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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
Q

How often should you follow up with PID?

A

Pts who tested positive with GC and Chla -> 3 months

25
Q

Pathogen that causes trichomoniasis?

A

Trichomonas vaginalis

26
Q

Presnetations of trichomoniasis?

A
  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
Q

Vaginal signs of tricohminosis>

A
  1. elevated pH (>5)
  2. Strawberry spots
  3. Malodours
  4. White, yellow, green discharge
  5. Thick/thin, frothy
28
Q

Who should be screeened for trichomoniasis?

A
  1. HIV women -> annually
  2. High prevalence for infection: STI clinic, MSP, transactional sex, STI hx
  3. Symptomatic preganant women
29
Q

How do you diagnosis trichomoniasis?

A
  1. Wet mount of vaginal discharge
  2. Culture (gold standard) -> long time
  3. NAAT
30
Q

Tx for standard trichomoniasis infection?

A

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
Q

Tx for persistent, recurrent trichomoniasis infection?

A

Metronidazole 2 g QD for 7 days
OR
Tinidazole 2g QD for 7 days (alt)

32
Q

Tx for trichomoniasis in pregnancy?

A

Metronidazole (cat B) 500mg BID for 7 days
Avoid tinidazole (Cat C)

33
Q

How often do you follow up with trichomiasis tx?

A

3 months if sexually active
* avoid retesting in 3 weeks -> false positive

34
Q

What is the pathogen for syphilis?

A

Treponema pallidum -> transmission through intercouse and intacts itself to mucous membrane

35
Q

What are the sx of primary syphilis?

A

10-90 days: Single, painless indurated lesion (chancre) that erodes, ulcerates, and typically heals

36
Q

What are the presentations of secondary syphilis?

A

2-8 weeks: Pruritic or non rash that starts on the trunk and proximal arms spreading bilaterraly involving palms and soles

37
Q

What is latent syphilis

A

4-10 weeks: risk for secondary relapse within the first years
* asymptommatic

38
Q

What are the presentations of tertiary syphillis?

A
  1. CV syphilis
  2. Gummatous lessions of organs and tissues
39
Q

What is meurosyphillis?

A

Neuroinvasion of any stage -> neurological complications

40
Q

What is congenital syphillis?

A

Cross the placenta during pregnancy
Early: first 3 weeks of life resembling secondary syphillis
Late: >2YO revaling saddle nose and anterior bowing

41
Q

What is the tx choice for all syphillis stages?

A

IV penicillin G (first line)
Pen G benzathine (IM, not IV)
Pen G procaine IM
Doxycycline
tetracycline

42
Q

Counseling point with Bicillin LA?

A

Not for IV use -> cardiorespiratory arrest and death
* Not the same as Biccillin CR which is not for STIs

43
Q

What is caused by trepnemal endotoxins and considered an acute reaction during tx of primary and secondary syphillis?

A

Jarisch-Herxheimer Reaction
* Not a penicillin allergy
* Supportivcare: analgesic, antipyretics, rest

44
Q

Tx for primary, secondary, and early latent (<1Y) syphillis?

A

Penicillin benzathin G 2.4u IM once
Alt for allergy:
* Non pregnant: doxycycline or tetracycline for 14 days
* Pregnancy: desensitization then penicillin

45
Q

Tx for late latent (>1yr) and unknown syphilis?

A

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
Q

Tx for tertiary or retreatment after failure syphilis?

A

Penicillin benzathin G 2.4mu IM 3 times
Alt for pen allergy:
* see ID specialist

47
Q

What is desensitization?

A

Process of giving med in a controlled and gradual manner so patient can tolerate allergc rx

48
Q

Tx for neurosyphillis?

A

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
Q

Preffered dosage forms for neurosyphillis?

A

IV infusion
Bicillin LA doesnt get into the CSF -> tx failure

50
Q

Txx for congenital syphillis?

A

Aqueous crystalline penicillin G
OR
Procain Pen G

Both for 10 days

51
Q

Those who have HPV are more at risk for getting ___?

A

Cervical cancer and genital warts

52
Q

Pathology of HPV

A
  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
Q

Who do you diagnoses HPV?

A

Pap smear
HPV specific tests:
* Approved in women >30 with abnormal pap smears
* Not for men
* Not for screening

54
Q

How often should someone be screened for HPV?

A

routine cervical cancer screening every 3 years for ages 21-65 regardless of vaccination status

55
Q

Tx for HPV warts?

A
  1. Cyrotherapy w/ liquid nitrogen
  2. Surgery
  3. TCA
  4. BCA
56
Q

How do we prevent HPV?

A

Gardasil 9 (9vHPV)

Therapeutics IV (31 decks)

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