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therapeutics V > Sexually Transmitted Infections > Flashcards

Sexually Transmitted Infections Flashcards

1
Q

PREP use

A

Prevent HIV in patients>77lb

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2
Q

PREP
Emtricitabine w/ tenofovir disproxil fumarate

A

-po qd
-prevent HIV in all people

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3
Q

PREP
emtricitabine w/ tenofovir alafenamide

A

-prevent HIV through sexual transmission, excluding vaginal sex

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4
Q

PREP
cabotegravir

A

-im injection
-all people

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5
Q

PEP

A

-use less than 72h after exposure
-post exposure prevention

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6
Q

preferred nPEP regimen

A

-Tenofovir disoproxil fumarate
-Emtricitabine
-raltegravir or dolutegravir

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7
Q

Alt nPEP regimen

A

-TDF
-F
-dolutegravir
-ritonavir

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8
Q

Ritonavir (RTV)

A

pk enhancer to increase concentration and prolong t1/2 of protease inhibitors

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9
Q

nPREP duration

A

28 days

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10
Q

STIs

A

-gonorrhea
-syphilis
-chlamydia
-mycoplasma genitalium
-genital HSV
-trichomoniasis
-PID

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11
Q

Gonorrhea bacterium

A

Neisseria gonorrhoeae
-gram -, diplococci

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12
Q

A major cause of PID

A

gonorrhea

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13
Q

STI associated w/ increased risk of HIV transmission

A

gonorrhea

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14
Q

Gonorrhea clinical manifestations
uncomplicated, women

A
  • endocervix
    -80% asymptomatic or mild
    -symptoms:
    -> increased vaginal discharge, dysuria, urinary frequency, intermenstrual bleeding, menorrhagia
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15
Q

Gonorrhea clinical manifestation
men

A

-acute urethritis
-symptoms
-> prulent urethral discharge and dysuria
-spontaneous resolution

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16
Q

Anorectal Gonorrhea Infection
clincial manifestations

A

-most asymptomatic
-symptoms
-> acute proctitis, tenesmus, purulent discharge, rectal bleeding/discharge, rectal pain

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17
Q

Pharyngeal gonorrhea infection
clinical manifestations

A

-major risk factors
-> orogenital sexual exposure
-most asymptomatic
-may cause pharyngitis or cervical lymphadenitis

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18
Q

Gonorrhea in newborns

A

-transmitted in utero
-transmitted via passage thru the birth canal
-most commonly -> opthalmia neonatorum
-can lead to corneal ulceration and blindness

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19
Q

Gonorrhea diagnosis

A

Standard of care -> Nucleic acid amplification tests (NAAT)
-urine, rectum, throat

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20
Q

Gonorrhea tx
uncomplicated, cervix, urethra, and rectum
pharynx

A

-weight based
-<150kg
–> ceftriaxone 500mg im
->150kg
–> ceftriaxone 1g im
-if chlamydia not excluded add
–> doxycycline x 7days
-if chlamydia not excluded and pregnant add
–> azithromycin x1

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21
Q

Gonorrhea patient education

A

-abstain from sex for 7 days
-tx sexual partner -> EPT

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22
Q

Syphilis
etiologic agent

A

treponema pallidum
-spirochete

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23
Q

All pts with syphilis should be tested for

A

HIV

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24
Q

primary syphilis

A

Painless lession (chancre)
-chancres disappear spontaneously w/o tx

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25
secondary syphilis
-develops 2-6 weeks after onset -variety of mucocutaneous eruptions -lesions anywhere on body -systemic symptoms -signs disappear in 4-10 weeks
26
latent syphilis
-Positive serologic test but no other evidence of disease -early latent --> potentially infectious --> 1 year from onset of infections -late latent --> noninfectious
27
Tertiary (Late) syphilis
-slowly progressing inflammatory phase -Affects any organ in the body
28
Neurosyphilis
-any stage of syphilis -HA, meningismus, increased CSF leukocyte count and protein -VDRL-CSF --> reactive, diagnostic for neurosyphilis
29
Congenital syphilis
-t.padilldum can cross the placenta -may result in fetal death, prematurity, or congenital syphilis -early congenital syphilis --> resembles secondary syphilissy
30
syphilis diagnosis
-primary syphilis -> presence of T. pallidum on dark feild microscopy -secondary syphilis -> spirochete found in cutaneous lesions and lymph nodes -direct fluorescent antibody test --> requires fresh specimen
31
syphilis diagnostic tests
1) nontreponemal tests -detect reagin -commonly used -positive indicates presence of any stage of syphilis 2) treponemal test -more sensitive -confirmatory
32
Syphilis Treatment
Penicillin G -> all stages
33
Syphilis treatment PCN allergy
-doxycyline -tetracycline
34
Neurospyhilis tx
-csf penetration should be prolonged -pcn iv -pcn allergy -> ceftriaxone
35
syphilis clinical pearls
jarisch-herxheimer rxn -tx with antipyretics -common in early stage syphilis
36
chlamydia etiologic agent
chlamydia trachomatis -gram negative, anerobic
37
most common infectious disease
chlamydia
38
chlamydia presentation males
-dysuria, urinary frequency, mucoid urethral discharge
39
Chlamydia presentation females
-majority asymptomatic -endocervicitis w/ mucopurulent discharge -major cause of PID
40
chlamydia presentation infants
-transmitted via contact w/ cervicovaginal secretions -neonatal eye infections and pneumonia
41
chlamydia diagnosis
-NAAT -> detect chlamydia antigen in urine -giemsa stain -direct immunofluorescence -cell culture
42
chlamydia recommended treatment
Doxycycline 100mg po bid x 7 days
43
chlamydia treatment in pregnancy
standard -azithromycin 500mg x 1 dose alt -amoxil x 7 days
44
chlamydia patient education
-abstain from sex for 7 days -test for hiv, gonorrhea, and syphilis
45
Mycoplasma Genitalium
Motile, flask-shaped bacteria, no cell wall
46
cause of male urethritis
Mycoplasma Genitalium
47
Mycoplasma Genitalium may be sole pathogen or coinfection with
c. trachomatis
48
Mycoplasma Genitalium is associated w/
-cervicitis -PID -preterm delivery -spontaneous abortion -infertility
49
Mycoplasma Genitalium clinical presentation
same as chlamydia
50
Mycoplasma Genitalium diagnosis
-takes up to 6mo for positive culture -NAAT preferred
51
Mycoplasma Genitalium treatment
depends on availability of resistance testing -macrolide susceptible --> doxycycline x 7 days --> azithromycin x 7 days, plus 3 additional days -macrolide resistance/testing not available --> doxycycline x 7 days, then moxifloxacin x 7 days
52
Genital herpes
-HSV1 -HSV2 **
53
Herpes presentation
primary infection - prolonged sypmtoms -local symptoms --> lesions on genital area, itching, discharge, inguinal adenopathy recurrent infections -prodrome -symptoms more severe in women and immunocompromised
54
Herpes diagnosis
-viral culture ** -HSV NAAT -Serologic test
55
Herpes treatment First clinical episode
-acyclovir 400mg tid -famciclovir 250mg tid -valacyclovir 1g bid Treatment duration: 7-10 days
56
Herpes Treatment reccurent
- acyclovir 800 bid x 5 days or 800mg tid x 3 days -famciclovir 125mg bid x 5 days or 1g bid x 1 day -valacyclovir 500mg bid x 3day or 1g qd x 5 days
57
Herpes Treatment Severe disease
acyclovir 5-10mg/kg/dose iv q8h for 2-7 days, followed by oral for at least 10 days
58
Herpes suppressive treatment
-acyclovir 400mg bid -famciclovir 250mg bid -valacylovir 500mg qd (not as effective) -valacylovir 1g qd
59
resistant herpes treatment
-foscarnet 40-80mg/kg/dose iv -cidofovir 5mg/kg iv once weekly
60
Trichomoniasis etiologic agent
trichomonas vaginalis flagellated, motil protozoan
61
Trichomoniasis presentation women
-vaginal discharge (greenish-yellow) -vulvar pruritis -dysuria -3x risk of having gonorrhea
62
Trichomoniasis presentation men
-urethral discharge, pruritis, dysuria -trichomoniasis -> tx failure in pts w/ presumed NGU treaated w/ tetracycline or erythromycin -examine for other STDs
63
Trichomoniasis Diagnosis
-wet mount --> pear-shaped, flagellating organism -NAAT -culture
64
Trichomoniasis Treatment Agents
Nitroimidazoles -tinidazole -metronidazole --not metronidazole gel
65
Trichomoniasis Treatment Regimen women
-metronidazole 500mg bid x 7 days --alt: tinidazole 2g x 1 dose
66
Trichomoniasis Treatment Regimen men
-metronidazole 2g x 1 dose --alt: tinidazole 2g x 1 dose
67
Trichomoniasis Treatment Regimen HIV
metronidazole 500mg po bid x 7 days
68
Trichomoniasis Clinical Pearls
-retest < 3mo of initial tx -avoid alc -tx sexual partner
69
Pelvic Inflammatory Disease etiologic agents
-n. gonorrhea -c. trachomatis - vaginal flora -mycoplasma -ureaplasma urealyticum
70
PID is
a spectrum of inflammatory disorrders -endometritis -salpingitis -tubo-ovarian abscess -pelvic peritonitis
71
PID Diagnosis/Symptoms
-pelvic or lower pain -adnexal or uterine tenderness -cervical motion tenderness -increase ESR and/or CRP
72
PID Treatment standard regimen
ceftriaxone + doxycycline + metronidazole x 14 days

therapeutics V (19 decks)

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