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Chlamydia and STDs: Diagnosis & Treatment

This document provides information on common sexually transmitted infections (STIs), including Chlamydia, gonorrhea, trichomoniasis, and HIV. It describes the causative agents, signs and symptoms, diagnostic testing, and treatment recommendations for each STI. Clinical features may include abnormal discharge, pelvic or testicular pain, and asymptomatic infection. Diagnosis involves tests such as nucleic acid amplification, culture, and microscopy. Treatment involves antibiotics or antiprotozoals and counseling to prevent spread.

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10 views23 pages

Chlamydia and STDs: Diagnosis & Treatment

This document provides information on common sexually transmitted infections (STIs), including Chlamydia, gonorrhea, trichomoniasis, and HIV. It describes the causative agents, signs and symptoms, diagnostic testing, and treatment recommendations for each STI. Clinical features may include abnormal discharge, pelvic or testicular pain, and asymptomatic infection. Diagnosis involves tests such as nucleic acid amplification, culture, and microscopy. Treatment involves antibiotics or antiprotozoals and counseling to prevent spread.

Uploaded by

sgolbari
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd

Presented by: Victoria Dawson and Chinwe

Okeke
Chlamydia
• Most common bacterial STD in the US
• Causative Agent: Chlamydia Trachomatis
• Can infect the genital tract, urethra, anus and eye
• In men: non-gonoccocal urethritis
• Risk factors:
– Unprotected sex
– New or multiple partners
– Fequent douching
Chlamydia
Often coexists with N. Gonorrhoeae infection
LGV serovars cause lymphogranulomatous venerium
(emerging cause of proctocolitis)
Chlamydia
History/PE
Signs/Symptoms
Often asymptomatic
Urethritis,
mucopurulent cervicitis
PID
Chlamydia
History/PE
On Exam:
Cervical/adnexal tenderness in women
Penile discharge and testicular tenderness in men
Differential
Gonorrhea, endometriosis, PID, orchitis, vaginitis,
UTI
Chlamydia
History/PE
Lymphogranuloma Venereum
Primary Form: painless, transient papule or shallow
ulcer
Secondary Form: Painless swelling of inguinal nodes
Tertiary Form: Anogenital syndrome – anal pruritis
with discharge, rectal strictures, rectovaginal fistula
and elephantiasis
Chlamydia
Diagnosis
Usually clinical
Culture – gold standard
Urine test (PCR or ligase chain reaction)
DNA probes
Immunofluorescence
Gram stain of urethral or genital discharge may show
PMN’s but no bacteria (intracellular)
Chlamydia
Treatment
Doxycycline 100 mg PO BID x 7 days
Azithromycin 1g PO x 1 day
Erythromycin in pregnancy
Treat for gonorrhea as well
Treat sexual partners
LGV serovars require treatment for 21 days
Gonorrhea

Gram negative intracellular diplococcus


Can infect any site in female genital tract
Infection in men, usually limited to urethra
Gonorrhea
History/PE
Signs/Symptoms:
• Women
– Greenish-yellow discharge
– Pelvic or adnexal pain
– Swollen Bartholin’s glands
• Men
– Purulent urethral discharge
– Dysuria
– Erythema of the urethral meatus
Gonorrhea
History/PE
Disseminated disease:
Monoarticular septic arthritis
Rash
Tenosynovitis
Gonorrhea
History/PE

Differential
Chlamydia, endometriosis, pharyngitis, PID, vaginitis,
UTI, salpingitis, tubo-ovarian abcess
Gonorrhea
Diagnosis

Gram stain and culture are the gold standard for any
site
Nucleic acid amplification tests
Gonorrhea
Treatment
Ceftriaxone IM
Cefepime PO x 1 dose
Treat for chlamydia coinfection
Treat sexual partners
Disseminated disease requires IV ceftriaxone for at
least 24 hours
Trichomonas
Trichomonas Vaginalis (protozoa)
Risk Factors:
An STD
Unprotected sex with multiple partners
Trichomonas
History/PE
Signs/Symptoms
• Discharge
• Odor
• Pruritis
• Dysuria
On Exam:
• “strawberry petechiae” in the upper vagina/cervix
• Profuse, malodorous yellow-green, frothy discharge
Trichomonas
Diagnosis

Wet mount
Motile Trichomonads (flagellated organisms that are
slightly larger than WBCs)
Trichomonas
Treatment

Single dose PO metronidazole or tinidazole


Treat sexual partners
HIV
CD4 count important because it guides therapy and
prophylaxis and help guides treatment
Viral load may predict the rate of disease progression;
provide indications for treatment and gauges
responses to antiretroviral therapy
HIV
History/PE
In acute infection it can often be asymptomatic, but
can also present with mono or flu like symptoms
Fever, lymphadenopathy, maculopapular rash,
pharyngitis, diarrhea, N/V, weight loss, headache
It may present later as night sweats, thrush, weight
loss, recurrent infections, oppurtunistic infections
Complications are inversely correlated with CD4
count
HIV
Diagnosis
ELISA
High sensitivity, moderate specificity
Can take 6 months to appear after exposure
Western blot
Low sensitivity, high specificity
confirmatory
Rapid HIV test
RNA/PCR
Evalutaion for acute retroviral syndrome
In newborns
HIV
Treatment
4 categories you initiate treatment for
1. Symptomatic patients regardless of CD4 count or viral
load
2. Asymptomatic patients with CD4 count of less than
350
3. Pregnant patients
4. Those with specific HIV-related conditions
The initial regimen should consist of two RTI, plus
NNRTI or PI
HIV
Treatment
Choice of regimen depends on multiple factors;
monotherapy should not be used
The goal of therapy is viral suppression “less than 50
copies”
HIV genotype should be obtained before starting
therapy and is additionally helpful if resistance is
suspected as it can help better target therapy

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