HPV and Herpes Quiz

Infections of the Reproductive Tract

• Infections discussed include Chlamydia, Gonorrhea, Syphilis, Pelvic Inflammatory Disease (PID), Human Papillomavirus (HPV), Herpes Simplex Virus (HSV), Toxic Shock Syndrome (TSS), Bacterial Vaginosis, Candidiasis, and Trichomoniasis, and HIV.

Reproductive System Concerns

• Infections: Chlamydia, Gonorrhea, Syphilis, Pelvic Inflammatory Disease, HPV, Herpes Simplex Virus, Toxic Shock Syndrome, Bacterial Vaginosis, Candidiasis, Trichomoniasis, and HIV.
• These infections affect the reproductive system, potentially leading to various complications.

Chlamydia

• Most common: Chlamydia trachomatis (CT) is the most frequently reported bacterial STI in the US and a common STI in Ohio.
• Prevalence: 1 in 20 sexually active women aged 14-24 are diagnosed yearly.
• Asymptomatic: Often asymptomatic in both men and women. Can persist for weeks or longer without symptoms.
• Incubation: 1-5 days.
• Complications: Causes damage to the female reproductive system. Common cause of infertility.
• Male Symptoms: Discharge from penis, burning sensation during urination, pain and swelling in one or both testicles. These are less common.
• Female Symptoms: Burning and frequent urination, thin or purulent discharge, discomfort or bleeding during sex. These are also less common.

Chlamydia Symptoms

• Female: Chlamydial cervicitis (inflammation of the cervix) and conjunctivitis (inflammation of the conjunctiva, the membrane covering the eye) are potential symptoms. Visual images of these are available.
• Male: Discharge from the penis and potential inflammation in the testicles.

CDC Recommendations for Chlamydia

• Annual Screening: Sexually active females under 25 should be screened annually. Individuals over 25 should be screened if at risk (e.g., history of STIs, multiple partners).
• Screenings for sexually active young men should also be considered in clinical settings with high prevalence of chlamydia or populations with high burden of infection.
• Pregnant women: Screening at first prenatal visit.

Chlamydia Diagnosis

• Women: Endocervical or vaginal swab using NAAT (Nucleic Acid Amplification Tests) testing.
• Men: Urethral swab using NAAT testing.
• Alternative: First-catch urine sample (less reliable).

Chlamydia Treatment

• First-line: Azithromycin 1 gram orally as a single dose.
• Alternative: Doxycycline 100 mg orally twice daily for 7 days.
• Partners: Both partners should be treated. Sexual activity should be avoided for at least a week after treatment.
• Follow up: Test-of-cure (TOC) is recommended 30-90 days post-treatment.
• EPT: Expedited Partner Treatment (EPT) available for partner treatment.

Gonorrhea

• Bacterium: Neisseria gonorrhoeae (gram-negative diplococcus).
• Risk factors: Adolescence, poverty, drug abuse, prostitution, and other STIs.
• Prevalence: Ohio ranks 11th nationally for cases (265 cases per 100,000).

Gonorrhea Symptoms

• Urination: Burning or painful sensation when urinating.
• Discharge: Vaginal or penile discharge (various colors).
• Bleeding: Vaginal bleeding between periods, heavier periods, or bleeding after sex.
• Pain: Testicular pain, rectal infections (discharge, itching, soreness, bleeding, painful bowel movement), abdominal pain (especially if infections spread), fever, and sore throat.
• Other symptoms: Infection can spread to fallopian tubes and uterus, manifesting in further symptoms like severe pain/fever. Visual images of certain symptoms are available.

CDC Recommendations for Gonorrhea

• Screening: Same as for Chlamydia (but in some cases recommendations are different).

Gonorrhea Diagnosis

• Same as Chlamydia: Endocervical or vaginal swab (NAAT testing) for women, urethral swab (NAAT testing) for men, first-catch urine sample is considered less reliable.

Gonorrhea Treatment

• First-line: Ceftriaxone (Rocephin) IM injection (dose based on weight).
• Mixing: Often mixed with lidocaine to mitigate pain of injection.
• Partner Treatment: Both partners should be treated.
• Abstinence: Sexual abstinence for 7 days post-treatment.
• Follow Up: Test-of-cure 30-90 days post treatment is optional

Trichomoniasis

• Cause: Trichomonas vaginalis, a protozoan.
• Prevalence: Most frequent non-viral STI.

Trichomoniasis Symptoms

• Asymptomatic: Often asymptomatic.
• Discharge: Copious, yellow-green, frothy, malodorous discharge, a classic sign.
• Other symptoms: Inflammation, itching, dysuria (painful urination).
• Physical signs: Cervix and vaginal walls may exhibit "strawberry spots," and vaginal bleeding.

Trichomoniasis - Diagnosis and Treatment

• Diagnosis: Diagnosed by culture or wet prep (slide under microscope) to identify the protozoa and their flagella.
• Treatment: Metronidazole (Flagyl) 2 g orally in a single dose.

Syphilis

• Cause: Treponema pallidum bacterium.
• Incubation: 3-90 days (average is 21 days).
• Transmission: Can be transmitted across the placenta to a fetus.
• Primary Stage: Painless sore (chancre) in the genital area lasting about 4 weeks.
• Secondary Stage: Rash appearing 6 weeks to 6 months after the chancre.
• Tertiary Stage: Untreated syphilis can lead to neurological, cardiovascular, musculoskeletal, or multi-organ failure if left untreated. Visual aids depicting these stages are available.

Syphilis - CDC Estimates

• US cases: 176,000 new cases in the US annually.
• Global cases: Six million cases worldwide annually.
• Epidemic: Cases have increased 2000%+ in the US over the past 25 years.

Syphilis - Diagnosis

• Screening tests: VDRL (Venereal Disease Research Laboratory) and RPR (Rapid Plasma Reagin) tests.

• Diagnostic test: Treponemal Antibody Tests.

Syphilis Treatment

• Treatment: A single dose of Benzathine PCN G 2.4 million units IM (intramuscular injection).
• Partner treatment: Sexual partners should be treated.

Pelvic Inflammatory Disease (PID)

• Cause: Ascending spread of microorganisms from the vagina and endocervix to the upper genital tract, often caused by gonococci and chlamydia.
• Organisms: Most commonly involves the uterine tubes (salpingitis) and uterus (endometritis).
• Complications: Increased risk of ectopic pregnancy, infertility, chronic pelvic pain.
• Symptoms vary.

Pelvic Inflammatory Disease (PID) Symptoms

• Symptoms include: Cervical tenderness, uterine tenderness, adnexal tenderness.

Human Papillomavirus (HPV)

• Cause: A group of 200 related viruses spread through vaginal, anal, or oral sex.
• Types:
  • Low-risk: HPV types 6, 11, 42, 43, and 44. Often cause warts, but rarely cancer.
  • High-risk: HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59. Can cause several types of cancer; HPV 16 and 18 are the most frequent causes.

Human Papillomavirus (HPV) Symptoms

• Symptoms: Soft, papillary swellings occurring singly or in clusters on the vulva, vagina, cervix, or anus. These can manifest as cauliflower-like masses.

HPV Vaccine

• Recommended Age: 11 or 12 years old; can be administered as early as age 9.
• Doses:
  • 15 and under: 2 doses.
  • 15-26 and immunocompromised populations: 3 doses.

Herpes Simplex Virus (HSV)

• Types: HSV-I (oral herpes), HSV-II (genital herpes).
• Transmission: Can be transmitted via oral-genital contact.
• Symptoms:
  • Initial outbreaks: Painful ulcers or blisters around the mouth (oral) or genitals (genital). Flu-like symptoms, fever, headache, swollen lymph nodes, sore throat are sometimes present.
  • Recurring outbreaks: Usually milder and less severe lesions.
• Symptoms: Painful lesions, fever, chills, malaise, dysuria, inguinal tenderness, heavy watery vaginal discharge.

HSV Treatment

• No cure. Treatments involve antiviral medications (e.g. acyclovir, valacyclovir, famciclovir) to reduce outbreak duration/severity.
• Treatment timing: Ideally started within the first 3-7 days of an outbreak; 48 hrs is best.
• Medication frequency: High-dose medicine is recommended initially. Dose may be reduced for chronic outbreaks or milder recurrences.

HSV in Pregnancy

• Risk: HSV during pregnancy is a risk to the fetus.
• Management: Goal is to suppress outbreaks during pregnancy and delivery. Patients may be treated with antiviral medications. New infections are particularly risky, possibly causing congenital herpes (fatal to newborn).

Human Immunodeficiency Virus (HIV)

• Transmission: Through blood, blood products, and body fluids.
• Target: Affects T lymphocytes.
• Seroconversion: HIV positivity is typically observed following 6-12 weeks of infection.
• Complications: AIDS (HIV positive plus opportunistic infections).

HIV Management

• Education: Crucial; includes contraception.
• Treatment: Antiretrovirals.
• Breastfeeding contraindications: If HIV positive, avoid breastfeeding.

Toxic Shock Syndrome (TSS)

• Cause: Certain bacteria (commonly Staphylococcus aureus or group A Streptococcus).
• Trigger: Often associated with tampon use, particularly if tampons are left in for extended periods or are high-absorbency.
• Symptoms:
  • Characteristic rash
  • High fever
  • Low blood pressure
  • Malaise
  • Confusion
• Progression: Potential rapid progression to stupor, coma, and multiple organ failure if untreated.

Bacterial Vaginosis (BV)

• Cause: Bacterial imbalance in the vagina.
• Risk Factors: Multiple sex partners, history of BV in partners, hormonal changes, such as those during pregnancy, and sharing sex toys.
• Symptoms: Often asymptomatic; may include a "fishy" odor, especially after intercourse, and thin, watery gray/white vaginal discharge.

Bacterial Vaginosis (BV) Diagnosis

• Diagnosable through wet prep (microscopy with potassium hydroxide = whiff test), looking for clue cells, and assessing vaginal pH.

Bacterial Vaginosis (BV) Treatment

• Treatment: Metronidazole (Flagyl) 500 mg orally twice daily for 7 days (or other similar antibiotics).

Candidiasis (Yeast Infection)

• Cause: Candida albicans yeast.
• Risk factors: Changes in pH, antibiotics, diabetes, pregnancy, and obesity.
• Symptoms: Itching, thick white lumpy discharge, red/swollen labia, cervix, and vagina.

Candidiasis Diagnosis and Prevention

• Diagnosis: Vaginal swab/culture, microscopy.
• Prevention: Wash genitalia with plain water/unscented soap, wear breathable fabrics, avoid scented feminine products, avoid hot tubs, consider probiotics (if on antibiotics).

Candidiasis Treatment

• Treatment: Antifungal creams/suppositories (3-7 day course); oral medications (like fluconazole, Diflucan).

Additional Important Considerations

• In all cases it is important to consult healthcare providers for proper evaluation and treatment.
• The information provided is for educational purposes only.

Test your knowledge on HPV and Herpes Simplex Virus in this engaging quiz. Discover low-risk HPV types, vaccine recommendations, and symptoms related to both viruses. Perfect for students and health enthusiasts!