GU & STI Infections Flashcards
What are the first line treatment options for uncomplicated cystitis?
Nitrofurantoin 100 mg PO BID x 5d (not in pyelonephritis)
Septra 1 DS Tab BID x 3 days
Fosfomycin 3 g sachet x 1 (not in pyelo)
What are the options for treatment of pyelonephritis?
Beta-lactam (CTX) x 1-2 weeks
Fluoroquinolone x 5-7d
When is screening and treatment for asymptomatic bacteruria recommended?
Pregnancy
Invasive Urological Procedures (endoscopic with mucosal damage)
What is the treatment for Chlamydia?
Azithromycin 1 gram PO x 1 OR
Doxy 100 mg PO BID x 7 days
What is the treatment for gonorrhea?
Ceftriaxone 250 mg IM x 1 AND
Azithromycin 1 gram PO x 1 (to cover Chlamydia as well)
How is neurosyphilis treated?
Aqueous penicillin 4mU q4 hrs IV x 14 days, then Benzathine Pen G 2.4 MU IM x 1 if possible late latent
How would you treat late latent & tertiary syphilis?
Benzathine Pen G 2.4 MU IM weekly x 3 weeks
How would you treat primary, secondary or early latent syphilis?
Benzathine Pen G 2.4 MU IM x 1
What is tabes dorsalis?
Locomotor ataxia caused by syphilis due to damage of the dorsal columns and roots of the spinal cord.
Characterized by:
- Sensory Ataxia
- Areflexia
- Lancinating Pains
- Pupillary Abnormalities (Argyll-Robertson pupil)
- Urinary Retention
What is an Argyll-Robertson pupil?
A small pupil that odes not react to light but can accommodate and coverage normally.
What is defined as treatment failure of Chlamydia and Gonorrhea?
Positive Gram stain > 72 hrs after tx
Positive Cx > 72 hours after tx
Positive NAAT 2-3 weeks after tx
When is test of cure indicated for gonorrhoea and chlamydia infection?
Gonorrhoea: ALL infections
Chlamydia: Sub-optimal compliance, unresolved symptoms, pregnancy, pre-puberty OR alternative Rx used.
What is the incubation period and manifestations of primary syphilis?
Within 3 weeks
Painless chancre, regional LN
What are the manifestation of secondary syphilis?
Constitutional - Fever, malaise Rash Alopecia Uveitis Meningitis Lymphadenopathy Hepatitis Arthralgia Condylomata Lta
What is the definition of early and late latent syphilis?
No Clinical Manifestations
Early < 1 year
Late > 1 year
What are the non-treponemal tests?
VRDL
RPR (rapid plasma reagin)
What are the indications in syphilis for penicillin desensitization in the setting of allergy?
Neurosyphilis
Pregnancy
Late Latent or Unknown Duration
Tertiary Syphilis
What are the indications for LP in syphilis?
- Neurological, ocular or auditory symptoms.
- HIV & Neuro signs/symptoms
- Previously treated but failed to achieve adequate serological response to treatment.
What causes Chancroid?
H. ducreyi
How does chancroid present?
Painful ulcer with granulomatous base that bleeds and is associated with painful lymphadenopathy.
How do you treat chancroid?
Ciprofloxacin 500 mg PO x 1 dose OR
Azithromycin 1 g PO x 1 dose
How do you treat bacterial vaginosis?
Metronidazole 500 mg PO BID x 7 days
What STI classically causes a “strawberry cervix”?
Trichomonas vaginalis
With which STI do you see clue cells on gram stain?
Bacterial vaginosis
What makes a UTI “complicated”(6)?
(1) Hemodynamic Instability
(2) Male
(3) Pregnancy
(4) Indwelling Foley or Instrumentation
(5) Functional or Anatomic Anomalies
(6) Urinary Tract Obstruction
What is the preferred treatment for pyelonephritis in pregnancy?
IV beta-lactate for 7-14 days
What is the empiric treatment for postpartum endometritis?
Empiric treatment with clindamycin and an aminoglycoside (+/- ampicillin or vancomycin if enterococcus suspected).
What is the empiric treatment for prostatitis?
(1) Well —> Fluoroquinolone (FQ)
(2) Unwell —> Empiric piptazo, third generation cephalosporin OR FQ
Pathogen directed therapy on culture results.
Acute Prostatitis Duration: 2-4 weeks
Chronic Prostatitis Duration: 4-6 weeks for FQ, 8-12 weeks if other abx
How would you treat a disseminated gonococcal infection/arthritis?
Ceftriaxone 2 grams IV/IM daily x 7 days minimum - would still add azithromycin to cover for undiagnosed Chlamydia AND to ensure that gonorrhea is covered.
What are the indications for penicillin desensitization in the treatment of syphilis (3)?
(1) Neurosyphilis
(2) Pregnancy
(3) Late latent, latent of unknown duration or tertiary syphilis.
What is the inguinal syndrome in lyphogranuloma venereum?
Secondary infection 2-6 weeks after the initial inoculation, with local/direct extension into the region lymph nodes (inguinal/femoral), which grow quite large and can rupture (“groove sign”).
What is Fitz-Hugh-Curtis syndrome?
Inflammation of Glisson’s capsule around the liver, most commonly with Gonorrhoea infection (“gonococcal peri hepatitis”).
What is an alternative treatment for gonorrhoea in someone who is allergic to penicillin?
(1) Azithromycin 2g PO
PLUS one of:
(A) Gentamicin 240 mg IV/IM x 1 OR
(B) Ciprofloxacin 500 mg PO x 1
What are 3 alternative treatments for primary, secondary or early latent syphilis if a patient is allergic to penicillin?
(1) Azithromycin 2 g x 1 dose
(2) Doxycycline 100 mg BID x 14 days
(3) Tetracycline 500 mg QID x 14 days
What do you see on biopsy of LGV?
Mimics IBD on biopsy with:
Crypt abscesses
Granulomas
Giant cells
How do you treat Trichomonas vaginalis?
Metronidazole 2g PO x 1 or 500 mg PO x 7 days
