Special Populations Management

STIs in Pregnancy - Precious Cargo Care

Protecting mother and child is paramount. Early STI detection and management prevent severe maternal/neonatal complications. Use pregnancy-safe drugs.

• Screening: Universal for Syphilis, HIV, HBsAg at 1st antenatal visit. Others based on risk.
• Syphilis:
  • Screen: VDRL/RPR, confirm with treponemal test.
  • Treat: Benzathine Penicillin G (e.g., 2.4 MU IM for early syphilis).
  • Prevents: Congenital syphilis (rash, snuffles, bone changes, Hutchinson's teeth).
• HIV:
  • Screen all. Mother: ART. Infant: ARV prophylaxis.
  • ⭐ > HIV vertical transmission risk drops to <1% with timely ART and optimal perinatal care.
• Hepatitis B (HBV):
  • Screen: HBsAg.
  • Newborn (HBsAg+ mother): HBIG + HBV vaccine within 12 hours.
• Gonorrhea/Chlamydia:
  • Screen high-risk. Treat (e.g., Ceftriaxone + Azithromycin; verify guidelines).
  • Prevent: Ophthalmia neonatorum.
• Herpes Simplex Virus (HSV):
  • Active genital lesions at delivery: Caesarean section.
  • Acyclovir prophylaxis from 36 weeks for recurrent HSV.

HIV & STI Co-infections - Immune System Under Siege

• Bidirectional Harm: HIV & STIs create a vicious cycle. STIs ↑ HIV acquisition & transmission risk. HIV impairs immunity, worsening STI severity & treatment response.
• Screening is Key: Regular, comprehensive STI screening for all HIV+ individuals (syphilis, GC, chlamydia, HSV, HPV).
• Management Nuances:
  • Atypical presentations common.
  • ↑ Risk of complications (e.g., neurosyphilis).
  • Treatment failures more frequent.
  • Consider IRIS unmasking STIs.
• Prevention: Consistent condom use, ARV adherence, regular STI checks.

⭐ HIV infection significantly increases the risk of human papillomavirus (HPV) persistence and progression to cervical or anal cancer.

Adolescents & STIs - Youth Guard Duty

Adolescents (10-19 yrs) are disproportionately affected by STIs. Unique approach needed for confidentiality, consent, screening & health education.

• Core Principles:
  • Confidentiality: Paramount; laws often allow minors to consent for STI services.
  • Screening: Annual Chlamydia/Gonorrhea (CT/NG) for sexually active females ≤25 yrs. HIV screening for all aged 13-64 at least once. Screen others based on risk.
  • Prevention:
    • HPV vaccination (target ages 11-12, catch-up up to 26 or 45 based on risk).
    • Consistent condom use.
    • Behavioral counseling.
  • Management: Age-appropriate, consider psychosocial impact. Partner notification is key.

⭐ Expedited Partner Therapy (EPT) is recommended for treating partners of patients with chlamydia or gonorrhea without a prior medical evaluation of the partner, especially in adolescents, to prevent reinfection and spread.

• Challenges: Asymptomatic infections, stigma, access to care, incomplete partner treatment. 📌 Remember the "5 Ps" of sexual history: Partners, Practices, Protection, Past STIs, Pregnancy prevention/plans.

MSM & VSA Care - Tailored STI Tactics

• MSM (Men who have Sex with Men):
  • ↑ Risk: HIV, Syphilis, GC/CT (pharyngeal/rectal/urethral), LGV, HBV, HCV, HPV.
  • Screening: Annual HIV Ag/Ab, Syphilis serology, HBsAg. Site-specific GC/CT NAAT. Anal Pap (HIV+).
  • Vaccinate: Hepatitis A, Hepatitis B, HPV.
  • Consider PrEP for HIV.
• VSA (Victims of Sexual Assault):
  • Immediate Care: Psych support, EC, STI prophylaxis.
  • Empirical STI Prophylaxis:
    • GC: Ceftriaxone 500mg IM (or 1g if >150kg).
    • CT: Doxycycline 100mg BD x7d OR Azithromycin 1g single dose.
    • Trichomoniasis (TV): Metronidazole 2g single dose.
  • HIV PEP: Start <72h (e.g., TDF+FTC+DTG).
  • Hepatitis B: Vaccination +/- HBIG.
  • Follow-up: STI/HIV tests (baseline, 2wk, 3mo, 6mo).

⭐ HIV PEP for VSA: Initiate ideally <2h, up to 72h post-exposure.

High‑Yield Points - ⚡ Biggest Takeaways

• Syphilis in pregnancy: Penicillin G is crucial (desensitize if allergic); watch for Jarisch-Herxheimer reaction.
• Gonorrhea/Chlamydia in pregnancy: Treat with Ceftriaxone + Azithromycin; avoid tetracyclines.
• HSV in pregnancy: Use Acyclovir suppression (late term); C-section for active lesions at delivery.
• HIV & Syphilis: Higher neurosyphilis risk; adjust Penicillin G regimen.
• HIV & HPV: Increased anogenital cancer risk (cervical, anal); screen vigilantly.
• STIs in children: Always consider sexual abuse; ensure medico-legal compliance.
• Congenital Syphilis: Key late stigmata: Hutchinson's teeth, saddle nose, saber shins.