment for gonorrhea in patients with possible coinfection of Chlamydia?
What is a crucial consideration when selecting a treatment for gonorrhea in patients with possible coinfection of Chlamydia?
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In which situation is retesting necessary for pregnant women under 25?
In which situation is retesting necessary for pregnant women under 25?
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What is the treatment protocol for a patient weighing 150 kg or more diagnosed with gonorrhea?
What is the treatment protocol for a patient weighing 150 kg or more diagnosed with gonorrhea?
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What does EPT stand for in the context of gonorrhea treatment?
What does EPT stand for in the context of gonorrhea treatment?
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What is the primary causative agent of gonorrhea?
What is the primary causative agent of gonorrhea?
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Which demographic group has an increased risk of contracting gonorrhea?
Which demographic group has an increased risk of contracting gonorrhea?
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How is gonorrhea primarily transmitted?
How is gonorrhea primarily transmitted?
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What is noted about the transmission of gonorrhea from men to women?
What is noted about the transmission of gonorrhea from men to women?
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Where is gonorrhea more commonly reported in the United States?
Where is gonorrhea more commonly reported in the United States?
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Which of the following options is NOT a treatment goal for gonorrhea?
Which of the following options is NOT a treatment goal for gonorrhea?
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What kind of bacteria is Neisseria gonorrhoeae classified as?
What kind of bacteria is Neisseria gonorrhoeae classified as?
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What factor contributes to the higher transmission rates of gonorrhea from males to females?
What factor contributes to the higher transmission rates of gonorrhea from males to females?
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Which group is recommended to have annual chlamydia testing if sexually active, regardless of condom use?
Which group is recommended to have annual chlamydia testing if sexually active, regardless of condom use?
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What is a common symptom of chlamydia in men?
What is a common symptom of chlamydia in men?
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Which testing method is NOT recommended for diagnosing chlamydia?
Which testing method is NOT recommended for diagnosing chlamydia?
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What is the primary treatment regimen for females diagnosed with Trichomoniasis?
What is the primary treatment regimen for females diagnosed with Trichomoniasis?
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In which population is routine screening for Trichomoniasis recommended?
In which population is routine screening for Trichomoniasis recommended?
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What is the primary treatment goal for chlamydia?
What is the primary treatment goal for chlamydia?
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For women under 25 who are sexually active, what is recommended regarding chlamydia screening?
For women under 25 who are sexually active, what is recommended regarding chlamydia screening?
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What is a common diagnosis method for Trichomoniasis?
What is a common diagnosis method for Trichomoniasis?
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What condition is associated with potential chlamydia infection in pregnant women under 25?
What condition is associated with potential chlamydia infection in pregnant women under 25?
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Which of the following statements about Trichomoniasis in men is true?
Which of the following statements about Trichomoniasis in men is true?
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Which treatment strategy is an alternative to metronidazole for Trichomoniasis?
Which treatment strategy is an alternative to metronidazole for Trichomoniasis?
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What specific group of persons with HIV should have chlamydia testing?
What specific group of persons with HIV should have chlamydia testing?
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What should be taken into account when deciding to perform rectal testing for chlamydia?
What should be taken into account when deciding to perform rectal testing for chlamydia?
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What is the goal of syphilis treatment?
What is the goal of syphilis treatment?
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Which drug regimen is the first line treatment for primary and secondary syphilis?
Which drug regimen is the first line treatment for primary and secondary syphilis?
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For treating late latent syphilis, how is Benzathine penicillin G administered?
For treating late latent syphilis, how is Benzathine penicillin G administered?
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What is the alternative treatment for patients with a verified IgE-mediated allergy to penicillin?
What is the alternative treatment for patients with a verified IgE-mediated allergy to penicillin?
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Which of the following is a recommended treatment for neurosyphilis?
Which of the following is a recommended treatment for neurosyphilis?
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What pretreatment is recommended to manage Jarisch-Herxheimer reactions?
What pretreatment is recommended to manage Jarisch-Herxheimer reactions?
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In which scenario is desensitization for penicillin typically not recommended?
In which scenario is desensitization for penicillin typically not recommended?
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What is a potential side effect from syphilis drug therapy?
What is a potential side effect from syphilis drug therapy?
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What is the success rate for a single dose treatment of vaginalis at test-of-cure?
What is the success rate for a single dose treatment of vaginalis at test-of-cure?
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Which of the following regimens includes a single dose of Cefotetan?
Which of the following regimens includes a single dose of Cefotetan?
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What type of reaction can Cefotetan cause?
What type of reaction can Cefotetan cause?
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Which antibiotic is paired with Cefoxitin in Regimen 2?
Which antibiotic is paired with Cefoxitin in Regimen 2?
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Which of the following represents a combination therapy in PID treatment?
Which of the following represents a combination therapy in PID treatment?
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Which antibiotic is effective against Group A/B Streptococcus in PID therapy?
Which antibiotic is effective against Group A/B Streptococcus in PID therapy?
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What regimen involves the use of a 14-day course for both Doxycycline and Metronidazole?
What regimen involves the use of a 14-day course for both Doxycycline and Metronidazole?
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Which antibiotic is most frequently prescribed for a 14-day regimen in PID therapy?
Which antibiotic is most frequently prescribed for a 14-day regimen in PID therapy?
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Study Notes
Sexually Transmitted Diseases and Infections
- Objectives include identifying prevalence, recalling therapy goals, matching clinical presentations to treatment regimens, selecting appropriate follow-up measures and matching drug information to treatment regimens.
- Key references include DiPiro: Pharmacotherapy (2021) and the Centers for Disease Control and Prevention 2021 Sexually Transmitted Infections Treatment Guidelines.
- Important considerations include public health risks, complications, prevalence, duration, psychosocial consequences, and healthcare costs.
General Epidemiology (2013-2022)
- Data shows trends in STD incidence (Chlamydia, Gonorrhea, and Syphilis).
- Graph presentation displays cases per 100,000 people in the US.
- Syphilis incidence is increasing, whereas Chlamydia and Gonorrhea have fluctuating trends.
2022 Texas STD Epidemiology
- Texas STD rates for Chlamydia, Gonorrhea, Primary/secondary Syphilis and congenital syphilis are provided.
- Texas's incidence is compared to the national average for each STD in 2022.
Clinical Prevention Strategy
- Accurate risk assessment, counseling, and changes in sexual behavior.
- Pre-exposure vaccination
- Identifying symptomatic and asymptomatic infected persons.
- Effective diagnosis, treatment, counseling, and follow-up of infected persons.
- Evaluation, treatment, and counseling of sex partners of infected persons.
CDC STD Prevention Measures for Patients
- Accurate sex education
- Abstinence
- Vaccination
- Decrease sex partners
- Mutual monogamy
- Condoms
- Get tested
Expedited Partner Therapy (EPT)
- Patient-delivered partner therapy (PDPT).
- Only one partner is assessed by the prescriber.
- Therapy is provided to the patient to deliver to their partner.
- Prescriber and patient partner relationship is not required for non-patient partners.
- EPT is permissible by law in Texas, encouraging treatment of gonorrhea and chlamydia.
STD Lesions
- A hierarchical chart showing different STD lesions and their associated conditions like Urethritis, Vulvovaginitis, Cervicitis, Chlamydia, Gonorrhea, Syphilis, Anogenital warts, Trichomoniasis, and Genital Herpes.
Urethritis
- Discharge may vary (clear, mucopurulent, or very purulent).
- Common causes include Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma genitalium, and herpes simplex virus.
- Symptoms include dysuria, hematuria, feeling of genital heaviness, epididymitis, or prostatitis if untreated.
Cervicitis
- Mucopurulent secretions from the endocervical canal.
- Causes include N. gonorrhoeae, C. trachomatis, and herpes simplex virus.
- Symptoms include dysuria, abnormal uterine bleeding, lower abdominal pain, dyspareunia, and postcoital bleeding.
Vulvovaginitis
- Inflammation of internal and external female genitals, caused by Trichomonas vaginalis or Candida albicans.
- Symptoms may include vulvular itching or irritation, dysuria, dyspareunia, purulent vaginal discharge, and a "musty" odor.
Skin and Mucous Membrane Lesions
- Types of lesions include chancres, condyloma latum, herpetic vesicles, and condyloma acuminata.
Chancres
- Primary syphilis symptom.
- Painless, highly infectious lesion at transmission site.
- Solitary, often occurring in the genitals.
Condyloma Latum
- Secondary syphilis skin lesion.
- Raised, nodular or plaque-like rash on genitals.
Palmar-plantar Rash
- Secondary syphilis manifestation.
- Pigmented, macular lesions on palms and soles of the feet.
Herpetic Vesicles
- Herpes simplex virus sores in clustered vesicles.
- Can be more painful in women.
- Occurs in clusters of small blisters.
Condyloma Acuminata
- Caused by human papillomavirus (HPV).
- Cauliflower-like masses, potentially oncogenic.
- Affect both internal and external genitals.
Overview
- Presentation flow for STDs includes etiology, epidemiology, clinical presentation, diagnosis, and treatment of the infection.
Chlamydia
- Etiology: Chlamydia trachomatis (intracellular bacterium), sexual or vertical transmission.
- Epidemiology: Commonly reported STD in US, affecting females < 25, MSM, and low socioeconomic populations.
- Clinical Presentation: Men often asymptomatic, sometimes with urethritis; cervicitis, conjunctivitis, and pharyngeal/rectal lesions are other presentation factors.
- Diagnosis: Urethral swab, endocervical/vaginal swab, or urine culture can identify the infection.
- Screening: Women < 25, pregnant women, and high-risk populations should be screened frequently.
- Treatment Strategies: Doxycycline 100 mg BID x7 days, Azithromycin 1 g POx1, or Levofloxacin 500 mg QD x 7 days is the regimen of choice. EPT is permissible.
- Follow-up: Adherence is key; retesting partners in 60 days (or 3 months for women after treatment) is crucial.
Gonorrhea
- Etiology: Neisseria gonorrhoeae (gram-negative diplococci). Transmission via sexual or vertical means; increased prevalence in Southern US.
- Epidemiology: More frequently reported in males < 25 and MSM.
- Clinical Presentation: Men often asymptomatic; symptoms may include urethritis, cervicitis, conjunctivitis, and pharyngeal/anal lesions. Women may have similar symptoms, though women frequently are asymptomatic.
- Diagnosis: Similar to Chlamydia, diagnosed via urethral swab, endocervical/vaginal swab, or urine culture.
- Screening: Screening for gonorrhea is very similar to screening for Chlamydia.
- Treatment: Ceftriaxone 500 mg IM x1 or 1 g IM x1 (weight >150 kg); concomitant treatment with doxycycline is frequently associated. EPT use is permissible.
- Follow-up: Testing partners within 60 days is crucial, and retesting women 3~6 months post-treatment is standard.
Syphilis
- Etiology: Treponema pallidum (spirochete bacterium). Transmitted through sexual, blood, or vertical means; increased male-to-male transmission.
- Epidemiology: Uncommon but increasing incidence. Texas is fourth nationally, and affects males and MSM.
- Clinical Presentation: Stages include primary (chancres), secondary (rash on palms and soles, condylomata lata), latent (asymptomatic), and tertiary (organ damage). Neurosyphilis, a potential complication, can lead to serious CNS damage.
- Diagnosis: Darkfield microscopy, non-treponemal tests (RPR, VDRL), and treponemal tests (FTA-ABS) are used to diagnose syphilis. Quantitiative testing is often used for this.
- Screening: Screening is based on risk factors: men and MSM under 25 should be screened frequently.
- Treatment: Benzathine penicillin G 2.4 million units IM x1 for primary, secondary, and early latent syphilis; penicillin G procaine 2.4 million units IM can be used in combination with probenecid. Alternative treatments are available for penicillin-allergic patients.
- Follow-up: Testing partners and retesting patients with various stages are necessary to avoid long term complications of syphilis.
Trichomoniasis
- Etiology: Trichomonas vaginalis (flagellated protozoa). Transmitted through sexual and vertical transmission.
- Epidemiology: Most common curable STD in US; high prevalence in women < 25, WSW and incarcerated persons.
- Clinical Presentation: Often asymptomatic, but symptomatic individuals may experience vulvovaginitis (in women) or urethritis (in men).
- Diagnosis: Vaginal/urethral culture, wet-mount slide, urine tests, or point-of-care (POC) rapid tests are frequently used to detect Trichomonas.
- Screening: High-risk populations should be screened frequently.
- Treatment: Metronidazole 500 mg PO BID x7 days for women; metronidazole 2 g PO x1 for men. Tinidazole 2 g PO x1 may be an alternative.
- Follow-up: Partner treatment, adherence is key; retesting is required 3 months later.
Genital Herpes
- Etiology: Herpes simplex virus type 2 (HSV-2). Sexually and vertically transmitted; recurs through reactivation and latency during normal disease expression.
- Epidemiology: ~50 million Americans affected, impacting women and MSM at higher rates.
- Clinical Presentation: Primary and recurrent infection stages exist; primary infection often asymptomatic; recurrent infection involves recurrent outbreaks of herpetic vesicles.
- Diagnosis: Tissue culture(most sensitive), serological testing (blood/serum testing), and virological testing (PCR for HSV DNA) exists to diagnose Genital Herpes.
- Screening: HSV serology is frequently recommended for individuals with multiple sexual partners or a history of STIs; routine screening for asymptomatic pregnant women is not recommended.
- Treatment: Initial therapy aims to reduce duration and severity of outbreaks; Suppressive therapy aims to reduce frequency of outbreaks; episodic therapy is often used to control individual outbreaks. Commonly used drugs include acyclovir, valacyclovir, and famciclovir for therapy.
- Follow-up: Adherence is essential. Follow-up recommendations are highly based on individual risk factors and prevalence of the STI.
- Important Note: No cure exists for genital herpes. Treatment focuses on reducing symptoms and preventing transmission.
Anogenital Warts
- Etiology: Human papillomavirus (HPV), a non-enveloped virus. Primarily transmitted through sexual contact.
- Epidemiology: HPV is the most common STI in the US; annual incidence of infections impacting ~14 million people. Prevalence rates among different demographics (eg. 15-19, 20-24, 25-29) vary.
- Clinical Presentation: Usually asymptomatic, but warts can develop on the genitals. Symptoms include itching, burning, discomfort and postcoital bleeding. Warts are commonly present in the genital/anal region.
- Diagnosis: Physical exam, biopsy, or testing for HPV using an Acetic Acid test.
- Treatment: Drugs like Imiquimod and Podofilox can be used; cryotherapy and surgical removal also present as options.
- Screening: Routine screening for all individuals based on their risk exposure.
Pelvic Inflammatory Disease (PID)
- Etiology: Untreated vaginal/cervical infections like gonorrhea and chlamydia (~50%), other bacterial infections.
- Risk Factors: Low socioeconomic status, recent IUD placement, previous PID, and sexual activity in those with multiple partners.
- Clinical Presentation: Can vary; may include lower abdominal pain, abnormal bleeding, dyspareunia, cervical/uterine tenderness, fever, and increased WBCs in vaginal fluid.
- Diagnosis: Clinical examination and lab tests (such as ESR and CRP) aid in diagnosis.
- Treatment: Empiric therapy covering potential polymicrobial infections; parenteral regimens are frequently used as initial treatment. Commonly used drugs include ceftriaxone, cefotetan, cefoxitin, and metronidazole.
- Follow-up: Treatment adherence and abstinence from vaginal intercourse and partner treatment for duration of treatment are crucial. Routine testing for cure is typically conducted after 3 months.
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Description
This quiz covers the clinical presentation, screening recommendations, and treatment protocols for gonorrhea specifically in women. It also addresses considerations for coinfections and the importance of retesting in certain populations. Test your knowledge on the latest guidelines and recommendations!
