Description
1. Week 2: Case Scenario 2
Table 1
Infection
Description
Presentation
Causes/ Risk Factors
Treatment per CDC
Addtl info
Candida
An overgrowth of budding yeast (Epocrates, 2024).
Presents with itching, thick white curd like discharge, vulvar erythema, and dysuria (Epocrates, 2024).
Candida most often occurs with increased estrogen levels caused by antibiotic use, glucocorticoids, DM, IUD’s and/or an immunicompromised status, such as HIV (Epocrates, 2024).
Fluconazole 150 mg PO single dose (CDC, 2024).
May weaken latex condoms and diapragms (CDC, 2024).
BV
Most common cause of abnormal vaginal discharge in women of reproductive age (Epocrates, 2024).
Presents with an abnormal milky vaginal discharge with fishy odor (Epocrates, 2024).
BV is caused by gram negative lactobacillus that alter vaginal pH >4.5 (Epocrates, 2024).
Metronidazole 500 mg PO BID for 7 days (CDC, 2024).
Patients should be advised to refrain from sexual activity or use condoms during BV treatment (CDC, 2024).
Chlamydia
Chlamydia is the most common STI in males and females (Epocrates, 2024).
Chlamydia presents with dysuria, dyspurenia, and inflammation of the genitals (Epocrates, 2024).
Chlamydia is caused by a small gram negative bacterium spread through sexual contact (Epocrates, 2024).
Doxycycline 100 mg orally BID for 7 days (CDC, 2024).
Patients under treatment for Chlamydia should tested for HIV, gonorrhea and syphilis and be advised to abstain from sex for 7 days after single dose or 7 day treatment regimen. Their sexual partners should also undergo treatment simultaneously to prevent reinfection. Untreated chlamydia may result in PID and infertility in females (CDC, 2024).
Gonorrhea
The second most common communicable disease among sexually active persons (Epocrates, 2024).
Genital symptoms usually present within 10 days. Symptoms include vaginal pruritus and mucropurulent discharge. Abdominal pain may be present and the cervix may be friable (Epocrates, 2024).
Gonorrhea is caused by the gram-negative coccus Neisseria gonorrhoeae spread through sexual contact (Epocrates, 2024).
Ceftriaxone 500 mg IM injection in a single dose for persons weighing less 150 kg. For patients more than 150 kg 1 gram is administered (CDC, 2024).
Patients should be instructed to abstain from sexual activity for 7 days after treatment and until all partners receive treatment and also abstain from sex for 7 days (CDC, 2024).
Trichomonas
Trichomonas is a common non-viral STI that causes a genitourinary infection (Epocrates, 2024).
Trichomonas causes purulent, malodorous thin vagin al discharge, pyuria, frequency, dyspareunia and lower abdominal pain (Epocrates, 2024).
Trichomonas is caused by a protozoan and spread through sexual contact (Epocrates, 2024).
Recommended treatment of women: women Metronidazole 500 mg PO BID for 7 days.
For men: Metridazinole 2 g PO in a single dose (CDC, 2024).
NAAT testing is preferred and highly sensitive for testing. Wet mounts are the second choice for diagnosing thrichomonas (CDC, 2024).
Cervicitis
Inflammation of the cervix affecting columnar epithelial cells of the endocervical glands and the squamous cells of the ectocervix at times (Epocrates, 2024).
Friability of the cervix with purulent or mucopurulent discharge which may cause postcoital bleeding and abnormal vaginal discharge (Epocrates, 2024).
Cervicitis is often caused by STIs, but can also be caused by mechanical or chemical irritation (Epocrates, 2024).
Cervicitis is presumptively treated similar to a chlamydial infection with Doxycycline 100 mg PO BID for 7 days (CDC, 2024).
Screening and treatment for gonorrhea is recommended if the patient lives in a community where the prevalence is high (CDC, 2024).
PID
Inflammation of the uterus, fallopian tubes and ovaries caused by STIs that can result in infertility (Epocrates, 2024).
Lower abdominal pain and cervical motion tenderness (Epocrates, 2024).
PID is caused by STI’s that go untreated (Epocrates 2024).
Recommended Oral Regimen:
Ceftriaxone 500 mg IM in a single dose, Doxycycline 100 mg PO BID for 14 days, and Metronidazole 500 mg PO BID for 14 days (CDC, 2024).
Abstain from intercourse until all medications are complete and sexual partners have also completed treatment. All women with PID should be screened for gonorrhea, chlamydia, HIV and syphilis (CDC, 2024).
HIV
Human viral infection that attacks CD-4 cells (Epocrates, 2024).
Symptoms include fever, sore throat, lymphadenopathy, myalgia, headache and painful cutaneous ulcerated lesions (Epocrates, 2024).
HIV is spread through sexual contact, exposure to blood or perinatal transmission (Epocrates, 2024).
Anteretroviral therapy ART and viral suppression is indicated for patients who do have low ASCVD risk.
Dolutegravir 50 mg PO once daily and tenofovir 10 or 25 mg PO twice daily (CDC, 2024).
Adverse side effects include headache, malaise, anorexia, nausea, lactic acidosis and loss if limb fat (UpToDate, 2024).
Syphilis
STI that may cause cardiovascular and neurologic complications if left untreated (Epocrates, 2024).
Symptoms include a primary infectious chancre (Epocrates, 2024).
Syphilis is caused by T. Pallidum and can be spread by kissing, or touching an active lesion (Epocrates, 2024).
Treatment depends on the stage of syphilis. The standard therapy for primary, secondary and early latent syphilis is treated with a single dose of Penicillin G Benathine 2.4 million units IM injection (CDC, 2024).
Alternative regimens with doxycycline and tetracycline are available for patients with an allergy to penicillin (CDC, 2024).
Hep B
Double stranded DNA virus HBsAg (Epocrates, 2024).
70% of patients with acute Hepatitis B have subclinical hepatitis while 30% develop icteric hepatitis causing liver disease (UpToDate, 2024).
Hepatitis B is spread through sexual contact, sharing needles or perinatal transmission (Epocrates, 2024).
Treatment is supportive to suppress HBV and remission of liver disease. There is no specific regimen for therapy (CDC, 2024).
The presence of HBc alone may indicate an acute, resolved or chronic infection. The presence of IgM and anti-Hbc is indicative of a new infection (CDC, 2024).
Hep C
Hepatitis C or HCV virus can result in hepatic failure if left untreated (Epocrates, 2024).
Fatigue is a common symptom of HCV (Epocrates, 2024).
Hepatitis C is spread through sexual contact, sharing needles or perinatal transmission (Epocrates, 2024).
Hepatitis C is curable and their are specific guidelines and treatment parameters based on the individual patient. Testing for the Y93H-NSSA resistance guides treatment. Sofosbuvir-velpatasir is one tretament (CDC, 2024).
Patients with HCV should be vaccinated against Hep A and B. The antibody to HCV remains positive after resolving (CDC, 2024).
HSV
HSV I-Oral
HSV II- Gential hepres is a common sexually transmitted disease (Epocrates, 2024).
Painful ulcerated blisters that form crusts or scabs in the oral (HSV I) or genital (HSV II) regions (Epocrates, 2024).
HSV is cause by the herpes simplex virus and it can be latent or active infection that recurs (Epocrates, 2024).
HSV initial treatment is Acyclovir 400 mg PO TID for 7-10 days.
Episodic therapy is Acyclovir 800 mg PO BID for 5 days (CDC, 2024).
Helping patients cope with the diagnosis and educatin on the prevention of spreading to their sexual partners is essential (CDC, 2024).
Table 2
Question
Answer
Name 10 Risk Factors for contracting STI’s and HIV
History of multiple sexual partners
History of IV, methamphetamine or crack/cocaine drug use.
History of sex with HIV positive person.
History of sex with an IV drug user.
History of blood transfusions.
History of Intimate partner violence.
History of tattoos or body piercings.
Engaging in unprotected sex.
Exchanging in sex for money.
Women are more likely to be infected with HIV by male partners (Alexander, 2023).
Name 5 safer sex practices
STI testing before engaging in sex with a new partner.
Using male or female condoms during intercourse.
Abstaining from using drugs or alcohol.
Reporting Intimate partner violence.
Getting screened for STIs regularly (Alexander, 2023)
Can HIV be transmitted through sweat, saliva, and tears? (Include rationale)
No, HIV is only spread through sexual fluids and blood (Alexander, 2023)
Name 2 types of intercourse are at the highest risk for contracting HIV
Anal or vaginal sex are the two types of intercourse that post the highest risk for HIV transmission (Alexander, 2023)
Why are women more susceptible to HIV in a male to female relationship (versus a male contracting it from a female)?
Women are twelve times more likely to contract HIV form a male sexual partner due to their physiological vulnerability to being exposed to sexual fluids and blood in the vagina (Alexander, 2023 )
Tina is a 27-year-old female who presents to the clinic complaining of a painful burning sensation in her left labial area for 3 days. She reports recently having unprotected vaginal intercourse with a new male partner. Upon examination, you note fluid-filled vesicles on the left labia minora that are painful to touch.
Chief Complaint: The patient is a 27-year-old female complaining of a “painful burning sensation in her left labial area for three days”.
History of Present Illness: (G0P0AL0) No remarkable previous medical history. The patient reports having unprotected sex with a new male partner. The Onset of the painful lesions was three days ago. The location is on the left labia. The character of pain is “burning”. Aggravating factors are “tight clothing” and “wiping after urination”. Relieving factors are a “cool compress”. Timing is “three days ago”. Severity is “7/10”.
OB/GYN History: (G0P0AL0) LMP 2/29/2024. The last PAP was on 6/2020 with normal results. Mammogram N/A.
Sexual History: The patient is heterosexual and identifies as a female. She has no previous history of STIs. The patient uses Depo-Provera injections as her contraceptive.
PMH: No past medical history.
PSH: The patient had wisdom teeth removed in 2020.
Immunization Status: The patient is up to date with all of her MMR, Hep B, Varicella, COVID-19, HPV, Influenza, and TDAP vaccinations with no history of any reactions.
Medications: DepoProvera 150 mg IM injection every 13 weeks. Next Injection Due 5/5/24.
Allergies: NKDA
Family History: Father has hypertension. Mother is alive without medical conditions. No family history of breast, uterine, cervical, or ovarian cancer.
Social History: The patient occasionally drinks alcohol “2-3 drinks socially”. No history of tobacco or drug use. The patient does not plan to become pregnant in the next year.
ROS
General/Constitutional: The patient is “anxious” about the lesions and the pain she is experiencing.
Cardiovascular: The patient denies any palpitations, chest pain, or shortness of breath.
Respiratory: The patient denies any cough, wheezing, or dyspnea on exertion.
Gastrointestinal: The patient denies any abdominal pain, constipation, diarrhea, or blood in her stools.
Reproductive/ Genitourinary: The patient complains of “painful, burning lesions” on her left labia that appeared 3 days ago after unprotected sex with a new male partner. The pain worsens when she urinates. The patient denies frequency or urgency with urination.
Breast/Lymphatics: The patient denies any changes in her breast tissue or swollen or painful lymph nodes.
Integumentary: The patient denies having lesions or cold sores on any other locations of her body.
OBJECTIVE
PHYSICAL EXAM
GENERAL/CONSTITUTIONAL: The patient presents as a well-groomed, well-nourished 27-year-old female. The patient appears anxious and is alert and cooperative.
VITAL SIGNS: BP: 117/82, HR: 78, RR: 18, O2 Saturation: 99%, Weight: 124 Height: 5’6” BMI: 20 (healthy weight)
Cardiovascular: Regular rate and rhythm. No thrills or bruits. No JVD and no edema.
Respiratory: The lungs are clear to auscultation bilaterally. No wheezes or rales.
Integumentary: (+) 5 vesicular lesions noted on left labia. No other lesions or excoriations were found elsewhere on the body.
Gastrointestinal: Bowel sounds are present in all 4 quadrants. No abdominal guarding, tenderness, or distention was noted.
Reproductive/Genitourinary: (+) Left labia has 5 vesicular ulcerations. No other lesions or excoriations are present on the labia or vaginal canal.
Speculum exam: Cervical os is small, runs, and nulliparous. Cervical epithelium is smooth and pink. No abnormal or malodorous discharge was noted.
Bimanual exam: Negative for cervical motion tenderness. Ovaries are impalpable.
Rectal exam: Deferred by patient. No lesions are visible on the anus.
Breast/ Lymphatic: Breasts are symmetrical with no nipple discharge, palpable lumps, or masses. Lymph nodes are non-palpable and non-tender.
POCT: Perform a physical exam of genitalia with speculum to assess vaginal and cervical health. Order specific virology testing by NAAT or culture to confirm HSV-2 diagnosis. Test for chlamydia, gonorrhea, syphilis, and HIV per CDC guidelines (CDC, 2024).
Assessment/Diagnosis:
A60.00 Herpes infection of the urogenital system, unspecified.
Herpes Simplex is a lifelong recurring viral infection transmitted through direct contact with the secretions or mucosa of an infected individual who is shedding the virus. The virus is characterized by vesicular lesions that ulcerate, crust, and heal without scarring (Cash p. 622, 2024).
DDX:
A57. Chancroid: A sexually transmitted disease caused by the Haemophilus ducreyi resulting in ulcers of the genitals often accompanied by swollen lymph nodes in the groin (CDC, 2024). This patient does not have swollen lymph nodes in the groin.
L66.2 Folliculitis: Inflammation of the hair follicles is often caused by bacteria resulting in small pustules on the skin. The skin lesions in this patient are vesicular and ulcerated which is more characteristic of HSV.
PLAN
DIAGNOSTIC LABS: Order cell culture and/or polymerase chain reaction (PCR) and NAAT for HSV-2 testing and STI testing. Perform Pelvic exam with Speculum to culture cervix for BV and Candida cultures. Obtain a sample from labia by swabbing ulceration and vesicular fluid with cotton and placing the applicator in a viral transport medium before drying. Order RPR for Syphilis and HIV blood tests. Women over the age of 25 who have new sexual partners should be screened for Chlamydia, Gonorrhea, HIV, and Syphilis (CDC, 2024).
PHARMACOLOGIC: Prescribe Acyclovir 400 mg PO TID for 7-10 days. (21-30 tablets with one refill). Discuss treatment for recurrent episode Acyclovir 800 mg PO BID for 5 days.
NON-PHARMACOLOGIC: Advise the patient to abstain from all sexual activity when symptoms and lesions are present. Partner testing and treatment are not usually performed unless the partner becomes symptomatic (CDC. 2024). Encourage the use of condoms to prevent sexual transmission (Cash, 2024). Counseling patients with HSV-2 is essential to assist with coping and prevent sexual and perinatal transmission through suppressive medication therapy if the patient chooses to become pregnant. Anxiety is common among newly diagnosed patients (Johnston, 2022).
PATIENT EDUCATION: If you fail to abstain from sexual activity during the prodromal or active infection period, you can transmit HSV-2 to your partner (Johnston, 2022). The risks or potential side effects of Acyclovir treatment are nausea, vomiting, diarrhea, headache, dizziness, arthralgia, rash, agitation, confusion, and elevated BUN. Report any worsening symptoms or adverse reactions to your healthcare provider. Call 911 if you experience seizures, hallucinations, anaphylaxis, or angioedema (Epocrates, 2024).
REFERRAL: No additional referrals are needed at this time.
FOLLOW-UP: Follow-up for HSV-2 is not necessary unless the patient is unresponsive to antiviral therapy. In this case, follow-up in two weeks is necessary to review other STI test results, provide additional necessary treatments, and discuss a plan for recurrent HSV-2 treatments.
2. Case Scenario #2
Table 1
Infection
Description
Presentation
Causes/ Risk Factors
Treatment per CDC
Additional info
Candida
Characterized by inflammation of the vulva and vagina due to the Candida albicansinfection (Sobel & Mitchel, 2023a)
Vulvovaginal itching is the key presentation. Patient may also have a sore, burning or irritated sensation. Discharge may be present as non-odorous, thick, and white; however, may be thin, water as well. Upon physical exam, the vulva and vagina will be erythematic, edematous, with a normal cervix (Sobel & Mitchel, 2023a)
Causes include contamination of organism from rectum to the vagina, overgrowth of Candida within the vagina,
Risk factors include diabetes mellitus, females with high levels of or on estrogen therapy, immunosuppression, or correctional facility
(Sobel & Mitchel, 2023a)
Prescription: Fluconazole 150 mg PO once OR Butoconazole 2% cream intravaginally once
OTC: Clotrimazole 2% intravaginally daily for 3 days
(Workowski et al., 2021)
Diagnosis can be made with Candida presence on wet mount, culture, or gram stain. Second most common cause of female vulvovaginal inflammation (Sobel & Mitchel, 2023a)
BV
Characterized by increase in vaginal pH due to high concentration of anaerobic bacteria (Sobel & Mitchel, 2023b)
Key presentation is malodorous, thin, white discharge that is present as a biofilm on the vaginal wall and increased after intercourse
(Sobel & Mitchel, 2023b)
The increase of anaerobic bacteria causes an increase in the vaginal pH, leading to BV. But cause of increased bacteria within the vagina is unknown
Risk factors include having multiple partners, women who have sex with women, not using protection during intercourse, African American or Mexican American background, tobacco use, douching, and high BMI,
(Sobel & Mitchel, 2023b; Workowski et al., 2021)
Prescription: Metronidazole 500 mg PO BID for 7 days OR Clindamycin cream 2% intravaginally HS for 7 days OR metronidazole gel 0.75% intravaginally daily for 5 days
(Workowski et al., 2021)
Diagnosis is made through Microscopy with Amsel criteria being a thin, gray/off-white discharge, vaginal pH> 4.5, positive whiff-amine test, and clue cells present on wet mount
Most common cause of female vulvovaginal inflammation (Sobel & Mitchel, 2023b)
Chlamydia
Characterized by bacterial infection of Chlamydia trachomatiscausing either no symptoms or vaginal discharge/bleeding (Hsu, 2022)
Key presentation includes increase in purulent endocervical discharge, abnormal or increase in vaginal bleeding and spotting. Patient may complain of dysuria or pyuria, or pain around the anus (Hsu, 2022)
Causes include having vaginal, anal or oral sex with a partner that has chlamydia or in neonates born to mothers with current infection
Risk factors include females aged <25, new sex partner, multiple partners, or correctional facility (Hsu, 2022; Workowski et al., 2021) Prescription: Doxycycline 100 mg PO BID for 7 days OR Levofloxacin 500 mg PO Daily for 7 days If pregnant: Azithromycin 1g PO once (Workowski et al., 2021) Diagnosis with nucleic acid amplification testing (NAAT) with presence of chlamydia trachomatis bacteria and coinfection with gonorrhea Incubation period of 5-14 days after sexual contact (Hsu, 2022) Gonorrhea Characterized as an STI caused by the bacteria Neisseria gonorrhoeae (Ghanem, 2023) Key presentation begins 10 days after initial infection or 2 days after menstrual cycle ended. Symptoms include dysuria, change in vaginal discharge, increased bleeding or spotting, pruritus, dyspareunia. Can be asymptomatic. Can progress to disseminated gonococcal infection which would present as fever, body aches, joint pain (Ghanem, 2023) Caused by sexual intercourse with an infected partner through bodily fluids or in neonates born to mothers with current infection Risk factors include men who have sex with men, age < 25, history of chlamydia (Ghanem, 2023) Prescription for uncomplicated infection: Ceftriaxone 1g IM once If allergic to cephalosporin: Gentamicin 240 mg IM once + Azithromycin 2g PO once (Workowski et al., 2021) Diagnosis made by NAAT with presence of gonococcal colonies and co infection for chlamydia After treatment, repeat lab to ensure resolution Gram stain to show negative diplococci (Ghanem, 2023) Trichomonas Characterized as an STI that is caused by Trichomonas vaginalis (Alexander et al., 2023) Key presentation is heavy amounts of yellow/green discharge that is mucopurulent, malodorous, frothy and worsens after sexual intercourse. Patients also present with erythema, edema, soreness and pruritis of vulva, vagina, dysuria, dyspareunia. Women will complain of increased vaginal bleeding, especially after intercourse. Upon physical examination the vaginal walls will have petechiae with an easily bleeding cervix (Alexander et al., 2023) Caused by sexual intercourse between a male and female Risk factors include women < 40 years old, correctional facility (Alexander et al., 2023) Prescription: Metronidazole 500 mg PO BID for 7 days OR Tinidazole 2g PO once (Workowski et al., 2021) Diagnosis made by NAAT is most sensitive but microscopy can also diagnose. pH: 5-6, positive Whiff test Most common cause of vaginitis 2-3x more likely to contract HIV if diagnosed with Trichomonas In pregnancy: Can lead to preterm labor and low-birth weight (Alexander et al., 2023) Cervicitis Characterized by easily bleeding cervix and purulent discharge (Alexander et al., 2023) Key presentation and characteristic are purulent or mucopurulent endocervical exudate and easily bleeding endocervix. Patients may present with abnormal vaginal discharge, heavy spotting, or vaginal bleeding after sex (Alexander et al., 2023) Caused by Chlamydia, Gonorrhea. Can also be caused by or in conjunction with Trichomoniasis, HSV-2, and Mycoplasma Risk factors include douching, multiple sexual partners (Alexander et al., 2023) Prescription: Doxycycline 100 mg PO BID for 7 days If pregnant: Azithromycin 1g PO once (Workowski et al., 2021) Patients should be advised to abstain from sex for full course of therapy, symptom alleviation, and partner treatment (Workowski et al., 2021) PID Characterized as an upper genital tract infection within the uterus, ovaries and fallopian tubes (Ross, 2023) Key presentation is fever, lower abdominal pain and uterine bleeding that worsens with activity, and abdominal tenderness with rebound tenderness. Patient may present with urinary frequency, urgency, and yellow or brown colored discharge (Ross, 2023) Caused by sexually transmitted infections such as Chlamydia, Gonorrhea, syphilis, and trichomonas that are recurrent, or untreated Risk factors include history of PID, female gender, sexually active females with multiple partners, and females who recently terminated pregnancy (Ross, 2023) Prescription: Moderate to Severe PID: Ceftriaxone 1g IV Daily + Doxycycline 100 mg PO or can be IV BID for 14 days + Metronidazole 500 mg PO or can be IV BID for 14 days Mild to Moderate PID: Ceftriaxone 500 mg IM once + Doxycycline 100 mg PO BID for 14 days + Metronidazole 500 mg PO BID for 14 days (Workowski et al., 2021) To help prevent PID, routine testing for STIs should be completed for at risk females to be treated (Ross, 2023) HIV Characterized as a retrovirus that attacks that attacks the own body’s CD4+ T cells. When the CD4+ count is < 200, the disease progressed to acquired immunodeficiency syndrome (AIDS) (Sax, 2022; Alexander et al., 2023) Key presentation is often nonspecific with flu-like symptoms with incubation period of 2-4 weeks, but can be longer. Symptoms include fever, sore throat, body ache, weakness, headache, weight loss, and lymphadenopathy (Sax, 2022) Caused by a retrovirus that is transmitted through direct contact with blood and bodily fluids. Risk factors include female sex workers, men who have sex with men, IV drug users who share needles, having unprotected sex, multiple partners, heathcare workers, and newborns being born to mothers who have HIV (Sax, 2022; Alexander et al., 2023) Treatment for HIV includes antiretroviral therapy that is individualized based on patient CD4+ count and viral load. Prescription typically includes two different nucleoside reverse transcriptase inhibitors + one integrase strand transfer inhibitors OR two nucleoside reverse transcriptase inhibitors + non-nucleoside reverse transcriptase inhibitors Other types of antiretrovirals include protease inhibitors, integrase strand transfer inhibitors, CCR5 antagonists and fusion inhibitors Prescription Tenofovir disoproxil fumarate/ Emtricitabine PO Daily for at risk individuals (Workowski et al., 2021) Diagnosed with enzyme-linked immunosorbent assay (ELISA) that will detect antibodies Western blot test will determine viral load and differentiate between HIV-1 and HIV-2 Routine testing of CD4+ count and drug resistance should be performed PrEP for prevention is recommended to help reduce risk of HIV by up to 93% (Sax, 2022; Alexander et al., 2023) Syphilis Characterized as a bacterial infection caused by the bacteria Treponema pallidum (Hicks & Clement, 2023) Key presentation depends on disease stage Primary syphilis: 21 days after initial infection a 2cm indurated chancre appears with surrounding lymphadenopathy near vagina, anus and pharynx Secondary syphilis: systemic symptoms such as fever, headache, body aches, weight loss, rash, lesions and lymphadenopathy showing dissemination Tertiary syphilis: 1-30 years after initial infection that was not treated, symptoms include aortic regurgitation, body ulcers, hearing loss, and central nervous system symptoms like meningitis (Hicks & Clement, 2023) Caused by direct contact with lesions or intercourse with an individual with syphilis Risk factors include sexually active individuals especially men who have sex with men, multiple partners, or young adolescents who engage in risky sexual behaviors. Newborns born to mothers currently infected with syphilis are also at risk (Hicks & Clement, 2023) Prescription for nonpregnant and pregnant: Primary/secondary/early latent: Benzathine penicillin G 2.4 million units IM once Latent: Benzathine penicillin G 2.4 million units IM once a week for 3 weeks Penicillin allergy: Doxycycline 100 mg PO Q6H for 28 days (Workowski et al., 2021) Diagnosed with rapid plasma regain test. If positive, should test for HIV as well as coinfection is common. Retesting after treatment to determine if syphilis treatment was successful or if resistance and need for continued treatment should be done (Alexander et al., 2023; Workowski et al., 2021) Hep B Characterized by inflammation of the liver due to hepatitis B hepadnavirus that invade the liver and destroys the liver cells (Lok, 203) Key presentation is fever, nausea, vomiting, abdominal pain especially in RUQ. Physical examination will show jaundice symptoms such as yellow sclera, dark colored urine, and hepatomegaly (Lok, 2023) Caused by exposure or contact with blood or bodily fluids of infected individuals Risk factors include individuals who are unvaccinated, multiple partners, IV drug use with needle sharing, men who have sex with men, healthcare workers. Newborns born to mothers with current HBV infection (Lok, 2023; Alexander et al., 2023) Treatment for HBV depends on acute or chronic infection. Acute HBV treated with supportive therapy such as rest, fluids Chronic HBV treated with antiretrovirals to avoid liver damage. These include nucleoside reverse transcriptase inhibitors and non-nucleoside reverse transcriptase inhibitors (Workowski et al., 2021) Diagnosed with triple panel: hepatitis B surface antigen, hepatitis B antibody to surface antigen, and hepatitis B total antibody to core antigen. Adults aged 18 or older should be screened at least once in their lifetime. HBV is the most sexually transmitted preventable infection in the hepadnavirus family. It is completely preventable with HBV vaccine (Alexander et al., 2023; Workowski et al., 2021) Hep C Characterized as the “most common bloodborne disease in the world” (Alexander et al., 2023, p. 576) Key presentation in acute: asymptomatic or flu-like symptoms such as fever, chills, body aches, joint pain, jaundice symptoms such as dark urine, yellow sclera Key presentation in chronic: Typically present as extrahepatic manifestations such as glomerulonephritis, diabetes mellitus, cryoglobulinemia, and lymphoma (CDC, 2023) Caused by sharing illicit drug needles, sexual transmission, use of dirty needles from tattoos Risk factors include men who have sex with men, current HIV infection, IV drug use, multiple partners, unprotected sex, working in healthcare, blood transfusion before 1992 (Workowski et al., 2021) Prescription for Simple HCV w/o cirrhosis: Glecaprevir 300 mg/ Pibrentasvir 120 mg PO daily for 8 weeks OR Sofosbuvir 400 mg/Velpatasvir 100 mg PO daily for 12 weeks Simple HCV with compensated cirrhosis: Gecaprevir 300 mg/Pibrentasvir 120 mg PO daily for 8 weeks In genotype 3 patients w/ compensated cirrhosis and NS5A Y93H is present: Sofosbuvir 400 mg/ Velpatasvir 100 mg + weight based Ribavirin PO Daily for 12 weeks Decompensated cirrhosis patients: liver transplant (Workowski et al., 2021; AASLD & IDSA, 2020a; AASLD & IDSA, 2020b) Diagnosed with anti-HCV antibody (+), PCR for HCV RNA to determine if acute or chronic infection After treatment, retesting to determine if posttreatment cure achieved, if not continue to treat (Alexander et al., 2023) HSV Characterized as a chronic viral disease that can be transmitted sexually and nonsexually (Alexander et al., 2023) Key presentations in HSV-1 are gingivostomatitis, fever blisters, but can occur in genitals as well. Key presentations in HSV-2 are genital lesions, but can occur orally as well. Female patients will complain of fever, chills, body aches 1 week postexposure with presence of painful vesicles on the vulva, vagina, cervix, and perianal area. The vesicles will become ulcerated and last up to 15 days. Patients may also have bilateral lymphadenopathy in the inguinal area (Alexander et al., 2023) HSV-1: Transmitted nonsexually HSV-2: Sexually transmitted Risk factors include age < 35, multiple sexual partners, unprotected sex (Alexander et al., 2023) Prescription for HSV-1 or HSV-2: Acyclovir 400 mg PO TID for 7-10 days OR Valacyclovir 1g PO BID for 7-10 days Recurrent infection:Acyclovir 800 mg PO TID for 5 days or Valacyclovir 500 mg PO BID for 3 days In pregnancy:Acyclovir 400 mg PO TID or Valacyclovir 500 mg PO BID starting at 36 weeks gestation (Workowski et al., 2021) Diagnosed with Western blot, glycoprotein serology, and type-specific HSV NAATs to determine if HSV-1 or HSV-2. Most common STI in females. Can be recurrent Treatment should begin at first sign of lesion (Alexander et al., 2023) Question Answer Name 10 Risk Factors for contracting STI’s and HIV 1. Female gender 2. Younger age (15-35) 3. Having unprotected sex 4. Having multiple partners 5. The use of alcohol or illicit drugs 6. IV drug needle sharing 7. Vaginal douching 8. Women who have sex with women or men who have sex with men 9. History of previous STI 10. Newborn being born to mother with current HIV or STI infection (Alexander et al., 2023) Name 5 safer sex practices 1. Use of external condoms 2. Reduce number of sexual partners 3. Abstinence during STI treatment 4. Pre-exposure prophylaxis 5. Routine testing and open communication with sexual partners about health status (Alexander et al., 2023) Can HIV be transmitted through sweat, saliva, and tears? (Include rationale) HIV cannot be transmitted through saliva, sweat or tears because the viral load in these fluids are undetectable or not present. HIV is transmitted through direct contact with blood and bodily fluids such as semen, blood, rectal fluid, vaginal fluid and breast milk (Alexander et al., 2023; Sax, 2022)
