Sexually Transmitted Infections (STIs) Risk Factors

Pelvic Inflammatory Disease (PID)

• Risk factors: females 15-25 years old, history of chlamydia or gonorrhea, multiple partners, a partner with an STI, unprotected intercourse
• Symptoms: fever, chills, cervical motion tenderness, WBC on vaginal microscopy
• Assessment: laboratory examination for gonorrhea, chlamydia, and vaginal microscopy of vaginal discharge, pregnancy test, and serum analysis for HIV and syphilis
• Treatment: inpatient or outpatient management dependent on patient's ability to follow outpatient regimen; pregnant patients should always be treated inpatient; outpatient treatment involves 2-3 antibiotics, including ceftriaxone, doxycycline, and flagyl; inpatient treatment involves IV antibiotics, often cefoxitin and clindamycin

Trichomoniasis

• Definition: a sexually transmitted parasite, most common non-viral STI
• Risk factors: unprotected intercourse
• Symptoms: copious frothy, yellow vaginal discharge, fishy vaginal odor, vulvar irritation
• Treatment: metronidazole 500 mg 1 po bid x 7d, no ETOH

Chlamydia

• Definition: most common STI, fast spreading, often asymptomatic
• Risk factors: past chlamydia infections, increase risk of ectopic pregnancies and tubal factor infertility
• Symptoms: mucopurulent discharge from the cervical os, friable, edema in the area of ectopy
• Screening and diagnosis: cervical cultures, urine culture, CDC recommendations for screening; gold standard diagnosis: nucleic acid amplification test (NAAT)
• Treatment: doxycycline 100 mg po bid x 7 days or azithromycin 1 gm po x 1; sexual partners should also be treated; retesting should be done 3 months after treatment

Gonorrhea

• Symptoms: purulent vagina.d/c, dysuria, cervical motion tenderness; 80% of females are asymptomatic in early stages
• Diagnosis: direct culture from urethra, endocervix, throat, rectum; NAAT test is the most sensitive for detection
• Treatment: ceftriaxone 500 mg IM once (1 gram IM once if > 300 pounds); sexual partners should also be treated; retesting should be done 3 months after treatment

Syphilis

• Definition: earliest described STI, highly communicable and rates have been rising since 2000
• HPV vaccine: protects against anal and oropharyngeal cancers; 3 injections (baseline, 2 mos, 6 mos); ages 9-45; given IM (0.5 ml, recommended in deltoid)

HIV

• Definition: human immunodeficiency virus, attacks the body's immune system; if not treated, can lead to AIDS (acquired immunodeficiency syndrome)
• Risk factors: heterosexual transmission, women are the fastest-growing population of individuals with HIV, transmission occurs through exchange of body fluids
• Symptoms: seroconversion occurs within 6-12 weeks, usually without symptoms, may have flu-like symptoms, fever, HA, night sweats, nausea, diarrhea, weight loss, sore throat, and rash
• Treatment options: HIV treatment (antiretroviral therapy or ART) involves taking medicine as prescribed by a health care provider; pre-exposure prophylaxis (PrEP) involves taking antiretrovirals to prevent replication of the virus and infection; daily adherence to tenofovir/emtricitabine (Truvada); follow-up care: HIV AB test q 3 m, STI testing q 6 m.