Day 3 Flashcards
You are visualizing a patient with a cauliflower like lesion on his penis and are trying to decide; what is it? How do you treat this?
A condyloma acuminata indicative of HPV, treat w/ podofilox .5% solution or gel (Condylox)
What is the dosing regimen for Podofilox gel when prescribing for a pt with HPV…
3 days on/4 days off can do up to 4 cycles.
How do most infections of HPV present?
Asx; but warts are most common sign…
What are some complications of HSV that you want to be cautious for…
blindness especially if there is a vesicle on the nose…
aseptic meningitis, herpes encephalitis, radicular pain, constitutional sx, painful lesions.
How would u go about working up to DX HSV once suspected..
Viral Culture (Gold standard)
- PCR in the CSF
- Western Blot/ELISA more common to check partners as opposed to acute sx.
Which test was previously used to dx HSV but no longer is reliable?
Tzanck Smear..
What is your tx for HSV
Acyclovir 800 mg PO TID 7-10 days.
What’s an alternate to acyclovir
Vancyclovir only requires BID dosing, but is more expensive.
Whats a benefit of using the Fanicyclovir for episodic suppressive therapy…
Only requires 1 day dosing..
What are benefits to treating HSV suppressive therapy?
- reduces outbreaks
- reduces viral shedding
- reduces risk of infxn partner
How do you tx Chlamydia?
Azithromycin PO 1g x1 dose Ceftriaxone IM (gonorrhea)
How do you distinguish chlamydia from gonorrhea?
Discharge will be watery. mucoid in chlamydia vs. pururlent/yellow/creamy in gonorrhea
How else do u dx Chlamydia?
Historically the gold standard was culture… nowadays ppl use Nucleic Acid Amplication Test (NAAT) b/c it covers both C/G
What is the time frame for when u want to test a pt’s partner for a + C/G
< 60 days or their last sex partner if greater than 60 days…
What could be some sx consistent with disseminated gonoccocal infxn (DGI)
- skin lesions
- arthralgia/arthritis
- tenosynovitis
- hepatitis
- myocarditis
- endocarditis
7 meningitis
How would u dx gonorrhea?
Culture as gold standard, but nowadays the NAAT w/ a “dirty” urine sample…
How would u describe a “dirty” urine sample for the NAAT test to dx C/G
-must not have urinated for 2 hours and catch the 1st 20cc’s
how do u tx gonorrhea?
Ceftriaxone 250mg IM x1
PLUS
Azithromycin 1g PO x1
What do u want to educate ur patient about sex after u prescribe abx?
No sex in 7 days or until sx are gone!!
How do u dx trichomonas
greyish-green dx and possible dysuria; wet mount, culture to confirm.
How do u tx a trichomonas pt?
metronidazole 2g PO x 1
What pt education do u want to provide after prescribing metronidazole?
No ETOH for 24 hrs
How does the nitrite dipstick change over time and why?
due to air exposure, it can cause 1/3 false-+ in a wk. and 3/4 false + in 2 wks…
How do u a treat a male w/ sx of frequency and urgency suggesting a cystitis?
Bactrim or FQ x 7 days
