Transcript Sexually transmitted infections

Nadine M McGraw PA-C MHS
 Chancroid
 Lymphogranuloma
 Herpes
 Syphilis
 HPV
 Gonorrhea
 Chlamydia
 Pubic
lice
 HIV
 Hepatitis
 Trichomoniasis
venereum
 An
STD characterized by painful genital
ulcerations and inflammatory inguinal
adenopathy
 Haemophilus ducreyi is causative organism.
 It is uncommon in the United States but
found worldwide, endemic in developing
countries
 What is the difference between a chancre
and chancroid?
CHANCROID
Incidence/Preval
ence in USA: 28
cases reported in
2009. Actual
numbers felt to be
greater due to
underreporting of
cases and
difficulty with
diagnosis.
Predominant age:
Teenagers and
adults
Predominant sex:
Male > Female
Signs and Symptoms
•Tender genital papule that ulcerates
after 24 hours (little round lumps)
•Irregular edged, painful ulcer(s)
Ulcers may be 1 mm to 5 cm in size
•Ulcers may occur on the shaft of the
penis, glans and meatus in men
•Ulcers in women most commonly occur
in labia majora but also seen in labia
minora, perineum, thigh, and cervix
•Painful inguinal adenopathy with abscess
formation in 30% of patients
•Atypical presentations include folliculitis
and foreskin abscess

Not quite a diagnosis of exclusion,
however no PCR test is available
and you must culture H. ducrey on
special media usually not readily
available. Therefore, you rule out
other ulcerations including herpes
and syphilis first.

“A probable diagnosis of chancroid,
for both clinical and surveillance
purposes, can be made if all of the
following criteria are met: 1) the
patient has one or more painful
genital ulcers; 2) the patient has
no evidence of T. pallidum
infection by darkfield examination
of ulcer exudate or by a serologic
test for syphilis performed at least
7 days after onset of ulcers; 3) the
clinical presentation, appearance
of genital ulcers and, if present,
regional lymphadenopathy are
typical for chancroid; and 4) a test
for HSV performed on the ulcer
exudate is negative.” from the CDC
Recommended Regimens
 Azithromycin 1 g orally in a single dose
 OR
 Ceftriaxone 250 mg intramuscularly (IM) in a
single dose
 OR
 Ciprofloxacin* 500 mg orally twice a day for 3
days*
 OR
 Erythromycin base 500 mg orally three times a
day for 7 days
 * Ciprofloxacin is contraindicated for pregnant
and lactating women.
 Rare,
systemic STD
caused by the 3 most
virulent strains of
Chlamydia! (L1, L2, L3)
 Usually a disease of the
tropics
 Tender unilateral node inguinal
 3 stages - primary,
secondary & tertiary
Groove sign Poupart’s ligament

Primary: Superficial lesions such as papules,
vesicles, ulcers or erosions appear on the
external genitalia 3 days to 3 weeks after
exposure. Lesions are painless and disappear in
a few days leaving no scar.

Secondary: fever, chills, regional
lymphadenopathy-week to months after primary,
buboes begin as a mass of firm, tender, enlarged
nodes. Buboes usually unilateral and involve
overlying skin with erythema and adhesions.

Tertiary: anogenital stage, proctitis, perirectal
abscesses
 Culture
pus
from buboes,
check for
chlamydia
 Treat with doxy
or emycin
 Viral
infection
 HSV I and HSV II what is the difference?
Exposure to virus
Subclinical
   

Primary Infection

Systemic

Oral/Genital – Cutaneous – Genital

Latency

Recurrent Infections
 Initial
infection will have
lymphadenopathy, fever,
maliase then outbreak
 Painful ulcerations or vessicles
erupt
 Usually a “tingling” or burning
feeling prior to outbreak
 Females may present with
burning with urination and
“UTI” symptoms
 Serologic

IGM and IGG
 Viral

testing for HSV I and II
culture of ulceration for typing as well
Must be kept on ice and to lab ASAP
 With
viral treatment, remember topical
treatments to prevent secondary infections

Initial outbreak

Valtrex (valacyclovir)



acyclovir


400 mg po TID X 7-10 days
Recurrence

Valtrex



500 mg po q 12 X 3 days
Begin within 24 hrs of onset
acyclovir


1000 mg PO q 12 X 7-10 days
Begin within 48 to 72 hrs of onset
400 mg poi TID X 5
Suppression

Valtrex


1000 mg po qd, or 500 mg po qd if less than 5/year
acyclovir

400 mg po BID
Bacteria: Neisseria gonorrhoeae
 Often asymptomatic as well, screen at paps, if
symptoms discharge, dysuria
 Diagnosed with cervical culture, urethral swab or
urine culture
 Treatment: ??? Cephalosporins or quinolones
 SUPERGONORRHEA

The new MRSA/VRE
 http://abcnews.go.com/Health/Wellness/supergonorrhea-scientists-discover-antibiotic-resistantstd/story?id=14027745


Requires test of cure!
 MOST
FREQUENTLY REPORTED STI IN US!
 Bacteria: Chlamydia trachomatis
 Many times asymptomatic, screen at paps for
high risk women. If symptoms: discharge,
dysuria, lymphadenopathy.
 PID is major complication of Chlamydia
 Diagnosed by cervical culture, urethral swab
or urine culture
 Treatment azithromycin or doxy
 Need a test of cure!
 Management



Issues
Systemic virus- high incidence
of recurrence
Laser Rx can aeroslize viral
particles and place OR
personnel at risk
Local Rx




TCA
Podophyline
Cautery
N2O
 Bacterial
infection caused by Treponema
pallidum with 4 stages
 Primary: painless ulcer or chancre
 Secondary: skin rash, mucocutaneous lesions,
and lymphadenopathy), neurologic infection
(i.e., cranial nerve dysfunction, meningitis,
stroke, acute or chronic altered mental
status, loss of vibration sense, and auditory
or ophthalmic abnormalities)
 Latent
 Tertiary: neurosyphilis cardiac or gummatous
lesions
A presumptive diagnosis of syphilis is possible
with the use of two types of serologic tests: 1)
nontreponemal tests (e.g., Venereal Disease
Research Laboratory [VDRL] and RPR) and 2)
treponemal tests (e.g., fluorescent treponemal
antibody absorbed [FTA-ABS] tests, the T.
pallidum passive particle agglutination [TP-PA]
assay, various EIAs, and chemiluminescence
immunoassays).
 Darkfield testing for T. pallidum
 If you order the RPR and it is positive, the lab
will typically do the VDRL
 Penicillin is drug of choice, azithromycin may be
used

 If
anyone is positive for one STI look for all
others!
 PREVENTION PREVENTION PREVENTION!
 http://www.cdc.gov/std/treatment/2010/ge
nital-ulcers.htm#chancroid