STI"s II
Terms
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- Syphilis
-
Treponema Pallidum, motile spirochete
(replicates q30min)
enters through breaks in skin or mucous membranes - Syphilis risk of acquisition of syphilis
- from an infected 30-60%
-
Syphilis
stage -
Primary
Secondary
Latent-early
late
Tertiary - Primary Syphilis
- first sign occurs 10-90days after exposure (average 21 days)
- Secondary Syphilis
- begins 3wks to 6mo after primary inoculation
-
Primary Syphilis
clinical manifestations -
painless papule appears at site of inoculation
incase to 0.5-1.5cm and ulcerates into a chancre (indurated and firm), no exudate seen -
Secondary Syphilis
clinical manifestations -
system involvement-
flulike symptoms
highly variable rash
generalized lymphadenopaty,
Condyloma lata lesions - Condyloma lata
-
large rasised whitish or gray lesions,
commonly seen in are adjacent to primary chancre,
loaded with spirochetes - Early latent syphilis
-
less than 1 yr duration,
usually asymptomatic
potentially infectious for 4 yrs
need documented seroconversion or hs or unequivocal signs of primary or secondary syphilis - Late latent syphilis
- greater than 1 yr duration, or duration unknown; if asymptomatic and lesion-free, not infections
- Tertiary syphilis
-
15-30yrs after initial infection,
neurosyphilis, gumma formation, cardiovascular diseease, - Gumma formation
-
in syphilis: subcuatenous process of chronic and progressive inflammation.
granulomatous lesion, most commonly involves skin and bones - Non-treponemal test
-
VDRL or RPR
eg. four-fold change in titer to a change of two doubling dilutions 1:8 to 1:32
*primary s. have high viral loads 1:256 reactic serofast reaction - False negative non-treponal tests
-
HIV
pregancy
leprosy, malaria,lupus, vaccines,pregnancy, narcotic addiction - False positive
- occur 1-2%, provider needs to prove patient doesn't have syphilis
- Treponemal tests
-
FTA-ABS 90-95% sensitive
and MHA-TP 80-85% sensitive
tests indicate present or past infection - When to screen for syphilis
-
Suspicious lesion,
suspicious rash, pregnant women, presence of other STI, risk factors for syphilis -
Syphilis, Primary&Secondary
Treatment -
Benzathine PCN G 2.4 millin units IM in single dose;
mayse use doxyciline for 14 days in non-pregnant PCN sensitive patients -
Syphilis, Latent
Treatment -
early latent: Benzathine PCN G 2.4 million units IM x1;
late latent: Benzathine PCN G 2.4 million units IM 1/week x3weeks - Syphilis-treat presumptively?
- presumptively treat if exposed within 90 days, even is serologic testing is neg.
-
Syphilis
Patient Education - avoid safe until both pt and partner have completed treatment; HIV testing; follow-up
- Jarisch-Herxheimer Reaction
-
can occur after treatment of syphilis;
occurse several hrs after treatment
symptoms last 24-48hrs: fever,malaise, HA, myalgia, nausea, tachycardia, chancre may swell or develop sympotoms of disease for first time
cause: rapid relase of treponemal antigens
(endotoxin reaction)
TREAT w/ ASPIRIN -
Syphilis
follow-up -
clinical and serologic testing at 3 and 6 mo.
need to see 4fold decrease at 6 mo.-
if not HIV test/CSF test +retreat - Neurosyphilis
-
repeat CSF examination q6mo until titer is normal
if not decreased by 6mo. or nl at 2 years--retreat - Syphilis and HIV disease
-
repeat nontreponemal testing at 1,2,3, 6, 9 and 12 mo.
CSF eval 6mo after treatment or if you don't see 4-fold decrease by 3 months - Congenital syphilis
-
most infants borth to women with primary or secondary syphilis;
manifest 10-14 days after birth, rash copious nasal DC, -
HPV
biology - small slowly growing double DNA virus can infect epithilial surface and mucous membranes,
- HPV "high risk types"
-
contain genome sequence with oncogenic activity
(16 and 18) - Can HPV vaccine be give with an abornmal PAP?
- YES
- Can HPV vaccine be give with visible warts?
- YES
- Can HPV vaccine be give with breastfeeding?
- YES
- Can HPV vaccine be given in pregnancy?
- Not recommended
- HPV vaccine dosing
-
3 doses
2nd dose 2 months after 1st,
3rd dose 6 months afer 1st - What strains of HPV does Gardisil prevent?
- HPV 6, 11,16, and 18
- What ages is HPV vaccine recommended for?
- 9-26yrs
- Treatment options for HPV
-
cryotherapy, laser therapy, surgery,
Podofilix (self-treatment),
Imiquimod (cream self-treatment)
Tricholoracetic acid (TCA only treatment available for pregnancy) - Treatment options for HPV in pregnancy
-
Tricholoracetic acid (TCA only treatment available for pregnancy)
Note: never podophyllin or 5FU