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BCPID Review > DS: Infection of reproductive organs/STD > Flashcards

DS: Infection of reproductive organs/STD Flashcards

1
Q

Chlamydia: linical manifestations

A

Incubation time is from 1 weeks -3 weeks
Asymptomatic male and female
Clinical syndromes: urethritis in males and females, cervicitis, proctitis, conjunctivitis in both adults and neonates, PNA in neonates

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2
Q

Chlamydia in infants and children

A

Rare, most common presentation in conjunctivitis, but can also cause PNA usually occurs in 4-12 weeks after birth

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3
Q

Complication of chlamydia infections

A
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4
Q

Non genital Chlamydia clinical manifestation

A
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5
Q

Chlamydia screening recommendations

A
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6
Q

Chlamydia - repeat testing

A

Test of cure is only recommended in pregnant patients → should have test of cure 3-4 weeks after chlamydia treatment and repeat for re-infection approximately 3 months after completing treatment.

All patient diagnosed and treated should have a repeat test in 3 months to detect re-infection due to substantial risk for reinfection during the 3-months period following initial diagnosis

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7
Q

Chlamydia - Patient Education

A

Abstain from sexual intercourse x 7 days after one time dose of azithromycin or until completion of 7 days course regimen of doxycycline
DDi of doxycycline with polyvalent cations
Retest 3 month for re-infection

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8
Q

Gonorrhea - Clinical Manifestation

A
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9
Q

Gonorrhea - Non genital Gonococcal Clinical Manifestation

A
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10
Q

Gonorrhea - Screening Recommendation

A

NAAT Assays are recommended for detection of urogenital infection in both men / women with or without symptoms, however, NAATs do not yield live organisms → Now used GISP to detect and see if there any growing resistance of drug class

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11
Q

Gonorrhea - Treatment

A
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12
Q

Gonorrhea - Treatment Key points

A
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13
Q

Gonorrhea - allergies consideration

A

If serious anaphylactic allergy to cephalosporin → DUAL TREATMENT of one time dose of IM gentamicin 240 mg + oral azithromycin 2 gram

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14
Q

Gonorrhea - Why ceftriaxone?

A

Other oral cephalosporin have been investigated but have inferior efficacy
Vantin was inferior to cefixime
Cefixime will probably be effective - however, wise use of cefixime may increase N gonnorrhea MIC and cross resistance to CTX.

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15
Q

Disseminated gonococcal infection (DGI)

A
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16
Q

Other non genital gonococcal treatment

A
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17
Q

Gonococcal neonate conjunctivitis treatment

A
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18
Q

Gonorrhea test of cure

A

Test of cure is recommended for any person with pharyngeal gonorrhea regardless of the treatment regimen
7-14 days after the treatment should do a test of cure
Using culture +/- NAAT

  • If NAAT is positive, confirmatory culture needed before treatment
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19
Q

Gonorrhea treatment failure

A
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20
Q

Gonorrhea sex partners treatment and referrals:

A

Highly contagious, highly transmissible,
All sexual partners within the preceding 60 days should be referred for treatment
Or most recent partner if this contact occurred >60 days ago.

Providers should use Expedite partner therapy (EPT)
EPT: Cefixime 800 mg x 1 oral dose and if chlamydia co-infection not excluded ADD doxycycline 100 mg BID x 7 days

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21
Q

Gonorrhea patient education

A

Should be abstaining for 7 days after treatment and until all sex partners are adequately treated (7 days after receiving treatment and resolution of symptoms)
Person who receive diagnosis of gonorrhea should be tested for other STDs including chlamydia, syphilis and HIV

22
Q

Syphillis

A

Caused by bacterium called Treponema pallidum
Transmitted via sexual contact, human bites, mother-to child across placenta, blood transfusion

23
Q

Staging of syphillis

A

Nuerosyphillis - can occurs at any stages
Secondary syphilis skin rash - can be present on palms and bottom of feed

24
Q

Congenital Syphillis

A
25
Q

Screening of Syphilis

A
26
Q

Syphilis testing

A
27
Q

Syphilis Treatment

A
28
Q

Syphillis Alternative treatment

A
29
Q

Consideration syphilis treatment in pregnancy

A

Should have additional quantitative non treponemal testing because titers are essential in monitoring treatment course
Pregnant women who miss any dose, must repeat full course therapy due to potential congenital syphilis

30
Q

Consideration syphillis tretament in allergies

A
31
Q

Jarish-Herxheimer Reaction (JHR)

A
32
Q

Syphilis Treatment Failure

A
33
Q

Syphillis patient education

A

Patient should be informed about JHR and how to manage it - need to explain that it is not a reaction to medication, rather response to treatment
Abstinence, mutual monogamy with an uninfected partner, use condom and limiting the number of sex partners
Develop individualized risk reduction plan

34
Q

Pelvic inflammatory disease (PID)

A

Studies suggest that the proportion of PID cases attributable to N gonorrhea or C trachomatis is declising
No single diagnostic test for PID, difficult to diagnose, provides maintain a lowe threshold for the diagnosis of PID due to potential damage to reproductive health of women
Comprises a spectrum of inflammatory disorders of the upper female genital tract, including any combination of endometritis, salpingitis, tubo-ovarian abscess and pelvic peritonitis

35
Q

Fitz-Hugh- Curtis Syndrome of PID

A
36
Q

PID Treatment

A
37
Q

PID Alternative regimen

A
38
Q

PID other consideration

A

All women who received a diagnosis of acute PID should be tested for HIV, gonorrhea and chlamydia
Clinical improvement should be seen within 3 days
If no improved after 72 hours - hospitalization, assessment of abx regimen and additional diagnostic should be done.
Pregnant - high risk for morbidity and preterm delivery → need to be hospitalized and treat with IV

38
Q

PID recommended IM/Oral regimen

A

In women with PID of mild/moderate clinical severity → IV and PO regimens appears to have similar efficacy
Anaerobic coverage should be considered due to lack of data on regimens without anaerobic coverage, and bacterial vaginosis is frequently associated with PID
When Tubo-ovarian abscess is present, either clindamycin or flagyl should be included for at least 14 days

39
Q

Epididymitis

A

Inflammation of the epididymis due to infectious and non infectious etiology
Most frequently caused by C trachomatis or N. gonorrhea
Men age >35 years (STI less common) usually infected as secondary infection to bacteriuria and obstruction (BPH)

40
Q

Epididymitis: Clinical Presentation

A
41
Q

Epididymitis: Treatment recommendation

A
42
Q

Human papillomavirus (HPV)

A

Most common sexually transmitted infection in teh US

43
Q

Recommend treatment for HPV - external anogenital warts

A
44
Q

Herpes Simplex Virus (1&2)

A

Genital herpes is chronic, lifelong viral infection usually caused for HSV-2 and sometimes Hs1b
Recurrence and subclinical shedding most common in HSV2
HSV is not a national reportable condition

45
Q

HSV screening recommendation

A

Does not support routine HSV screening amont asymptomatic pregnancy women
Should be considered for persons presenting for an STD evaluation
Does not support screening in the general population

46
Q

HSV Diagnostic testing

A
47
Q

HSV Initial Therapy

A
48
Q

HSV Recurrent episodes

A
49
Q

HSV Suppressive treatment

A
50
Q

HSV Antiviral Resistance

A

Low, but it is more commonly seen in immunocompromised patients
Most HSV acyclovir resistance is due to decreased or absent in production of viral thymidine kinase (TK)
High dose oral acyclovir and valacyclovir cannot overcome this resistance mechanism
Famciclovir and penciclovir not recommended - similar to acyclovir
Alternative option is IV foscarnet

BCPID Review (10 decks)

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