Episode 202: Sexually Transmitted Infections 2.0

We review Sexually Transmitted Infections and pertinent updates in diagnosis and management.
Hosts:
Avir Mitra, MD
Brian Gilberti, MD



https://media.blubrry.com/coreem/content.blubrry.com/coreem/Sexually_Transmitted_Infections_2_0.mp3



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Tags: gynecology, Infectious Diseases, Urology





Show Notes
Table of Contents
(1:49) Chlamydia 
(3:31) Gonorrhea
(4:50) PID
(6:14) Syphilis
(8:08) Neurosyphilis 
(9:13) Tertiary Syphilis
(10:06) Trichomoniasis 
(11:13) Herpes
(12:49) HIV
(14:10) PEP
(15:13) Mycoplasma Genitalium 
(18:00) Take Home Points

Chlamydia:

* Prevalence:






Most common STI.
High percentage of asymptomatic cases (40% to 96%).






* Presentation:






Urethritis, cervicitis, pelvic inflammatory disease (PID), prostatitis, proctitis, pharyngitis, arthritis.
Importance of considering extra-genital sites (oral and rectal infections).






* Testing:






Gold Standard: Nucleic Acid Amplification Test (NAAT) via PCR.






* Sampling Sites:








Endocervical or urethral swabs preferred over urine samples due to higher sensitivity.
Triple-site testing (genital, rectal, pharyngeal) recommended for comprehensive detection.








* Treatment Updates:






Previous Regimen: Azithromycin 1 g orally in a single dose.
Current First-Line Treatment: Doxycycline 100 mg orally twice daily for 7 days.






* Alternatives:






Azithromycin remains an option for patients unlikely to adhere to a 7-day regimen or for pregnant patients.


Note: PID treatment differs and will be discussed separately.



Gonorrhea:

* Presentation:






Similar to chlamydia; can be asymptomatic.
Symptoms include urethritis, cervicitis, PID, prostatitis, proctitis, pharyngitis.






* Testing:






Gold Standard: NAAT.






* Sampling Sites:








Endocervical swabs are more sensitive than urine samples.
Triple-site testing is crucial to avoid missing infections.