Exam 4 Flashcards
What is syphilis caused by?
Spirochete
How is syphilis transmitted?
Direct mucocutaneous contact
What are the stages of syphilis?
- Primary (chancre at site of inoculation, can be symptomatic or asymptomatic)
- Secondary (within 6 months of initial infection, high risk of hematogenous dissemination, rash, fatigue, malaise, sore throat)
- Latency (early latency occurs within 1-2 years of initial infection and is asymptomatic, late latency has progressive organ involvement like CV complications)
When should asymptomatic patients be screened for syphilis?
If they have high risk factors for acquisition and factors for transmission (like pregnancy)
What diagnostic tests can be done for symptomatic syphilis patients?
- Nontreponemal test (also used for disease monitoring, tells us if there is an active infection)
- Treponemal test (antibody test, can tell us that the patient had syphilis at one point)
Drug of choice for treating syphilis
Benzathine penicillin G 2.4 million units IM single dose
What is chlamydia caused by?
C. trachomatis
How does chlamydia look like in women?
- Affects the cervix
- 75% are asymptomatic
- 50% end in endometritis
- Small percent has severe infection
- Symptoms = vaginal discharge, abnormal vaginal bleeding, purulent endocervical discharge
How does chlamydia look like in men?
- Common cause of nongonococcal urethritis
- Majority asymptomatic
- Symptoms = mucoid or watery urethral discharge and dysuria
Treatment of chlamydia
Doxycycline 100 mg PO BID for 7 days
- Alternatives = Azithromycin 1 g PO , Levofloxacin 500 mg PO QID for 7 days
Treatment of chlamydia in pregnancy
- Azithromycin 1 g PO
- Amoxicillin 500 mg PO TID for 7 days
Presentation of gonorrhea
Urethritis, cervicitis, pharyngitis, PID
- Symptoms appear within 10 days (there are some cases of asymptomatic patients)
If you don’t treat gonorrhea, what can it lead to?
- Bacteremia
- Arthritis
- Meningitis
Treatment of gonorrhea
Ceftriaxone 250 mg IM
- Alternative = cefixime, cefotaxime + azithromycin, cefoxitin + azithromycin
- If penicillin allergy = azithromycin, gentamicin
Treatment of gonorrhea in pregnancy
Ceftriaxone + azithromycin
Inpatient treatment of PID
- Cefotetan IV, Cefoxitin IV + doxycycline PO
- Clindamycin IV + gentamicin
For 14 days
Outpatient treatment of PID
Ceftriaxone IM
Cefoxitin IM + doxycycline PO
For 14 days
What is expedited partner therapy (EPT)?
Allows health care providers to provide a patient with either antibiotics or a written prescription intended for the patient’s sexual partner
EPT Recommended Drug Regimens for Sexual Partners with Chlamydia but not Gonorrhea
Azithromycin 1 g PO single dose
EPT Recommended Drug Regimens for Sexual Partners with Gonorrhea Regardless of Chlamydia
Cefixime single dose + azithromycin single dose
When should people be screened for chlamydia and gonorrhea?
Any sexually active individual with signs and symptoms
- Do NAATs (nucleic acid amplification tests
COVID delta variant attributes
- Increased transmissibility
- Reduction in neutralization by post-vaccination era
COVID omicron variant attributes
- Potential increased transmissibility
- Potential reduction in neutralization by post-vaccination era
Why are neutralizing monoclonal antibodies not used anymore for treatment of COVID?
Because they are not active against the different variants
Therapies for patients who are at high risk of progressing to severe COVID-19
- Preferred = paxlovid, remdesivir
- Alternative = molnupiravir
Therapies for hospitalized patients that don’t need oxygen supplementation (COVID)
If they are at high risk of progressing to severe COVID, give remdesivir
Therapies for hospitalized patients that require oxygen supplementation (COVID)
- If minimal conventional oxygen is required, use remdesivir
- In most patients, use dexamethasone + remdesivir
- In patients who are receiving dexamethasone and who have rapidly increasing oxygen needs and systemic inflammation, use PO baricitinib or IV tocilizumab
