Exam 4 lecture 5 Flashcards
What are the 4 types of prevention for STIs
mechanical barriers
pre-exposure prophylaxis (PrEP)
Post-exposure prophylaxis (PEP)
HPV vaccine
what STDs do condoms not provide protection against?
STI spread by skin to skin contact (genital herpes, HPV, syphilis)
What are some meds to prevent HIV in adults
- Emtricitabine + tenofovit disoproxil fumarate (truvada)
- Emtricitabine + Tenofovir alafenamide (descovy)
- Cabotegavir (apretude)
Do people who are uding PrEP need PEP?
no
When is PEP not recommended
after 72 hr window
What is the second most common notifiable disease in the US
Gonorrhea
primary sites of gonorrhea in men and women
Primary site- endocervix in women and urethritis in men
What are the two types of infection that could be caused by gonorrhea? sx?
Anorectal infection and pharyngeal infection
Asymptomatic for both
clinical manifestation in newborn for gonorrhea
opthalmal neonatorum, couldlead to blindness
Diagnosis of gonorrhea
Gram stain of male urethral specimen
NAAT- standard of care
most common coexisting infection with gonorrhea
Chylamydia
What is the treatment for uncomplicated Gonorrhea infection of cervix, urethra and rectum
If weight < 150 kg- ceftriaxone 500 mg
If weight >150 kg, ceftriaxone 1 gm
If chylamydia is not excluded during gonorrhea test, what do we use
If <150 kg- doxy 100 mg
pregnant- azithro
If >150 kg- doxy 100 mg
pregnanct-azithro
For gonorrhea, if ceftriaxone is not available or severe cephalosporin allergy what do we use
gentamicin IM + Azithro PO
Cefixime PO
if chylamydia not excluded- doxy and azithro
when is test of cure recommended for gonorrhea
7-14 days
patient education for gonorhea tx
Instruct patients to abstain from sex for 7 days after tx and until all partners are tx
What is the expedited partner therapy (EPT)
patient may deliver tx to partner without being seen by doc
What are the clinical presentations of syphilis
primary syphilis
secondary syphilis
latent syphilis
Tertiary syphilis
Neurosyphilis
Congenital syphilis
Describe primary syphilis
After exposure, a painless lesion (chancre) appears->highly infectious
disappears without tx after 3-6 wks
When does secondary syphilis occur? What is it characterized by?
Develops 2-6 wks after onset of primary stage
variety of mucocutaneous eruptions and lesions
Describe latent syphilis? What is it divided into?
Patient has positive serologic tests but no other evidence of disease.
Divided into early latent and late latent stages
- early latent- potentially infectious (1 yr from infection)
- Late latent- patient is considered non infectious (excpetion->pregnancy)
What % of patients progress to tertiary syphilis from latent
25-30%
Describe late syphilis
Slowly progressing inflammatory phase of disease. Can affect any organ in body
Timeline of stages of syphilis
Primary- within 21 days of exposure
Seocndary- 4-10 wks
Latent- lasts years/decades
Tertiary- serious stage causes complications
When does neurosyphilis occur? Symptoms? Diagnosis?
May occur at any stage of syphilis
Headache, meningismus, increased CSF leukocyte count and protein
VDRL-CSF when reactive, diagnostic for neurosyphilis
for diagnosis of syphilis, What do we do?
microscopic testing
Serologic testing (2 tests)
What are the two serologic tests for diagnosis of syphilis
- nontreponemal tests- detect reagin
2.treponemal test (more sensitive)
What does positive test and negative test mean for nontreponemal
Positive test indicates presence of any stage of syphilis
Negative in incubating syphilis and early primary syphilis
tx of syphilis
Pen G for all stages
What drug to use for syphilis if PCN allergy
doxy
tetracycline
What is the treatment of neurosyphilis
Aqueous pen G IV 10-14 days (better)
or
Procaine penicillin IM
What to use for neurosyphilis if pen allergy present
ceftriaxone
what is treatment of HIV patients with primary or secondary syphilis
Benzathine penicillin
How to treat HIV patient with early latent syphilis infections
Benzathine penicillin G IM x 1 dose
How to treat HIV patient with late latent syphilis or unknown duration
Benzathine penicillin once weekly x 3 wks
How to treat syphilis in pregnant women? What if allergic (exam)
Penicillin is ONLY agent that reliably protects and treats the fetus
If pen allergic- skin testing is required
tx of primary and secondary syphilis
Benzathine pen G X 1 dose
doxy, tetra, axithro if allergic
early laten syohilis (<1 yr tx)
Benzathine pen G x 1 dose
Treatment of late latent > 1 yr syphilis
Benzathine Pen G x 3 wks
What is the most common notifiable infectious disease
chlamydia
What happens if chlamydia is left untreated
40% of women with untreated chlamydia develop PID.
infertility occurs in 1 in women with PID
clinical presentation of chlamydia in men and women
men- dysuria, frequency, mucoid urethral discharge. 50% asymptomatic.
Females- asymptomatic. (endocervicitis with discharge if symptomatic)
How is chlamydia diagnosed
NAAT (90-100 % specificity and sensitivity
chlamydia tx for adolescents and adults
Doxy x 7 days BID
aternative could be azithro 1 dose or levo x 7 days
Tx of chlamydia for pregnant patients
azithro x 1 dose
alterative tx could be amoxicillin x 7 days
mycoplasma genitalium diagnosis
NAAT testing
tx of mycoplasma genitalium
depends on availability of resistance testing
Macrolide susceptible- doxy folloewed by azithro
MAcrolide resistance- doxy followed by moxifloxacin
testing not available- docy 100 mg PO followed by moxifloxacin
describe symptoms of 1st episode primary herpes infections and first episode nonprimary genital herpes
first episode primary- Flu like sx, fever, headache, malaise, myalgias
First episode non primary genital herpes- infection in pts who have clinical or serologic evidence of prior HSV (less symptomatic that primary)
does patient have to be symptomatic for herpes to shed virus
no
How to diagnose herpes
viral culture- preferred virologic test
HSV NAAT- most sensitive for detection
initial tx of 1st episode of genital tx
acyclovir or famciclovir or valacyclovir
Duration of tx of first clinical episode
7-10 days
describe the prodrome phase in HSV
Headache
numbness lesion
When do recurrent infection tx for HSV help?
If started in prodrome or within 1 day of onset of lesion
recurrent HSV tx
Acyclovir 800 mg PO BID x 5 days or TID x 2 days
Famciclovir 125 mg PO BID x 5 days or 1 g BID x 1 day
valacyclovir 500 mg BID x 3 days or valacyclovir 1g PO x 5 days
Who has shprter duration of tx, initial episodes or recurrent infections
Shorter in recurrent tx (5 days or less)
How to treat severe disease HSV
acyclovir 5-10 mg/kg/dose for 2-7 days x 10 days
regimen for HSV with HIV
acyclovir, famciclovir and valacyclovir
if acyclovir resistant, what drug to use for HPV
foscarnet 40-80, or cidofovir 5 mg/kg IV
diagnosis of trichromonas
NAAT and culture
tx of trichromonas
Nitroimidazole only drug
cliical pearls of STD
avoid alcohol with metrondazole and tinidazole (24 hrs after last dose)
excrete din breast milk
