STDs Flashcards
(51 cards)
CDC vaccination recommendations: Females and Males
Recommend for routine vaccination at age 11 or 12 (can start at age 9) and through age 26 for females or age 21 for males (males may be vaccinated through age 26)
MSM and immunocompromised persons
Through age 26 if not vaccinated previously
Urethritis
Discharge of purulent/mucopurulent material from the urethra, and burning upon urination
Commonly asymptomatic
Bacterial pathogen of importance in males in Neisseria gonorrhea
Urethritis diagnosis
> /= 5 WBC/hpf on gram-stain of swab, or evaluation of 1st void urine with + leukocyte esterases or >/= 10 WBC/hpf
Specific gonorrhea/Chlamydia tests should be performed
N. gonorrhea gram stain
G- intracellular diplococci
Chlamydia gram stain
nothing on gram stain
Treatment of uncomplicated gonococcal infection of cervix/urethra/rectum and pharynx
Ceftriaxone 250mg IM x 1
PLUS
Azithromycin 1g PO x 1
Disseminated/Complicated Gonococcal Infections (DGI) s/sx
Chills Fever Arthralgias Skin lesions Tenosynovitis of small joints Septic arthritis
DGI
results from gonococcal bacteremia that disseminates into skin, joints, CNS, and heart
Disseminated/Complicated Gonococcal Infections therapy
Ceftriaxone 1g IV/IM q24h PLUS Azithromycin 1g PO x 1 - at least 1 week of total therapy
Continued therapy outpatient - can switch to PO agent guided by antimicrobial susceptibility testing 24-48 hours after substantial clinical improvement
Gonococcal Endocarditis and Meningitis Treatment
Ceftriaxone 1-2g IV q24h PLUS Azithromycin 1g PO x 1 Meningitis duration: 10-14 days Endocarditis: > 4 weeks
Pelvic Inflammatory Disease consequences
Infertility
Ectopic pregnancies
Chronic pelvic pain
When is empiric therapy initiated for PID?
In sexually active women and other women at risk for STDs if they are experiencing pelvic or lower abdominal pain, if no cause for the illness other than PID can be identified, and if one or more of the following minimum criteria are present on pelvic examination:
Cervical motion tenderness OR
Uterine tenderness OR
Adnexal tenderness
Organisms responsible for PID
GNRs Anaerobes N. gonorrhea Mycoplasma hominis Ureaplasma urealyticum H. influenzae S. agalactiae Chlamydia trachomatis
PID preferred parenteral Regimen A
Cefotetan 2g IV q12h
or
Cefoxitin 2g IV q6h
PLUS: Doxycycline 100mg BID
PID preferred parenteral Regimen B
Clindamycin 90mg IV q8h
PLUS: Gentamicin IV
PID inpatient duration of therapy
Doxycycline (or oral clinda) should be continued for 14 days.
IV therapy should continue for at least 24-48 hours beyond the 1st sign of improvement.
When tubo-ovarian abscess is present, use PO clinda/flagyl and doxy to provide more effective anaerobic coverage
PID outpatient treatment
Only for mil-to-moderately severe acute PID
If no response in 72 hours, should be reevaluated to confirm diagnosis and given IV therapy
Preferred PID outpatient treatment regimen A
Ceftriaxone 250mg IM x 1 PLUS Doxycycline x 14 days w/ or w/out Metronidazole 500mg BID x 14 days
Preferred PID outpatient treatment regimen B
Cefoxitin IM x 1 + probenecid PO x 1 PLUS Doxycycline x 14d w/ or w/out metronidazole x 14d
Preferred PID outpatient treatment regimen C
Cefotaxime/Ceftizomine IV
PLUS
Doxycycline x 14 days
w/ or w/out metronidazole x 14 days
Syphilis
caused by a spirochete: Treponema pallidum, which is highly infectious, especially in early stages (chancre)
Primary syphilis
Average incubation period = 21 days
Chancre develops at site of inoculation as a painless papule which becomes ulcerated and indurated; non tender and filled with spirochetes
Lasts 1-5 weeks, resolves on its own
Secondary syphilis
Rash (hands, feet), lymphadenopathy, alopecia, H/A, weight loss
Lasts 2-6 weeks, fever
1st year of disease = highly infectious
