Sexually Transmitted Infections

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

Leave a Comment