Infections

Question 1

Treatment for Gonorrhea/Chlamydia? (60% co-infection rate)

Answer 1

IM Ceftriaxone WEIGHT BASED 500 mg ( 1 g if > 150 kg)
Doxycycline 100 mg BID x 7 days
(Don’t need doxy if negative chlamydia is documented)

If pregnant: Azithromycin 1 g PO or amoxicillin 500 mg TID x 7 days

Question 2

Treatment for outpatient PID?

Answer 2

IM Ceftriaxone WIEGHT BASED 500 mg (1 g if > 150 kg)
Doxycycline 100 mg BID x 14 days
Metronidazole 500 mg BID x 14 days

Question 3

Treatment for inpatient PID?

Answer 3

IV Ceftriaxone 1 g Q24 hrs
IV/PO Doxycycline 100 mg BID
IV/PO Metronidazole 500 mg Q12

Transition all to 14 days of PO doxy + metronidazole

Question 4

Treatment for BV?

Answer 4

Metronidazole 500 mg BID x 7 days
OR
Clindamycin 2% cream 5 g x 7 days vaginally (may weaken latex condoms)
OR
Metronidazole 0.75% Gel 5 g x 5 days vaginally

Question 5

Treatment for Primary/Secondary/Early Latent (< 1 year) Syphilis?

Answer 5

Benzathine PCN 2.4 mil U IM x 1

Question 6

Treatment for Unknown/ Late latent syphilis?

Answer 6

Benzathine PCN 2.4 mil units IM weekly x 3 (if prior negative status not confirmed)

Question 7

Indication for inpatient PID treatment?

Answer 7

Cannot exclude surgical emergency (appendicitis)
Pregnant
No response clinically to oral therapy
Patients unable to follow oral regimen
Patient has severe illness (N/V/Fever)
Tubo ovarian abscess found

Question 8

Symptoms of primary syphilis

Answer 8

Incubation = days to weeks after infection (days to weeks)

Painless chancre (ulcer w/ clear margins and punched out, crater like appearance)

Heals spontaneously even without treatment

Question 9

Symptoms of secondary syphilis

Answer 9

Occurs 6 weeks - 6 months after chancre (weeks to months)
Systemic symptoms
Condylomata lata
Maculo-papular RASH (torso, PALMS/SOLES, mucous membranes)
Lymphadeopathy

Question 10

How do you diagnosis latent syphilis?

Answer 10

Positive lab testing, no evidence of disease

Early latent = less than 1 year since infection (or previous negative testing)

Question 11

Symptoms of tertiary syphilis?

Answer 11

MANY YEARS LATER

Gumma (uncommon, but seen with HIV)
Cardiac Lesion - aortic root aneurysm
Tabes dorsalis - sensory ataxia and lancinating pains
Argy II-Robinson Pupil - small pupil, does not respond to light

Question 12

How can you diagnose syphillis?

Answer 12

Non specific testing = RPR, VDRL
This is a SCREENING test, can have false positives
Reported as an antibody titer
Usually reverts to non-reactive within 1 year (some stay weakly positive)

If positive screening test, then perform confirmatory test

T. pallidum specific test
No false positive
These tests detect antibodies against specific treponemal antigens
Will STAY POSITIVE for life

Question 13

What kind of testing would you expect in a patient that had a previously treated syphilis infection?

Answer 13

Negative screening test

Positive confirmatory test/Treponema specific test

Question 14

What if a patient with a history of syphilis has a positive screening and confirmatory test?

Answer 14

Likely a new infection and needs treatment!
Screening test would show high titers

Question 15

Treatment for syphilis in PCN allergic patient?

If pregnant also?

Answer 15

Erythromycin

If pregnant, then desensitize (tetracycline contraindicated in pregnancy) and erythromycin doesn’t adequately treat fetusTre

Question 16

Treatment of vulvar ulcer in a non-pregnant patient?

Answer 16

Erythromycin will cover for syphilis, chancroid, granuloma inguinale and lymphogranulmoa Venereum

Question 17

Surgical management of TOA

Answer 17

• Start laparoscopically, with low threshold to convert to laparotomy
• Ensure it was actually a TOA and not appendicitis
• Goal is to remove as much of the infected and inflamed tissue as possible
• Copiously Irrigate!!!!