{"id":166,"date":"2020-08-13T15:56:30","date_gmt":"2020-08-13T15:56:30","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=166"},"modified":"2021-05-09T20:45:31","modified_gmt":"2021-05-09T20:45:31","slug":"36-sexually-transmitted-infections-and-urinary-tract-infections","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/pa_obgyn\/overview\/36-sexually-transmitted-infections-and-urinary-tract-infections\/","title":{"rendered":"36. STIs and UTIs"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/BOksgV3g9Bo\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration = 9:27<\/p>\n<input type='hidden' bg_collapse_expand='69e9c8f6c36ec6027959506' value='69e9c8f6c36ec6027959506'><input type='hidden' id='bg-show-more-text-69e9c8f6c36ec6027959506' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9c8f6c36ec6027959506' value='Hide Transcript'><button id='bg-showmore-action-69e9c8f6c36ec6027959506' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9c8f6c36ec6027959506' ><\/p>\n<p>00:00<br \/>\nAPGO educational topic number<br \/>\n00:01<br \/>\nthirty-six sexually transmitted<br \/>\n00:03<br \/>\ninfections and urinary tract infections<br \/>\n00:05<br \/>\nhello and welcome to gynecology national<br \/>\n00:08<br \/>\nnews my name is Victoria duce and<br \/>\n00:10<br \/>\ntonight we will delve into sexually<br \/>\n00:12<br \/>\ntransmitted infections all forms of<br \/>\n00:15<br \/>\nsexual contact and spread sexually<br \/>\n00:17<br \/>\ntransmitted infections including<br \/>\n00:18<br \/>\npenetrative sex oral sex anal sex<br \/>\n00:20<br \/>\nsharing sex toys and skin-to-skin<br \/>\n00:22<br \/>\ncontact over fifty percent of new<br \/>\n00:25<br \/>\ninfections annually are in people less<br \/>\n00:26<br \/>\nthan twenty five do you know where the<br \/>\n00:29<br \/>\nyoung people in your life are right now<br \/>\n00:30<br \/>\nthe objectives of this video are to<br \/>\n00:33<br \/>\ndescribe the guidelines for STI<br \/>\n00:34<br \/>\nscreening and partner notification and<br \/>\n00:36<br \/>\ntreatment discuss STI prevention<br \/>\n00:38<br \/>\nstrategies including immunization<br \/>\n00:40<br \/>\ndescribe the symptoms physical exam<br \/>\n00:42<br \/>\nfindings evaluation and management of<br \/>\n00:44<br \/>\ncommon SDI&#8217;s discuss the pathophysiology<br \/>\n00:47<br \/>\nevaluation diagnostic criteria initial<br \/>\n00:50<br \/>\nmanagement and possible long-term<br \/>\n00:51<br \/>\nsequelae of salpingitis and pelvic<br \/>\n00:53<br \/>\ninflammatory disease and lastly describe<br \/>\n00:55<br \/>\nthe diagnosis and management of urinary<br \/>\n00:57<br \/>\ntract infections welcome back folks<br \/>\n00:59<br \/>\nlet&#8217;s start with screening should we be<br \/>\n01:01<br \/>\nscreening patients more for sti&#8217;s this<br \/>\n01:04<br \/>\nreporter went to the gynecology clinic<br \/>\n01:05<br \/>\nto find the answers dr. Maia Hammoud<br \/>\n01:08<br \/>\ntell us how women&#8217;s health care<br \/>\n01:10<br \/>\nproviders should be screening for esti<br \/>\n01:11<br \/>\nis well VD screening recommendations are<br \/>\n01:14<br \/>\ndifferent based on sex age and sexual<br \/>\n01:16<br \/>\npractices the Centers for Disease<br \/>\n01:18<br \/>\nControl recommend that women less than<br \/>\n01:20<br \/>\n25 should have annual screening for<br \/>\n01:21<br \/>\nchlamydia and gonorrhea and what about<br \/>\n01:24<br \/>\nwomen older than 25 they should be<br \/>\n01:27<br \/>\nscreened if they have new or multiple<br \/>\n01:29<br \/>\npartners or partner with no an STD what<br \/>\n01:32<br \/>\nabout pregnant women all pregnant women<br \/>\n01:34<br \/>\nshould be screened for syphilis<br \/>\n01:35<br \/>\ngonorrhea chlamydia HIV and hepatitis B<br \/>\n01:39<br \/>\nin the first trimester test should be<br \/>\n01:41<br \/>\nthe period for high-risk patients in the<br \/>\n01:43<br \/>\nthird trimester any other<br \/>\n01:45<br \/>\nrecommendations all people aged 13 to 64<br \/>\n01:49<br \/>\nshould be screened for HIV at least once<br \/>\n01:51<br \/>\nthen repeat annually of high-risk all<br \/>\n01:54<br \/>\nmen who have sex with men should have an<br \/>\n01:55<br \/>\nannual gonorrhea and chlamydia screen<br \/>\n01:57<br \/>\nand anyone who shares injection drug<br \/>\n01:59<br \/>\nequipment or has unsafe sex should be<br \/>\n02:01<br \/>\nscreened for HIV annually well what can<br \/>\n02:04<br \/>\nwe do to protect ourselves against sti&#8217;s<br \/>\n02:06<br \/>\nlet&#8217;s start with the basics number one<br \/>\n02:08<br \/>\ndelay the onset of sexual activity<br \/>\n02:10<br \/>\nnumber two try to limit the number of<br \/>\n02:12<br \/>\npart<br \/>\n02:13<br \/>\nnumber three use condoms number four<br \/>\n02:16<br \/>\npartner notification expedited therapy<br \/>\n02:19<br \/>\nrefers to a patient&#8217;s sexual partner<br \/>\n02:20<br \/>\nreceiving drug therapy for an STI<br \/>\n02:22<br \/>\nwithout undergoing a physical<br \/>\n02:24<br \/>\nexamination or testing vaccination is<br \/>\n02:27<br \/>\nanother form of prevention some strains<br \/>\n02:29<br \/>\nof the human papilloma virus cause<br \/>\n02:30<br \/>\ngenital warts and cervical cancer there<br \/>\n02:33<br \/>\nare three vaccinations currently<br \/>\n02:35<br \/>\navailable that protect against low and<br \/>\n02:37<br \/>\nhigh risk HPV strains the vaccines<br \/>\n02:39<br \/>\ncontain virus-like particles and are<br \/>\n02:41<br \/>\nrecommended for boys and girls age 11 to<br \/>\n02:43<br \/>\n12 they can be given between the ages of<br \/>\n02:46<br \/>\n9 and 26 and ideally should be given<br \/>\n02:48<br \/>\nbefore the initiation of sexual<br \/>\n02:49<br \/>\nintercourse lastly new on the scene is<br \/>\n02:51<br \/>\nprep pre-exposure prophylaxis against<br \/>\n02:53<br \/>\nHIV this is a daily pill which is a<br \/>\n02:55<br \/>\ncombination of two Nova veer and<br \/>\n02:57<br \/>\nemtricitabine for people engaged in<br \/>\n02:59<br \/>\nhigh-risk sexual activities such as a<br \/>\n03:01<br \/>\npartner with known HIV let&#8217;s now move on<br \/>\n03:04<br \/>\nto common STI s<br \/>\n03:05<br \/>\nas mentioned earlier many sti&#8217;s are<br \/>\n03:07<br \/>\nasymptomatic underlying the importance<br \/>\n03:09<br \/>\nof screening chlamydia is the most<br \/>\n03:11<br \/>\nfrequently reported infectious disease<br \/>\n03:13<br \/>\nin the United States it can have a full<br \/>\n03:15<br \/>\nspectrum of disease from asymptomatic<br \/>\n03:17<br \/>\n2mu Co purulent cervicitis<br \/>\n03:19<br \/>\nhere is a photograph of a cervix with<br \/>\n03:22<br \/>\nneucopia land discharge pelvic<br \/>\n03:24<br \/>\ninflammatory disease yura thright Asst &#8211;<br \/>\n03:27<br \/>\nvertical transmission to infants at<br \/>\n03:29<br \/>\ndelivery resulting in ophthalmic jnana<br \/>\n03:31<br \/>\ntourim and or pneumonia treatment for<br \/>\n03:33<br \/>\nchlamydia is oral as a thorough myosin<br \/>\n03:35<br \/>\nor doxycycline and it&#8217;s very important<br \/>\n03:37<br \/>\nfor the partner to get treated as well<br \/>\n03:38<br \/>\ngonorrhea is the second most common STI<br \/>\n03:41<br \/>\nin the United States women younger than<br \/>\n03:43<br \/>\n25 are at highest risk it tends to be<br \/>\n03:46<br \/>\nmore symptomatic than chlamydia and in<br \/>\n03:48<br \/>\nmen the infection is characterized by<br \/>\n03:49<br \/>\nmukou purulent or purulent discharge<br \/>\n03:51<br \/>\nfrom the urethra in women the symptoms<br \/>\n03:54<br \/>\ncan be mild enough to be overlooked and<br \/>\n03:55<br \/>\ncan include pee relent discharge from<br \/>\n03:57<br \/>\nthe urethra cervix vagina or anus the<br \/>\n04:00<br \/>\ndiagnosis of gonorrhea and chlamydia is<br \/>\n04:02<br \/>\nmade by PCR amplification of either a<br \/>\n04:04<br \/>\nurine or cervical discharge sample<br \/>\n04:06<br \/>\ntreatment for gonorrhea is ceftriaxone<br \/>\n04:08<br \/>\nhowever given the high likelihood of<br \/>\n04:10<br \/>\nconcurrent chlamydial infection positive<br \/>\n04:13<br \/>\ngonorrhea results should lead to<br \/>\n04:14<br \/>\ntreatment for chlamydia treatment as<br \/>\n04:16<br \/>\nwell so the treatment will be<br \/>\n04:17<br \/>\nceftriaxone plus azithromycin or<br \/>\n04:19<br \/>\ndoxycycline<br \/>\n04:20<br \/>\nlet&#8217;s now move to a pelvic inflammatory<br \/>\n04:22<br \/>\ndisease PID is an ascending infection of<br \/>\n04:25<br \/>\ntypically gonorrhea and chlamydia<br \/>\n04:27<br \/>\nyeah here is the uterus fallopian tubes<br \/>\n04:29<br \/>\nand ovaries that bacteria ascend from<br \/>\n04:32<br \/>\nthe cervix up through the endometrium<br \/>\n04:34<br \/>\nand into the fallopian tubes this leads<br \/>\n04:38<br \/>\nto an inflammatory process which will<br \/>\n04:42<br \/>\ncreate swollen mucosal and serosal<br \/>\n04:44<br \/>\nsurfaces of the fallopian tubes<br \/>\n04:47<br \/>\nanaerobic organisms can flourish and<br \/>\n04:49<br \/>\ngrow in this fluid collection which can<br \/>\n04:51<br \/>\nlead to a tubo-ovarian abscess even<br \/>\n04:56<br \/>\nwithout a tubo-ovarian abscess fibrin<br \/>\n04:59<br \/>\ndeposition can lead to scarring of the<br \/>\n05:01<br \/>\nfallopian tubes the public peritoneum<br \/>\n05:03<br \/>\nand ovaries this photograph shows a<br \/>\n05:06<br \/>\ndilated and likely scarred right<br \/>\n05:08<br \/>\nfallopian tube fitz hugh curtis syndrome<br \/>\n05:11<br \/>\nrefers to the rare infection of the<br \/>\n05:13<br \/>\nliver capsule and peritoneal surfaces of<br \/>\n05:15<br \/>\nthe liver<br \/>\n05:15<br \/>\nhere is the liver the diaphragm and the<br \/>\n05:18<br \/>\nfibrin is exudates from PID the<br \/>\n05:21<br \/>\ndiagnosis of PID can be difficult and<br \/>\n05:23<br \/>\nchallenging because of the wide<br \/>\n05:24<br \/>\nvariation of symptoms and signs and the<br \/>\n05:26<br \/>\nclinical diagnosis is imprecise delaying<br \/>\n05:29<br \/>\ndiagnosis can lead to potential damage<br \/>\n05:31<br \/>\nto the reproductive health for young<br \/>\n05:32<br \/>\nwomen this illustration shows a<br \/>\n05:34<br \/>\nfallopian tube that&#8217;s been damaged by<br \/>\n05:36<br \/>\nPID an early intervention is meant to<br \/>\n05:38<br \/>\ntry to prevent this from occurring<br \/>\n05:40<br \/>\nthus the Centers for Disease Control<br \/>\n05:41<br \/>\nrecommend that treatment for PID should<br \/>\n05:44<br \/>\nbe initiated in sexually active young<br \/>\n05:46<br \/>\nwomen with pelvic or lower abdominal<br \/>\n05:48<br \/>\npain and cervical motion tenderness or<br \/>\n05:50<br \/>\nuterine tenderness or adnexal tenderness<br \/>\n05:52<br \/>\nan elevated temperature white-blood-cell<br \/>\n05:55<br \/>\ngreater than 10,000 or frank purulent<br \/>\n05:57<br \/>\ndischarge from the cervix can help in<br \/>\n05:59<br \/>\nmaking the diagnosis but treatment<br \/>\n06:00<br \/>\nshould be initiated even without these<br \/>\n06:02<br \/>\nfindings the treatment of PID involves<br \/>\n06:05<br \/>\n10 to 14 days of antibiotics either oral<br \/>\n06:07<br \/>\nor parental one common antibiotic<br \/>\n06:11<br \/>\nregimen is cefoxitin plus doxycycline<br \/>\n06:13<br \/>\nthis is known as the foxy Knoxy regimen<br \/>\n06:17<br \/>\nthus aqualia PID can be severe and are<br \/>\n06:20<br \/>\ncommon in fertility and 10 to 20%<br \/>\n06:22<br \/>\nectopic pregnancy in six to ten percent<br \/>\n06:25<br \/>\nchronic pelvic pain and 15 to 20 percent<br \/>\n06:28<br \/>\nand 25 percent of PID patients will have<br \/>\n06:31<br \/>\nat least one of these sequelae let&#8217;s<br \/>\n06:33<br \/>\nmove now to other important and common<br \/>\n06:35<br \/>\nSTI s let&#8217;s start with trichomonas women<br \/>\n06:39<br \/>\nwith trichomonas may have<br \/>\n06:40<br \/>\nincreased frothy greenish yellow<br \/>\n06:41<br \/>\ndischarge and vulvar itching and<br \/>\n06:43<br \/>\nirritation diagnosis is made by the wet<br \/>\n06:46<br \/>\nprep here is a photograph of the<br \/>\n06:48<br \/>\nflagellated parasite on wet prep this<br \/>\n06:50<br \/>\norganism will be seen often moving<br \/>\n06:51<br \/>\nrapidly around the slide treatment for<br \/>\n06:53<br \/>\ntrichomonas is a single to gram dose of<br \/>\n06:55<br \/>\nmetronidazole herpes is a very common<br \/>\n06:58<br \/>\ninfection and up to 75% of primary<br \/>\n07:00<br \/>\ninfections go unrecognized the HSV one<br \/>\n07:03<br \/>\nstrain typically causes oral lesions and<br \/>\n07:05<br \/>\nthe HSV 2 strain typically leads to<br \/>\n07:07<br \/>\ngenital lesions there is however now an<br \/>\n07:10<br \/>\nincreasing proportion of new genital<br \/>\n07:12<br \/>\ninfections due to HSV one the initial<br \/>\n07:14<br \/>\npresentation can be very painful and<br \/>\n07:16<br \/>\nsevere painful vesicles can appear on<br \/>\n07:18<br \/>\nthe vulva vagina cervix perineum and<br \/>\n07:20<br \/>\nperianal skin these vesicles are<br \/>\n07:22<br \/>\nextremely tender and patients may<br \/>\n07:24<br \/>\ndevelop urinary retention from pain and<br \/>\n07:26<br \/>\nare urethral and bladder involvement<br \/>\n07:28<br \/>\nhere is a helpful teaching tip a patient<br \/>\n07:30<br \/>\npresenting with painful vulva symptoms<br \/>\n07:32<br \/>\nand urinary retention is often having a<br \/>\n07:34<br \/>\nprimary herpes outbreak treatment is<br \/>\n07:36<br \/>\nwith the antiviral acyclovir Pham<br \/>\n07:38<br \/>\nCyclovia<br \/>\n07:38<br \/>\nor valus i clavier episodic treatment<br \/>\n07:41<br \/>\nmeans treatment at the time of<br \/>\n07:42<br \/>\nrecurrence this decreases the duration<br \/>\n07:45<br \/>\nof the episode suppressive therapy<br \/>\n07:46<br \/>\nrefers to daily therapy and prevents 80%<br \/>\n07:49<br \/>\nof recurrences and results in a 48%<br \/>\n07:51<br \/>\nreduction and viral transmission between<br \/>\n07:53<br \/>\nsexual partners let&#8217;s now change gears<br \/>\n07:56<br \/>\nas this reporter will share a personal<br \/>\n07:58<br \/>\njourney of my experience with a urinary<br \/>\n07:59<br \/>\ntract infection it started one day when<br \/>\n08:01<br \/>\nI developed suprapubic pain urinary<br \/>\n08:04<br \/>\nfrequency and blood in my urine the<br \/>\n08:05<br \/>\ndiagnosis was made with a urine analysis<br \/>\n08:08<br \/>\nthis measured the pH protein level<br \/>\n08:10<br \/>\npresence of nitrates white blood cells<br \/>\n08:11<br \/>\nand leukocyte esterase a urine sample<br \/>\n08:14<br \/>\ncan also be sent to the lab for culture<br \/>\n08:16<br \/>\nmy health care provider per treated me<br \/>\n08:18<br \/>\nwith a three day course a trimethoprim<br \/>\n08:19<br \/>\ncellphone ethics is all he could have<br \/>\n08:22<br \/>\nalso treated me with a three day course<br \/>\n08:23<br \/>\nof a fluoroquinolone i want to get to<br \/>\n08:25<br \/>\nthe source of why UTIs are more common<br \/>\n08:27<br \/>\nin women it turns out that women have a<br \/>\n08:29<br \/>\nshorter urethral length their me a disc<br \/>\n08:31<br \/>\nit&#8217;s exposed to vestibular and rectal<br \/>\n08:33<br \/>\npathogens and sexual activity may induce<br \/>\n08:35<br \/>\ntrauma or other organism which all<br \/>\n08:37<br \/>\nincrease the potential for infection<br \/>\n08:38<br \/>\n11 percent of US women will report at<br \/>\n08:41<br \/>\nleast one physician diagnosed UTI per<br \/>\n08:43<br \/>\nyear and the lifetime probability that a<br \/>\n08:45<br \/>\nwoman will have a UTI is 60%<br \/>\n08:48<br \/>\nthis concludes our expose on sti&#8217;s and<br \/>\n08:51<br \/>\nUTIs we have reviewed STI<br \/>\n08:53<br \/>\nscreening partner notification symptoms<br \/>\n08:56<br \/>\nand physical exam findings of common<br \/>\n08:57<br \/>\nsti&#8217;s we reviewed PID and UTIs and<br \/>\n09:01<br \/>\nthat&#8217;s the way it is this is Victoria<br \/>\n09:03<br \/>\nDeuce and on behalf of dr. Maia Hammoud<br \/>\n09:06<br \/>\ngood night<\/p>\n<p><\/div>\n<hr>\n","protected":false},"excerpt":{"rendered":"<p>Duration = 9:27<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":46,"menu_order":36,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-166","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/166","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/comments?post=166"}],"version-history":[{"count":2,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/166\/revisions"}],"predecessor-version":[{"id":2842,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/166\/revisions\/2842"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/media?parent=166"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}