Gynecologic and Pregnancy Related Infections Part 3 Flashcards
What is the herpes virus?
- DNA virus
- Lifelong persistent infection
What is the usual site of involvement of the herpes virus?
- HSV I: orofacial
- HSV II: genital
What is the treatment of herpes?
- Acyclovir
- Famciclovir
- Valacyclovir
When is treatment of herpes most effective?
- If started within 72 hours
What is the MOA of acyclovir?
- Inhibits herpes virus DNA polymerase competitively
- Gets incorporated in viral DNA and stops lengthening of DNA strands
How does acyclovir resistance develop?
- Decreased or absent production of viral thymidine kinase
- Prevents acyclovir from reaching the activated triphosphate state
What is seen in primary syphillis?
- Painless chancre that develops 3-6 weeks after contact
What is seen in secondary syphillis?
- Condyloma lata; macular red rash on palms and soles
- Patchy hair loss
- Lymphadenopathy
What is seen in tertiary syphillis?
- Gummatous lesions of skin and bone
- Thoracic aortic aneurysm
- Tabes dorsalis –> involvement of posterior columns and dorsal roots
When does syphilis become tertiary?
- 6 years after secondary infection
What is tabes dorsalis in tertiary syphillis?
- Decreased coordination
- Loss of pain and temp sensation
- Diminished proprioception and vibratory sensation
What is the cause of syphillis?
- Spirochete –> treponema pallidum
- Looks like corkscrew organism on silver stain
What is seen histologically in syphillis?
- Lymphoplasmacytic infiltrate
What can be used to diagnose syphillis?
- Non-treponemal tests –> VDRL, RPR
- Treponemal tests –> FTA-ABS
- Direct specimen –> PCR
What is the general treatment for primary, secondary or early latent syphilis?
- Benzathine penicillin or Doxycycline
What is the general treatment for neurosyphilis?
- Aqueous crystalline penicillin G
What is the spectrum for benzathine penicillin?
- Gram pos bacteria
- Gram neg bacteria
What is the MOA of beta lactam antibiotics?
- Inhibition of bacterial wall synthesis
What is a chancroid? Association?
- Multiple painful ulcers usually 1-2 cm
- Associated with inguinal lymphadenopathy
What is the main cause of chancroids?
- Haemophilus ducreyi
What are some treatment options of chancroids?
- Azithromycin
- Ceftriaxone
- Ciprofloxacin
- Erythromycin
What is lymphogranuloma venereum?
- A single, painless genital ulcer
- Heals within few days
What happens weeks after a lymphogranuloma venereum?
- Buboes develops
- A painful unilateral inguinal lymphadenopathy
What is the main cause of lymphogranuloma venereum?
- Chlamydia trachomatis L1, L2, L3
What is the treatment for lymphogranuloma venereum?
- Doxycycline
- Azithromycin or Erythromycin if pregnant
What is a granuloma inguinale?
- Painless, slowly enlarging, highly vascular, beefy red nodules/ulcers
Does granuloma inguinale usually produce lymphadenopathy?
- No
What is the main cause of granuloma inguinale?
- Klebsiella granulomatosis
What is seen with Klebsiella granulomatosis?
- Donovan bodies
What is the treatment for granuloma inguinale?
- Azithromycin
What is seen in TSS?
- Rapid onset fever
- Diffuse macular rash involving palms and feet
- Desquamation of rash after a week or two
- Hypotension
- Multiorgan involvement
What organism causes TSS?
- S. aureus –> Coag pos, catalase pos
What toxin causes TSS?
- TSST-1 which crosslinks T cells and macrophages producing a bunch of cytokines
What is the treatment of TSS?
- Removal of foreign body
- Supportive care for shock
- Empiric antibodies until culture results
What drug is used for MRSA?
- Vancomycin
What is the MOA of vancomycin?
- Inhibits bacterial wall synthesis
What is tazobactam?
- Beta lactamase inhibitor
- Used in conjunction with beta lactam antibiotics
What is the combo piperacillin/tazobactam used for?
- P. aeruginosa
- PID
What is the MOA of cefepime?
- 4th gen cephalosporin
What is the spectrum for cefepime?
- P. aeruginosa
- S. aureus
- Multiple drug resistant S. pneumoniae
** Front line agent when infection Enterobacteriaceae
What is the MOA of meropenem?
- IV beta lactam
What are some serious side effects of meropenem?
- C diff infection
- Seizures
- Allergic reactions
What is imipenem/cilastatin?
- Carbapenem
- Not active against MRSA
What degrades imipenem?
- Renal enzyme dehydropeptidase 1 (DHP1)
Why is imipenem combined with cilastatin?
- To prevent inactivation by DHP1
