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PT2 ID 7-9 > STD therapeutics > Flashcards

STD therapeutics Flashcards

1
Q

when children have gonorrhea, syphilis or chlamydia we should be suspicious of

A

sexual abuse

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2
Q

barriers to treatment of adolescents

A

parental notification

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3
Q

HSV rates are highest in

A

young adults

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4
Q

percentage of women under 25 infected with HPV

A

28-46%

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5
Q

when is STD screening most routine

A

during pregnancy

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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
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7
Q

best STD prevention method

A

abstinence and avoiding sex w/ infected partners

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8
Q

ways to prevent STD transmission

A
  • abstinence
  • immunizations if available
  • clear instructions
  • condoms, clean needles
  • treat partners when applicable
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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

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10
Q

STDs that expedited partner therapy is used for

A

gonorrhea and chlamydia

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11
Q

chlamydia rates are highest in

A

women 20-24

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12
Q

gonorrhea rates are highest in

A

males 25-29

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13
Q

HSV-1 is located where

A

orally

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14
Q

HSV-2 is located where

A

genitals

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15
Q

HSV transmission

A

infected secretions making contact with mucosa or broken skin

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16
Q

HSV stays where

A

nerve root ganglia

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17
Q

HSV initial presentation

A

-painful lesion
-dysruia
-vaginal discharge
-headache
occurs 2-14 days after exposure, resolves in 1-3 weeks

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18
Q

HSV recurrent episode presentation

A
  • may or may not have symptoms
  • still sheds virus
  • shorter duration
  • sometimes prodrome
  • frequency decreases over time
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19
Q

treatment for primary episode of HSV

A

-acyclovir
-famiciclovir
-valacyclovir
7-10 days

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20
Q

treatment for recurrent episodes of HSV

A
  • acyclovir 400 tid x5d
  • acyclovir 800 bid x5d
  • acyclovir 800 tid x2d
  • famiciclovir
  • valacyclovir
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21
Q

treatment for cold sores

A

valacyclovir 2 gm bid for one day

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22
Q

treatments for suppression of HSV

A
  • acyclovir 400 mg bid
  • famiciclovir
  • valacyclovir
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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

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24
Q

HSV suppression in pregnant women

A

from 36 weeks until delivery

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25
Q

HSV suppression drugs in pregnancy

A
  • acyclovir 400 mg tid

- valacyclovir 500 mg bid

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26
Q

when to have C-section in HSV

A

if genital warts are present or prodrome has started at time of delivery

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27
Q

use of topical antivirals in HSV

A

don’t do it, they don’t really have any benefit

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28
Q

syphilis is caused by

A

spirochete: treponema pallidum

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29
Q

syphilis is transmitted by

A

sexual contact with infected mucosa or skin lesions

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30
Q

syphilis is diagnosed by

A
  • using RPR AND VDRL
  • may also do FTA-Abs
  • need at least 2 tests always*
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31
Q

primary early presentation of syphilis

A
  • chancer (dimple thing)
  • 10days-3 months after exposure
  • painless
  • disappears on its own
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32
Q

secondary early presentation of syphilis

A

2-6 weeks after chancre disappears:

  • rash
  • systematic flu like symptoms
  • may last weeks to months
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33
Q

late latent presentation of syphilis

A
  • gumma (defined ulcer)
  • may be on any part of body, possibly painless
  • not infectious
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34
Q

syphilis CV and neuro presentation

A
  • CV symptoms 15-30 years after initial

- neurosyphilis leads to deafness, blindness, dementia seen any time, usually in tertiary stage

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35
Q

STD that can cause deafness, blindness or dementia

A

syphilis

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36
Q

adult treatment of syphilis in primary/secondary stage

A

-benzathine PCN G 2.4 million units IM x 1 dose

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37
Q

adult treatment of syphilis in primary/secondary stage if PCN allergy

A

doxycycline 100 mg bid x 2 weeks

38
Q

adult treatment of syphilis in primary/secondary stage in pregnancy

A

only benzathine PCG, desensitize if necessary

39
Q

adult treatment of syphilis in latent/tertiary stage

A
  • if early - benzathine PCN G

- if late or unknown, 3 doses of benzathine PCN G at weekly intervals

40
Q

adult treatment for neurosyphilis

A
  • aqueous crystalline PCN G 3-4 mu q4h x10-14d

- procaine PCN

41
Q

syphilis follow up

A
  • retest serologically at 6 and 12 months

- if titers still positive treat with same dose of PCN at weekly intervals of 3 doses

42
Q

Jarisch-Herxheimer reaction

A

reaction where massive death of spirocetes causes person to feel really terrible and have a fever

43
Q

chlamydia is caused by

A

intracellular parasite, chalmydia trachomatis

44
Q

patients with chlamydia are often coinfected with

A

gonorrhea

45
Q

how to diagnose chlamydia

A
  • test urine

- endocervical or urethral swab

46
Q

symptoms of chlamydia in men

A
  • dysuria
  • increased frequency
  • urethral discharge
  • proctitis
47
Q

symptoms of chlamydia in women

A
  • endocervicitis
  • vaginal discharge
  • dyscuria
48
Q

onset of chlamydia symptoms

A

1-3 weeks

49
Q

symptoms of chlamydia in infants

A

conjunctivitis

pneumonia

50
Q

percentage of asymptomatic chlamydia patients

A

50% women

25% men

51
Q

treatment for chlamydia

A
  • azithromycin 1g one dose OBSERVED

- doxycycline 100 mg bid x 7d

52
Q

treatment for chlamydia in pregnancy

A

azithromycin 1 gm

53
Q

counseling points in chlamydia

A
  • abstinence until treatment complete (7 days in one time dose)
  • may cause breakthrough bleed when on OCPs
  • rescreen yearly
54
Q

gonorrhea is caused by

A

neisseria gonorrhoeae (Gm- diplococcus)

55
Q

gonorrhea transmission

A

unprotected sex

56
Q

gonorrhea diagnosis

A

NAAT - urine or swab of affected area

57
Q

gonorrhea symptoms

A

-dysuria
-urethral discharge
-proctitis
start 2-10 days after infection
women usually asymptomatic

58
Q

gonorrhea treatment

A

ceftriaxone 250 mg IM x 1 dose AND azithromycin 1 gm x 1 dose
no quinolones

59
Q

gonorrhea treatment if cephalosporin allergy

A

gemifloxacin + azithromycin

60
Q

why can’t we do expedited partner Rx for gonorrhea

A

pharmacies can’t do IM ceftriaxone, needs to be done in clinic

61
Q

emerging problem with gonorrhea

A

resistance

62
Q

gonorrhea counseling

A
  • PID and infertility possible
  • treat all partners in 60 days
  • abstain until all are treated
63
Q

symptoms of gonorrhea in newborns

A

conjunctivitis

64
Q

bacterial vaginosis is caused by

A

gardnerella, ureaplasma, gm- and anaerobes

65
Q

bacterial vaginosis transmission

A

not via sex

66
Q

diagnosis of bacterial vaginosis

A
  • white thin discharge
  • clue cells
  • pH >4.5
  • sometimes fishy odor after adding KOH
  • 50% asymptomatic
67
Q

treatment for bacterial vaginosis in nonpregnant women

A
  • metro PO bid for 7d
  • metro gel for 5d
  • clindamycin cream for 7d
68
Q

treatment for bacterial vaginosis in pregnant women

A
  • metro PO bid for 7d
  • clindmycin PO for 7d
  • topicals can still be used though
69
Q

trichomoniasis is caused by

A

protozoan parasite, trichomoniasis vaginalis

70
Q

trichomoniasis diagnosis

A

presence of protozoan on wet mount slide

71
Q

trichomoniasis symptoms

A

Men=dysuria, ureathral discharge

Women=foamy yellow discharge with odor, itching, erythema, inflammation, dysuria

72
Q

treatment for trichomoniasis

A

-metronidazole single dose

73
Q

trichomoniasis counseling

A
  • treat partners
  • rescreen in 3 months
  • pregnancy is ok
74
Q

vulvovaginal candidiasis is caused by

A

candida albicans

75
Q

symptoms of of vulvovaginal candidiasis

A
  • extreme itching
  • erythema
  • dysuria
  • thick, white discharge w/ no odor
76
Q

treatment of vulvovaginal candidiasis

A
  • azole antifungal cream
  • fluconazole
  • 7 days
77
Q

recurrent vulvovaginal candidiasis

A

more than 4 symptomatic episodes/year

78
Q

pelvic inflammatory disease is caused by

A
  • gonorrhea
  • chlamydia
  • Gm- anaerobes
79
Q

pelvic inflammatory disease symptoms

A
  • lower abdominal pain
  • uterine tenderness
  • cervical motion tenderness
  • may have discharge
  • fever
  • dysuria
  • irregular bleeding
80
Q

inpatient treatment of pelvic inflammatory disease

A

-cefotetan or cefoxitin + doxycycline
OR
-clindamycin + gent

81
Q

outpatient treatment of pelvic inflammatory disease

A

-cefoxitin/probenecid
OR
-ceftriaxone + doxycycline +/- metro

82
Q

pelvic inflammatory disease counseling

A

-treat all partners for chlamydia AND gonorrhea

83
Q

HPV manifestation

A

genital warts

84
Q

main problem with HPV

A

can cause cancer

85
Q

prevention of HPV

A

Gardasil 9 vaccination

86
Q

Gardasil who should get it recommendations

A
  • 11-12 for females (up to 25 y/o)

- 11-12 for males (up to 21 y/o)

87
Q

gardasil dose series recommendations

A
  • if before 15 only 2 doses (1, 6-12 mos)

- if after 15 then 3 (0, 1-2, 6 mos.)

88
Q

treatment for HPV warts

A
  • podofilox bid x 3d, then 4 days off; 4 cycles

- imiquimod for up to 16 weeks (must wash off after 6-10 hours)

89
Q

HPV counseling

A
  • can be transmitted even if not visible

- condoms can decrease, but not eliminate transmission

90
Q

treatment for lice

A

ivermectin PO, repeat in 2 weeks

91
Q

treatment for scabies

A
  • permethrin

- ivermectin PO, repeat in 2 weeks

92
Q

when to not use ivermectin

A

in pregnancy

PT2 ID 7-9 (3 decks)

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