Lecture 9 - STI & VVI 2 Flashcards
Which HPV causes most genital warts
HPV 6, 11
HPV implement and follow up
Vaccine
Follow up Pap smears
Med counseling points
In mass when can you use EPT?
Chlamydia = yes
Syphillis = no
HSV reactivation triggers
fatigue
stress
fever
immunosuppression
Virologic tests preferred for HSV for those…
seeking treatment for genital ulcers/mucocutaneous lesions
tissue viral culture = early stages of infection
NAAT/PCR = test of choice for systemic or CNS infections
Herps treatments 1st episode
Acyclovir 400 TID 7-10 days
Valacyclovir 1000mg BID 7-10 days
Famciclovir 250mg TID 7-10 days
Herps latency suppressive therapy
Acyclovir 400 BID
Valacyclovir 500/1000mg QD
Famciclovir 250mg BID** less effective viral shedding
Herps Episodic management treatment (w/I 24h of prodrome/lesion onset)
Acyclovir 800mg BID 5 days or 800 TID 3 days
Valacyclovir 500 BID 3 days or 1000mg QD 5 days
Famciclovir, bunch of options
Tric in women signs
Discharge = frothy, yellow/green
Cervical petechiae = strawberry cervix
smells fishy
Preferred Tric treatment
Men: metro 2g X 1 dose
Women = Metro 500 BID X 7 days
Alternative: Tinidazole 2g X 1
Tric follow up
retesting within 3 months for all sexually active women
abstain from sex for 7 days after initiation of therapy
BV pathophys
overgrowth of anaerobes due to dec lactobacillus.
end up with higher pH
BV testing Amsel criteria
pH > 4.5
whiff test…does it smell like fish
discharge look
> 20% cue cells
need 3 of 4 unless pH > 4.5, then 2 of 4
BV preferred therapy
Metro 500mg Bid 7 days
Clinda cream 2%, 1 app QHS X 7 days..can breakdown latex condoms
BV alternative treatments
Tinidazole
Secnidizole
Clinda other forms
BV following and monitoring
all women w/ BV tested for HIV n STIs
refrain from sex or use condoms consistently and correctly during treatment regiment
treat sex partners and follow up visits not recommended if symptoms resolved
VVC uncomplicated
non-pregnant, healthy
mild-moderate disease = < 4.5pH
Discharge lacks odor
non-immunocompromised
sporadic or infrequent infections
VVC complicated have >1 of the following…
severe disease
> 3 episodes in < 1 yr
non-albicans candidiasis
pregnant, DM, immunocompromised
What does VVC look like
thick, white cottage cheese like
uncomplicated OTC agents
clotirmazole cream
micronazole cream
ticonazole creams
RX uncomplicated agents
Butoconazole cream
Terconazole cream
fluc tab
Complicated VVC agents
Topical azoles 7-14 days
Fluc 150mg X 2 doses, sep by 72hrs
Topical vs oral for pregnant VVC?
prefer topical
