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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
Q

How often should CSF cultures be repeated for neurosyphilis?

A

6 months until CSF normal

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26
Q

How does herpes present? (4)

A

Multiple painful lesions or vesicles, local itching, tender lymphadenopathy, flu-like symptoms

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27
Q

How do recurrent episodes present for herpes? (3)

A

Prodromal symptoms like mild itching, burning and tingling

28
Q

How is herpes diagnosed?

A

NAAT for HSV DNA

29
Q

What are some non-antiviral management strategies for herpes? (3)

A

Warm saline bath
Analgesic and anti-itch
Good genital hygiene

30
Q

When should herpes drugs be started?

A

Best within 72h

31
Q

How does acyclovir work?

A

It inhibits DNA polymerase hence preventing DNA synthesis and replication

32
Q

What drugs can be given for first exposure for herpes?

A

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
Q

What drugs can be given for chronic suppressive therapy in herpes?

A

PO Acyclovir 400mg BD
PO Valacyclovir 1g OD
PO Valacyclovir 500mg OD (if < 10 episodes a year)

34
Q

What drugs can be given for episodic treatment of herpes?

A

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
Q

What are the 4 recommended ART combinations?

A
  1. tenofovir + emtricitabine + bictegravir
  2. tenofovir + emtricitabine + dolutegravir
  3. abacavir + lamivudine + dolutegravir
  4. emtricitabine + dolutegravir
36
Q

Which 3 patient groups can the 1NRTI + 1INSTI combination not be used in?

A
  1. HIV RNA > 500,000 copies/mL
  2. HBV coinfection
  3. unkwown genotypic resistance testing results for HBV
37
Q

How is HIV diagnosed? (2)

A
  1. Serum antibody detection (HIV EIA or Western blot)
  2. HIV RNA detection for viral load (PCR)
38
Q

What are the two surrogate markers of HIV?

A

CD4 count and Viral load

39
Q

What is CD4 count most importantly used for?

A

When to initiate and assess response to ART (indicator of immune function)

40
Q

When should CD4 count be assessed?

A

Baseline
3-6 months
then 12 months in adequate response

41
Q

What is considered adequate response for CD4 count?

A

Increase in CD4 count by 50-150 cells/mm3 in the first year of therapy

42
Q

What is the normal CD4 count range?

43
Q

What is viral load used to assess?

A

ART response

44
Q

When should viral load be measured?

A

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
Q

What are the 5 benefits of starting ART earlier?

A
  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
Q

What are HIV-associated complications? (5)

A

Tuberculosis, non-Hodgkin’s lymphoma, Kaposi’s sarcoma, peripheral neuropathy, HIV-associated cognitive impairment

47
Q

What are the 6 limitations of starting ART earlier?

A
  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
Q

List the NRTI drugs

A

Tenofovir
Emtricitabine
Lamivudine
Abacavir
Zidovudine

49
Q

What are the main side effects of NRTIs? (4)

A

Mitochondrial toxicity, lactic acidosis, hepatic steatosis, lipoatrophy

50
Q

What are the main side effects of tenofovir? (3)

A

nvd
renal impairment
lower bone mineral density (osteoporosis)

51
Q

What are the main side effects of emtricitabine and lamivudine?

A

nvd
hyperpigmentation for emtricitabine
(generally minimal toxicity)

52
Q

What are the main side effects of abacavir? (3)

A

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
Q

What are the main side effects of zidovudine? (3)

A

nvd
myopathy
bone marrow suppression

54
Q

List the INSTI drugs

A

Bictegravir
Dolutegravir
Raltegravir
Elvitegravir

55
Q

What are the general side effects of INSTI drugs?

A

Weight gain, nvd, some suicidal thoughts

56
Q

What class of drugs cannot be given with polyvalent cations?

57
Q

What are the side effects of bictegravir and dolutegravir?

A

Increased SCr

58
Q

What are the side effects of raltegravir
(hint: R)

A

Rhabdomyolysis and pyrexia

59
Q

List the NNRTIs

A

Efavirenz and Rilpivirine

60
Q

Which class of drugs have a low genetic barrier to resistance?

61
Q

How do NNRTIs compare with PIs?

A

NNRTIs result in less metabolic toxicity than PIs

62
Q

What are the side effects of efavirenz? (4)

A

Rash (SJS)
hyperlipidemia
neuropsychiatric SE
QTc prolongation

63
Q

List the protease inhibitors (5)

A

Ritonavir
Darunavir
Atazanavir
Lopinavir
Fosapmrenavir

64
Q

What are the general side effects of PIs? (4)

A

dyslipidemia
insulin resistance
liver toxicity (with hepatitis B and C)
osteoporosis

65
Q

What are the side effects of ritonavir? (2)

A

Paresthesia and taste perversion

66
Q

What are the side effects of darunavir?

A

skin rash, SJS

67
Q

What are the side effects of atazanavir?

A

Skin rash, QTc prolongation, hyperbilirubinemia

CI with PPI

PR3151 Revision (7 decks)

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