Exam 4 - STIs

Question 1

Congenital/neonatal infections:

______ can be transmitted transplacentally

Answer 1

Syphillis

Question 2

Congenital/neonatal infections:

Opthalmia neonatorum result from what infections?

Answer 2

chlamydia and gonorrheal infections

Question 3

Congenital/neonatal infections:

Neurologic impairment caused by what infections?

Answer 3

syphilis or herpes

Question 4

Congenital/neonatal infections:

which infections are acquired at birth?

Answer 4

C. trachomatis
N. gonorrhoeae
herpes simplex virus

Question 5

Gonorrhea Presentation:
in Men?

in Women?

Answer 5

Men: urethritis (purulent discharge and dysuria)

Women: usually asymptomatic (urethritis tho too)

Question 6

Gram stain of Neisseria gonnorheae?

Answer 6

Gram NEGATIVE diplococci

Question 7

Treating Gonnorheae:

what is the most common coexisting infection?

Answer 7

chlamydia

Question 8

Treating Gonnorheae:

If negative for chlamydia — still treat for it?

Answer 8

yup still do dual therapy (can help prevent resistance!)

Question 9

what is the drug of choice gonnorheae?

Answer 9

ceftriaxone

Question 10

Treating Gonnorheae:

how to treat uncomplicated gonococcal infections?

Answer 10

Ceftriaxone IM one dose
Azithromycin 1 gram PO single dose

(doxycycline BID x7 days if azith allergy!)

Question 11

High or Low resistance seen in gonorrhoeae?

FQs

Answer 11

high

Question 12

High or Low resistance seen in gonorrhoeae?

Cefixime

Answer 12

low (getting lower but because being used less..)

Question 13

High or Low resistance seen in gonorrhoeae?

Ceftriaxone

Answer 13

LOW! why we use it

Question 14

High or Low resistance seen in gonorrhoeae?

Azithromycin

Answer 14

getting higher

Question 15

Treating Gonnorheae:

how to treat uncomplicated gonococcal infections if ceftriaxone is not available?

Answer 15

cefixime PO single dose
PLUS
Azith PO single dose
(doxyccline BID x7)

Question 16

Treating Gonnorheae:

how to treat uncomplicated gonococcal infections AND severe cephalosporin allergy?

Answer 16

Spectinomycin 2 g IM x1
or
Azithromycin 2 grams PO x1 PLUS gentamicin 240 mg IM x1

Question 17

what bug causes syphilis?

Answer 17

treponema pallidum (spirochete)

Question 18

Clinical presentation of Syphilis:

Primary Syphilis?

Answer 18

Painless lesion (chancre -- dull/red/macule)
it will disappear spontaneously without treatment (in about 3 -6 weeks)

Question 19

Clinical presentation of Syphilis:

Secondary Syphilis?

Answer 19

Lesions are anywhere on body — PALMS OF HANDS AND SOLES OF FEET
and more systemic sxs

Question 20

Latent Syphilis:

Divided into ______ latent stage and ______ latent stage

Answer 20

early and late….

Question 21

Latent Syphilis:

Early or late — person is considered infectious?

Answer 21

early

Question 22

Latent Syphilis:

Early latent stage is defined as _____ from the onset of infections

Answer 22

1 year

Question 23

What are signs of Neurosyphilis?

Answer 23

headache
meningismus
increased CSF leukocyte count and protein

Question 24

Drug of choice for syphilis?

Answer 24

Penicillin G (parenteral)

Question 25

How to treat primary or secondary or tertiary syphilis?

Answer 25

BENZATHINE PCN IM x 1 dose

Question 26

How to treat early latent or late latent syphilis of unknown duration?

Answer 26

BENZATHINE PCN IM x 1 dose

Question 27

How to treat syphilis if penicillin allergic (non neurosyphilis)

Answer 27

Doxycycline BID x 28 days

or tetracycline 500 mg PO QID x 28 days

Question 28

How to treat neurosyphilis?

Answer 28

IV AQUEOUS PCN!!!! (NOT benzathine IV – ya kill em)

Question 29

How to treat pregnant patients with syphilis?

Answer 29

PCN!!! only!!

if allergic desensitize them and give them PCN

Question 30

what is Jarisch-herxheimer rxn

Answer 30

happens 2 - 4 hours after initiating therapy of PCN for syphilis— flu like symptoms
this is not a penicillin allergy!!

Question 31

Clinical Presentation for Chlamydia:
In males?

In females?

Answer 31

Males: urethritis stuff

Females: usually asymptomatic (can cause PID tho)

Question 32

________ is the most common cause of neonatal eye infection and afebrile interstitial pneumonia

Answer 32

Chlamydia

Question 33

Treatment for Chlamydia?

Answer 33

Azithromycin 1 gm PO single dose

Doxy BID x 7

Question 34

How to treat a pregnant women for Chlamydia?

Answer 34

Azithromycin 1 gm PO single dose

NOT DOXY!! no tetracyclines!!

Question 35

How to treat Mycoplasma genitalium?

Answer 35

Z-PAK!
(maybe Moxiflox too)

NO DOXY—super low cure rate

Question 36

Symptoms of a herpes infection?

Answer 36

Flu like symptoms!

Painful or itching etc

Question 37

Treatment of first clinical episode of genital herpes?

Answer 37

for 7 - 10 days

Acyclovir, Famiclovir, Valacyclovir

Question 38

Regimen for recurrent herpes??

Best to start in _____ or within ____ day(s)

Answer 38

Acyclovir, Famiclovir, Valacyclovir x 5 days

start in prodrome/start within 1 day of lesion

Question 39

Do daily suppressive therapy for herpes when patients have recurrences _______ times per year

Answer 39

6 times per year

Question 40

How to do suppressive therapy for pregnant women with genital herpes??

Answer 40

Start at 36 weeks gestation!

Acyclovir and Valacyclovir

Question 41

How to treat trichamonas?

Answer 41

metronidazole 2 g PO single dose (not best for dudes tho)

metronidazole 500 mg BID x 7 days

Question 42

Treatment options for pelvic inflammatory disease?

Answer 42

Clindamycin + Gentamicin (not best tho)
————————

IM/PO option
Ceftriaxone + Doxy +/- Metronidazole