Infectious Diseases I Flashcards
What types of HPV cause cervical, penile, vulvar, vaginal, anal, and oropharyngeal cancers?
Oncogenic types 16 and 18
What types of HPV cause genital warts?
Nononcogenic types 6 and 11
For who is the HPV vaccine recommended?
9-26 years (who have not completed the series)
Individuals 27-45 years - use shared decision-making
What is the HPV vaccine series?
If started < 15 years = 2 doses given 6-12 months apart
If started 15-26 years = 3 doses (0, 1-2, and 6 months)
What is the recommended treatment for uncomplicated gonorrhea infection?
If < 150 kg = ceftriaxone 500 mg IM x 1
If > 150 kg = ceftriaxone 1000 mg IM x 1
What is an alternative treatment for uncomplicated gonorrhea infection?
Gentamicin 240 mg IM x 1
PLUS
Azithromycin 2 g PO x 1
What is the recommended treatment for chlamydia infection?
Doxycycline 100 mg PO BID x 7 days
What is an alternative treatment for chlamydia infection?
Azithromycin 1 g PO x 1
How long should patients abstain from sexual activity after being treated for chlamydia?
7 days after last dose
What is the recommended treatment for primary, secondary, and early latent syphilis?
Benzathine PCN G 2.4 million units IM x 1
What alternatives can be used in PCN-allergic patients for treatment of primary, secondary, and early latent syphilis?
-Doxycycline 100 mg BID PO x 14 days
-Tetracycline 500 mg QID PO x 14 days
-Ceftriaxone 1 g daily IV/IM for 10 days
What is the recommended treatment for late latent syphilis?
Benzathine PCN G 2.4 million units IM once weekly x 3 weeks
What alternatives can be used in PCN-allergic patients for treatment of late latent syphilis?
-Doxycycline 100 mg BID PO x 28days
-Tetracycline 500 mg QID PO x 28days
What is the recommended treatment for tertiary syphilis?
Benzathine PCN G 2.4 million units IM once weekly x 3 weeks
What is the recommended treatment for neurosyphilis, ocular syphilis, and otosyphilis?
Aqueous crystalline PCN G 18-24 millions units/day - given as 3-4 million units IV every 4 hours or as a continuous infusion for 10-14 days
What are recommended treatment options for first episode of genital herpes?
-Acyclovir 400 mg TID or 200 mg 5x/day
-Valacyclovir 1 g BID
Duration: 7-10 days
What are recommended treatment options for subsequent episodes of genital herpes?
-Acyclovir 800 mg TID x 2 days OR 800 mg BID x 5 days
-Valacyclovir 500 mg BID x 3 days OR 1 g daily x 5 days
What are recommended treatment options for suppression of genital herpes?
-Acyclovir 400 mg BID
-Valacyclovir 1 g daily
What is recommended treatment for trichomoniasis?
Women: Metronidazole 500 mg BID x 7 days
Men: Metronidazole 2 g as single dose
What patients are at high risk of HIV and should be screened?
-MSM
-Multiple sexual partners (men or women)
-Injection drug users
What are symptoms of conversion syndrome (acute HIV infection)?
-Fever
-Rash
-Fatigue
-Malaise
-Lymphadenopathy
What test should be performed before initiating any antiviral therapy that contains abacavir?
HLA-B*5701
What medications are considered NRTIs?
Nucleoside:
-Emtricitabine
-Abacavir
-Lamivudine
-Zidovudine
Nucleotide:
-TDF
-TAF (lower renal and bone effects)
What medications are considered NNRTIs?
-Nevirapine
-Efavirenz
-Etravirine
-Rilpivirine
-Doravirine
What medications are considered protease inhibitors (PIs)?
-Darunavir
-Atazanavir
-Ritonavir (only used as a booster)
What medication is considered a fusion inhibitor?
Enfuvirtide
What medication is considered an attachment inhibitor?
Fostemasavir
What medication is considered a co-receptor antagonist?
Maraviroc
What medications are considered integrase strand transfer inhibitors (INSTIs)?
-Raltegravir
-Dolutegravir
-Elvitegravir
-Bictegravir
-Cabotegravir
What medication is a pharmacokinetic booster?
Cobicistat
What HIV treatment regimens are considered first-line for most patients?
INSTI-based regimens:
-Dolutegravir/abacavir/lamivudine
-Dolutegravir + TDF/emtricitabine
-Dolutegravir + TAF/emtricitabine
-Bictegravir/TAF/emtricitabine
What HIV treatment regimen is recommended for patients who received cabotegravir for PrEP who do not undergo integrase inhibitor resistance testing?
Boosted darunavir + TDF or TAF + emtricitamine or lamivudine
When is antiviral treatment for HIV considered a failure?
Viral load fails to become undetectable within 24 weeks of therapy
OR
When a previously undetectable viral load becomes detectable
What vaccines are recommended for patients with HIV?
-MMR (if CD4 > 200)
-Varicella (if CD4 > 200)
-Hep A
-Hep B
-Pneumococcal
**If received a dose of PCV13, can use either PPSV23 or PCV20
-Tdap
-Influenza
-HPV
-Zoster
How often should patients w/ HIV be screened for TB?
Annually
When is primary prophylaxis for PJP indicated?
CD4 < 200 or < 14% of total lymphocyte count
OR
CD4 200-250 if ARV therapy initiation must be delayed and routine Cd4 monitoring is not possible
Can discontinue when CD4 > 200 for at least 3 months
What is the recommended regimen for primary prophylaxis of PJP?
Trimethoprim/sulfamethoxazole 1 DS tablet daily (preferred) or 1 SS tablet daily or 1 DS tablet three times weekly
*Alternatives: dapsone, atovaquone, nebulized pentamidine
What is the recommended regimen for treatment of PJP?
Trimethoprim/sulfamethoxazole 15-20 mg/kg IV for 21 days
When is primary prophylaxis for toxoplasmosis indicated?
CD4 < 100
What is the recommended regimen for primary prophylaxis of toxoplasmosis?
Trimethoprim/sulfamethoxazole 1 DS tablet daily
Can discontinue when CD4 > 200 for at least 3 months
When is primary prophylaxis for MAC indicated?
CD4 < 50
What is the recommended regimen for primary prophylaxis of MAC?
Azithromycin 1200 mg once weekly or 600 mg twice weekly
Can discontinue when CD4 > 100 for at least 6 months
How soon should treatment be used following occupational exposure to HIV?
ASAP but at least within 72 hours
Regimen: TDF/emtricitabine + raltegravir for 28 days
What regimens are available for PrEP?
-TDF 300 mg + emtricitabine 200 mg daily (Truvada)
-TAF 25 mg + emtricitabine 200 mg daily (Descovy)
What is the time to protective effects for oral PrEP?
7 days for anal tissue
21 days for vaginal tissue
How often should patients be screened for HIV when on PrEP
Every 3 months
What patients should influenza treatment be considered for?
-High risk of complications w/ persistent illness and a positive test result > 48 hours after symptom onset
-Confirmed or highly suspected influenza within 48 hours of symptoms onset who wish to shorten duration of illness or who are in contact with high-risk individuals
Which influenza vaccines are recommended for patients 65 years+?
-HD-IIV
-RIV
-aIIV
What is the recommended treatment for uncomplicated herpes zoster infection?
Acyclovir 800 mg PO five times daily for 7-10 days
What is recommended for all patients when they begin to receive HIV care, regardless of initiation of ART?
Genotype testing
