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PHRM 865: Theraputics V > Lecture 28: STIs > Flashcards

Lecture 28: STIs Flashcards

1
Q

What are some of the factors that can lead to STIs?

A
  • NUMBER OF SEXUAL PARTNERS
  • Teens and Twenites
  • African Americans or Hispanics
  • Men that have sex with Men
  • Higher rates in those with Erectile Dysfunction
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2
Q

What is the etiologic agent and some of the epidemiology of Gonorrhea?

A
  • Neisseria Gonorrhoeae
  • Second MOST COMMON disease
  • 50% are resistant to ONE antibiotic
  • Higher in those that have low socioeconmic status, urban living, unmarried, previous history
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3
Q

What are the Clinical Manifestions of Genital infection in Menin Gonorrhea?

What is it? Symptoms? Resolution?

A
  • Acute Urethria inflammotion
  • Symptoms: Urethral discharge and dysuria
  • Can resolve on its now
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4
Q

What are the Clinical Manifestions of Uncomplicated Gential Infections in womenin Gonorrhea?

A
  • Mainly in the Endocervix
  • 80% are asymptomatic; leading to ~15% becoming infertile
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5
Q

What are the Clinical Manifestions of Pharyngeal Infection in Gonorrhea?

A
  • Asymptomatic
  • Orogential Sexual Exposure
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6
Q

What are the Clinical Manifestions of Gonococcal Infections in the Newborn in Gonorrhea?

A
  • From Passign through birth canal
  • Commonly –> Ophthalmia Neonatorum
  • NOT treated = ulceration and blindness
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7
Q

What is the way we Diagnose for Gonorrhea?

A
  • Gram Stains [diplococci]
  • NAAT: Standard [urine, rectum, throat]
  • Swabs
  • Test other STIs if HIV -
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8
Q

What is the Treatment for Gonorrhea when it is uncomplicated Gonococcal infection of the Cervix, Urethra and Rectum?

2021 guildlines

A
  • Ceftriaxone 500mg IM ONCE < 150kg [1g for > 150kg]
  • Has Chlamydia too: Doxycycline 100mg PO BID x 7d
  • Has Chlamydia & Pregnant: Azithromycin 1g ONCE

Alternative: Gentamicin 240mg IM ONCE + Azithromycin 2g PO ONCE [only when you cant get Ceftriaxone]

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9
Q

What is the Treatment for Gonorrhea when it is Uncomplicated Gonococcal Infection of the Pharynx?

A
  • Ceftriaxone 500mg IM ONCE < 150kg [1g for > 150kg]
  • Has Chlamydia too: Doxycycline 100mg PO BID x 7d
  • Has Chlamydia & Pregnant: Azithromycin 1g ONCE

Test -of-cure: 7-14 days after start

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10
Q

What are some of the important instructions to tell someone with Gonorrhea?

A
  • Abstain from sex for 7 days after treatment
  • Treat ALL sexual partners [Cefixime 800mg PO ONCE + Doxycycline 100mg PO BID x 7d]
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11
Q

What is the etiologic agent and some of the epidemiology of Syphilis?

A
  • Treponema Pallidum
  • 45% from Men having sex with Men
  • STRONG association with HIV and Syphilis
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12
Q

What is the Clinical Presentation of Primary Syphilis in Syphilis?

A
  • Paineless lesions [like chancre sore] that HIGHLY infectious
  • Can dissappear without treatment (3-6w)
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13
Q

What is the Clinical Presentation of Secondary Syphilis in Syphilis?

A
  • Develops 2-6w after primary onset
  • Lesion are anywhere [even palms and soles]
  • Can cause malaise, fever, pharyngitis, headache, anorexia, arthralgis…
  • May disappear in 4-10w
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14
Q

What is the Clinical Presentation of Latent Syphilis in Syphilis?

Early or Late?

A
  • Positive Serologic test but no other signs
  • Early: Maybe infectious; 1 year from onset
  • Late: Not infection except during pregnancy
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15
Q

What is the Clinical Presentation of Neurosyphilis in Syphilis?

A
  • MAY HAPPEN AT ANY STAGE
  • Causes headaches, meningismus, increased CSF
  • Looking for VDRL-CSF [very specfic for it]
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16
Q

What is the Diagnosis for Syphilis?

Speices? Tests? Screens?

A
  • Presence of T. Pallidum [primary]
  • Testing: VDRL, RPR, USR, TRUST [(+) means any stage]
  • Screening: fourfold change in titer [increase = treat]
17
Q

What is the Treatment for Primary and Secondary Syphilis in Nonpregnant Adults?

A
  • Penicillin G benzathine 2.4 mil unit ONCE IM
  • Doxycycline 100mg PO BID x14d [1st alt]
  • Ceftriaxone 1-2g QD IM or IV for 10-14d [2nd alt]

This includes HIV patients

18
Q

What is the Treatment for Latent Syphilis in Nonpregnant Adults?

Early and Late

A
  • Early: Penicillin G Benzathine 2.4 mil unti ONCE IM [Doxycyline 100mg PO BID for 14d]
  • Latent: Penicillin G Benzathine 7.2 unit; given 3 IM doses of 2.4 mil 1 week apart [Doxycycline 100mg PO BID x28d (alt)]

This includes HIV patinets

19
Q

What is the Treatment for Late Syphilis?

not neuro?

A
  • Penicillin G Benzathine 7.2 mil units; given 3 IM dose of 2.4 mil 1 week apart
20
Q

What is the Treatment for Neurosyphilis and Ocular Syphilis?

A
  • Penicillin G 18-24 mil units per day; continuous IV for 10-14d
  • Penicillin G Procaine [alt]
21
Q

What is the Treatment for Primary and Secondary Syphilis in Pregnant Adults?

A
  • Penicillin G Benzathine 2.4 mil unit ONCE IM

Pencillin is the ONLY thing that will help mother and baby

22
Q

What is the Treatment for Latent Syphilis in Pregnant Adults?

Early and Late?

A
  • Early: Pencillin G Benzathine 2.4 mil unit ONCE IM
  • Late: Pencillin G Benzathine 7.2 mil unit; 3 doses of 2.4 mil unit IM 1 week apart
23
Q

What is Jarish-Herxheimer Reaction?

A
  • Flu-like reaction of headache, fever, chills, malaise, arthralgia, myalgia, tachycardia…
  • May start 2-4 hours; DO NOT confuse with Penicillin allergy
24
Q

What is the etiologic agent and some of the epidemiology of Chlamydia?

A
  • Chlamydia Trachomatis
  • The MOST COMMON infectious disease
  • Highest among African Americans
  • Untreated in women –> Infertility
25
Q

What is the clinical presentations in Male, Females, Infants for Chlamydia?

A
  • Males: dysuria, urinary frequency, mucoio urethral discharge [asymptomatic]
  • Females: Most are asymtompatic; IF symptomatic [endocervicitis]
  • Infants: transmitted via cervicovaginal secretion; commonly causes eye infections
26
Q

What is the diagnosis for Chlamydia?

A
  • NAAT
  • Giemas Stain of Cells
  • Immunofluorescence
  • Cell Culture ~100% specific
27
Q

What is the Treatment for Chlamydia?

Teens & adults? Pregnacy?

A
  • Teens and adults: Doxycycline 100 mg PO BID x 7d [Alt: Azithromycin 1g PO ONCE or Levofloxiacin 500mg PO q24h x7d]
  • Pregnancy: Azithromycin 1g PO ONCE [Alt: amoxicillin 500mg PO TID x 7d]

Abstain from sex for 7 days and have all sex partners tested

28
Q

What is the Etiology and Epidemiology of Gential Herpes Simplex Virus Infections?

HSV 1 & 2?

A
  • HSV 1: anogenital [mainly in young women & MSM]
  • HSV 2: MOST genital herps
29
Q

What is the Clinical Presentations for Primary HSV Infections?

A
  • First-Episode: prolonged duration [Fever, headache, malasie, gential pain, discharge]
30
Q

What is the Treatment for the First Clinical Episode of HSV?

A
  • Acyclovir 400mg PO TID
  • Famciclovir 250mg PO TID
  • Valacyclovir 1g PO BID

Treat for 7-10 days
Same thing for those that have HIV

31
Q

What is the Treatment for Recurrent HSV infections?

A
  • Acyclovir 800mg PO BID x 5d or 800mg PO TID x 2d
  • Famciclovir 125mg pO BID x 5d or 1g PO BID x1d
  • Valacyclovir 500mg PO BID x 3d or 1g PO QD x 5d

Same thing for those with HIV

32
Q

What is the Treatment for Trichomoniasis?

A
  • Metronidazole

PHRM 865: Theraputics V (42 decks)

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