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APGO educational topic number
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thirty-six sexually transmitted
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infections and urinary tract infections
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hello and welcome to gynecology national
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news my name is Victoria duce and
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tonight we will delve into sexually
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transmitted infections all forms of
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sexual contact and spread sexually
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transmitted infections including
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penetrative sex oral sex anal sex
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sharing sex toys and skin-to-skin
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contact over fifty percent of new
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infections annually are in people less
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than twenty five do you know where the
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young people in your life are right now
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the objectives of this video are to
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describe the guidelines for STI
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screening and partner notification and
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treatment discuss STI prevention
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strategies including immunization
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describe the symptoms physical exam
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findings evaluation and management of
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common SDI’s discuss the pathophysiology
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evaluation diagnostic criteria initial
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management and possible long-term
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sequelae of salpingitis and pelvic
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inflammatory disease and lastly describe
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the diagnosis and management of urinary
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tract infections welcome back folks
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let’s start with screening should we be
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screening patients more for sti’s this
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reporter went to the gynecology clinic
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to find the answers dr. Maia Hammoud
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tell us how women’s health care
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providers should be screening for esti
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is well VD screening recommendations are
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different based on sex age and sexual
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practices the Centers for Disease
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Control recommend that women less than
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25 should have annual screening for
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chlamydia and gonorrhea and what about
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women older than 25 they should be
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screened if they have new or multiple
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partners or partner with no an STD what
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about pregnant women all pregnant women
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should be screened for syphilis
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gonorrhea chlamydia HIV and hepatitis B
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in the first trimester test should be
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the period for high-risk patients in the
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third trimester any other
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recommendations all people aged 13 to 64
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should be screened for HIV at least once
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then repeat annually of high-risk all
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men who have sex with men should have an
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annual gonorrhea and chlamydia screen
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and anyone who shares injection drug
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equipment or has unsafe sex should be
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screened for HIV annually well what can
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we do to protect ourselves against sti’s
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let’s start with the basics number one
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delay the onset of sexual activity
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number two try to limit the number of
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part
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number three use condoms number four
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partner notification expedited therapy
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refers to a patient’s sexual partner
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receiving drug therapy for an STI
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without undergoing a physical
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examination or testing vaccination is
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another form of prevention some strains
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of the human papilloma virus cause
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genital warts and cervical cancer there
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are three vaccinations currently
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available that protect against low and
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high risk HPV strains the vaccines
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contain virus-like particles and are
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recommended for boys and girls age 11 to
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12 they can be given between the ages of
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9 and 26 and ideally should be given
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before the initiation of sexual
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intercourse lastly new on the scene is
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prep pre-exposure prophylaxis against
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HIV this is a daily pill which is a
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combination of two Nova veer and
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emtricitabine for people engaged in
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high-risk sexual activities such as a
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partner with known HIV let’s now move on
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to common STI s
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as mentioned earlier many sti’s are
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asymptomatic underlying the importance
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of screening chlamydia is the most
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frequently reported infectious disease
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in the United States it can have a full
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spectrum of disease from asymptomatic
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2mu Co purulent cervicitis
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here is a photograph of a cervix with
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neucopia land discharge pelvic
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inflammatory disease yura thright Asst –
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vertical transmission to infants at
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delivery resulting in ophthalmic jnana
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tourim and or pneumonia treatment for
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chlamydia is oral as a thorough myosin
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or doxycycline and it’s very important
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for the partner to get treated as well
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gonorrhea is the second most common STI
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in the United States women younger than
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25 are at highest risk it tends to be
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more symptomatic than chlamydia and in
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men the infection is characterized by
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mukou purulent or purulent discharge
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from the urethra in women the symptoms
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can be mild enough to be overlooked and
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can include pee relent discharge from
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the urethra cervix vagina or anus the
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diagnosis of gonorrhea and chlamydia is
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made by PCR amplification of either a
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urine or cervical discharge sample
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treatment for gonorrhea is ceftriaxone
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however given the high likelihood of
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concurrent chlamydial infection positive
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gonorrhea results should lead to
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treatment for chlamydia treatment as
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well so the treatment will be
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ceftriaxone plus azithromycin or
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doxycycline
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let’s now move to a pelvic inflammatory
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disease PID is an ascending infection of
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typically gonorrhea and chlamydia
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yeah here is the uterus fallopian tubes
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and ovaries that bacteria ascend from
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the cervix up through the endometrium
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and into the fallopian tubes this leads
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to an inflammatory process which will
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create swollen mucosal and serosal
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surfaces of the fallopian tubes
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anaerobic organisms can flourish and
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grow in this fluid collection which can
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lead to a tubo-ovarian abscess even
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without a tubo-ovarian abscess fibrin
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deposition can lead to scarring of the
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fallopian tubes the public peritoneum
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and ovaries this photograph shows a
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dilated and likely scarred right
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fallopian tube fitz hugh curtis syndrome
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refers to the rare infection of the
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liver capsule and peritoneal surfaces of
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the liver
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here is the liver the diaphragm and the
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fibrin is exudates from PID the
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diagnosis of PID can be difficult and
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challenging because of the wide
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variation of symptoms and signs and the
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clinical diagnosis is imprecise delaying
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diagnosis can lead to potential damage
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to the reproductive health for young
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women this illustration shows a
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fallopian tube that’s been damaged by
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PID an early intervention is meant to
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try to prevent this from occurring
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thus the Centers for Disease Control
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recommend that treatment for PID should
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be initiated in sexually active young
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women with pelvic or lower abdominal
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pain and cervical motion tenderness or
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uterine tenderness or adnexal tenderness
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an elevated temperature white-blood-cell
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greater than 10,000 or frank purulent
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discharge from the cervix can help in
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making the diagnosis but treatment
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should be initiated even without these
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findings the treatment of PID involves
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10 to 14 days of antibiotics either oral
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or parental one common antibiotic
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regimen is cefoxitin plus doxycycline
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this is known as the foxy Knoxy regimen
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thus aqualia PID can be severe and are
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common in fertility and 10 to 20%
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ectopic pregnancy in six to ten percent
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chronic pelvic pain and 15 to 20 percent
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and 25 percent of PID patients will have
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at least one of these sequelae let’s
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move now to other important and common
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STI s let’s start with trichomonas women
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with trichomonas may have
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increased frothy greenish yellow
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discharge and vulvar itching and
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irritation diagnosis is made by the wet
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prep here is a photograph of the
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flagellated parasite on wet prep this
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organism will be seen often moving
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rapidly around the slide treatment for
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trichomonas is a single to gram dose of
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metronidazole herpes is a very common
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infection and up to 75% of primary
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infections go unrecognized the HSV one
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strain typically causes oral lesions and
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the HSV 2 strain typically leads to
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genital lesions there is however now an
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increasing proportion of new genital
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infections due to HSV one the initial
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presentation can be very painful and
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severe painful vesicles can appear on
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the vulva vagina cervix perineum and
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perianal skin these vesicles are
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extremely tender and patients may
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develop urinary retention from pain and
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are urethral and bladder involvement
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here is a helpful teaching tip a patient
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presenting with painful vulva symptoms
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and urinary retention is often having a
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primary herpes outbreak treatment is
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with the antiviral acyclovir Pham
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Cyclovia
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or valus i clavier episodic treatment
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means treatment at the time of
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recurrence this decreases the duration
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of the episode suppressive therapy
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refers to daily therapy and prevents 80%
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of recurrences and results in a 48%
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reduction and viral transmission between
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sexual partners let’s now change gears
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as this reporter will share a personal
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journey of my experience with a urinary
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tract infection it started one day when
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I developed suprapubic pain urinary
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frequency and blood in my urine the
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diagnosis was made with a urine analysis
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this measured the pH protein level
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presence of nitrates white blood cells
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and leukocyte esterase a urine sample
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can also be sent to the lab for culture
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my health care provider per treated me
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with a three day course a trimethoprim
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cellphone ethics is all he could have
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also treated me with a three day course
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of a fluoroquinolone i want to get to
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the source of why UTIs are more common
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in women it turns out that women have a
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shorter urethral length their me a disc
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it’s exposed to vestibular and rectal
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pathogens and sexual activity may induce
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trauma or other organism which all
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increase the potential for infection
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11 percent of US women will report at
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least one physician diagnosed UTI per
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year and the lifetime probability that a
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woman will have a UTI is 60%
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this concludes our expose on sti’s and
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UTIs we have reviewed STI
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screening partner notification symptoms
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and physical exam findings of common
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sti’s we reviewed PID and UTIs and
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that’s the way it is this is Victoria
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Deuce and on behalf of dr. Maia Hammoud
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good night