Infectious disease/STDs Flashcards

1
Q

**

5 P’s of sexual health

A

1.) Partners
2.) Practices
3.) Prevention of pregnancy
4.) Protection from STIs
5.)Past history of STIs

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2
Q

Gonorrhea

A

A bacterial STI caused Neisseria gonorroeae (gram-negative diplococci)
Common in young adults (15-24)
* If left untreated in women can lead to PID–>fallopian tube damage–>infertiity or increased risk of ectopic pregnancy.
* If left untreated in men can lead to epididymitis–>infertility (rare).
* Male ejaculation is not a requirement for transmission
* S/S:
-Males and females are often asymptomatic.
-Dysuria, urinary frequency, mucopurulent vaginal discharge (green/yellow), labial pain and swelling, lower abd pain, fever, dysmenorrhea, N/V, white/yellowish-green penile discharge, testicular pain. “GG: Green gooky”
* Lab/diagnostics: Nucleic-acid amplification test (NAAT) using urine sample and/or culture using modified Thayer-Martin media
* Treatment: Persons infected by gonohrrea are also frequently infected with chlyamydia, preempitevly treat for chlamydia.
-<150kg: ceftriazone 500mg IMx1
>150kg: ceftriazone 1g IMx1
If chamydial infection not ruled out then add doxycycline 100mg BID POx7 days.
If ceftriazone not available:
Gentamycin 240mg IMx1 dose plus azithromycin 2g PO x1dose OR
Cefixime 800mg POx1 plus doxycycline 100mg PO BIDx7days if chlamydia not ruled out.
If pregnant:
Ceftriaxone 500mg IMx1 and azithromycin 1g POx1

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3
Q

Syphilis

A

STI involving multiple organ systems and caused by Treponema Pallidum (a spirochete bacteria).
Called The Great Pretender due to the s/s looking like other diagnoses.
Typically follows a progression of stages for weeks, months to even years.
Infection occurs at the site of inocculation and a small abrasion or sore results.
Can affect the unborn and transported via blood stream.
Four clinical stages:
Primary, Secondary, Latent, Tertiary

  • Serologic tests:
    -Positive dark field microscopic examination and direct fleuroescent antibody test of lesion exudate are definitve tests for diagnsing early syphilis.
    -Non-treponemal antibody test: venereal disease research lab (VDRL) and/or rapid plasma reagin (RPR)
    -Confirmed with a treponema test: Treponema pallidum partile agglutination assay (TP-PA), fluorescent treponemal antibody absorption (FTA-ABS).
  • Treatment:
    -For primary, seondary or early syphilis: Benzathine penicillin G, 2.4million units IMx1 dose
    -For late latent, indeterminate length or tertiary: Benzathin penicillin G, 2.4million units IM weekly x 3 weeks.
    -For neurosyphilis/ocular syphilis/otosyphilis: Aqueous crystalline penicillin G 18-24 million units/day (3-4 million units IV q4hrs or continuous infusion) for 10-14 days
    If pt able to be compliant than an alternative tx would be procaine penicillin G, 2.4 million units IM once daily PLUS probenecid 500mg PO QID both for 10-14 days.
    -Penicillin allergy: Doxycycline or tetracycline
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4
Q

Primary Syphilis

A

-Chancre present at site of infection common 3 weeks after exposure.
-Chancre indurated and PAINLESS, heals spontaneously within 1-5 weeks.
-Regional lymphadenopathy.

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5
Q

Secondary syphilis

A

Occurs 2-8 weeks later.
Flu like symptoms.
Generalized lymphadenopathy.
Generalized reddish brown rash on palsm/soles/trunk (heals within 5-10 weeks)

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6
Q

Latent syphilis

A

Seropositive, but asymptomatic.
Can last 2-20 years
Early latent: infection lasting less than a year, infectious
Late latent: infection lasting more than a year, non infectious.

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7
Q

Tertiary syphilis

A

10-30 year after initial infection
Multisystem involvement
Leukoplakia (thick, white patches inside mouth), cardiac insufficiency, infiltrative tumors of skin/bones/liver, CNS involvement.

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8
Q

Chlamydia

A

A parasitic STI that produces serious reproductive tract complications
-Chlamydia trachomatis.
Remains the most common cause of cervicitis and urethritis.
Most common bacterial STI in U.S.
* S/S: Dysuria, intramenstrual spotting, post coital bleeding, dyspareunia (painful intercourse), vaginal discharge, thick/cloudy penile discharge, testicular pain, rectal tenesmus (persistant feeling of needing to poop).
* Lab/diagnostics: McCoy cell culture is gold standard, NAAT ro detect bacteria DNA or RNA.
* Treatment: Doxycycline 100mg PO BID x7days OR azithromycin 1g POx1 dose (prefered), OR levofloxacin 500mg PO daily x7days.

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9
Q

Vulvovaginitis

A

Inflammation or infection of the vulva and vagina most commonly cased by bacteria, protozoa and/or fungi.
Characterized by vaginal discharge, vulvar itching/irritation and vaginal odor.
* Three most common diseases: bacterial vaginosis, trichomoniasis, candidiasis.
Only trichomonas is considered an STD.
* Diagnostic tests: Microscopic wet-prep, may use NAAT (urine test) or vaginal culture.

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10
Q

Trichomoniasis

A

Malodorous, frothy yellowish/green discharge, pruritis, vaginal erythema, petechia (strawberry patches) on cervix and vagina, dysareunia (painful intercourse) and dysuria.
* Diagnostic tests: Normal saline mixture shows motile trichomonads
* Treatment: Metronidazole (GI upset, no alcohol) or tinidazole.

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11
Q

Bacterial vaginosis

A

Watery, grey, fishy smelling discharge, vaginal spotting.
* Diagnostic tests: Normal saline mixture shows irregularly-shaped vaginal epithetial cells (clue cells which are squamous epithethial cells with poorly defined borders).
* Treatment: Metronidazole PO or clindamycin cream. Other regimens Tinidazole PO, clindamycin PO

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12
Q

Candidiasis

A

Thick, white, curd like discharge. Vulvovaginal erythema with pruritis.
* Diagnostic test: KOH mixture show pseudohyphae (looks like spaghetti and meatballs).
Treat empirically if wet prep is negative but pt is symptomatic
* Treatment: OTC intravaginal agents clotrimazole, miconazole, tioconazole. Prescription intravaginal agents Butoconozole, terconazole. Oral agent Fluconazole (contraindicated in pregnancy).

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13
Q

Chancroid

A

Highly contagious STD caused by hemophilus ducreyi.
Must be a part of a differential diagnosis for genital ulcers.
Well established as a cofactor for HIV transmission. Many pts may also be infected with syphilis and HSV.
* S/S: Women are usually asymptomatic and men have a sinle or multiple superficial *PAINFUL *ulcer surrounded by an erythematous halo. Ulcer may be necrotic or severely erosive.
* Diagnosis: Diagnosed by a matter of exclusion. Involved genitalia and unilateral bubo or both (swollen inguinal lymph node).
* Treatment: Azithromycin, ceftriaxone, ciprofloxacin

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14
Q

Herpes (HSV)

A

A recurrent viral STI with no cure and associated with painful vesicles or ulcers.
Two types, 1 and 2.
Type 1 usually contracted non sexually in childhood. Type 2 is usually transmitted sexually
Most HSV infections are asymptomatic and can be latent.
* Diagnosis: Culture from lesion, NAAT from lesion
* Management: No cure.
-Symptomatic treatment with Docosanol (abreva) for HSV-1 to shorten healing time (should be given at first sign).
-Acyclovir usually 1st drug of choice
-Famciclovir
-Valayclovir (especially useful for reducing asymptomatic viral shedding of HSV-2).

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15
Q

HSV-1

A

Found on lips, face, mucosa.
Basal ganglia behind cheek.
Triggered by stess, lack of sleep, too much exposure to sun, cold weather and hormonal changes.

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16
Q

HSV-2

A

Found on the genitals
S/S: HA, fever, body aches, malaise, joint pain (flu like symptoms)
The first outbreak is usually the worst (2-3 weeks). Recur with additional outbreaks but less severe and shorter duration.
Triggered by other viral or bacterial infections, mestrual periods and stress.
The genital lesions are usually groups/clusters of painful/itching/burning blisters or ulcers that appear on the buttocks/anus/thighs/vulva/vagnia/penis/scrotum.
Prodromal sytmpoms (appear before lesions appear) are tingling/burning in the area where the lesions will develop.

17
Q

Dog, cats and human bites

A
  • All bites lead to infection, particularly human bites.
  • Timely, copious, high pressure irrigation with normal saline may be useful to reduce infection rates.
  • For animal bites, ask about rabies status.
  • Wounds of the hands or lower extremity should be left open.
  • Any wound older than 6 hours is generally left oen to heal by secondary intention.
  • 3-7 days of oral prophylactic antibiotic coverage for both staphylococci and anaerobes (augmentin).
18
Q

General approach to managing infections (PSSP)

A

P: Establish PRESENCE of infection
-Increased or decreased WBC, fever, infiltrated on chest x-ray, erythema, pus, secretions.
S: Estabish SEVERITY of infection.
-Age of pt, immune status, comorbidities.
S: Establish SITE of infection.
-Respiratory, skin, blood, IV-line, urine.
P: Establish likely PATHOGEN.
-Based on anatomical site and/or pt factors.

19
Q

Gram positive organisms

A
  • Staphylococcus
  • Streptococcus
  • Enterococcus
  • C-diff

Any others assume gram negative

20
Q

Streptococcus Pneumoniae

A

Most likely pathogen to cause (itis):
-Acute otitis media
-Sinusitis
-Bronchitis
-Meningitis
-CAP

Other likely pathogens:
2. Haemophilus influenzae
3. Moraxella catarrhalis

21
Q

Empiric therapy for acute otitis media and sinusitis

A

-Amoxicillin
-Amoxicillin-clavulanate (augmentin) or
Cefuroxime or trimethoprim-sulfamethoxazole (TMP-SMZ, bactrim)

22
Q

Endocarditis

A

Acute:
Causative organism: Staphylococcus aureus
Treat with vancomycin+ceftriazone

Subacute:
Causative organism: Viridans streptococci, enterococci
Treat with penicillin and gentamicin

23
Q

Peritonitis due to ruptured viscus

A

Likely pathogen:
Coliforms or bacteroides fragilis

Treat with:
Metronidazole plus cephalosporin or
piperacillin/tazobactam

24
Q

Intra-abdominal

A

Likely pathogen:
E-coli, klebsiella, bacteroides fragilis, enterococcus

Treat with:
Cefuroxime or ceftriaxone or ciprofloxacin or levofloxacin each in combo with metronidazole

25
Q

Cellulitis

A

Likely pathogen:
Staphylococcus aureus, group A streptococcus

Treat with:
1st gen cephalosporin (cefazolin), vancomycin, clindamycin, linezolid, daptomycin

26
Q

Sepsis

A

Can be any pathogen

Treat with:
Vancomycin plus 3rd or 4th generation cephalosporin or piperacillin/tazobactam or imipenem or meropenem

27
Q

Antibiotic prophylaxis for surgery such as appendectomy

A

Likely pathogen: Staphylococci, streptococci, enteric gram negative rods
-Use cefazolin

If MRSA positive
-Use vancomycin

Likely pathogen is enteric gram negative rods, anaerobes
-Use cefoxitin or cefotetan or cefazolin PLUS metronidazole

28
Q

Transplant rejection, what does it look like? What to do?

A

-Immediate failure of that organ and flu like symptoms.
-Get an immediate biopsy of transplanted organ.

All pts are immunosuppressed pre-transplant, so consider risk of infection.

29
Q

Anti-rejection regimens

A

Involves triple therapy (three immunosuppressants from different classes):
-A corticosteroid (methylprednisone or prednisone) PLUS
-Antimetabolite (mycophenolate mofetil (cellcept)) and either a
-Calcineurin inhibitor (tacrolimus) OR a
-Mammalian target or rapamycin (mTOR) inhibitor (sirolimus)

30
Q

Herpes Zoster (Shingles)

A

An acute vesicular eruption due to infection with varicella-zoster virus. May be life threatening in immunocompromised adults.

S/S:
-Pain along a dermatomal distribution, usually on the trunk or chest first.
-Grouped vesicle eruption or erythema and exudate along the dermatomal pathway.
-Regional lymphadenopathy may be present.

Management:
Antivirals
-Acyclovir, famciclovir, valacyclovir
-If suspected ocular involvement, immediate referal to ophthalmologist as it’s a medical emergency
-If pt has post herpetic neuralgia give gabapentin or pregabalin (lyrica)
-Shingrix (vaccine) is indicated for all dults >50. It’s a two dose regimen with 2nd dose given within 2-6 months. May cause arm soreness.

31
Q

Keratoses and skin cancers

A
  • Actinic keratoses
  • Squamous cell carcinoma
  • Seborrheic keratoses
  • Basal cell carcinoma
  • Melignant melanoma
32
Q

Actinic Keratoses

A
  • Small patches occurring on sun-exposed parts of the body
  • Premalignant to SCC
  • Aysmptomatic, small patches may be tender.
  • Rough, flesh colored pink or hyperpigmented.
  • Treat with liquid nitrogen
33
Q

Squamous cell carcinoma

A
  • Arise out of actinic keratoses
  • Firm, irregular papule or nodule
  • Develop over a few months
  • Prolonged sun exposure areas in fair skin people
  • Keratotic, scaly bleeding

Treat with biopsy and Mohs surgical excision

34
Q

Seborrheic keratoses

A
  • Benign, not painful lesions although they look the worst.
  • Beige, brown or black plaques
  • “Stuck on” appearance.
  • 3-20mm in diameter

Treat: none or liquid nitrogen

35
Q

Basal cell carcinoma

A
  • The most common skin cancer
  • Slow growing lesion
  • Waxy, pearly, appearance
  • Central depression or rolled edge
  • May have telangiectatic vessels (spider veins running from the lesion)

Treat: shave/punch biopsy and surgical excision

36
Q

Malignant melanoma

A
  • Mortality rate highest of all skin cancer
  • Median age is 40
  • May metastasize to any organ
    -Asymmetry
    -Border irregularity
    -Color variation
    -Diameter >6mm
    -Elevation
    -Enlargement

Treat with biopsy and surgical excision