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Therapeutics IV > STIs - Block 1 > Flashcards

STIs - Block 1 Flashcards

1
Q

What is the pathogen associated with gonorrhea?

A

Neisseria gonorrhoeae infects mucous membranes of GUT -> purulent exudates

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2
Q

S/s of gonorrhea?

A

Foul-smeeling vaginal discharge is NOT a sx
* Typically odorless

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3
Q

Who chould be screened for gonorrhea?

A
  1. Women sexually active <25YO
  2. > 25YO: multiple partners, partners with STI, no condoms, transactional sex, hx of STIs
  3. Pregnancy: first prenatal and 3rd trimester visits
  4. MSM -> annually
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4
Q

How do we diagnosis gonorrhea?

A

Nucleic Acid Amplifications Test (NAATs) -> combined test for GC and chlamydia
* Disad: no resistance data

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5
Q

How do you treat uncomplicated gono in pharynx?

A

Ceftriaxone

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5
Q

How do you treat uncomplicated gono in GUT?

A

Ceftriaxone 500 mg IM
* >150 kg -> 1 g
* Ceph allergy: Gentamicin + azithromycin

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6
Q

How do you treat gonococcal conjunctivitis?

A

Ceftriaxone 1g
Saline solution lavage in infected eye

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7
Q

How do you treat DGI?

A

Ceftriaxone 1-2 g Q12-24H

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8
Q

What supplemental tx is given in those with gonorrhea?

A

Tx for chlamydia: Doxycycline 100mg BID for 7 days

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9
Q

Gonorrhea and chlamydia interventions for partners?

A
  1. Tests with 60 days of sx onset or diagnosis
  2. Most recent partner should be treated even after 60 days
  3. Abstain from unprotected sex for 7 days or until resolution
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10
Q

What are the causes of chlamydia?

A
  1. Nongonococcal urethritis (NGU)
  2. Coinfection with gonorrhea
  3. Ocular infection
  4. Phrayngeal and rectal infection
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11
Q

Chlamydia increases the risk of acquiring ____?

A

HIV

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12
Q

What is the pathogen that causes chlamydia?

A

Chlamydia trachomatis

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13
Q

How does chlammydia differ from gonorrhea?

A

Genital tract infections are typically asymptomatic
* Urethral discharge is less profuse and more mucoid or watery

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14
Q

Who should be screened for chlamydia?

A
  1. MSM annually
  2. Pregant (first prenatal and 3rd trimester)
  3. Sexually active women <25YO annually
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15
Q

How is chlamydia dianosed?

A

NAATs
Cell culture (3-7 days)

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16
Q

Tx for uncomplicated chlamydia infection?

A

Doxycycline 100 mg BID for 7 days
* Non-adherence: azithromycin
* levofloxacin (7 days)

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17
Q

Tx for urogenital infections from chlamydia during pregnancy?

A

Azithromycin 1g PO once
Alt: amoxicillin 500mg TID for 7 days

Doxy and FQ are CI in pregnancy

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18
Q

Tx for conjunctivitis from chlamydia in newborns?

A

Erythromycin base or ethysuccinate 50mg/kg/d PO in 4 divided doses for 14 days

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19
Q

What is PID?

A

Inflammatory disorder of upper femal genital tract -> long term reproductive damage and caused by STI

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20
Q

Pathogen associated with PID?

A

Mycoplasma genitalium

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21
Q

How do you diagnosis PID?

A

Hallmark sign: sudden onset pelvic and lower ab pain, notable after menses
* Abnormal vag discharge. intermenstrual or postcoital bleeding, dyspareunia, dysuria

Screening for gono and chlamydia with NAAT

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22
Q

Tx for PID (hospitalization)

A

Ceftriaxibe 1g Q24H
+
Doxycycline (PO or IV)
+
Metronidazole (PO or IV)

23
Q

Tx for mild-moderate PID?

A

Ceftriaxibe 1g IM
+
Doxycycline PO x 14 days
WITH
Metronidazole PO x 14 days

24
How often should you follow up with PID?
Pts who tested positive with GC and Chla -> 3 months
25
Pathogen that causes trichomoniasis?
Trichomonas vaginalis
26
Presnetations of trichomoniasis?
1. Malodours Vaginal discharge (pH 4-5.6) 2. Both genders: urethral discharge and dysuria 3. Common in women (endocervical canal), men is asymtomatic (urethra)
27
Vaginal signs of tricohminosis>
1. elevated pH (>5) 2. Strawberry spots 3. Malodours 4. White, yellow, green discharge 5. Thick/thin, frothy
28
Who should be screeened for trichomoniasis?
1. HIV women -> annually 2. High prevalence for infection: STI clinic, MSP, transactional sex, STI hx 3. Symptomatic preganant women
29
How do you diagnosis trichomoniasis?
1. Wet mount of vaginal discharge 2. Culture (gold standard) -> long time 3. NAAT
30
Tx for standard trichomoniasis infection?
**Women:** metronidazole 500mg BID for 7 days * Alt: Tinidazole 2 g once **Men:** Metronidazole 2 g once Patients who fail should get a second course of Flagyl 500mg BID for another 7 days
31
Tx for persistent, recurrent trichomoniasis infection?
Metronidazole 2 g QD for 7 days **OR** Tinidazole 2g QD for 7 days (alt)
32
Tx for trichomoniasis in pregnancy?
Metronidazole (cat B) 500mg BID for 7 days Avoid tinidazole (Cat C)
33
How often do you follow up with trichomiasis tx?
3 months if sexually active * avoid retesting in 3 weeks -> false positive
34
What is the pathogen for syphilis?
Treponema pallidum -> transmission through intercouse and intacts itself to mucous membrane
35
What are the sx of primary syphilis?
10-90 days: Single, painless indurated lesion (chancre) that erodes, ulcerates, and typically heals
36
What are the presentations of secondary syphilis?
2-8 weeks: Pruritic or non rash that starts on the trunk and proximal arms spreading bilaterraly involving **palms and soles**
37
What is latent syphilis
4-10 weeks: risk for secondary relapse within the first years * asymptommatic
38
What are the presentations of tertiary syphillis?
1. CV syphilis 2. Gummatous lessions of organs and tissues
39
What is meurosyphillis?
Neuroinvasion of any stage -> neurological complications
40
What is congenital syphillis?
Cross the placenta during pregnancy **Early:** first 3 weeks of life resembling secondary syphillis **Late:** >2YO revaling saddle nose and anterior bowing
41
What is the tx choice for all syphillis stages?
IV penicillin G (first line) Pen G benzathine (IM, not IV) Pen G procaine IM Doxycycline tetracycline
42
Counseling point with Bicillin LA?
Not for IV use -> cardiorespiratory arrest and death * Not the same as Biccillin CR which is not for STIs
43
What is caused by trepnemal endotoxins and considered an acute reaction during tx of primary and secondary syphillis?
Jarisch-Herxheimer Reaction * Not a penicillin allergy * Supportivcare: analgesic, antipyretics, rest
44
Tx for primary, secondary, and early latent (<1Y) syphillis?
Penicillin benzathin G 2.4u IM once **Alt for allergy:** * Non pregnant: doxycycline or tetracycline for 14 days * Pregnancy: desensitization then penicillin
45
Tx for late latent (>1yr) and unknown syphilis?
Penicillin benzathin G 2.4u IM 3 times **Alt for pen allergy:** * Non pregnant: doxycycline or tetracycline for 14 days * Pregnancy: desensitization then penicillin
46
Tx for tertiary or retreatment after failure syphilis?
Penicillin benzathin G 2.4mu IM 3 times **Alt for pen allergy:** * see ID specialist
47
What is desensitization?
Process of giving med in a controlled and gradual manner so patient can tolerate allergc rx
48
Tx for neurosyphillis?
Aqueous crystallin penicillin 3-4million Q4H or continuous infusion for 10-14 days ALt: 10-14 days Aqueous procaine penicillin G 2.4 million units IM daily **PLUS** probenecid
49
Preffered dosage forms for neurosyphillis?
IV infusion Bicillin LA doesnt get into the CSF -> tx failure
50
Txx for congenital syphillis?
Aqueous crystalline penicillin G **OR** Procain Pen G Both for 10 days
51
Those who have HPV are more at risk for getting ___?
Cervical cancer and genital warts
52
Pathology of HPV
1. dsDNA virus breaks through epithelium 2. Replicates in basal cells 3. Differentiates 4. Virus is shed with dead keratinocytes 5. Infection is transmited with dead keratinocytes
53
Who do you diagnoses HPV?
Pap smear HPV specific tests: * Approved in women >30 with abnormal pap smears * Not for men * Not for screening
54
How often should someone be screened for HPV?
routine cervical cancer screening every 3 years for ages 21-65 regardless of vaccination status
55
Tx for HPV warts?
1. Cyrotherapy w/ liquid nitrogen 2. Surgery 3. TCA 4. BCA
56
How do we prevent HPV?
Gardasil 9 (9vHPV)

Therapeutics IV (39 decks)

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