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PR3124 > STD > Flashcards

STD Flashcards

1
Q

Mode of transmission of STDs

A
  • Sexual contact
  • Direct contact of broken skin with open sores/ blood/ genital discharge
  • Receiving contaminated blood
  • Mother -> Child (Via placenta: HIV, Syphillis) / (Breastfeeding: HIV) / (Childbirth: Chlamydia, gonorrhea, HSV)
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2
Q

Risk factors for STDs

A
  • Unprotected sexual intercourse
  • No. of sexual partners
  • MSM
  • Prostitution (CSW)
  • Illicit drug use
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3
Q

Prevention methods for STDs

A
  • Abstinence & no. of sexual partners
  • barrier contraceptive methods
  • avoid drug use & sharing of needles
  • pre-exposure vaccination (HPV, Hep A & B)
  • Pre & post exposure prophylaxis
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4
Q

Importance of management of STDs

A
  • Reduce related morbidity, progression to complicated disease (Can be lifelong; affect QOL)
  • Prevent HIV Infection
  • Prevent serious complications
  • -> Main preventable cause of infertility in women
  • Reduced no. of women with cervical cancer
  • Protect babies
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5
Q

Gonorrhoea (Caused by which bacteria/Transmission/Diagnosis/Sites infected)

A
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6
Q

Presentation of Gonorrhoea

A

Male
- Purulent urethral discharge, dysuria, urinary frequency

Female
- Mucopurulent vaginal discharge, dysuria, urinary frequency

Note: can be asymptomatic

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7
Q

Complications of Gonorrhoea (if untreated)

A

Males:
- Epididymitis, prostatitis, urethral stricture

Females:
- Ectopic pregnancy, pelvic inflmm disease, infertility

Both:
Disseminated disease - Skin lesions, tenosynovitis, monoarticular arthritis

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8
Q

Management of Uncomplicated Urogenital Gonorrhoea

A

1) Ceftriaxone: 500mg IM single dose (For > 150kg: 1g)

2) Gentamicin 240mg IM single dose +
Azithromycin 2g PO single dose

3) Cefixime 800mg PO single dose

If gonorrhoea + chlamydia:
1) Ceftriaxone: 500mg IM single dose
(For > 150kg: 1g) +
Doxycycline 100mg PO BD x 7days

2) Cefixime 800mg PO single dose +
Doxycycline 100mg PO BD x 7days

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9
Q

Management of sexual partners (Gonorrhea/Chlamydia)

A

1) Sex partners in last 60 days should be evaluated & treated (If last exposure > 60 days: Most recent partner to be treated)
2) Persons treated for ___ should abstain from sexual activity for 7 days after receiving treatment (or till symptoms resolve)
3) Abstain from sexual activity until all sexual partners have been treated

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10
Q

Management of Chlamydia

A

1) Doxycycline 100mg PO BD x 7 days

Alternatives:

1) Azithromycin 1g PO single dose (can be used if adherence is a concern)
2) Levofloxacin 500mg PO OD x 7 days

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11
Q

Management of Chlamydia

A

1) Doxycycline 100mg PO BD x 7 days

Alternatives:

1) Azithromycin 1g PO single dose (can be used if adherence is a concern)
2) Levofloxacin 500mg PO OD x 7 days

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12
Q

Serological tests for Syphilis

A

1) Treponemal test
- Use trepenomal antigen to detect trepenomal antibody
- More sensitive & specific, used for DIAGNOSIS but not for monitoring as it may remain active for life

2) Nontrepenomal test
- Use nontrepenomal antigen to detect trepenomal antibodies
- Result reported in quantitative VDRL/RPR test: Most dilute [serum] with a positive reaction
- Less specific, used for MONITORING

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13
Q

Management of Syphilis

A

Pri/Sec/Early latent stage (< 1yr duration):

1) IM Benzathine Pen G 2.4mil units x 1 dose
2) PO Doxycycline 100mg BD x 14days
- Take with glass of H20 & remain upright for 30mins

Late latent (> 1yr duration)/ Tertiary Stage:

1) IM Benzathine Pen G 2.4mil units x 1/week x 3doses
2) PO Doxycycline 100mg BD x 28days

Neurosyphilis:
1) IV Crystalline Pen G 3-4mil units Q4h/ 18-24 mil units a day as continuous infusion x 10-14days
2) IM Procaine Pen G 2.4 mil units +
PO Probenicid 500mg QID x 10-14days

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14
Q

Management of Syphilis

A

Pri/Sec/Early latent stage (< 1yr duration):

1) IM Benzathine Pen G 2.4mil units x 1 dose
2) PO Doxycycline 100mg BD x 14days
- Take with glass of H20 & remain upright for 30mins

Late latent (> 1yr duration)/ Tertiary Stage:

1) IM Benzathine Pen G 2.4mil units x 1/week x 3doses
2) PO Doxycycline 100mg BD x 28days

Neurosyphilis:
1) IV Crystalline Pen G 3-4mil units Q4h/ 18-24 mil units a day as continuous infusion x 10-14days
2) IM Procaine Pen G 2.4 mil units daily +
PO Probenicid 500mg QID x 10-14days

3) IV/IM Ceftriaxone 2g daily x 10-14days

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15
Q

What is the Jarisch-Herxheimer reaction?

A

An acute febrile reaction accompanied by HA, myalgia & other symptoms that occur within 24hrs after any therapy for syphilis

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16
Q

Monitoring of syphilis treatment

A

Decrease of VDRL/RPR titre by at least fourfold

Latent syphilis: 6, 12 & 24 mths
Neurosyphilis: CSF examination every 6 month until CSF
normal

Treatment failure @ 6mths:

  • Shows signs & symptoms of disease
  • Failure to decrease VDRL/RPR titre by fourfold or increased
  • Retreat & re-evaluate for unrecognised syphilis
17
Q

How is genital herpes transmitted?

A

Bodily fluids/ intimate skin-to-skin contact

18
Q

Genital herpes (Virus, cycle of HSV infection)

A 
Virus: HSV-1 & HSV-2
Cycle:
- Pri mucocutaneous infection
- Infection of the nerve ganglia
- Establishment of latency
- Reactivation
- Recurrent outbreak/flairs
  • Vesicles develop over 7-10days, heal in 2-4 weeks
  • Intermittent viral shedding from epithelial cells
  • Chronic & lifelong viral infection
19
Q

Diagnosis of genital herpes

A
  • Patient history (Previous lesion/ sexual contact with person with lesions)
  • Classic painful multiple vesicular or ulcerative lesions
  • Local itching, pain, tender inguinal lymphadenopathy
  • Mild burning, itching or tingling prior to appearance of recurrent lesions
  • Flu-like symptoms

Tests:

1) Virologic tests (Send fluid from genital lesions)
2) Type-specific serologic tests (Send blood to look for Ab)
- Presence of HSV-2 antibody

20
Q

Management of genital herpes

A

NO CURE!!!
- Relieve symptoms, shorten clinical course, prevent complications & recurrences, decrease transmission

Supportive care:

  • Warm saline bath to relieve discomfort
  • Good genital hygiene
  • Counselling regarding natural history
21
Q

Antiviral treatment for genital herpes

A

1) Acyclovir 400mg TDS X 7-10days or
IV 5-10mg/kg Q8H x 2-7days, complete
with PO for a total of 10 days
2) Valacyclovir 1g BD x 7-10days

22
Q

Chronic suppressive therapy vs Episodic therapy

A

Chronic suppressive therapy Decreases transmission:
- Red frequency of recurrence by 70-80%
- Many pts report no symptomatic outbreaks
- Improve QOL
- Long term efficacy & safety
BUT cost & compliance issues

Episodic therapy
- Shorten duration & severity of symptoms
- Less costly & btr compliance
BUT does not reduce risk of transmission & requires initiation of therapy within 1 day of lesion onset/ during prodome that precedes some outbreaks

23
Q

Chronic suppressive therapy antiviral regimen

A

1) Acyclovir 400mg BD
2) Valacyclovir 500MG OD (may be < effective)
3) Valacyclovir 1g OD
4) Famciclovir 250mg BD

24
Q

Episodic therapy antiviral regimen

A

1) Acyclovir 800mg BD x 5days OR
Acyclovir 800mg TDS x 2days

2) Valacyclovir 500mg BD x 3days OR
Valacyclovir 1g OD x 5 days

3) Famciclovir 1g BD x 1day
Famciclovir 500mg OD once, followed by 250mg BD x
2 days
Famciclovir 125mg BD x 3days

25
Q

ART combinations for HIV patients

A

2 NRTIs + 1 INSTI:

1) Tenofovir + Emtricitabine + Dolutegravir
2) Tenofovir + Emtricitabine + Bictegravir
3) Abacavir + Lamivudine + Dolutegravir

1 NRTI + 1 INSTI (Cannot if HIV RNA > 500,000 copies/mL or HBV coinfection or ART is to be started before results of HIV genotypic resistance testing or HBV testing are available):
1) Emtricitabine + Dolutegravir

26
Q

NRTIs (Examples, Advantages, Disadvantages, ADE, DDI)

A

Eg: Tenofovir, Emtricitabine, Abacavir, Lamoivudine, Zidovudine

  • Renal elimination (Abacavir no need renal adj)
  • Adverse effect related to mitochondrial toxicity (Lactic acidosis, hepatic steatosis, lipoatrophy, Zidovudine**)

Emtricitabine & Lamoivudine: Minimal toxicity
Tenofovir: Decrease in bone marrow density, renal impairment
Abacavir: Hypersensitivity (HLA-B*5701), Associated with MI; Not in CVS risk patients
Zidovudine: Bone marrow supression

27
Q

INSTIs (Examples, Advantages, Disadvantages, ADE, DDI)

A

Eg: Bictegravir, Dolutegravir, Raltegravir, Elvitegravir

Advantages:

  • Good virologic effectiveness
  • High genetic barrier to resistance
  • Generally well tolerated

Disadvantages:

  • Weight gain, diarrhoea, nausea, HA
  • Depression & sucidality (Pri in patients with pre-existing psychiatric conditions)
  • DDI: Bioavailability lowered by concurrent polyvalent cations
  • All CYP3A4 substrates EXCEPTS Raltegravir

Dolutegravir & Bictegravir: Increase in serum Cr
Raltegravir: Pyrexia, Increase in creatine kinase elevation (Rhabdomyolysis)

28
Q

NNRTIs (Examples, Advantages, Disadvantages, ADE, DDI)

A

Eg. Efavirenz, Rilpivirine (preferred)

Advantages:

  • Long t 1/2
  • Less metabolic toxicity

Disadvantages:

  • Low genetic barrier to resistance
  • Skin rash, SJS (Efavirenz)
  • Potential for CYP450 DDI
  • QTc prolongation

Efavirenz: Neuropsychiatric SE, SJS, Increase in LDL-C &
triglycerides, hepatotoxicity
Rilvipirine: Depression, HA

29
Q

PIs (Examples, Advantages, Disadvantages, ADE, DDI)

A

Advantages:

  • High genetic barrier to resistance
  • PI resistance < common

Disadvantage:

  • Dyslipidaemia, insulin resistance, N/V, Diarrhoea, liver toxicity, Fat maldistribution, Increased risk of osteopenia/osteoporosis
  • CYP3A4 inhibitors & substrates

Ritonavir:

  • Potent CYP3A4, 2D6 inhibitor, freq combined with other PI to “boost” their levels
  • Paresthesia (Numbness of extremeties), taste perversion

Darunavir

  • Good GI tolerability, less lipid effects
  • Skin rash, SJS concern

Atazanavir:

  • Good GI tolerability, less lipid effects
  • hyperbilirubinemia, QTc prolongation, skin rash
30
Q

Fusion Inhibitor (Examples, Advantages, Disadvantages, ADE, DDI)

A

Enfuvirtide

  • Injection site reaction
  • Increased bacterial pneumonia
31
Q

CCR5 Antagonist (Examples, Advantages, Disadvantages, ADE, DDI)

A

Maraviroc

  • Used only in ppl whose HIV strain use CCR5 receptor to enter CD4 cells
  • Ab pain, cough, dizzines, muscoskeletal symptoms, pyrexia, rash, URTI, hepatotoxicity, orthostatic hypotension

PR3124 (16 decks)

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