Section 8: Sexually Transmiited Diseases Flashcards by Leonard Emuren

Rx for folliculitis, furuncles, carbuncles and boils.

Minor disease: Dicloxacillin or cephalexin orally

Severe disease: Oxacillin, nafcillin, or cefazolin IV

If large, as in boils, do I & D.

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Best initial diagnostic test for fungal infection of the skin or nail

KOH preparation
1. Scrape the skin or nail.
2. Place the scraping on a slide with KOH and acid and heat it.
3. The epithelial cells will dissolve and leave the fungal forms behind, visible on the slide

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 650-654). . Kindle Edition.

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Rx for fungal infection of the skin and nail

Topical antifungal medication (if no hair or nail involvement): Clotrimazole, miconazole, ketoconazole, econazole, terconazole, nystatin, or ciclopirox

Oral antifungal medication for scalp (tinea capitis) or nail (onychomycosis)

– Terbinafine: Causes increased liver function tests

– Itraconazole

– Griseofulvin (for tinea capitis): Has less efficacy than either terbinafine or itraconazole

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 656-665). . Kindle Edition.

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Best initial test for urethritis

Urethral swab for Gram stain, WBC count, culture, and DNA probe

Nucleic acid amplification tests (NAATs) are highly effective as well

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 672-673). . Kindle Edition.

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Basic principle for Rx of urethritis

Two medications: one for gonorrhea and another for Chlamydia

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List some gonorrhea medications

Ceftriaxone IM

Cefixime oral

Cefpodoxime oral

Ciprofloxacin oral (2nd line)

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List the medications for Chlamydia urethritis

Azithromycin (single dose)

Doxycycline (for one week)

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Rx for urethritis in pregnancy

Ceftriaxone IM and

Azithromycin

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What predisposes a patient to recurrent infections with Neisseria?

Terminal complement deficiency

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Single best test for gonorrhea and Chlamydia?

Nucleic acid amplification test (NAAT)

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What blood finding is a measure of severity in PID?

Leukocytosis

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Best initial test for PID

Pregnancy test, then cervical culture and DNA probe for Chlamydia and gonorrhea

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 722-724). . Kindle Edition.

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Most accurate test for PID

Laparoscopy

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How to collect samples for nucleic acid amplification test

NAAT can be done on voided urine for men or blind vaginal swab in women.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 726-727). . Kindle Edition.

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Outpatient Rx for PID

Ceftriaxone (IM) and doxycycline (oral)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 740). . Kindle Edition.

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Inpatient Rx of PID

Cefoxitin (IV) and doxycycline and maybe metronidazole.

Cefotetan can be used instead of cefoxitin.

Remember, PID ends with D and its Rx always includes Doxycycline whether inpatient or outpatient. For inpatient Rx the accompanying cephalosporin is cefoxitin, which has an “X” like the one in doXicyclin. Of course cefotetan can be used in place of cefoxitin since these are the cephalosporins with anerobic effects.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 741-742). . Kindle Edition.

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List four classes of antibiotics safe in pregancy

Penicillins

Cephalosporins

Aztreonam

Macrolides (Azithromycin and Erythromycin)

Use the mnemonic “CAMP”

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Presentation of epidydimo-orchitis

An extremely painful and tender testicle with a normal position in the scrotum.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 750-752). . Kindle Edition.

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Rx of epidydimo-orchitis

< 35 years of age: Ceftriaxone and doxycycline

> 35 years of age: Fluoroquinolone

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 754-755). . Kindle Edition.

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Causative agent: painful genital ulcer

Haemophilus ducreyi

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 760-761). . Kindle Edition.

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Best initial test for chancroid

Swab for Gram stain (gram-negative coccobacilli) and culture (will require specialized medium: Nairobi medium or Mueller-Hinton agar).

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 763-764). . Kindle Edition.

Rx for chancroid

Single IM shot of ceftriaxone or single oral dose of azithromycin.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 765-766). . Kindle Edition.

Causative agent: Lymphogranuloma venereum (LGV)

Chlamydia trachomatis

Rx of Lymphogranuloma venereum (LGV)

Aspirate the bubo.

Treat with:

Ddoxycycline
Azithromycin

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 773-774). . Kindle Edition.

Causative agent: Genital herpes

Herpes simplex virus type 2 (HSV2)

When is it necessary to do the Tzanck prep test in HSV2

If the roofs come off the vesicles and the lesion becomes an ulcer of unclear etiology, Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 785-786). . Kindle Edition.

Rx for HSV2

Acyclovir Valacyclovir Famciclovir Rx is for 7– 10 days Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 784-785). . Kindle Edition.

Rx for acyclovir resistant herpes

Foscarnet

Rx for HSV2 in pregnancy

Acyclovir

Rx for cytomegalovirus (CMV)

Ganciclovir

What is the most accurate test in primary syphilis?

**Darkfield microscopy**. Darkfield microscopy is far more sensitive than a VDRL or RPR in primary syphilis. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 804-805). . Kindle Edition.

Rx for primary syphylis

Single shot of IM penicillin

Rx of primary syphilis in those with penicillin allergy

Doxycycline

Diagnosis: development of fever, headache, and myalgia within 24 hours after treatment for early stage syphilis. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 810-811). . Kindle Edition.

Jarisch-Herxheimer reaction. It is a benign, self-limited reaction caused by the release of pyrogens from dying treponemal. Treat with aspirin and continue the treatment. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 810). . Kindle Edition.

Initial diagnostic test for secondary syphilis

RPR (Rapid Plasma Reagin) FTA (Flourescent Treponemal Antibody)

Rx for secondary syphilis

Single IM shot of penicillin Use doxycycline for the penicillin-allergy Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 815-816). . Kindle Edition.

Features of tertiary syphilis

Neurosyphilis: **Tabes doralis, general paresis, Argyll-Robertson pupil** **Gummas** ** Aortitis** Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 851-854). . Kindle Edition.

Initial diagnostic test for tertiary syphilis

RPR and FTA Lumbar puncture for neurosyphilis (test CSF with VDRL and FTA). CSF VDRL is only 50 percent sensitive. Neurosyphilis is excluded with a negative CSF FTA. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 820-821). . Kindle Edition.

Rx for tertiary syphilis

IV penicillin If allergic, desensitize

Rx of syphilis in pregnancy

Desensitization

Diagnosis: rare, beefy red genital lesion that ulcerates. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 876-877). . Kindle Edition.

Granuloma inguinale

What is the diagnostic testing and causative organism for Granulama inguinale

Biopsy or “touch prep,” Klebsiella granulomatis Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 879-880). . Kindle Edition.

Rx for Granuloma inguinale

Doxycycline TMP/SMX Azithromycin

Compare and contrast pediculosis and scabies

Pediculosis Scabies * Larger • Small * In hair-bearing areas, such as the pubic area or axilla • Burrows in web spaces * Visible on the surface • Scrape and magnify * Treat with permethrin, pyrethrins, or lindane. • Treat with permethrin, lindane, or ivermectin. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 887-898). . Kindle Edition.

Rx of Warts

Perform surgical removal if large. Imiquimod is an immunostimulant that leads to sloughing off of the wart. Cryotherapy, laser removal, and melting with podophyllin are other options. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 902-904). . Kindle Edition.

Rx of cystitis

Uncomplicated cystitis is treated with TMP/ SMX orally for 3 days, if E. coli resistance in that area is low. If resistance is \> 20 percent, then use ciprofloxacin or levofloxacin. “Complicated” cystitis is treated with 7 days of TMP/ SMX or ciprofloxacin. Complicated means an anatomic abnormality is present, such as a stone, stricture, tumor, or obstruction. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 911-915). . Kindle Edition.

When is it right to treat asymptomatic bacteriuria

In pregnancy

What are the outpatient and inpatient Rx of pyelonephritis

Outpatient: **Ciprofloxacin** Inpatient: **IV Ampicillin + Gentimicin**

Diagnoses: 1. Dysuria + white cells in urine + suprapubic tenderness 2. Dysuria + white cells in urine + flank pain + fever Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 948-950). . Kindle Edition.

1. Cystitis 2. Pyelonephritis

List those for whom Rx is required in asymptomatic bacteriuria

* Pregnancy * Urologic intervention * Hip arthropathy

List those who do not require Rx in asymptomatic bacteriuria

* Nonpregnant premenopausal women * The elderly * DM * Patients with spinal cord injury * Patients with chronic indwelling urinary catheters