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Sexually Transmitted Infection

Variety of clinical syndrome caused by pathogens that can be acquired and transmitted through sexual activity

chlamydia, gonorrhea

Most common infections are c_____ and g_______ and most are asymptomatic

PID, infertility, HIV

Some infections can lead to _ _ _ and i_________ along with infant morbidity and mortality along with increased _ _ _ transmission risk

15-24

At risk populations would be males ##-## years old
African Americans and Men who have Sex with Men

Men, Complication

Predisposing factors would be m___ having more incidence than women
C______ are more common in women than men
Teens and Those in their 20s have more occurrence along with # of sexual partners and unprotected sex

Treponema Pallidum

Causative organism:
Syphillis
______ p______

Neisseria Gonorrheae

Causative organism:
Gonorrhea

Chlamydia Trachomatis

Causative organism:
Chlamydia
C______ T____ (type L for lymphogranuloma)

Condylomata acuminata

Causative organism:
HUMAN PAPILLOMAVIRUS

Spirochete, thin, corkscrew, darkfield, VDRL

Syphillis
Causes by Treponema Pallidum
it is a Gram - s_______ with a t____ peptidoglycan layer. Has a characteristic c_____ type movement.
Can be detected by movement under d______ microscopy
Also detected via _ _ _ _ and RFR (treponemal tests)

Sexual, placenta

Syphyillis is HIGHLY CONTAGIOUS!
Transimtted through S_____ contact and passage through p_____
Kissing/Close Contact or Transfusion with contaminated blood

inact mucous, abraded, lymphatics, disseminates

Syphillis
T. Pallidum penetrates I____ mucous and gains access through a____ skin
Enters the L_____ and bloodstream
D______ throughout the body (involvement can occur through almost ANY organ)

Incubating, primary, secondary, latent, late tertiary

Stages of Syphillis Infection
I_______
P______
Se______
L_____
L___ T______ (stages CAN overlap)

Incubating, 3

Which Syphilis Stage?
Development of SPIROCHETAL LOAD
3-90 days, AVERAGE OF # weeks

Chancre, immunologic, painless, solitary, 2-8

DURING THE PRIMARY STAGE OF SYP:
C_____ --> primary lesion that develops at the site of inoculation/infection
I________-mediated s/sx
P_____/S____ lesion
Usually heal spontaneously in approximately #-# weeks
SOME may present with multiple lesions

Secondary, 2-8, nonpruritic, trunk, constitutional

DISSIMENINATED SYPH or S_______
Usually occurs about #-# weeks after the apperance of chancre
While immune system gains control the virus goes throughout the body widely (HIGH organism load)
Clinical manifestations commonly inclue the skin
N_-____ lesions (pink --> red lesions)
Usually begins on T____ and Extremeties
Often present with C______ symptoms (low grade fever, malaise, pharyngitis)

Early Latent, 4, 1

E____ L____ Syphillis is characterized by POSITIVE Ab test BUT NO clinical s(x)
Still infectious for about # YEARS
Recurrence bay occur, usually about # year

Late Latent

__ ____ Syphillis
Usually not at risk for re-infection or relapse, organism is still present

Late, 5-30, neurosyphilis, Cardiovascular, Gummatous, Leutic Osteitis

L___ Syphillis!
SLOWLY progressive, destructive, inflammatory disease. Fatality is about 30% if left untreated
Can produce illness anywhere in body #-## YEARS AFTER INFECTION
Fatal if it involves critical organs
N________
C_______
other such as G_______ (nonspecific gramulamoutous lesions) and L____ O____

Congenital Syphilis, secondary, tertiatry

______ ____
Infection of the fetus in utero. Can occur AT ANY stage of infection, most likely during EARLY syphillis
Can reslult in S_____ syphillis during the early 1st mo of life
Can result in T____ in adults if late adol
MOTHERs NEED TO BE SCREENED

BENZATHINE PENICILLIN G 2.4 MU, slowly, prolonged

SINGLE DOSE, IM
_____ P______ _ ## (units?)
FOR THE TREATMENT OF
PRIMARY AND SECONDARY SYPHILLIS!!!
T. Pallidum DIVIDES S____! NEED A P_____ Exposure!

Desensitize, Doxycycline 100 mg PO BID, 14

PRIMARY AND SEC. SYPHILLIS TREATMENT
D_______ if worried about adherence to PCN
D______ ### (strength) (route) (frequ) x ## days
is the alternative (preferred)

benzathine penicillin g 7.2, 3, 2.4, IM, 1

LATE Latent Syphillis
ADMINISTER
B______ P______ _ #.# MU admin as # DOSES (#.# MU EACH!) (route) at # WEEK INTERAVALS!!

Jarisch-Herxheimer, 1-2

Systemic reaction resembling sepsis AFTER IM administration administered
Begins #-# hours AFTER PCN administration

Fever, Tachydardia, Vasodilation, Hypoventiliation, Hypotension, 1-2, 12-24, ALLERGY, ASA, 24-48

JARISH-HERXHEIMER REACTION!
Systemic Reaction RESEMBLING SEPSIS!!
F____/Chills/HA and T______
V_____ WITH FLUSHING
H_________
MILD H_______
Begins #-# HOURS AFTER PCN admin
SELF LIMITING lasts about ##-## horus!!
THIS IS NOT AN A______!!!
PRETREAT WITH _ _ _ ##-## horus to PREVENT/Minimize

Negative, Diplococcus, Pilli, neutrophils

Neisseira Gonnorrhea is a gram ? D________ (Gonococci)
Has P___ that help in its Attachment to Mucosal Surfaces and help it RESIST KILLING BY N______

Epithelial, Endocytosis, Transport, replication, release, neutrophil, epithelium, pus

N. gonnorhea Pathophysiology!
1. Attachment of gonococci to the e_____ cell
2. E_______ and T_____ through epithelial cell and r______
3. R____ of the organism
AFTER epithelial invasion VIGOROUS N_____ response occurs
SLOUGHING OF E_______ --> Submucosal Microabscesses --> Exudation of P___

Gram Stain, Culture, NAAT

Gonorrhea Diagnosis
G___ S___ (GN diplococci with PMN)
Can do a C_____ even though NOT useful for Pharyngeal infections
Nucleic acid amplification tests _ _ _ _s

1-14, Asymptomatic, 2-8, Urethra, 10, Endocervical Canal

Gonorrhea. Incubation Period is #-## days
A_______ or minimally symptomatic
#-# Onset in the U____ (M A L E S)
## days ONSET in the E_______ C_____ (FE M A L E S)

Dysuria, polyuria, mucopurulent

Symptoms of Gonnorrhea in Males
D______
P_____ (urinary frequency)
M________ DISCHARGE!!
(Urethral Sx)

Dysuria, Urinary Frequency, Discharge, Bleeding

Gonorrhea
ENDOCERVIAL CANAL (FEMALES!)
D______
U____ F________
ABNORMAL VAGINAL D______
Uterine B_______!

Gonnorhea Epididymitis, prostatitis, Stricture

________ Complications
E______ (common)
Periurethral Abscesses
P_______
Urethral S______
DISSEMINATED infection (LESS common)
(MALES)

PID (Pelvic Inflammatory Disease), Perihepatitis, Disseminated

Gonorrhea Complications (WOMEN)
_ _ _
P__________is
D______ INFECTION (MORE COMMON)

Quinolones

DO NOT USE (this class of ABX) BECAUSE OF RESISTANCE for N. Gonorrhea

Ceftriaxone, 250, IM, 1, Azithromycin 1, Doxycycline, 100 mg BID, 7

There are increasing Cephalosporin Resistance in N. Gonnorrhea so be wary of dosing. DRUGS OF CHOICE:
C_______ ### mg (ROUTE) x# PLUS A______ # gram
OR
D_______ ### (strength) (frequency) for # days

intracellular, LPS, peptidoglycan

Chlamydia is an obligate i_____ pathogen that is like gram negatives in that it has a _ _ _ layer BUT it Lacks a P_____ layer

HIV, breaks, Lymphatic drainage, mononuclear phagocytes, granuloma, necrotic

Chlamydia
Transmission via anal, vaginal, oral. Increases risk of _ _ _ infection and b___ in skin --> organism gains entry.
Carried to regional LN via L_____ D____. Multiplies in M_____ P______ IN LN
Causes G____ FORMATION AND MICROABSCESSES THAT CAN BECOME N____ and Coalsece

Urethral, Mucoid, Watery

Chlamydia Presentation
50% are Asymptomatic
U______
MILD DYSURIA, Discharge
M____-W___ DISCHARGE (male and female)

Mucoid-watery, bleeding

Cervical Chlamydia
Abnormal Discharge
M____-W_____ and B______

Epididymitis, PID, ectopic, infertility

Chlamydia!
Males --> E_________
Females --> _ _ _
E_____ Pregnancy
Scarring BLOCKS fallopian tubes --> I____

Azithromycin 1 gram, Doxycycline, 100 mg, BID, 7

Chlamydia
A______ # G____ ONCE is the Treatment of Choice
D_____ ### (strength) is the alternative (Frequency) for # days

HSV-2

Infected secretions onto mucosal surfaces or abraded skin
Genital Herpes is mostly caused by ___-# (close contact)

vesicular, ulcerative, 2, 2-4

Genital Herpes
Classic, Painful multiple v_____ and U_____ lesions
Appear within # weeks of infection and heal within #-# weeks
May be ABSENT and recurrences and clinical shedding may occur

Valacyclovir 1, gram, PO, BID, 7-10, Acyclovir, 400, TID, 7-10

V_______ # g____ (route) (frequency) for #-## days or A_____ ### mg (Frequency) for #-## days for
INITIAL OUTBREAK (first episode)

1, Valacyclovir, 1 gram, Daily, 5, Acyclovir, 400, TID, 5

Start within # day of HSV-Prorome
V______ # (strength) PO D_____ for # days OR
A_____ ### (strength) (frequency) for # days

400, BID, Valacyclovir, 1 gram

SUPPRESIVE GH THERAPY
Acyclovir ### mg (frequency)
V______ # g___ daily

Human Papilloma Virus

MOST COMMON VIRAL STI
____ ____ _______
over 100 types identified (transmitted via skin to skin contact with infected person)

1-3, 1-2, Imiquimod, 6, 11, 16, 18

HPV --> Genital Warts (cauliflower)
#-# months following infection with a spontaneous resolution in #-# years
Patient appled I_____ 5% cream can be used
Vaccines protect from HR subtypes
Gardasil HPV #, ## (NONONCOGENIC)
Cervarix and Gardasil against HPV ##, ## (ONCOGENIC)

Abstinence, Vaccination, Condoms, Spermacide, Circumcision

PREVENTION AND SELF CARE
A_______ or long term monogamous relationship
Pre-Exposure V_____ (HPV, HBV, HAV, HBV)
Co_____, S_______, and Cir________

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