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Therapeutics P3 Spring > Exam 4 lecture 5 > Flashcards

Exam 4 lecture 5 Flashcards

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1
Q

What are the 4 types of prevention for STIs

A

mechanical barriers
pre-exposure prophylaxis (PrEP)
Post-exposure prophylaxis (PEP)
HPV vaccine

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2
Q

what STDs do condoms not provide protection against?

A

STI spread by skin to skin contact (genital herpes, HPV, syphilis)

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3
Q

What are some meds to prevent HIV in adults

A
  1. Emtricitabine + tenofovit disoproxil fumarate (truvada)
  2. Emtricitabine + Tenofovir alafenamide (descovy)
  3. Cabotegavir (apretude)
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4
Q

Do people who are uding PrEP need PEP?

A

no

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5
Q

When is PEP not recommended

A

after 72 hr window

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6
Q

What is the second most common notifiable disease in the US

A

Gonorrhea

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7
Q

primary sites of gonorrhea in men and women

A

Primary site- endocervix in women and urethritis in men

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8
Q

What are the two types of infection that could be caused by gonorrhea? sx?

A

Anorectal infection and pharyngeal infection

Asymptomatic for both

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9
Q

clinical manifestation in newborn for gonorrhea

A

opthalmal neonatorum, couldlead to blindness

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10
Q

Diagnosis of gonorrhea

A

Gram stain of male urethral specimen
NAAT- standard of care

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11
Q

most common coexisting infection with gonorrhea

A

Chylamydia

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12
Q

What is the treatment for uncomplicated Gonorrhea infection of cervix, urethra and rectum

A

If weight < 150 kg- ceftriaxone 500 mg

If weight >150 kg, ceftriaxone 1 gm

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13
Q

If chylamydia is not excluded during gonorrhea test, what do we use

A

If <150 kg- doxy 100 mg
pregnant- azithro

If >150 kg- doxy 100 mg
pregnanct-azithro

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14
Q

For gonorrhea, if ceftriaxone is not available or severe cephalosporin allergy what do we use

A

gentamicin IM + Azithro PO

Cefixime PO

if chylamydia not excluded- doxy and azithro

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15
Q

when is test of cure recommended for gonorrhea

A

7-14 days

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16
Q

patient education for gonorhea tx

A

Instruct patients to abstain from sex for 7 days after tx and until all partners are tx

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17
Q

What is the expedited partner therapy (EPT)

A

patient may deliver tx to partner without being seen by doc

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18
Q

What are the clinical presentations of syphilis

A

primary syphilis
secondary syphilis
latent syphilis
Tertiary syphilis
Neurosyphilis
Congenital syphilis

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19
Q

Describe primary syphilis

A

After exposure, a painless lesion (chancre) appears->highly infectious

disappears without tx after 3-6 wks

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20
Q

When does secondary syphilis occur? What is it characterized by?

A

Develops 2-6 wks after onset of primary stage

variety of mucocutaneous eruptions and lesions

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21
Q

Describe latent syphilis? What is it divided into?

A

Patient has positive serologic tests but no other evidence of disease.

Divided into early latent and late latent stages
- early latent- potentially infectious (1 yr from infection)

  • Late latent- patient is considered non infectious (excpetion->pregnancy)
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22
Q

What % of patients progress to tertiary syphilis from latent

A

25-30%

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23
Q

Describe late syphilis

A

Slowly progressing inflammatory phase of disease. Can affect any organ in body

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24
Q

Timeline of stages of syphilis

A

Primary- within 21 days of exposure
Seocndary- 4-10 wks
Latent- lasts years/decades
Tertiary- serious stage causes complications

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25
When does neurosyphilis occur? Symptoms? Diagnosis?
May occur at any stage of syphilis Headache, meningismus, increased CSF leukocyte count and protein VDRL-CSF when reactive, diagnostic for neurosyphilis
26
for diagnosis of syphilis, What do we do?
microscopic testing Serologic testing (2 tests)
27
What are the two serologic tests for diagnosis of syphilis
1. nontreponemal tests- detect reagin 2.treponemal test (more sensitive)
28
What does positive test and negative test mean for nontreponemal
Positive test indicates presence of any stage of syphilis Negative in incubating syphilis and early primary syphilis
29
tx of syphilis
Pen G for all stages
30
What drug to use for syphilis if PCN allergy
doxy tetracycline
31
What is the treatment of neurosyphilis
Aqueous pen G IV 10-14 days (better) or Procaine penicillin IM
32
What to use for neurosyphilis if pen allergy present
ceftriaxone
33
what is treatment of HIV patients with primary or secondary syphilis
Benzathine penicillin
34
How to treat HIV patient with early latent syphilis infections
Benzathine penicillin G IM x 1 dose
35
How to treat HIV patient with late latent syphilis or unknown duration
Benzathine penicillin once weekly x 3 wks
36
How to treat syphilis in pregnant women? What if allergic (exam)
Penicillin is ONLY agent that reliably protects and treats the fetus If pen allergic- skin testing is required
37
tx of primary and secondary syphilis
Benzathine pen G X 1 dose doxy, tetra, axithro if allergic
38
early laten syohilis (<1 yr tx)
Benzathine pen G x 1 dose
39
Treatment of late latent > 1 yr syphilis
Benzathine Pen G x 3 wks
40
What is the most common notifiable infectious disease
chlamydia
41
What happens if chlamydia is left untreated
40% of women with untreated chlamydia develop PID. infertility occurs in 1 in women with PID
42
clinical presentation of chlamydia in men and women
men- dysuria, frequency, mucoid urethral discharge. 50% asymptomatic. Females- asymptomatic. (endocervicitis with discharge if symptomatic)
43
How is chlamydia diagnosed
NAAT (90-100 % specificity and sensitivity
44
chlamydia tx for adolescents and adults
Doxy x 7 days BID aternative could be azithro 1 dose or levo x 7 days
45
Tx of chlamydia for pregnant patients
azithro x 1 dose alterative tx could be amoxicillin x 7 days
46
mycoplasma genitalium diagnosis
NAAT testing
47
tx of mycoplasma genitalium
depends on availability of resistance testing Macrolide susceptible- doxy folloewed by azithro MAcrolide resistance- doxy followed by moxifloxacin testing not available- docy 100 mg PO followed by moxifloxacin
48
describe symptoms of 1st episode primary herpes infections and first episode nonprimary genital herpes
first episode primary- Flu like sx, fever, headache, malaise, myalgias First episode non primary genital herpes- infection in pts who have clinical or serologic evidence of prior HSV (less symptomatic that primary)
49
does patient have to be symptomatic for herpes to shed virus
no
50
How to diagnose herpes
viral culture- preferred virologic test HSV NAAT- most sensitive for detection
51
initial tx of 1st episode of genital tx
acyclovir or famciclovir or valacyclovir
52
Duration of tx of first clinical episode
7-10 days
53
describe the prodrome phase in HSV
Headache numbness lesion
54
When do recurrent infection tx for HSV help?
If started in prodrome or within 1 day of onset of lesion
55
recurrent HSV tx
Acyclovir 800 mg PO BID x 5 days or TID x 2 days Famciclovir 125 mg PO BID x 5 days or 1 g BID x 1 day valacyclovir 500 mg BID x 3 days or valacyclovir 1g PO x 5 days
56
Who has shprter duration of tx, initial episodes or recurrent infections
Shorter in recurrent tx (5 days or less)
57
How to treat severe disease HSV
acyclovir 5-10 mg/kg/dose for 2-7 days x 10 days
58
regimen for HSV with HIV
acyclovir, famciclovir and valacyclovir
59
if acyclovir resistant, what drug to use for HPV
foscarnet 40-80, or cidofovir 5 mg/kg IV
60
diagnosis of trichromonas
NAAT and culture
61
tx of trichromonas
Nitroimidazole only drug
62
cliical pearls of STD
avoid alcohol with metrondazole and tinidazole (24 hrs after last dose) excrete din breast milk
63

Therapeutics P3 Spring (33 decks)

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