Sexually Transmitted Diseases (PDF)

Sexually Transmitted Infections (STIs) DR KELLI STEPHENSON, CNM, FNP Resources CDC STD Tx Guide, 2015 Free iOS and Android https://www.cdc.gov/std/tg 2015/default.htm  Most common: Gardnerella vaginalis vaginal fluid pH >4.5...

Sexually Transmitted Infections (STIs) DR KELLI STEPHENSON, CNM, FNP Resources CDC STD Tx Guide, 2015 Free iOS and Android https://www.cdc.gov/std/tg 2015/default.htm  Most common: Gardnerella vaginalis vaginal fluid pH >4.5 Smelly discharge Dx: gram stain -> gold standard Bacterial Clinical criteria (need at least 3): Vaginosis Thin white discharge Clue cells pH >4.5 Fishy odor with the “whiff test” Treatment for BV Chlamydia (C. trachomatis) Most common STI Highest Either permissible or potentially allowed in 49 states (South Carolina it is prohibited) Test of cure is not required unless other co-morbidities exist (like pregnancy, HIV) If possible, try and treat patient / partner together No sexual intercourse for 7 days HSV (Herpes Simplex Virus) Life long viral infection HSV-1 & HSV-2 HSV-2 = genital herpes HSV-1=oral herpes Many have no signs or symptoms while shedding virus Testing: PCR assays for HSV DNA IGG testing -> most often as part of an STI panel Primary HSV Treatment Suppressive Episodic treatment of HSV Counseling: Management of long term & chronic infection Recurrent episodes and asymptomatic viral shedding Discuss initial Tx as well as episodic vs suppressive therapy Male condom can REDUCE but not eliminate risk Focus on Coping -> may be highly anxious Preventing sexual and perinatal transmissions No sexual intercourse during prodromal/active lesions If pregnant, tell HCP May be too much at first visit -> may need to see them again HSV does NOT cause cancer  Systemics disease -> Treponema pallidum Divided into stages: Primary: ulcers or chancre at infection site Syphilis Secondary: skin rashes; swollen lymph nodes Tertiary: advanced disease Early latent: 1st year Late latent or unknown duration: after 1st year Dx Trep-pal test and RPR RPR reported in titer w/fourfold change (1:4 to1:16) Syphilis Treatment (primary, secondary, early latent) Benzathine penicillin G 2.4 million units IM in a single dose Treatment late latent Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1- week intervals Trichomoniasis (T. vaginalis) Usually no to very mild s/s Consider in any woman with Discharge HR behaviors Not standard in screening Dx Wet mount -> low sensitivity Gold standard – Affirm (checks for BV, yeast, trich) Trichomoniasis Treatment Genital Warts HPV Type 6 or 11 Noncancerous Dx: usually visual Treatment Usually resolves in a year PID (Pelvic Inflammatory Disease) Upper female genital tract Most common cause -> Chlamydia and Gonorrhea Increased risk of HIV Difficult to diagnosis Presumptively treat for PID CMT Uterine tenderness Adnexal tenderness Treatment for PID HPV Vaccine HIV Screen all ages 13-64 Part of STI panel Rapid test most common -> + is confirmed Referral References 2015 STD Treatment Guidelines. (2020). CDC. https://www.cdc.gov/std/tg2015/default.htm Hollier, A. D. (2018). CLINICAL GUIDELINES IN PRIMARY CARE (3rd ed.). Advanced Practice Education Associates, Inc. St. Cyr, S., Barbee, L., Workowski, K. A., Bachmann, L. H., Pham, C., Schlanger, K., Torrone, E., Weinstock, H., Kersh, E. N., & Thorpe, P. (2020). Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. MMWR. Morbidity and Mortality Weekly Report, 69(50), 1911–1916. https://doi.org/10.15585/mmwr.mm6950a6