Episode 202: Sexually Transmitted Infect...

Show Notes

Table of Contents

(1:49) Chlamydia 

(3:31) Gonorrhea

(4:50) PID

(6:14) Syphilis

(8:08) Neurosyphilis 

(9:13) Tertiary Syphilis

(10:06) Trichomoniasis 

(11:13) Herpes

(12:49) HIV

(14:10) PEP

(15:13) Mycoplasma Genitalium 

(18:00) Take Home Points

Chlamydia:

• Prevalence:

• • • Most common STI.
    • High percentage of asymptomatic cases (40% to 96%).

• Presentation:

• • • Urethritis, cervicitis, pelvic inflammatory disease (PID), prostatitis, proctitis, pharyngitis, arthritis.
    • Importance of considering extra-genital sites (oral and rectal infections).

• Testing:

• • • Gold Standard: Nucleic Acid Amplification Test (NAAT) via PCR.

• Sampling Sites:

• • • • Endocervical or urethral swabs preferred over urine samples due to higher sensitivity.
      • Triple-site testing (genital, rectal, pharyngeal) recommended for comprehensive detection.

• Treatment Updates:

• • • Previous Regimen: Azithromycin 1 g orally in a single dose.
    • Current First-Line Treatment: Doxycycline 100 mg orally twice daily for 7 days.

• Alternatives:

• • • Azithromycin remains an option for patients unlikely to adhere to a 7-day regimen or for pregnant patients.
  • Note: PID treatment differs and will be discussed separately.

Gonorrhea:

• Presentation:

• • • Similar to chlamydia; can be asymptomatic.
    • Symptoms include urethritis, cervicitis, PID, prostatitis, proctitis, pharyngitis.

• Testing:

• • • Gold Standard: NAAT.

• Sampling Sites:

• • • • Endocervical swabs are more sensitive than urine samples.
      • Triple-site testing is crucial to avoid missing infections.

• Treatment Updates:

• • • Previous Regimen: Ceftriaxone 250 mg IM plus azithromycin 1 g orally.
    • Current Recommendation: Ceftriaxone 500 mg IM single dose.
      • Adjusted due to rising azithromycin resistance and updated pharmacokinetic data.

• Co-Infection Considerations:

• • High rates of chlamydia and gonorrhea co-infection (20% to 40%).
  • CDC recommends empiric treatment for chlamydia when treating gonorrhea to prevent complications like PID and infertility.

Pelvic Inflammatory Disease (PID):

• Etiology:

• • • Not solely caused by chlamydia and gonorrhea; about 50% of cases involve other pathogens like bacterial vaginosis (BV) organisms and anaerobes.

• Treatment Changes:

• Expanded Coverage Regimen:

• • • Ceftriaxone 500 mg IM once.
    • Doxycycline 100 mg orally twice daily for 14 days.
    • Metronidazole 500 mg orally twice daily for 14 days.
  • Inclusion of metronidazole addresses anaerobic bacteria contributing to PID.

Syphilis:

• Stages and Presentation:

• Primary Syphilis:

• • • Painless chancre on genitals.
    • Treatment: Penicillin G 2.4 million units IM single dose.

• Secondary Syphilis:

• • • Rash (often diffuse), mucocutaneous lesions, nonspecific joint pain.