Sexually Transmitted Infections (STIs)
are infections transmitted primarily by sexual contact Young adults (aged 20-24) are the highest risk group for STIs. These Infections may be transmitted through oral, vaginal, or anal sexual activity or through drug use. Many go untreated due to a lack of screening or unable to recognize signs & symptoms of infections.
Common Viral Diseases
HIV/AIDS Hepatitis Genital Herpes (HSV)Human Papilloma Virus (HPV)
Common Bacterial and Other Diseases
ChlamydiaGonorrheaSyphilisTrichomoniasis (protozoa)
Not an STI
Group B Streptococcus (Concern during Pregnancy)
Chlamydia
Most frequently reported STI, Infections often silent and highly destructive, can be difficult to diagnose. This is a reportable communicable disease.Symptoms: May be asymptomatic; women may have vaginal discharge, burning, itching in the vagina & painful urination. Men: clear thick discharge, painful urination
Chlamydia screening and diagnosis
Screening: Screen asymptomatic and pregnant women, as it may lead to infertility and neonatal infectionDiagnostic procedures: culture or antibody test
Chlamydia treatment
doxycycline or Azithromycin, all exposed sexual partners must be treated.
Gonorrhea
Caused by Neisseria gonorrhea, transmitted by sexual contact, one of the oldest communicable diseases. This is a reportable communicable disease.Symptoms: Women are often asymptomatic. Or may have greenish-yellow discharge, also may have menses that are longer or more painful than usual.Can lead to PID, infertility, ectopic pregnancy
gonorrhea screening and diagnosis
Screening: All pregnant women screened at first prenatal visit.Diagnosis: culture (endocervix, rectum or pharynx when indicated).
Gonorrhea treatment
Treat with antibiotics: Ceftriaxone recommended, however drug-resistant strains are on the rise. Treat patient and partners.
Syphilis
Caused by Treponema pallidum. Transmitted through sexual intercourse, kissing, biting or maternal-fetal. This is a reportable communicable disease. This is a systemic disease that can lead to death. Infection manifests itself in distinct stages -- Primary: 5 to 90 days; Secondary: 6 weeks to 6 months; and if left untreated tertiary syphilis that leads to death.Symptoms: Primary - primary lesion (chancre) appears. Secondary - Widespread lesions, lesions on palms and soles of feed and generalized lymphadenopathy. May also see fever, headache, and malaise.
Syphilis Screening and Diagnosis
Screening: All women diagnosed with another STI, All pregnant women (multiple screenings) Diagnosis: False negatives are common in early stages (prior to seroconversion). Antibody test is done and repeated in suspected infection 1-2 months later.
Syphilis treatment
Penicillin G is preferred drug for all stages. Monthly follow-up. Abstinence during treatment.
Trichomoniasis (Protozoa)
Caused by Trichomonas vaginalis (protozoa). A common cause of vaginal infections.Symptoms: Can be asymptomatic, but vaginal discharge, inflammation & dysuria may be present.
Trichomoniasis (Protozoa) Diagnosis
Speculum exam and wet smear test (like a PAP)
Trichomoniasis (Protozoa) Treatment
Metronidazole or tinidazole orally in a single dose, also treat partner(s)
Pelvic Inflammatory Disease
Results from ascending spread of microorganisms from vagina and endocervix to the upper genital tract. Caused by multiple organisms (bacterial). Most commonly involves Uterine tubes (salpingitis) and Uterus (endometriosis).Symptoms: Abdominal tenderness, cervical motion tenderness, fever, abnormal cervical or vaginal discharge, documentation of cervical infection with gonorrhea or trachomatis.
pelvic inflammatory disease (PID) diagnosis
Diagnosis: Hard to diagnose, based on presenting symptoms and lab values.
pelvic inflammatory disease (PID) treatment
Education, treat infectious organism, bedrest, pain management.***At increased risk for ectopic pregnancy, infertility, chronic pelvic pain.
Group B Streptococcus (GBS)
Pregnancy ConcernMay be considered normal vaginal flora in a non-pregnant woman. Present in 9% - 23% of healthy pregnant women. Associated with poor pregnancy outcomes.
Group B Streptococcus (GBS) screening and diagnosis
Screening: Screen all women at 35 to 37 weeks of gestation to decrease risks associated with transmission during labor.Diagnosis: recto-vaginal culture
Group B Streptococcus (GBS) treatment
Women who test positive are given antibiotics during labor to reduce the risk of fetal transmission.
Human Papillomavirus (HPV)
Also known as genital warts. Most common Viral STI seen in ambulatory health care settings. Approximately 100 types, with several types causing cervical, vaginal, vulvar, penile and oropharyngeal cancers. Two vaccines available for prevention, both approved for girls and boys starting at age 9 through 26. However, recently the vaccine was approved for adults age 27 through 45 years who are not already vaccinated. Whether or not to vaccinate after age 26 is a decision that is best made after speaking with a health care provider about the risks of HPV infection and the benefits of getting the vaccine.The CDC recommends the vaccine be administered to both boys and girls at the ages of 11-12.
Human Papillomavirus (HPV) Symptoms
Symptoms: Small soft papillary swellings (warts), irritating vaginal discharge with itching, dyspareunia, postcoital bleeding.
Human Papillomavirus (HPV) Screening and Diagnosis
Screening: Pap test, visual inspection of affected areas.Diagnosis: Histological examination of a biopsy specimen. Typically performed with the presence of "bumps" or a positive Pap.
Human Papillomavirus (HPV) Treatment
No therapy has been shown to eradicate. Removal of warts and relief of symptoms is typically the goals of treatment for HPV. Education on preventing spread to partners (Condoms/barrier methods).
Hepatitis B
Caused by the Hepatitis B virus. There are multiple strains of the virus (A, C, etc). Affects the Liver, often a silent infection. Spread through sexual contact, contaminated blood or maternal-fetal transmission.Prevention: Hep. B VaccineSymptoms: Most do not experience any symptoms. Some people have an acute illness with symptoms that last several weeks, including jaundice, dark urine, extreme fatigue, nausea, vomiting and abdominal pain. Ultimately some develop cirrhosis or cancer.
Hepatitis B Screening and Diagnosis
Screening: Those considered at risk & all pregnant women on the first prenatal visit.Diagnosis: Hepatitis B Antibody test
Hepatitis B Treatment
No specific treatment for acute, chronic infections may be treated with medications, however no cure. Liver transplant if liver failure develops.
Herpes Simplex Virus (HSV)
Two subtypes of HSV: HSV type 1 (HSV-1) and HSV type 2 (HSV-2). HSV-2 is usually transmitted sexually, and HSV-1 nonsexually. Chronic and recurring with no cure.Symptoms: Initial infection -- multiple painful lesions, fever, chills, malaise, and severe dysuria and may last 2 to 3 weeks. Women generally have a more severe clinical course than do men.
Herpes Simplex Virus (HSV) Screening and Diagnosis
Screening: Done with suspected infection.Diagnosis: Viral cuture from suspected lesions.
Herpes Simplex Virus (HSV) Treatment
Acyclovir for first diagnosis or outbreak. Treats symptoms only, not virus - no cure. Can be prescribed during pregnancy.
Human Immunodeficiency Virus (HIV)
Transmitted by exchange of body fluids -- sexual intercourse, shared needles, infected blood (maternal-fetal transmission). HIV causes severe depression of cellular immune system that characterizes AIDSSymptoms: Seroconversion occurs within 6-12 weeks. Individual may be asymptotic or have flu-like symptoms (fever, H/A, night sweats, N/V, sore throat, fatigue).
Human Immunodeficiency Virus (HIV) Screening and Diagnosis
Screening: CDC recommends screening all pregnant women. Screen individuals engaging in at-risk behaviors (needle sharing, unprotected sex, multiple partners).Diagnosis: HIV infection is usually diagnosed by using HIV-1 and HIV-2 antibody tests. There are currently 6 FDA approved rapid screening tests. See page 81.
Human Immunodeficiency Virus (HIV) Treatment
No cure, but supportive & preventative care prolong life expectancy. Treatment with antiviral medications (example: Retrovir).