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PDAT6 ID > 27/28 - STDs > Flashcards

27/28 - STDs Flashcards

1
Q

Chlamydia Trachomatis

Transmission & Long Term Complications

A

Typical - Anal/Vaginal/Oral Sex

  • *Vertical Transmission**
  • -> Baby = conjunctivitis & pneumonia

Long Term Complications:
Damage to FEMALE Reproductive system
10% of untreated women:
PID / Chronic pelvic pain / infertility / felopian tube dmg

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2
Q

Syphilis

DIAGNOSIS / TESTS

A

Serologic Tests:
RPR** + **EIA
need BOTH to confirm disease

RPR = non-treponemal & non-specific
measured titer –> used to monitor TX response or Re-Infection
correlates w/ disease activity
4-Fold Titer change = CLINICALLY SIGNIFICANT
1:2 = lowest

EIA = treponemal & specific
CONFIRMS DISEASE
but is positive for ENTIRE life –> can’t tract treatment progression

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3
Q

LATENT SYPHILIS

Presentation

A
  • Untreated Primary or Secondary Stage*
  • LACKS CLINICAL MANIFESTATIONS*

Detected by:
Serologic Testing = RPR + EIA

EARLY LATENT SYPHILIS
acquired within 12 months & patient remains INFECTIOUS

LATE LATENT SYPHILIS
acquired >1 year or unknown duration
thought to be NON-infectious
Treated like TERTIARY syphilis

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4
Q

Chlamydia Trachomatis

Testing & Follow-Up

A

NAAT
Nucleic Acid Amplification Test
Urine Sample –> 24 hour return
also for RECTAL & OROpharyngeal SWABS

RTC in 3 MONTHS
for ALL, to check for RE-INFECTION (common)
or RTC if sx persist after treatment

PARTNER NOTIFICATION
refer all sex partners in past 60 DAYS
EPT = expidited partner therapy

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5
Q

Neurosyphilis

TREATMENT

PCN ALLERGY

A

CSF Evaluation (Lumbar Puncture) –> confirm diagnosis

LIMITED DATA - NO GOOD ALTERNATES

  • *Ceftriaxone 2gm QD IM/IV**
  • *IM/IV for 10-14 days**

PREGNANT PATIENTS:
Can’t take Doxy –> PCN DESENSITIZATION

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6
Q

HERPES

Primary Infection

Signs & Symptoms

A

Incubation period b4 onset of lesions = 5 days
w/o tx –> 20-30 day infection

One or MORE blisters
on or around genital area, can break and leave a
PAINFUL SORE
that takes weeks to heal
(Syphilis is only 1 blister and no pain)

1/3 show systemic sxs:
fever / malaise myalgia

1-10% develop:
aseptic meningitis - neck rigidity / HA

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7
Q

HERPES

S/Sx

A
  • *PRODROMAL**
  • *burning / itching / tingling** @ site of infection
  • -> lesion within 12-24hr

TREAT ASAP

  • *Almost ALL persons** w/ symptomatic 1st HSV episode get recurrence of genital lesions
  • *3-4 episodes a year**
  • *Reactivates periodically** caused by factors:
  • *stress / UV light / menses / trauma / illness**
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8
Q

Late Latent** & **Tertiary Syphilis

TREATMENT

A
  • *Benzathine Penicillin G 2.4mil units IM**
  • *WEEKLY** for 3 WEEKS

if patients MISS >14 days –> START OVER

Late latent
no sxs+confirmed by RPR + EIA
> 1 year or Unknown

Tertiary Syphilis
CV Complications + Gummatous Lesions
1/3 of patients untreated –> 10-30 years later

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9
Q

Neisseria Gonorrhea
Gonococcal Cervicitis

1st Line Treatment

A

CEFTRIAXONE 250mg IM
oral doesnt have high bactericidal levels at anatomic sites
+
Azithromycin 1g
OR
Doxycycline 100mg BID x7days
for Chlamydia coverage

quinolones are RESISTANT now
& resistance to cephalosporins are rising –> surveillance is crucial

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10
Q

Chlamydia Trachomatis

Male & Female
SYMPTOMS

A

MOST COMMONLY: ASX DISEASE
reason for ROUTINE screening = women <25y/o q1year

Symptoms occur 1-3 weeks AFTER & are similar to UTI
Burning urination / Dysuria
Discharge
Swollen lymph nodesingroin

symptoms are SIMILAR to GONORRHEA

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11
Q

What STD has this condition and what is it?

SeroFast

A

SYPHILIS

Pts continue to have low RPR titers d
espite adequate treatment
Ex.
1:2 or 1:4 for many years

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12
Q

Syphilis

Epidemiology & Transmission

A
  • *MEN** > Women
  • *MSM epidemic**

Caused by:
Treponema Pallidum = Spirochete

Sexual contact w/ infectious lesions during:
PRIMARY** or **SECONDARY
stages

less common in utero / non-genital body contact w/ infectious lesions / blood borne

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13
Q

SYPHILIS

COUNSELING

A

Important for PARTNERS & INFECTED

Initiate treatment for recurrent disesae
@time of PRODROMAL SXs or 1st Blister

Transmission can occur during ASx periods

NO SEX
when lesions/prodromal Sxs present = highest risk of infection

CONDOMS

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14
Q

Neisseria Gonorrhea

Testing & Follow-Up

A

NAAT
Nucleic Acid Amplification Test
Bacterial culture –> ANTIMICROBIAL RESISTANCE TEST

Alternate Regimen** –> **RTC for TEST OF CURE in 14-21 DAYS

PARTNER NOTIFICATION
refer all sex partners in past 60 DAYS

RTC in 3 MONTHS?? - was for Chlamydia
for ALL, to check for RE-INFECTION (common)

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15
Q

Neisseria Gonorrhea

PREGNANCY

Treatment & Special Considerations

A
  • *SAME AS NORMAL TREATMENT**
  • except DOXY is C/I in pregnancy*

CEFTRIAXONE 250mg IM
+
Azithromycin 1g

Repeat NAAT (3 weeks) to confirm eradication
– FOR PREGNANT

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16
Q

HERPES

Supressive Treatment for Recurrent disease

A

Supressive Therapy –> ↓outbreaks by 70-80%

↓Frequency & ↓Risk of HSV transmission

  • BUT*
  • *Can result in DRUG RESISTANCE**

Recommended doses:

  • *Acyclovir 400mg BID**
  • *Valacyclovir 1g QD**
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17
Q

Neisseria Gonorrhea

Testing Recommendations?

A

CDC Recommendations:

ANNUAL GONORRHEA TESTING FOR:

All Sexually active WOMEN <25yo
(Same as Chlamydia)
commonly co-infected with CHLAMYDIA

18
Q

Late Latent** & **Tertiary Syphilis

TREATMENT

PCN ALLERGY

A

Doxycyline 100mg BID
for 28 DAYS
+ close clinical & serologic follow-up

Late latent
no sxs+confirmed by RPR + EIA
> 1 year or Unknown

Tertiary Syphilis
CV Complications + Gummatous Lesions
1/3 of patients untreated –> 10-30 years later

19
Q

HERPES

DIAGNOSIS

A

Clinical Diagnosis
most common, just can tell

PCR
is the preferred assay to CONFIRM
but is not often done –> need to scrape base of lesion

Serologic Testing
also available, but seldom used, just tells you if you had it

20
Q

Syphilis

Secondary Stage Presentation

A

Untreated infxn –> hematogenous dissemination
in 4-8 weeks after Chancre appreance

“Great Imitator”
Variety of Sxs –> affect many organs

RASH on PALMS & SOLES
is most common, but can occur in other areas

Tongue Lesions** + **ALOPECIA

Lymphadenopathy / low grade fever / weight loss
pain in bone + joints

21
Q

Chlamydia Trachomatis

PREGNANCY

Treatment & Special Considerations

A

Azithromycin 1g Single dose
STILL THE SAME

For Pregnant w/ allergy:

  • *Amoxicillin 500mg TID x7days**
  • Doxycycline & Quinolone (levo) are C/I in pregnancy*

REPEAT NAAT** in **3 WEEKS
to confirm eradication for PREGNANCY:
Still RTC 3 months later & possibly for 3rd trimester
to avoid vertical transmission / neonatal infxn

22
Q

​Syphilis

Primary Stage Presentation

A

CHANCRE
Single - PAINLESS ulcer
stage where spirochetes enter body

Sxs occur ~3 weeks after exposure

Ulcer will heal with scarring 2-8 weeks REGARDLESS of Treatment

23
Q

Chlamydia

Epidemiology

A

WOMEN 66% > men
BOTH are ASx (asymptomatic)

Most Common in:
Adolescents** & **Young Adults

MOST COMMON STD
Intracellular Bacterium

24
Q

Neurosyphilis

Presentation

A

Can occur at:
ANY STAGE of Disease
typically 2mo-2years after initial infxn

Treponemal Invasion of CNS

Symptoms:
Meningitis-like = Alterned Mental Status
Cranial Nerve Dysfxn / Stroke / Sensory-motor deficit

25
Q

Primary / Secondary / Early Latent (<1 yr)

TREATMENT

PCN ALLERGY

A

Doxycycline 100mg BID x 14 days
requires close serologic follow up –> more likely to have tx failure

Primary
Chancre

Secondary
sytematic symptoms
rash on palm/soles + alopecia + fever + weight loss

Early Latent
no sxs - confirmed by RPR + EIA
but < 1 year

26
Q

Primary / Secondary / Early Latent (<1 yr)

TREATMENT

A

Benzathine PENICILLIN G 2.4mil units IM
for one dose, 1.2mil/syringe into each gluteus

Primary
Chancre

Secondary
sytematic symptoms
rash on palm/soles + alopecia + fever + weight loss

Early Latent
no sxs - confirmed by RPR + EIA
but < 1 year

27
Q

Chlamydia Trachomatis

1st Line Treatment

A

Azithromycin 1g
in one dose
NO RESISTANCE FOUND + improved adherence

OR

Doxycycline 100mg BID x7days
NOT FOR WOMEN
may be more effective for Rectal infxn / LGV (caused by C serovars)

RTC in 3 MONTHS

28
Q

HERPES

Severe Disease
Classification&TREATMENT

A

Disseminated Infxn
severe morbidity / mortality –> hospitilization
Pneumonia / Hepatitis / Encephalitis

IV ACYCLOVIR 5-10 mg/kg** **q8h
for 10 days

HSV ENCEPHALITIS** –> **21 DAYS

29
Q

HERPES

Recurrent / Episodic
TREATMENT

A
  • *Acyclovir 400mg TID**
  • *x5 days**
  • *Valacyclovir 1gm QD**
  • *x5 days**

topical not effective

30
Q

HERPES

1st Episode TREATMENT

A
  • *Acyclovir 400mg TID**
  • *7-10 days**
  • *Valacyclovir 1gm BID**
  • *7-10 days**

Start within
24 HOURS of First Episode

31
Q

Neisseria Gonorrhea​
Gram (-) Diplococci

Male & Female
SYMPTOMS

A

MALES have Sx
Burning urination / Dysuria / Discharge - 90% have sxs by day 5
DGI = Disseminated Gonococcal Infection:
petechial skin rash, septic arthritis, endocarditis, meningitis

FEMALES** = **often ASx 50%
untreated –> PID / tubal scarring / infertility

32
Q

Syphilis

MONITORING

A

Test RPR Titers** –> fall by at least **4-fold
@
6 / 12 / 24 months
takes a MONTHS for RPR to decline

For SEX PARTNERS:
Persons exposed for 90** **DAYS should be referred for treatment
if serologic test not available
was 60 days for other

33
Q

Chlamydia Trachomatis

Alternate Treatment / Allergic

A

Levofloxacin 500mg BID x7days

RTC in 3 MONTHS

For Pregnant w/ allergy:
Amoxicillin 500mg TID x7days
Doxycycline & Quinolone (levo) are C/I in pregnancy

34
Q

Neurosyphilis

TREATMENT

A

CSF Evaluation (Lumbar Puncture) –> confirm diagnosis

HOSPITILAZTION REQUIRED:

  • *Aqueous Crystalline Penicillin G 18-24mil units**
  • *3-4mil units IV q4 hours** for 10-14 days

Can occur at:
ANY STAGE of Disease
typically 2mo-2years after initial infxn

Treponemal Invasion of CNS

Symptoms:
Meningitis-like = Alterned Mental Status
Cranial Nerve Dysfxn / Stroke / Sensory-motor deficit

35
Q

Chlamydia Trachomatis** & **Neissria Gonorrhea

Important Counseling

A

CONDOM USE

PARTNER NOTIFICATION
all sex partner in past 60 days
EPT = expidited partner therapy

RTC in 3 Months
for all to check for re-infection, RTC if sxs PERSIST
pregnant is 3WEEKS

Avoid SEX for 7 DAYS after tx** & **after sex partners treated

HIV + Syphilis Testing

36
Q

Neisseria Gonorrhea

Alternate Treatment / Allergic

A

when CEFTRIAXONE IM is NOT available:
CEFIXIME 400mg PO single dose
+
Azithromycin 1gm OR Doxycyline 100mg BID x7days

  • if severe PCN/Cephalosporin Allergy:*
  • *GEMIFLOXACIN 320mg_ + _Azithromycin 2GM single dose**
  • zithro has gonorrhea activity but needs 2GRAM DOSE*

Alternate Regimen: RTC for TEST OF CURE (NAAT) in 14-21 Days

37
Q

Chlamydia Trachomatis

Testing Recommendations?

A

CDC Recommendations:

ANNUAL CHLAMYDIA TESTING FOR:

All Sexually active WOMEN <25yo
+
All MSM (male sex w/ male)
+
Sexually active HIV infected persons

38
Q

Neisseria Gonorrhea​
Gram (-) Diplococci

Transmission & Long Term Complications

A

Typical - Anal/Vaginal/Oral Sex

  • *Vertical Transmission** –> Baby
  • *Co-infection w/ Chlamydia is COMMON**

Long Term Complications:

  • *Damage to FEMALE Reproductive system**
  • *PID** / Chronic pelvic pain / infertility / felopian tube dmg
39
Q

Which STD has the ADR of:
Jarisch Herxheimer Reaction

and what is it?

A

SYPHILIS

Acute Febrile Rxn = HA / Myalgia / Fever
within the first
48 hours of treatment
most common in those with high RPR primary disease

treat with Antipyretics

40
Q

Neisseria Gonorrhea

EPIDEMIOLOGY

A
  • *MEN** > Women
  • but might be because* MEN have Sx –> reported

Gram (–) Dipococci

2nd Most Common

41
Q

Herpes

Epidemiology

A

HSV-1** or **HSV-2
Genital / Oral
chronic/lifelong viral infection = NOT curable

Recurrence is MALE > Female, 3-4 episodes for first few years

Transmission:
Typically occurs in patients UNAWARE they have infxn
Active lesions –> MORE INFECTIVE
VERTICAL TRANSMISSION

42
Q

TERTIARY SYPHILIS

Presentation

A

1/3 of patients who have not been treated –> tertiary

10-30 years
AFTER initial infection

CARDIOVASCULAR COMPLICATIONS
+
GUMMATOUS LESIONS

PDAT6 ID (31 decks)

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