STD – Viro

Categorization of STDs
Viral: Herpes Simplex Virus (HSV), Human Immunodeficiency virus (HIV), Human Papilloma Virus (HPV) infection
Bacterial: Gonorrhea, Chlamydia, Syphilis
Protozoal: Trichomonas

2-5 fold increased risk for acquiring HIV in the setting of an STD  recommend HIV testing for these patients

STD Prevention and Control
Education and counseling to reduce risk of STD acquisition (prevent transmission)
Detection of asymptomatic and/or symptomatic individuals to seek evaluation
Avoiding healthcare and deny symptoms and don’t consider them important
Effective diagnosis and treatment
Lots of ways to diagnose and curable
They can get re-infected from same partner who is not receiving treatment or new partner who is not tested or treated so cycle of infection continues
Evaluation, treatment, and counseling of sexual partners
Immunization – ex. HPV (more discussed in Thursday’s lecture)

CDC: Prevention messages
Prevention tailored to client’s personal risk (interactive counseling)
Address risk reduction (educate partner as well)
Partner notification and referral  partner should be tested
Clients seeking evaluation or treatment of STDs should be informed about which tests will be performed

1. Chlamydia
Organism: Chlamydia trachomatis (C. trachomatis)
Accounts for majority of non-gonococcal urethritis
Co-infection with N. gonorrhoeae is common
Provide therapy for both  Chlamydia + N. gonorrhoeae
Affects: mostly sexual active adolescents, young adults, individuals with multiple sex partners, individuals with low socioeconomic status
Chlamydia Trachomatis
Incubation period: 7-21 days
Non-ulcerative disease
Uncomplicated C. trachomatis: often asymptomatic on both men and women
Signs and symptoms: similar to gonococcal infections – difficult to differentiate
Clinical presentation in MEN:
Most common site of infection: urethra
>50% are asymptomatic or show mildly transient symptoms:
Dysuria
Mucoid or clear urethral discharge
Complications: (if it goes undiagnosed and these are hard to treat)
Reiter’s syndrome – arthritis accompanied by skin lesions and inflammation of the eye and urethra
Epididymitis – acute bacterial infection of the epididymis (tube that stores sperm)
Fever, pain, swelling (symptoms)
Clinical presentation in WOMEN:
Frequently asymptomatic
Signs/symptoms: Mucopurulent discharge, Endocervictis, Dysuria, Dull pelvic pain, Intramenstrual bleeding
15% develop salpingitis (inflammation of fallopian tube) or pelvic inflammatory disease (PID)
Complications: infertility, ectopic pregnancy, vertical transmission to newborn, Reiter’s syndrome (also seen in men)
Clinical presentation
Lymphogranuloma Venereum (LGV): invasive
Inguinal lymphadenopathy (large lymph nodes in growing area) and genital ulcers
Common in men who have sex with men
Further considerations
Follow-up: (treatment is effective but adherence could be an issue)
Retest if symptomatic after treatment
Retest 3 weeks post therapy if treated with Erythromycin
Partner notification and referral for treatment
Recommend abstinence until treatment in completed OR 7 days after single dose tx
HIV co-infected patients
Treatment is the same as HIV (-) patients
Prevention: (for future infection)
Condoms, limit # of sexual partners

2. Gonorrhea
Organism: Neisseria gonorrhoeae
Neisseria Gonorrhoeae
Clinical presentation:
Variable presentation:
Asymptomatic: genital; pharyngeal; ocular; disseminated infection (monoarticular arthritic complaints – wrist, knee, ankle; pustular erythematous rash)
Co-infection with C. trachomatis or T. vaginalis
Increased risk for HIV transmission
Affect HIV testing so retest within 6 months & offer HIV testing to partner
Clinical presentation in MEN:
Incubation period: 2-7 days
Most men are symptomatic
Dysuria
Purulent urethral discharge
Clinical presentation in WOMEN:
Incubation period: 10 days
Endocervix and urethra are primarily involved
Most women are asymptomatic
Symptoms
Dysuria
Purulent vaginal discharge
Cystitis