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PR3151 Revision > IC18 STD > Flashcards

IC18 STD Flashcards

1
Q

Which STDs can be spread through pregnancy? (2)

A

Syphilis and HIV

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2
Q

Which STDs can be spread through childbirth? (3)

A

Chlamydia, gonorrhea, herpes
(remember, childbirth - CGH)

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3
Q

Which STDs can be spread through breastfeeding? (1)

A

HIV

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4
Q

How can gonorrhea be tested for? (3)

A

Gram stain of genital discharge
Culture
NAAT

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5
Q

What are the symptoms of gonorrhea and chlamydia? (3)

A

purulent genital discharge, dysuria, frequency

same for chlamydia but milder

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6
Q

What are possible complications if gonorrhea or chlamydia is left untreated?

A

General: disseminated disease

Men: epididymitis, prostatitis, urethral stricture, pelvic inflammatory disease

Women: ectopic pregnancy, infertility

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7
Q

What is the first line treatment for gonorrhea? (2)

A

IM Ceftriaxone 500mg single dose (1g if above 150kg) (with)
PO Doxycycline 100mg BD x 7 days (to cover for chlamydia)

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8
Q

What is the alternative treatment for gonorrhea if ceftriaxone is not available?

A

IM Gentamicin 240mg single dose (with)
PO Azithromycin 2g single dose

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9
Q

How is chlamydia diagnosed? (1)

A

NAAT

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10
Q

What is the first line treatment for chlamydia?

A

PO Doxycycline 100mg x 7 days

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11
Q

What are alternatives in chlamydia treatment? (2)

A

PO Azithromycin 1g single dose
PO Levofloxacin 500mg OD x 7 days

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12
Q

Should test of cure be done for gonorrhea?

A

Yes, in 14 days

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13
Q

Should test of cure be done for chlamydia?

A

No, unless the patient is pregnant, non-adherent or if symptoms persist

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14
Q

How is syphilis diagnosed?

A

Darkfield microscopy of exudates from lesions

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15
Q

What are the two treponemal tests

A

TPHA and TPPA

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16
Q

What is the treponemal test used for?

A

Diagnosis

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17
Q

What are the two non-treponemal tests?

A

VDRL and RPR

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18
Q

What is the non-treponemal test used for?

A

It is used as a screening tool or to confirm infection

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19
Q

Which test is more specific, treponemal or non-treponemal?

A

Treponemal

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20
Q

What are treatment options for primary, secondary or early latent syphillis? (2)

A

IM Benzathine Penicillin G 2.4 MU single dose
PO Doxycycline 100mg BD x 14 days

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21
Q

What are treatment options for tertiary or late latent syphillis? (2)

A

IM Benzathine Penicillin G 2.4 MU o.w. x 3 wks
PO Doxycycline 100mg BD x 28 days

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22
Q

What are treatment options for neurosyphilis? (3)

A

IV/IM Ceftriaxone 2g OD x 10-14 days
IV Crystalline Penicillin G 3-4 MU q4h x 10-14 days
IM Procaine Penicillin G 2.4 MU OD (with) PO Probenecid 500mg QDS x 10-14 days

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23
Q

How often should non-treponemal tests be repeated?

A

6, 12, 24 months

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24
Q

What should be assessed for treatment success in syphilis?

A

VDRL or RPR
Titre decreasing by at least 4 fold
(ie. 1:64 to 1:16)

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25
How often should CSF cultures be repeated for neurosyphilis?
6 months until CSF normal
26
How does herpes present? (4)
Multiple painful lesions or vesicles, local itching, tender lymphadenopathy, flu-like symptoms
27
How do recurrent episodes present for herpes? (3)
Prodromal symptoms like mild itching, burning and tingling
28
How is herpes diagnosed?
NAAT for HSV DNA
29
What are some non-antiviral management strategies for herpes? (3)
Warm saline bath Analgesic and anti-itch Good genital hygiene
30
When should herpes drugs be started?
Best within 72h
31
How does acyclovir work?
It inhibits DNA polymerase hence preventing DNA synthesis and replication
32
What drugs can be given for first exposure for herpes?
PO Acyclovir 400mg TDS x 7-10 days PO Valacyclovir 1g BD x 7-10 days IV Acyclovir 5-10mg/kg q8h for 2-7 days (followed by) PO Acyclovir for 10 days
33
What drugs can be given for chronic suppressive therapy in herpes?
PO Acyclovir 400mg BD PO Valacyclovir 1g OD PO Valacyclovir 500mg OD (if < 10 episodes a year)
34
What drugs can be given for episodic treatment of herpes?
PO Acyclovir 800mg BD x 5 days PO Acyclovir 800mg TDS x 2 days PO Valacyclovir 500mg BD x 3 days PO Valacyclovir 1g OD x 5 days
35
What are the 4 recommended ART combinations?
1. tenofovir + emtricitabine + bictegravir 2. tenofovir + emtricitabine + dolutegravir 3. abacavir + lamivudine + dolutegravir 4. emtricitabine + dolutegravir
36
Which 3 patient groups can the 1NRTI + 1INSTI combination not be used in?
1. HIV RNA > 500,000 copies/mL 2. HBV coinfection 3. unkwown genotypic resistance testing results for HBV
37
How is HIV diagnosed? (2)
1. Serum antibody detection (HIV EIA or Western blot) 2. HIV RNA detection for viral load (PCR)
38
What are the two surrogate markers of HIV?
CD4 count and Viral load
39
What is CD4 count most importantly used for?
When to initiate and assess response to ART (indicator of immune function)
40
When should CD4 count be assessed?
Baseline 3-6 months then 12 months in adequate response
41
What is considered adequate response for CD4 count?
Increase in CD4 count by 50-150 cells/mm3 in the first year of therapy
42
What is the normal CD4 count range?
500-1200
43
What is viral load used to assess?
ART response
44
When should viral load be measured?
Before initiation Within 2-4 weeks after initiation or modification Every 4-8 weeks after, until viral load is suppressed Once stable and suppressed, every 3-6 months
45
What are the 5 benefits of starting ART earlier?
1. Maintenance of higher CD4 count 2. Lower risk of transmission 3. Prevention of irreversible damage 4. Lower risk of HIV-associated complications (tb etc.) 5. Decreased risk of non-opportunistic conditions (CVD, renal disease, liver disease)
46
What are HIV-associated complications? (5)
Tuberculosis, non-Hodgkin's lymphoma, Kaposi's sarcoma, peripheral neuropathy, HIV-associated cognitive impairment
47
What are the 6 limitations of starting ART earlier?
1. More SE and toxicities 2. More drug resistance 3. Transmission of drug-resistant virus 4. Less time for patients to prepare for treatment and adherence 5. Higher risk of treatment fatigue 6. Increased cost
48
List the NRTI drugs
Tenofovir Emtricitabine Lamivudine Abacavir Zidovudine
49
What are the main side effects of NRTIs? (4)
Mitochondrial toxicity, lactic acidosis, hepatic steatosis, lipoatrophy
50
What are the main side effects of tenofovir? (3)
nvd renal impairment lower bone mineral density (osteoporosis)
51
What are the main side effects of emtricitabine and lamivudine?
nvd hyperpigmentation for emtricitabine (generally minimal toxicity)
52
What are the main side effects of abacavir? (3)
nvd hypersensitivity with HLA-B5701 (rash, fever, malaise, fatiguem loss of appetite, SoB etc) association with MI test for HLA-B5701 before initiation do not use in high CV risk patients
53
What are the main side effects of zidovudine? (3)
nvd myopathy bone marrow suppression
54
List the INSTI drugs
Bictegravir Dolutegravir Raltegravir Elvitegravir
55
What are the general side effects of INSTI drugs?
Weight gain, nvd, some suicidal thoughts
56
What class of drugs cannot be given with polyvalent cations?
INSTI
57
What are the side effects of bictegravir and dolutegravir?
Increased SCr
58
What are the side effects of raltegravir (hint: R)
Rhabdomyolysis and pyrexia
59
List the NNRTIs
Efavirenz and Rilpivirine
60
Which class of drugs have a low genetic barrier to resistance?
NNRTIs
61
How do NNRTIs compare with PIs?
NNRTIs result in less metabolic toxicity than PIs
62
What are the side effects of efavirenz? (4)
Rash (SJS) hyperlipidemia neuropsychiatric SE QTc prolongation
63
List the protease inhibitors (5)
Ritonavir Darunavir Atazanavir Lopinavir Fosapmrenavir
64
What are the general side effects of PIs? (4)
dyslipidemia insulin resistance liver toxicity (with hepatitis B and C) osteoporosis
65
What are the side effects of ritonavir? (2)
Paresthesia and taste perversion
66
What are the side effects of darunavir?
skin rash, SJS
67
What are the side effects of atazanavir?
Skin rash, QTc prolongation, hyperbilirubinemia CI with PPI

PR3151 Revision (7 decks)

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