Sexually Transmitted Infections (STIs) PDF

Infections of the Reproductive Tract Reproductive System Concerns Infections: Chlamydia Bacterial Vaginosis Gonorrhea Candidiasis Syphilis Trichomoniasis Pelvic Inflammatory Disease Group B Human Papillomavirus H...

Infections of the Reproductive Tract Reproductive System Concerns Infections: Chlamydia Bacterial Vaginosis Gonorrhea Candidiasis Syphilis Trichomoniasis Pelvic Inflammatory Disease Group B Human Papillomavirus HIV Herpes Simplex Virus Toxic Shock Syndrome Clinical Prevention Guidance Prevention and control of STIs are based on the following five major strategies ○ 1. Accurate risk assessment and education and counseling of persons at risk regarding ways to avoid STIs through changes in sexual behaviors and use of recommended prevention services ○ 2. Pre-exposure vaccination for vaccine-preventable STIs ○ 3. Identification of persons with an asymptomatic infection and persons with symptoms associated with an STI ○ 4. Effective diagnosis, treatment, counseling, and followup of persons who are infected with an STI ○ 5. Evaluation, treatment, and counseling of sex partners of persons who are infected with an STI The Five P’s approach for health care providers obtaining sexual histories Partners Practices Protection from STIs Past history of STIs Pregnancy Intention Chlamydia most common § Chlamydia trachomatis (CT) § Most frequently reported bacterial infectious disease in US § Most common STI in Ohio—509 cases per 100,000 § Every year, 1 in 20 sexually active women ages 14-24 are diagnosed with chlamydia § Asymptomatic infection is common among both men and women § Incubation = 1-5 days, may remain asymptomatic for weeks or longer § Causes severe damage to female reproductive system---common cause of infertility Chlamydia Symptoms Female Male Burning & frequency of ○ Discharge from urination penis Thin or purulent discharge ○ Burning sensation Discomfort or bleeding when when urinating having sex ○ Pain and swelling in one or both testicles *May Remain Asymptomatic (less common) Chlamydia Symptoms Chlamydial Conjunctivitis Chlamydial Cervicitis CDC Recommendations Annual screening for sexually active females 25 yrs: if at risk (hx of STIs, multiple partners, etc) Annual screening of sexually active young men should be considered in clinical settings with a high prevalence of chlamydia or for populations with a high burden of infection Pregnant women All women at 1st prenatal visit risk of pretermdelivery  Chlamydia Diagnosis Diagnosis: Endocervical or vaginal swab (NAAT testing) in women Urethral swab (NAAT testing) in men First-catch urine sample (less reliable) Chlamydia Treatment *Azithromycin 1 g PO in a single dose (tablets or powder suspension) first-line treatment OR Doxycycline 100 mg PO BID x 7 days  Chlamydia Treatment *Azithromycin 1 g PO in a single dose (tablets or powder suspension) first-line treatment OR Doxycycline 100 mg PO BID x 7 days Both partners should be treated—abstain from intercourse until at least 1 week after taking medication Test-of-cure (TOC) is recommended 30-90 days after treatment Expedited Partner Treatment (EPT) in Ohio able to gettreatment for partnerwithout seeing them  Gonorrhea Neisseria gonorrhea (gram negative diplococcus) Risk factors: adolescence, poverty, single, drug abuse, prostitution, other STIs Ohio ranks 11th in the nation for Gonorrhea 265 cases per 100,000 Gonorrhea Symptoms Urination: A burning or painful sensation when urinating Vaginal discharge: An unusual, thin, watery, or foul-smelling discharge that may be green or yellow in color Vaginal bleeding: Bleeding between periods, heavier periods, or bleeding after sex Penile discharge: A white, yellow, or green discharge from the penis Testicular pain: Painful or swollen testicles Rectal infections: Discharge, anal itching, soreness, bleeding, or painful bowel movement Abdominal pain: Severe pain in the lower abdomen, especially if the infection spreads to the fallopian tubes and uterus Fever: A fever, especially if the infection spreads to the fallopian tubes and uterus Sore throat: A sore throat Gonorrhea Symptoms cervix swollen inflammed occular gonorrhea CDC Recommendations same as chlamidya Annual screening for sexually active females 25 yrs; if at risk (hx of STI’s, multiple partners, etc) Annual screening for Men Who Have Sex with Men (MSM) Pregnant women ○ All women at 1st prenatal visit  Gonorrhea Diagnosis Diagnosis: same as chlamidya Endocervical or vaginal swab (NAAT testing) in women Urethral swab (NAAT testing) in men First-catch urine sample (less reliable)  Gonorrhea Treatment painful mixed very Ceftriaxone (Rocephin) IM injection (dose based on weight) Recommended to mix with lidocaine due to pain of injection with lidocaine *If Chlamydia infection is not ruled out, also treat for potential infection Abstain from intercourse for at least 7 days following treatment of both partners Test of Cure recommended 3 months after treatment Expedited Partner Treatment (EPT) in Ohio Trichomoniasis Trichomonas vaginalis – protozoan with characteristic flagella Most common non-viral STI Symptoms ○ May be asymptomatic ○ Copious yellow-green frothy discharge classic sign ○ Malodorous ○ Inflammation ○ Itching ○ Dysuria ○ Cervix and vaginal wills “strawberry spots” ○ Bleeding cervix Trichomoniasis Trichomoniasis—Diagnosis and Treatment Diagnosed by culture or wet prep (slide under microscope) Trichomonas are singe-celled protozoa with flagella that rotate in a twisting motion (can be observed on microscopy) Treatment: Metronidazole (Flagyl) 2g orally in a single dose (antifungal) *Important! Patients must not consume alcohol within 3 days of taking metronidazole (severe nausea/vomiting, flushing, tachycardia) Syphilis longterm problem Bacterium - Treponema palladium Can cross placenta & infect fetus Incubation period = 3-90 days (average =21) Primary Stage-hard, painless sore, “chancre” in genital area that lasts about 4 weeks (only 30-40%of women diagnosed in this stage) Secondary Stage – 6 weeks to 6 months after the appearance of chancre (rash) Tertiary Stage- untreated leads to neuro, CV, musculoskeletal, or multi-organ failure Syphilis  Syphilis CDC estimates 176,000 new cases each year in the US Six million cases worldwide each year Cases in the US are now considered an epidemic---cases have had greater than a 2000% increase over the past 25 years. #1 state for syphilis in 2024 is S. Dakota (Ohio is 18th) City of Columbus declared a syphilis outbreak in 2022  Congenital Syphilis wk labor delivery penicillin prenatal 28 visit Syphilis passed to fetus during pregnancy Congenital syphilis in the US has tripled in recent years 34 cases recorded in Franklin County in 2022 High percentage of babies die who have contracted congenital syphilis Importance of detection during pregnancy (first visit, at 28 weeks, and at hospital admission) Syphilis Diagnosis Screening Tests (serum): come back elevated VDRL (Venereal Disease Research Laboratory) RPR (Rapid Plasma Reagin) Diagnostic Test: Treponemal Antibody Tests CDC Recommendations Annual screening for sexually active gay men Persons with HIV ○ For sexually active individuals, screen at first HIV evaluation, and at least annually thereafter Pregnant women ○ All women at 1st prenatal visit ○ Retest early in the third trimester and at delivery if at high risk Syphilis Treatment A single dose of Benzathine PCN G 2.4 million units IM X1 ***Sexual partners should be treated Pelvic Inflammatory Disease (PID) bacteria from vaginalcervis move up into the uterus Results from ascending At increased risk for: spread of microorganisms Ectopic pregnancy (scarring) from vagina and endocervix Infertility to upper genital tract Chronic pelvic pain Caused by multiple organisms Symptoms depend on type of (gonorrhea/chlamydia) infections: Most commonly involves: Acute ○ Uterine tubes (salpingitis) Subacute ○ Uterus (endometriosis) Chronic PID Symptoms Cervical Motion Tenderness (CMT) anytype of movementto thecervix Uterine Tenderness causes immense pain Adnexal Tenderness Treat presumptively based on symptoms (while waiting for cultures)!! treat for other STIs while waiting giveall antibiotics Chandelier Sign touching anywhere near stomach cervix Human Papilloma Virus (HPV) A group of 200 related viruses spread through vaginal, anal, or oral sex: Low-risk HPV--Types 6, 11, 42, 43, and 44 are low-risk HPV types that rarely cause cancer. However, they can cause warts on the genitals, anus, mouth, or throat. High-risk HPV--Types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59 are high-risk HPV types that can cause several types of cancer. HPV 16 and HPV 18 are responsible for most HPV- related cancers  Human Papilloma Virus (HPV) Condylomata acuminata (genital warts) (HPV strains 6 & 11) Prevention: vaccination Symptoms: soft, papillary swellings occurring singly or in clusters on the vulva, vagina, cervix, or anus (genital and anal-rectal areas) May appear as cauliflower-type mass Lesions usually painless Human Papilloma Virus (HPV)  Human Papilloma Virus (HPV) Vaccine Prevents more than 90% of cancers caused by HPV The recommended age to get the HPV vaccine is 11 or 12 years old, but it can be started as early as age 9. The number of doses needed depends on the age at which the first dose is given: 2 doses: Most children who get the first dose before age 15 need 2 doses. 3 doses: People who get the first dose between 15-26 years old and younger people with certain immunocompromising conditions need 3 doses. Herpes Simplex Virus (HSV) HSV I = (cold sore) which can cause genital herpes through oral-genital contact HSV II = usually only associated with genital infections (both types of HSV can be found oral or genital) Symptoms: painful lesions, fever, chills, malaise dysuria tenderness Itching, inguinal tenderness groin Heavy watery to purulent vaginal discharge After healing, dormant in the nerve ganglia of the affected area Herpes Simplex Virus (HSV) Herpes Simplex Virus (HSV) Oral Herpes: Symptoms include painful blisters or ulcers in or around the mouth or lips. The initial outbreak can be severe and flu-like, with a fever, headache, swollen lymph nodes, and sore throat. Recurring outbreaks are usually milder and the sores appear on the edges of the lips. Genital Herpes: Symptoms include bumps, blisters, or ulcers around the genitals or anus. The first outbreak can be accompanied by flu-like symptoms, such as fever, body aches, or swollen glands. Repeat outbreaks are usually shorter and less severe than the first. The first outbreak tends to be VERY painful. Herpes Simplex Virus (HSV) Treatment There is no cure. Herpes simplex virus (HSV) is treated with antiviral medications, which can reduce the length and severity of outbreaks. The most common antiviral medications are acyclovir, valacyclovir, and Antiviral famciclovir. For initial outbreaks, the World Health Organization (WHO) recommends taking the following doses for 10 days: Acyclovir: 200 mg five times per day or 400 mg three times per day Valacyclovir: 500 mg two times per day It's best to start treatment within the first three days of an outbreak. For recurrent outbreaks, treatment is most effective if started within 48 hours. Taking a lower daily dose of medication can also help reduce how often outbreaks occur. Herpes Simplex Virus (HSV) in Pregnancy HSV during pregnancy is a risk to the fetus For those with known genital HSV, the goal is to suppress an outbreak during pregnancy (especially before and during delivery). Antivirals are given to patients with hx of genital HSV leading up to delivery (outbreak at time of delivery will require cesarean). Careful patient history is very important. New infections during pregnancy are especially dangerous—pose risk of congenital herpes (can be fatal to newborn) Human Immunodeficiency Virus (HIV) Enters body through blood, AIDS = HIV positive + blood products, body fluids diagnosed opportunistic Affects specific T infection(s) lymphocyte cells, causing destruction, decreasing the Management: immune system Education- include Once HIV enters the body- contraception seroconversion to HIV Antiretrovirals positivity in 6-12 weeks Can see severe depression No breastfeeding if HIV positive of the cellular immune system  Toxic Shock Syndrome (TSS) Rare, life-threatening complication of certain types of bacterial infections. (Often results from toxins produced by Staphylococcus aureus (staph) or group A streptococcus (strep) bacteria). Commonly associated with tampon use, especially if they are highly absorbent or left in for a long time. Change tampon every 4-6 hours Symptoms: ○ characteristic rash ○ high fever ○ low blood pressure ○ malaise ○ confusion ○ can rapidly progress to stupor, coma, and multiple organ failure  Bacterial Vaginosis (BV) Not sexually transmitted, although intercourse can be a contributing factor Causes by bacterial imbalance in vagina BV is more common in sexually active people, especially those who have multiple sex partners, female sex partners, or whose sex partner has BV. Hormonal changes: Pregnancy hormones can make it easier for certain bacteria to grow, which can lead to BV. About 25% of pregnant people get BV. Sharing sex toys: BV can be spread by sharing sex toys (hygiene important) Oral-genital contact: Oral-genital contact can spread BV. BV is the most common vaginal condition in women ages 15-44. Bacterial Vaginosis (BV) Anaerobic Bacteria Gardnerella or Mobiluncus Symptoms: ”Fishy” odor (especially after intercourse) Thin, watery gray/white discharge Pattach to white Diagnosis: blood cells Wet Prep microscopy, KOH solution (whiff test), clue cells, vaginal pH >4.5% Treatment: Metronidazole (Flagyl) 500 mg PO BID x 7 days Candidiasis (Yeast Infection) Candidiasis Yeast infection: Candida albicans Change in pH PH Predisposing factors ○ Antibiotics ○ Diabetes sugar ○ Pregnancy ○ Obesity Symptoms ○ Itching ○ Thick, white, lumpy discharge ○ Red, swollen labia, cervix, vagina  Candidiasis (Yeast Infection) Diagnosis: Vaginal swab/culture, microscopy Prevention: Wash genitalia with plain water, unscented soap Wear breathable fabrics, cotton Avoid scented feminine products Avoid hot tubs Probiotics (with antibiotic use) Treatment: Antifungal: creams, suppositories (3-7 day course--OTC vs. Rx) Oral medications: fluconazole (Diflucan)  Review STI symptoms treatment Review contraceptions Terms of wellwoman care Questions?