St Thomas University Sexually Transmitted Genital Infections Discussion Response

All replies must be constructive and use literature where possible. APA 7

• Elizabeth Varona-Martin

Case  # 3

• STIs are typically asymptomatic, but they can lead to a variety of issues. A wide variety of bacteria, viruses, protozoa, and ectoparasites can cause STIs. Five of the most common STIs include (Hsu, 2021):

1- Chlamydia trachomatis is the leading bacterial cause of sexually transmitted genital infections, and the bacteria Chlamydophila trachomatis cause it.

Chlamydia trachomatis is a gram-negative obligate intracellular parasitic bacteria. It has a specific life cycle that is divided into two key stages (Hsu, 2021):

Within six to eight hours, the small elementary bodies connect to and enter cells, transforming into the metabolically active form known as the reticulate body.

The reticulate bodies subsequently rearrange into small elementary bodies, and the cell ruptures within two to three days, releasing freshly produced elementary entities.The release of the elementary bodies commences the replicative process. Because of the long growth cycle, therapy with drugs with a long half-live course of antibiotics is required to eliminate the infection (Hsu, 2021).

Chlamydia trachomatis most usually infects the cervix in females. The majority of infected females are asymptomatic, while some may exhibit classic cervicitis signs on the exam, such as vaginal discharge, atypical vaginal bleeding, and purulent endocervical discharge (Hsu, 2021).

Management plan

It is essential to treat current and recent sexual partners (Schuiling & Likis, 2022). Treatment focuses on preventing complicated chlamydia infections, for example, pelvic inflammatory disease (PID), infertility, and ectopic pregnancy reducing the risk of transmission to others, relieving symptoms in individuals who have them, and preventing reinfection.

Recommended Treatment (Schuiling & Likis, 2022):

Azithromycin 1 gm orally in a single dose or 

Doxycycline 100 mg orally two times/day for 7 days

Alternative treatments (Schuiling & Likis, 2022):

1. Erythromycin base 500 mg orally four times/day for seven days or
2. Erythromycin ethylsuccinate 800 mg orally four times/day for seven days or

Levofloxacin 500 mg orally once/day for seven days or

Ofloxacin 300 mg orally two times/day for seven days

Patient education (Schuiling & Likis, 2022):

The patient’s sexual partners need to be referred to testing and treatment.  If they are unable or unwilling to do it, the provider may consider expedited partner therapy, which offers the patient the treatment to give to the partner.

Refrain from having sex until the patient and their sex partners have finished therapy and are symptom-free, which generally takes seven days.

2- Trichomoniasis is an infection of the genitourinary tract caused by the Trichomonas vaginalis, an anaerobic one-celled protozoan with distinctive flagella. It is the most prevalent nonviral sexually transmitted disease (STD) in the world. It is almost always transmitted sexually and may be found in 70 percent of infected females’ male sexual partners. It is common to be infected with different sexually transmitted diseases (STDs) and have bacterial vaginosis (Sobel & Mitchell, 2021). T. vaginalis primarily infects the urogenital tract’s squamous epithelium, including the vagina, urethra, and paraurethral glands. The cervix, bladder, Bartholin glands, and prostate are some of the less affected places.

• Trichomoniasis is usually asymptomatic. However, patients might have a distinctively yellow to greenish, frothy, mucopurulent, profuse, malodorous discharge. The vulva, vagina, or both may be inflamed and burning; pruritus, dysuria, frequency, and dyspareunia are signs and symptoms. The cervix and vaginal walls of patients with trichomoniasis may develop distinctive small petechiae, commonly referred to as “strawberry spots” (Schuiling & Likis, 2022).

Management plan (Schuiling & Likis, 2022):

Metronidazole 2 g orally in a single dose or 

• Tinidazole 2 g orally in a single dose.
• If treatment fails and reinfection is ruled out:
• Metronidazole 500 mg orally twice day for 7 days
• If the infection continues: 

Metronidazole 2 g orally for seven days or 

Tinidazole 2 g orally for seven days.

• Patient education (Schuiling & Likis, 2022):
• Abstain from drinking alcohol while taking medications to avoid disulfiram-like response. Avoid alcohol for 24 hours after metronidazole medication and 72 hours after tinidazole treatment.

Refrain from having sex until the patient and their sex partners have completed therapy and are asymptomatic, usually taking about a week.

3-Gonorrhea is an STI caused by the aerobic gram-negative diplococcus N. gonorrhoeae. Infection with N. gonorrhoeae has four distinct stages: local attachment, invasion, dissemination, and host immunity evasion. In all of these steps, several outer membrane structures are included (Price & Bash, 2019).

Gonorrhea is the second most often reported communicable disease in the United States and the second most common STI. Symptomatic gonorrhea causes urethritis in men and cervicitis in women. Untreated gonorrhea can cause epididymitis in men and pelvic inflammatory disease (PID) in women, both of which can result in significant complications such as infertility, ectopic pregnancy, and persistent pelvic discomfort (Price & Bash, 2019).

Approximately 80 percent of women are asymptomatic. Clinical manifestations include dyspareunia, a change in vaginal discharge, unilateral labial pain and edema, or lower abdominal discomfort. Patients may experience purulent, irritating vaginal discharge or rectal discomfort and discharge. Menstrual irregularities, with longer, more painful menstruations, may be the presenting sign. Unilateral labial pain and swelling may suggest infection of the Bartholin gland, whereas periurethral discomfort and swelling may indicate inflamed Skene glands (Schuiling & Likis, 2022).

Management plan (Schuiling & Likis, 2022):

• Ceftriaxone 250 mg IM in a single dose or 
• Cefixime 400 mg orally in a single dose or 

Doxycycline 100 mg orally two times/day for seven days or

Other single-dose injectable cephalosporin regimens (ceftizoxime 500 mg IM, cefoxitin 2g IM with probenecid 1 gm orally, or cefotaxime 500 mg IM) plus 

• Azithromycin 1 g orally in a single dose (preferred) or 

Doxycycline 100 mg orally two times/day for seven days

Patient education (Schuiling & Likis, 2022):

• Patients and their partners should refrain from sexual activity for seven days following a single-dose injectable treatment or during oral medication to prevent reinfection.
• Patients should wear a condom every time they have intercourse to help avoid gonorrhea.

4- Hepatitis B is caused by the Hepatitis B virus (HBV), a DNA virus linked to three antigens and their antibodies.

The liver is the primary organ affected by HBV infection. It is asymptomatic in up to half of the people who have the virus. When symptoms appear, they usually present 90 days after HBV exposure and continue for several weeks. Arthralgias, lethargy, anorexia, nausea, vomiting, fever, stomach discomfort, clay-colored feces, dark urine, and jaundice are all symptoms of HBV infection. Approximately 5 percent of adults with HBV infection acquire a chronic condition, and 15 to 25 percent of those with chronic HBV infection die prematurely from liver cancer or cirrhosis.

• Management plan:
• The existence or absence of cirrhosis, the alanine aminotransferase (ALT) level, and the HBV DNA level all play a role in the decision to start therapy (Lok, 2021).

Patients who are not considered treatment candidates at presentation and those who want to delay therapy should have their liver biochemistry tests, HBV DNA, and HBeAg status monitored because liver disease and HBV replication may become active later (Lok, 2021).

The suppression of HBV DNA is the purpose of antiviral treatment. Pegylated interferon (PegIFN) or nucleos(t)ide analogs (for example, entecavir and tenofovir) are antiviral therapies for chronic HBV (Lok, 2021).

Hepatitis B is an infection that can be avoided with vaccination. All nonimmune women at risk of hepatitis B should be made aware of the availability of a hepatitis B vaccination. Vaccination is suggested for patients with more than one sex partner in the last six months and anyone being examined or treated for an STI (Schuiling & Likis, 2022).

Patient education (Schuiling & Likis, 2022):

Use of condoms with unvaccinated partners to prevent transmission. 

Cover cuts, avoid donating body fluids or organs, and not share household objects contaminated with blood to prevent transmission. 

• To minimize additional liver damage, women with HBV should avoid or Restrict alcohol intake or any drugs that may affect the liver.

Get hepatitis A immunizations.

5- Pediculosis Pubis is a parasitic disease caused by Phthirus pubis (Schuiling & Likis, 2022).

Patients with pediculosis typically exhibit pruritus due to the lice swallowing saliva and depositing digestive juices and excrement into the skin. Individuals may describe noticing lice or being exposed to head, body, or pubic lice through a household member or sexual relationship. It is also a possible history of shared clothing, bathing equipment, or beds (Schuiling & Likis, 2022).

• Management plan (Schuiling & Likis, 2022):

Permethrin 1 percent cream rinse and pyrethrins with piperonyl butoxide administered to the afflicted regions for 10 minutes, then rinsed off.

Alternative regimen:

Malathion 0.5 percent lotion applied for 8 to 12 hours and washed off.

• Ivermectin (250 mcg/kg) orally taken initially and repeated in 2 weeks

Patient education (Schuiling & Likis, 2022):

To kill lice and nits, wash all clothing, bed linens, and towels in hot water and dry them thoroughly on the hot cycle.

Avoid contact with the eyes when applying topical treatment.

• Advise patients to contact sexual partners within the last month to be examined and, if necessary, treated.

Avoid sexual intercourse until after completion of treatment.

References

Hsu, K. (2021, September 20). Epidemiology of Chlamydia trachomatis infections. UpToDate. Retrieved from https://www.uptodate.com/contents/epidemiology-of-chlamydia-trachomatis-infections?search=chlamydia&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3. 

• Lok, A. S. F. (2021, July 30). Hepatitis B virus: Overview of management. UpToDate. Retrieved from https://www.uptodate.com/contents/hepatitis-b-virus-overview-of-management?search=hepatitis+b&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H1024602452. 

Price, G. A., & Bash, M. C. (2019, October 10). Epidemiology and pathogenesis of Neisseria gonorrhoeae infection. UpToDate. Retrieved from https://www.uptodate.com/contents/epidemiology-and-pathogenesis-of-neisseria-gonorrhoeae-infection?search=GONORRHEA&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3#H21428802. 

Schuiling, K. D., & Likis, F. E. (2022). Gynecologic Health Care: With an introduction to prenatal and postpartum care. Jones & Bartlett Learning. 

Sobel, J. D., & Mitchell, C. (2021, July 22). Trichomoniasis. UpToDate. Retrieved  from https://www.uptodate.com/contents/trichomoniasis?search=TRICHOMONIASIS&source=search_result&selectedTitle=1~95&usage_type=default&display_rank=1.