STD and Etc Flashcards
You’re seeing a homosexual male with rectal pain. What meds do you give before he leaves your office?
- Ceftriaxone 250mg IM x1 (gonorrhea)
- Doxycycline 100mg Bid x 21 days (Chlamydia + LGV)
- Valacyclovir 1g BID x 10 days (HSV)
What is the most common cause of proctitis in HIV+ men? And how do you treat it?
Hsv
Acyclovir 400mg TID x 7 days or
Valacyclovir 1g BID x 7 days
What is the rate of progression to cancer for AIN2/3?
What is the magic number for CD4 count?
You do an anal pap smear and comes back ASCUS. What do you do?
- 5% over 11 years if untreated
- 2% over 4 years if treated
CD4 > 200 is good
CD4 < 200 is bad
ASCUS- anal sq cell undetermined significance. Just repeat biopsy
What is the surveillance schedule for anal condyloma?
Describe how to do an HRA
If HIV+ then annual HRA
If HIV- then annual DRE or pap smear
AIN I:
AIN II/III:
HRA: 3% acetic acid with a large qtip. Leave in for 2-4 min. Dysplastic tissue = white
Lugol solution -> normal tissue = brown
Know the exact regimen of nigro protocol
What is the complete regression rate?
What is the 5 yr survival?
If fails to regress, what is the APR salvage rate?
When do schedule followup after Nigro is complete?
How long do you wait until you re-biopsy
5FU 1000mg/m^2/day IV on days 1-4 & 29-32
Mitomycin C 10mg/m^2 IV on day 1 and 29
25 fractions of 45G (1.8G/day) M-F x 5 weeks
Complete regression 85-90%
70-80% 5yr survival
50% APR salvage rate
Wait several weeks. Can respond 6-9 mo. After chemorad. Inguinal node exam.
Wait 6 months until re-biopsy.
Know the exact regimen of nigro protocol
What is the complete regression rate?
What is the 5 yr survival?
If fails to regress, what is the APR salvage rate?
When do schedule followup after Nigro is complete?
How long do you wait until you re-biopsy
5FU 1000mg/m^2/day IV on days 1-4 & 29-32
Mitomycin C 10mg/m^2 IV on day 1 and 29
25 fractions of 45G (1.8G/day) M-F x 5 weeks
Complete regression 85-90%
70-80% 5yr survival
50% APR salvage rate
Wait several weeks. Can respond 6-9 mo. After chemorad. Inguinal node exam.
Wait 6 months until re-biopsy.
Perianal Paget’s disease
Is it cancer?
1st so what?
Then definitive treatment?
What are the markers?
Yes, it is intra-epithelial adenocarcinoma. Develops from apocrine glands.
Colonoscopy to rule out proximal disease
Rx with WLE with 2.5cm margins
CK7+/CK20-: Paget’s
CK7-/CK20+: Rectal
