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- Chlamydia Trachomatis
biology and transmission
- obligate intracellular parasite
grows in columnar epithilium
most often sexually transmission
- Chlamydia Trachomatis
life span
- 6-14 incubation
can live indefinitely
- Chlamydia Trachomatis
clinical manifestations females
- 80% asymptomatic
dysuria
vaginal DC
nonspecific abdominal pain
dyspareunia
post-coital bleeding
cervicitis
uretrhitis
PID
Bartholin's cyst
Protocolitis
- Chlamydia Trachomatis
clinical manifestations males
- 25% asymptomatic
scant clear or cloudy DC
dysuria
urethral pruritis
urethritis
Epidymitis
Protocolitis
- Chlamydia Trachomatis
complications
- PID
Salgingits/Endometritis
Infertility
Ectopic pregnancy
Fitz-Hugh-Curtis Syndrome (perihepatitis associated with PID)
protocolitis (rectal pain)
Reiter's syndrome (urethritis, arthritis, conjunctivitis)
- Chlamydia Trachomatis in pregnancy
- ^risk of PROM and prematurity
^low birth weight
risk of pp endometritis
risk of infection in exposed infant (conjunctivitis or pneumonitis)
- Chlamydia Trachomatis
diagnositis testing
- Nucleic Acid Amplification testing
80-95% sensitivity >98% specificity
Tissue culture: >99% specifity, 50-85% sensitivity b/c inadequate specimin
gram stain for WBCs
- Chlamydia Trachomatis
treatment in NON PREGNANT WOMEN
first line
- Azithromycin 1gm POx1 or Doxycline 100mg PO BID x7days
- Chlamydia Trachomatis
treatment in PREGNANT WOMEN
first line
- Azithromycin 1gm POx1
Amoxicilin 500mg PO TIDx7days
- Chlamydia Trachomatis
Patient Education
- Acquisition, implications
safe sex,
no sexual intercourse for 7 days after both partners are treatment
- Chlamydia Trachomatis
follow up
- Test all sexual contacts within 60days or last partner if >60days
TOC not recommended except pregnant women (3-4 weeks)
TOC for pt's treated with erythromycin
ALL WOMEN need retesting in 3 months (b/c high reinfection rate)
- Gonorrhea "the Clap"
pathology
- Neisseria gonorrhea
gram negative intracellular diplococcus ("GNIC diplo")
- Gonorrhea
life cycle
- incubation 2-8 days
transmission by sexual contact
infection limited to mucosal surfaces-columnar epithilium
dervic, urethra, rectum pharynx, conjunctiva
- Gonorrhea
clinical manifestations
females
- cervicitis
urethritis
salpingitis/endmetriis
Bartholin's Gland cyst
Proctocolitis
Disseminated GC (associated with asymtomatic,infection of pharynx, urethra, or cervix)
- Gonorrhea in pregnancy
- controversial
may ^risk of PROM/prematurity
may ^risk of chorio
^of pp endometritis
- Gonorrhea diagnostic testing
- gram stain can be used for presumptive testing in males,
only for women if see intracellular diplo.
NAAT less sensitive in urine than cervical samples (women)
- Gonorrhea
treatment non-pregnant women and pregnant
first line
- ceftriazone 125 IMx1
cefixime,me 400mg POx1
cefpodoxime 400mg POx1
+presumptively treat for CT unless NAAT culture negative
- Gonorrhea
follow up
- treat all partners within 60days
no TOC of cure needed unless pregnant
re-test ALL WOMEN in 3 mo.
- Trichomonas
- pathogenic protozoan
flagellated parasite of GU tract
- Trichomonas
transmission and incubation
- usually sexually,
fomite transmission possible
incubation period 5-28days
- Trichomonas vaginalis
in Pregnancy
- ^PROM+premature delivery
exposed infants may develop vaginal d/c
- Trichomonas vaginalis
clinical manifestations
- malodorous DC
yellow, whitish yello, green FROTHY
urethritis,dysuria, frequency, urethral DC
vaginitis
may be asymptomatic
Strawberry cervix
- Trichomonas vaginalis
Diagnosis
- motile trichomonads on NaCl wetmount
+PMNs
KOH may have amine odor
pH elevated >4.5
culture-Diamond's medium
DNA probes
ADD: GC/CT/HIV/RPR
- Trichomonas vaginalis
Treatment
- Metronidazole 2gm PO x1 (ok pregnancy)
or Tinidazole 2gm PO x1
- Trichomonas vaginalis
Patient education
- no Etoh 24hrs after metronidazole or 72hrs after tinidazole
avoid sex until both partners complete treatment
- Herpes Simplex Virus
transmission
- humans are sole reservoir
readily inactivated by room temp and drying
transmitted via mucosal contact
incubation 1-45days, 4 day average
- Primary Herpes
Clinical manifestations
- systemic involvement (fever, HA, malaise, myalgia)
tender inginal lymphadenopathy;
viarlsehding during primary episode lasts 11-14days
- Non-primary first episode herpes
- initial outbreak in person with antibodies to either HSV1 or HSV2
-only way to distinguish a non-primary first oubreak is by seologic testing
- Recurrent Herpes outbreak
- usually 4x/year, then decrease
average 5-10 days,
viral shedding average 4 days
TRIGGERS: stress, menses, illness, trauma, sunlight, sexual activity (friction)
- Asymptomatic Herpes
- viral shedding 2-27% of time
is usually labia, not cervical
- HSV diagnostic testing
- tissue culture gold standard,
best samplef from intact vesicle within 48 hrs after symptoms (up to 40% falsely negative)
Additional: RPR and HIV
- HSV treatment goal
- decrease symptoms,
shoren duration of outbreak,
suppress recurrent outbreak,decrease asymptomatic shedding
Acyclovir 400mg TID 7-10days
- HSV suppression
- safe up to 6 years
offer if >or=6 outbreaks per year,
benefitis usually evident after 3-6mo
Acycolvir 400mg BID
reduces outbreaks 70-80%
- HSV suppression
- safe up to 6 years
offer if >or=6 outbreaks per year,
benefitis usually evident after 3-6mo
Acycolvir 400mg BID
reduces outbreaks 70-80%
