Urethritis and Sexually Transmitted Infections
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Introduction
Sexually transmitted infections are spread by fluids or secretions from mucosal surfaces, and can be caused by multiple microbial pathogens.
There is a high incidence worldwide
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Neisseria ghonorrhoeae
Chlamydia trachomatis
Ureaplasma urealyticum
Trichomonas vaginalis
Common sexually transmitted pathogens:
- bacteria: Chlamydia trachomatis, Neisseria gonorrhae, Treponema pallidum
- viruses: HSV, HIV, HPV, hepatitis B, hepatitis C
- fungi: trichomonas
Risk factors include:
- sexually active males and females, under 25 y.o.
- unprotected sex, previous STI, contact with known case of STI
- early age of first intercourse
- street involved
- substance abuse
- homosexual men
- new partner in past two months; >2 partners in past 12 months
Pathophysiology
Signs and Symptoms
- history
- physical exam
History
Ask about
- level of sexual activity, and type (oral, anal, vaginal)
- age of first intercourse
- sexual orientation
- sexual activity during travel
- total number of partners in last year/month/week
STI history
- STI awareness, previous STIs and testing
- partners with previous STIs
- contraception history
- last Pap and results
- local symptoms, such as burning, itching, discharge, sores, vesicles
- associated symptoms: fever, arthralgia, lymphadenopathy
- partner communication re: STIs
Physical Exam
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
People who are symptomatic, or asymptomatic but at increased risk, should be screened for chlamydia, gonorrhea, HIV, hepatitis B, and syphilis
Pap tests should be performed yearly, until three normal Paps cme back. At this point, bi-yearly testing should be carried out.
Diagnostic Imaging
Differential Diagnosis
Treatments
Ghonorrhea can be treated with ceftriaxone, cefixime, ciprofloxacin, or levofloxacin.
One gram azithromycin should be given as a single dose, or 100 mg doxycycline BID for 7 days.
Erythromycin is an alternative during pregnancy.
Prevention
Prevention is vastly more effective than treating STIs and their effects.
Offer the Hep B vaccine
Advise to always use condoms, or to abstain.
Medication
Gonococcal urethritis/cervicitis: cefixime 400 mg PO, single dose
Non-gonococcal urethritis/cervicitis: azithromycin 1 mg PO, single dose
Genital herpes (HSV-1/-2): acyclovir, famciclovir, valacyclovir
infectious syphillis: benzathine penicillin G IM
Public Health
Public health must be notified if an STI is diagnosed. An STI is not considered treated until partner management is ensured.
Consequences and Course
Resources and References
Topic Development
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