Full Review Flashcards
(50 cards)
Clinical Signs of Syphilis
1: lesion, lymph
2: rash, lesion, systemic
Latent: asym
3: CV, neuro, gummatous
Causative Pathogens of STIs
Chlamydia: chlamydia trachomatis
Syphilis: treponema pallidum
Herpes: HSV 1 > HSV 2
Gonorrhea: neisseria gonorrhoea
Syphilis TX
1/2/EL: Benz PCN G 2.4 MU IM x 1
3/LL: Benz PCN G 2.4 MU IM x 3 wk
NOO: Crystal Aq PCN G 12-24 MU IV 10-14 d
*can do PCN 2.4 with Probenecid 500 mg 10-14 d
Neuro Syphilis F/U
CSF exam Q6 months until cell count normal
PCN Allergy
Ceftriaxone 2 g IV 10-14 days (BL CR)
Doxy/Tetra (low response)
PCN desensitization
Chlamydia Tx
DOC: Doxycycline 100 BID x 7 days with food
Preg: Azithro 1 g single dose
Other: Levo 500 mg x 7 days
Gonorrhea Tx
< 150 kg = Ceftriaxone 500 mg
> 150 kg = Ceftriaxone 1 g
chlamydia coinf: doxy, azithro if preg
Alt: Genta + Azithro or Cefix + Doxy/Azithro
Herpes Tx
1st clinical episode: A43, F23, V12
1. Acyclovir 400 mg TID x 7-10 (can also do 200 mg five times a day but not preferred)
2. Famciclovir 250 mg TID x 7-10
3. Valacyclovir 1 g BID x 7-10
*all durations are 7-10
Recurrent infection: 1-5 day tx, A43, F12, V52
1. Acyclovir 400 mg TID x 5 (800 BID x 5 or 800 TID x 2)
2. Famciclovir 1000 mg BID for 1 day
3. Valacyclovir 500 mg BID x 3 or 1 g QD x 5
Suppressive is 42,22,11 x 1 year
Limitation of Acyclovir
Dosing frequency, 5 x day
Indication for PREP
-If you want it
-Share needles
-MSM
-Multiple partneres
Labs before starting PREP
-HIV status (RNA for cabe)
-STI testing
-Renal function
-Hep B for oral meds
-Lipid profile
DO NOT NEED CD4/preg/plt count/dexa/pap
Counseling for PREP
-Start up syndrome (after 1 month, nausea/HA/fatigue/abd pain)
-Does not cover STIs
-Renal toxicity signs (dark urine)
-Wanes after 7-10 days
-Risk of Hep B flare if d/c
Don’t Use Descovy
Assigned female at birth, receiving vaginal sex
PREP On-Demand
NOT FDA-approved
Event driven oral PREP for MSM at least 2 hours before sex using Truvada (Only F/TDF)
ER with HIV exposure
No urgent HIV test, test, then again in 2 weeks
Avoid in G6PD deficiency
Dapsone
2 drug regimen for HIV
Dovato (Dolutegravir + 3TC)
Dovato Caveats
-Do not use with HIV/HBV co-infection
-RNA > 500k
-HIV resistance testing, HIV testing
HLA B 5701 + Avoid
-Abacavir
-Trimeq
Sulfa allergy, Avoid
“NAVIRS”
-Darunavir
-Fosaprenavir
-Tipranavir
Goal of ART
-Undetectable
-RNA viral load < 50
-CD4 count > 200
Active Drugs in Genvoya
3 (Elvitegravir, Emtricitabine, Tenofovir)
Cobicistat doesn’t count
Avoid with PPIs
Rilpivirine (NNRTI)
Odefsey (descry + rilp)
TB drugs with DDIs
Rifampin has most
Rifapentine has least
