STD therapeutics Flashcards
1
Q
when children have gonorrhea, syphilis or chlamydia we should be suspicious of
A
sexual abuse
2
Q
barriers to treatment of adolescents
A
parental notification
3
Q
HSV rates are highest in
A
young adults
4
Q
percentage of women under 25 infected with HPV
A
28-46%
5
Q
when is STD screening most routine
A
during pregnancy
6
Q
why is primary infection of HSV in pregnancy most concerning
A
- they don’t usually have symptoms so they don’t know they have it
- can easily be transmitted to fetus
7
Q
best STD prevention method
A
abstinence and avoiding sex w/ infected partners
8
Q
ways to prevent STD transmission
A
- abstinence
- immunizations if available
- clear instructions
- condoms, clean needles
- treat partners when applicable
9
Q
expedited partner therapy does what
A
gives a Rx for the “partner of X” to treat partners without them having to visit a provider
10
Q
STDs that expedited partner therapy is used for
A
gonorrhea and chlamydia
11
Q
chlamydia rates are highest in
A
women 20-24
12
Q
gonorrhea rates are highest in
A
males 25-29
13
Q
HSV-1 is located where
A
orally
14
Q
HSV-2 is located where
A
genitals
15
Q
HSV transmission
A
infected secretions making contact with mucosa or broken skin
16
Q
HSV stays where
A
nerve root ganglia
17
Q
HSV initial presentation
A
-painful lesion
-dysruia
-vaginal discharge
-headache
occurs 2-14 days after exposure, resolves in 1-3 weeks
18
Q
HSV recurrent episode presentation
A
- may or may not have symptoms
- still sheds virus
- shorter duration
- sometimes prodrome
- frequency decreases over time
19
Q
treatment for primary episode of HSV
A
-acyclovir
-famiciclovir
-valacyclovir
7-10 days
20
Q
treatment for recurrent episodes of HSV
A
- acyclovir 400 tid x5d
- acyclovir 800 bid x5d
- acyclovir 800 tid x2d
- famiciclovir
- valacyclovir
21
Q
treatment for cold sores
A
valacyclovir 2 gm bid for one day
22
Q
treatments for suppression of HSV
A
- acyclovir 400 mg bid
- famiciclovir
- valacyclovir
23
Q
when to use suppressive therapy for HSV
A
if pt has more than 6 episodes per year
stop after 1 year to reassess
24
Q
HSV suppression in pregnant women
A
from 36 weeks until delivery
25
HSV suppression drugs in pregnancy
- acyclovir 400 mg tid
| - valacyclovir 500 mg bid
26
when to have C-section in HSV
if genital warts are present or prodrome has started at time of delivery
27
use of topical antivirals in HSV
don't do it, they don't really have any benefit
28
syphilis is caused by
spirochete: treponema pallidum
29
syphilis is transmitted by
sexual contact with infected mucosa or skin lesions
30
syphilis is diagnosed by
- using RPR AND VDRL
- may also do FTA-Abs
* need at least 2 tests always*
31
primary early presentation of syphilis
- chancer (dimple thing)
- 10days-3 months after exposure
- painless
- disappears on its own
32
secondary early presentation of syphilis
2-6 weeks after chancre disappears:
- rash
- systematic flu like symptoms
- may last weeks to months
33
late latent presentation of syphilis
- gumma (defined ulcer)
- may be on any part of body, possibly painless
- not infectious
34
syphilis CV and neuro presentation
- CV symptoms 15-30 years after initial
| - neurosyphilis leads to deafness, blindness, dementia seen any time, usually in tertiary stage
35
STD that can cause deafness, blindness or dementia
syphilis
36
adult treatment of syphilis in primary/secondary stage
-benzathine PCN G 2.4 million units IM x 1 dose
37
adult treatment of syphilis in primary/secondary stage if PCN allergy
doxycycline 100 mg bid x 2 weeks
38
adult treatment of syphilis in primary/secondary stage in pregnancy
only benzathine PCG, desensitize if necessary
39
adult treatment of syphilis in latent/tertiary stage
- if early - benzathine PCN G
| - if late or unknown, 3 doses of benzathine PCN G at weekly intervals
40
adult treatment for neurosyphilis
- aqueous crystalline PCN G 3-4 mu q4h x10-14d
| - procaine PCN
41
syphilis follow up
- retest serologically at 6 and 12 months
| - if titers still positive treat with same dose of PCN at weekly intervals of 3 doses
42
Jarisch-Herxheimer reaction
reaction where massive death of spirocetes causes person to feel really terrible and have a fever
43
chlamydia is caused by
intracellular parasite, chalmydia trachomatis
44
patients with chlamydia are often coinfected with
gonorrhea
45
how to diagnose chlamydia
- test urine
| - endocervical or urethral swab
46
symptoms of chlamydia in men
- dysuria
- increased frequency
- urethral discharge
- proctitis
47
symptoms of chlamydia in women
- endocervicitis
- vaginal discharge
- dyscuria
48
onset of chlamydia symptoms
1-3 weeks
49
symptoms of chlamydia in infants
conjunctivitis
| pneumonia
50
percentage of asymptomatic chlamydia patients
50% women
| 25% men
51
treatment for chlamydia
- azithromycin 1g one dose OBSERVED
| - doxycycline 100 mg bid x 7d
52
treatment for chlamydia in pregnancy
azithromycin 1 gm
53
counseling points in chlamydia
- abstinence until treatment complete (7 days in one time dose)
- may cause breakthrough bleed when on OCPs
- rescreen yearly
54
gonorrhea is caused by
neisseria gonorrhoeae (Gm- diplococcus)
55
gonorrhea transmission
unprotected sex
56
gonorrhea diagnosis
NAAT - urine or swab of affected area
57
gonorrhea symptoms
-dysuria
-urethral discharge
-proctitis
start 2-10 days after infection
*women usually asymptomatic*
58
gonorrhea treatment
ceftriaxone 250 mg IM x 1 dose AND azithromycin 1 gm x 1 dose
*no quinolones*
59
gonorrhea treatment if cephalosporin allergy
gemifloxacin + azithromycin
60
why can't we do expedited partner Rx for gonorrhea
pharmacies can't do IM ceftriaxone, needs to be done in clinic
61
emerging problem with gonorrhea
resistance
62
gonorrhea counseling
- PID and infertility possible
- treat all partners in 60 days
- abstain until all are treated
63
symptoms of gonorrhea in newborns
conjunctivitis
64
bacterial vaginosis is caused by
gardnerella, ureaplasma, gm- and anaerobes
65
bacterial vaginosis transmission
not via sex
66
diagnosis of bacterial vaginosis
- white thin discharge
- clue cells
- pH >4.5
- sometimes fishy odor after adding KOH
- 50% asymptomatic
67
treatment for bacterial vaginosis in nonpregnant women
- metro PO bid for 7d
- metro gel for 5d
- clindamycin cream for 7d
68
treatment for bacterial vaginosis in pregnant women
- metro PO bid for 7d
- clindmycin PO for 7d
- topicals can still be used though
69
trichomoniasis is caused by
protozoan parasite, trichomoniasis vaginalis
70
trichomoniasis diagnosis
presence of protozoan on wet mount slide
71
trichomoniasis symptoms
Men=dysuria, ureathral discharge
| Women=foamy yellow discharge with odor, itching, erythema, inflammation, dysuria
72
treatment for trichomoniasis
-metronidazole single dose
73
trichomoniasis counseling
- treat partners
- rescreen in 3 months
- pregnancy is ok
74
vulvovaginal candidiasis is caused by
candida albicans
75
symptoms of of vulvovaginal candidiasis
- extreme itching
- erythema
- dysuria
- thick, white discharge w/ no odor
76
treatment of vulvovaginal candidiasis
- azole antifungal cream
- fluconazole
- 7 days
77
recurrent vulvovaginal candidiasis
more than 4 symptomatic episodes/year
78
pelvic inflammatory disease is caused by
- gonorrhea
- chlamydia
- Gm- anaerobes
79
pelvic inflammatory disease symptoms
- lower abdominal pain
- uterine tenderness
- cervical motion tenderness
- may have discharge
- fever
- dysuria
- irregular bleeding
80
inpatient treatment of pelvic inflammatory disease
-cefotetan or cefoxitin + doxycycline
OR
-clindamycin + gent
81
outpatient treatment of pelvic inflammatory disease
-cefoxitin/probenecid
OR
-ceftriaxone + doxycycline +/- metro
82
pelvic inflammatory disease counseling
-treat all partners for chlamydia AND gonorrhea
83
HPV manifestation
genital warts
84
main problem with HPV
can cause cancer
85
prevention of HPV
Gardasil 9 vaccination
86
Gardasil who should get it recommendations
- 11-12 for females (up to 25 y/o)
| - 11-12 for males (up to 21 y/o)
87
gardasil dose series recommendations
- if before 15 only 2 doses (1, 6-12 mos)
| - if after 15 then 3 (0, 1-2, 6 mos.)
88
treatment for HPV warts
- podofilox bid x 3d, then 4 days off; 4 cycles
| - imiquimod for up to 16 weeks (must wash off after 6-10 hours)
89
HPV counseling
- can be transmitted even if not visible
| - condoms can decrease, but not eliminate transmission
90
treatment for lice
ivermectin PO, repeat in 2 weeks
91
treatment for scabies
- permethrin
| - ivermectin PO, repeat in 2 weeks
92
when to not use ivermectin
in pregnancy
