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pr3151_pharmacotherapeutics > STD > Flashcards

STD Flashcards

1
Q

What are the mode of transmission of STIs?

A

Childbirth
Breastfeeding
Infected mother to child during pregnancy

Sexual contact with an infected person

Direct contact of broken skin with open sores, blood or genital discharge

Receiving contaminated blood

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2
Q

What are the risk factors associated with STDs?

A

Unprotected sexual intercourse
Number of sexual partners
Male sex with male
Prostitution
Illicit drug use

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3
Q

What are the preventive methods to advice sexually active patients?

A

Abstinence and decrease number of sexual partners

Barrier contraception

Avoid drug use and sharing of needles

DO your pre-exposure vaccinations such as HPV and Hep B

Do your pre and post exposure prophylaxis especially those having sex with high risk patients and healthcare workers

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4
Q

What are the clinical presentations of gonorrhea?

A

Purulent urethral / vaginal discharge, dysuria and urinary frequency

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5
Q

What are the potential complications associated with gonorrhea?

A

Male: Epididymitis, prostatitis, urethral stricture and disseminated disease

Females: Pelvic inflammatory disease, ectopic pregnancy, infertility, disseminated disease

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6
Q

What is the pathogen and how is gonorrhea detected?

A

Gram stain of genital discharge
Culture
NAAT

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7
Q

What are the treatments recommended for gonorrhea? List the dose, frequency and duration.

A

<150kg: Ceftriaxone 500mg IM single dose

> 150kg: Ceftriaxone 1g IM single dose

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8
Q

What is the alternative treatment for gonorrhea? List the dose, duration and frequency

A

Gentamicin 240 IM single dose + Azithromycin 2g PO single dose

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9
Q

How should I monitor response for patients and their sex partners?

A

Patients: Abstain from sexual activity for 7 days after treatment and until all sexual partners have been tested

Sex partners: Those < 60 days exposure need to be tested; those > 60 days exposed, most recent sexual encounter need to be tested

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10
Q

How is chlamydia diagnosed? What bacteria is of concern?

A

NAAT
Chlamydia trachomatis

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11
Q

What is the first line regimen for chlamydia?

A

Doxycycline 100mg BD for 7 days

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12
Q

What are the other alternative regimens for chlamydia if patient has issues with adherence?

A

Azithromycin 1g orally in a single dose

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13
Q

What should you advice patients and sex partners upon diagnosis of chlamydia?

A

Patients: abstain from sexual intercourse for 7 days after single dose was initiated OR upon completion of 7 days regimen and resolution of symptoms if present

Abstain from sex until all partners have been tested

Sex partners: Last 60 days evaluate and tested; > 60 days most recent partner to be tested

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14
Q

Name the various stages of syphilis and describe the various clinical presentations?

A

Primary: single painless ulcer at site or infection OR multiple, atypical and painful lesions at external genitalia

Secondary: skin rash, mucocutaneous lesions, patchy alopecia, lymphadectomy

Latent: Asymptomatic but picked by serology testing

Tertiary: Gummateous lesions in joints and potential cardiac involvement

Neuropsychiatric

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14
Q

How is syphilis diagnosed?

A

Treponemal and non-treponemal antibody tests

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15
Q

What is the treponemal antibody test used for?

A

Acts as a confirmatory test for the diagnosis of syphilis

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16
Q

What is the nontreponemal serology antibody test used for? How are the results analysed?

A

Screening tool that detects any stage of syphilis

Monitor the response of treatment as it will decline after treatment initiation

Quantitative result with dilute serum concentration with positive results

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17
Q

What is one special considerations in the use of nontreponemal serology antibody testing?

A

VDRL and RPR are not interchangeable, need to use the same test for monitoring purposes

18
Q

What is the first line for primary, secondary and early latent syphilis?

A

IM Benzthiane penicillin G 2.4 mil units in a single dose

19
Q

What is the alternative for primary, secondary and early latent syphilis?

A

PO Doxycycline 100mg BD for 14 days

20
Q

What is the first line regimen for late latent or tertiary syphilis?

A

IM Benzthiane Penicillin G 2.4 mil units once a week (3 doses)

21
Q

What is the alternative for late latent or tertiary syphilis?

A

PO Doxycycline 100mg BD for 28 days

22
Q

What is the first line regimen for neurosyphilis?

A

IV Crystalline Penicillin G 3-4 MU q4h OR 18-24 MU/day as continuous infusion for 10 to 14 days

OR
IM Procaine penicillin G 2.4MU daily + PO Probenacid 500mg QD

23
Q

What is the alternative regimen for penicillin resistant neurosyphilis?

A

IV/IM Ceftriaxone 2g daily for 10-14 days

24
Q

What should we monitor for upon administration of drug for syphilis?

A

Jarisch-Herxheimer reaction where patient experiences acute febrile reaction of headache, myalgia within 24h

A four-fold reduction of titre to indicate treatment success

25
Q

How frequent should therapeutic response be monitored for syphilis?

A

3, 6, 12, 18 and 24 months

Neurosyphilis should check CSF every 6 months

26
Q

What to advice patients and sex partners upon diagnosis of syphilis?

A

Patients: Abstain from sex intercourse until lesions completely healed; advice to also check with doctor if fully treated

Sex partners: All to be evaluated and treat if positive

27
Q

What are the physical clinical presentation, flu like and prodromal symptoms of genital herpes?

A

Physical clinical presentation: multiple painful vesicular/ulcerative lesions

Flu like: fever, headache, malaise

Prodromal symptoms: Mild burning, itching and tingling

28
Q

How is genital herpes diagnosed?

A

Virulogic test done by viral cell culture / NAAT/ PCR

Type specific serologic test

29
Q

What should you consider before ordering a type specific serologic test?

A

Not useful for detecting a first episode infection as it takes 6-8 weeks for serologic detection

30
Q

What non-pharmacological advice can you give to patients with genital herpes?

A

Warm saline bath

Manage symptoms with antihistamines and analgesics

Good genital hygiene to be done

Educate natural history

31
Q

What is the place in therapy of antivirals like acyclovir and valacyclovir?

A

Decrease viral shedding
Decrease duration of symptoms
Decrease time of healing from 1st episode

32
Q

Does drug discontinuation affect genital herpes condition?

A

Yes
Drug does not prevent latency or affect frequency and severity of recurrent disease

33
Q

What is the dose of acyclovir for first episode uncomplicated and complicated genital herpes? List the dose, duration, route and frequency

A

Uncomplicated: PO 400mg TDS for 7-10 days

Complicated: IV 5-10mg /kg q8h for 2-7 days

33
Q

What are some counselling advice to give patients on acyclovir and valacylcovir?

A

Maintain hydration to prevent crystallisation in renal tubule

Take without food or after food if GI upset

34
Q

What is the dose of valacyclovir for initial episodes of genital herpes?

A

PO 1g BD for 7-10 days

35
Q

What are the types of therapy for recurrent genital herpes?

A

Chronic suppression or episodic

36
Q

What are the advantages and disadvantages of chronic suppressive therapy?

A

Advantages:
- Decreased frequency of recurrences
- No symptomatic outbreak
- Improve QOL
- Long term safety and efficacy
- Decreases risk of transmission

Disadvantages: Cost and compliance

37
Q

What is the dose of acyclovir for chronic suppressive therapy?

A

Acyclovir 400mg orally once a day

38
Q

What is the dose of valacylclovir for chronic suppressive therapy?

A

Valacyclovir 500mg once a day if less than 10 episodes a year

OR
Valacyclovir 1g once a day

39
Q

How frequent should chronic suppressive therapy be monitored?

A

Yearly

40
Q

What are the pros and cons of episodic therapy?

A

Pros
- Decreases duration and severity of symptoms
- Decreased cost
- Increased compliance

Cons:
- requires initiation of therapy within 1 day of lesion onset
- Does not decrease risk of transmission

41
Q

What is the dose of acyclovir for episodic therapy?

A

PO 800mg BD for 5 days
OR
PO 800mg TD for 2 days

42
Q

What is the dose of valacyclovir for episodic therapy?

A

PO 500mg BD for 3 days
OR
PO 1g OM for 5 days

pr3151_pharmacotherapeutics (9 decks)

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