Notifiable STIs: gonorrhea, chlamydia, syphilis, neonatal herpes, mucopurulent cervicitis, NGU
CHLAMYDIA
Female Sx: cervicitis, urethritis, dysuria, bartholinitis, endometritis (causes abnormal vaginal bleeding), salpingitis, perhepatitis (Fitz-Hugh-Curtis syndrome)
Male Sx: urethritis (causes white/clear urethral d/c with dysuria), epididymitis (unilateral scrotal pain with fever), proctitis (rectal pain/bleeding, mucous d/c, diarrhea), Reiter’s syndrome
Dx: cell culture (gold stnd), molecular dx tests
Female complications: PID, chronic pelvic pain, infertility, ectopic, Reiter’s
Male complications: epididymo-orchitis, Reiter’s, infertility (rare)
Perinatal complications: low birth wt, postpartum endometritis, UTI, preterm labour, inclusion conjunctivitis, nasopharyngeal infection, pneumonia
Rx: Azithromycin 2g po x 1 dose or Doxycycline 100 mg po bid x 7 days
If pregnant, use Amoxicillin or Azithromycin/ Erythromycin
GONORRHEA
Female Sx: cervicitis, PID, bartholinitis, perhepatitis
Male Sx: epididymitis
Female/Male Sx: urethritis, pharyngitis, conjunctivitis, proctitis, disseminated gonococcal infection (skin lesions, arthritis, +/- tenosynovitis; endocarditis/meningitis)
Rx: Cipro 500 mg po x 1 dose or cefixime 400 mg po x 1 dose
If pregnant, use 3rd generation cephalosporin (e.g. cefixime)
GENITAL WARTS
- most common viral STD
- 6/11 cause external warts
- 16/ 18 cause cervical, vulvar, anorectal & penile CAs
- clinical dx (examination & aceto-whitening)
- transmission decreased but not eliminated by condoms
- NO CURE; pts usually eradicate virus themselves
- bx all suspicious lesions (cancer risk)
Rx:
- Patient administered
- Imiquimod (Aldara) cream
- Podofilox 0.5% solution
- Physician administered
- Podophyllin 10%
- cryotherapy, electrodessication, electrocautery, laser
- surgery
– try to minimize # of lesions present at delivery
HERPES
- asymptomatic shedding most common mode of transmission
- 20% incidence, but 60-90% are asymp.
Primary manifestations: vesicles with superficial ulcers, painful inguinal lymphadenopathy, +/- urinary Sx; systemic Sx may be present (fever, HA, malaise)
Incubation 2 – 21 days; heals in 7 – 10 days
Recurrent: Sx localized to genitals, usually unilateral, less severe, shorter duration, 90% have prodrome (tingling, pain)
Dx: culture and/or direct Ag testing
Need to deroof vesicle & rotate swab firmly @ base of lesion
Rx: if pt has prodrome, consider episodic Rx
if > 6 episodes/yr, give suppressive Rx
use oral acyclovir, famciclovir, or valacyclovir
abstinence while lesions present
SYPHILIS
Sexual or congenital transmission
Primary Sx: painless indurated papules undergo necrosis to become ulcerated lesion
(chancre)
infectious
inguinal lymphadenopathy
heals spontaneously in 3-6 wks
Secondary Sx: disseminated
fever, malaise, HA, generalized lymphadenopathy, rash, mucus
occurs within 6 mo. of primary lesions
lasts weeks to months
infectious
latent stage: asymptomatic with +’ve serology
Tertiary Sx: neurosyphilis (dementia, gait, etc), cardiovascular, gumma
Dx: hx, clinical, dark field microscopy, fluorescent Ab test, serology
Rx: penicillin im (primary/secondary/latent/CV)
penicillin iv (CNS)
doxycycline/ ceftriaxone if allergic to penicillin