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infectious disease > STDs > Flashcards

STDs Flashcards

1
Q

CDC vaccination recommendations: Females and Males

A

Recommend for routine vaccination at age 11 or 12 (can start at age 9) and through age 26 for females or age 21 for males (males may be vaccinated through age 26)

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2
Q

MSM and immunocompromised persons

A

Through age 26 if not vaccinated previously

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3
Q

Urethritis

A

Discharge of purulent/mucopurulent material from the urethra, and burning upon urination
Commonly asymptomatic
Bacterial pathogen of importance in males in Neisseria gonorrhea

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4
Q

Urethritis diagnosis

A

> /= 5 WBC/hpf on gram-stain of swab, or evaluation of 1st void urine with + leukocyte esterases or >/= 10 WBC/hpf
Specific gonorrhea/Chlamydia tests should be performed

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5
Q

N. gonorrhea gram stain

A

G- intracellular diplococci

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6
Q

Chlamydia gram stain

A

nothing on gram stain

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7
Q

Treatment of uncomplicated gonococcal infection of cervix/urethra/rectum and pharynx

A

Ceftriaxone 250mg IM x 1
PLUS
Azithromycin 1g PO x 1

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8
Q

Disseminated/Complicated Gonococcal Infections (DGI) s/sx

A 
Chills
Fever
Arthralgias
Skin lesions
Tenosynovitis of small joints
Septic arthritis
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9
Q

DGI

A

results from gonococcal bacteremia that disseminates into skin, joints, CNS, and heart

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10
Q

Disseminated/Complicated Gonococcal Infections therapy

A

Ceftriaxone 1g IV/IM q24h PLUS Azithromycin 1g PO x 1 - at least 1 week of total therapy
Continued therapy outpatient - can switch to PO agent guided by antimicrobial susceptibility testing 24-48 hours after substantial clinical improvement

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11
Q

Gonococcal Endocarditis and Meningitis Treatment

A 
Ceftriaxone 1-2g IV q24h
PLUS
Azithromycin 1g PO x 1
Meningitis duration: 10-14 days
Endocarditis: > 4 weeks
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12
Q

Pelvic Inflammatory Disease consequences

A

Infertility
Ectopic pregnancies
Chronic pelvic pain

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13
Q

When is empiric therapy initiated for PID?

A

In sexually active women and other women at risk for STDs if they are experiencing pelvic or lower abdominal pain, if no cause for the illness other than PID can be identified, and if one or more of the following minimum criteria are present on pelvic examination:
Cervical motion tenderness OR
Uterine tenderness OR
Adnexal tenderness

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14
Q

Organisms responsible for PID

A 
GNRs
Anaerobes
N. gonorrhea
Mycoplasma hominis
Ureaplasma urealyticum
H. influenzae
S. agalactiae
Chlamydia trachomatis
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15
Q

PID preferred parenteral Regimen A

A

Cefotetan 2g IV q12h
or
Cefoxitin 2g IV q6h
PLUS: Doxycycline 100mg BID

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16
Q

PID preferred parenteral Regimen B

A

Clindamycin 90mg IV q8h

PLUS: Gentamicin IV

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17
Q

PID inpatient duration of therapy

A

Doxycycline (or oral clinda) should be continued for 14 days.
IV therapy should continue for at least 24-48 hours beyond the 1st sign of improvement.
When tubo-ovarian abscess is present, use PO clinda/flagyl and doxy to provide more effective anaerobic coverage

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18
Q

PID outpatient treatment

A

Only for mil-to-moderately severe acute PID

If no response in 72 hours, should be reevaluated to confirm diagnosis and given IV therapy

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19
Q

Preferred PID outpatient treatment regimen A

A 
Ceftriaxone 250mg IM x 1
PLUS
Doxycycline x 14 days
w/ or w/out 
Metronidazole 500mg BID x 14 days
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20
Q

Preferred PID outpatient treatment regimen B

A 
Cefoxitin IM x 1 + probenecid PO x 1
PLUS
Doxycycline x 14d
w/ or w/out 
metronidazole x 14d
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21
Q

Preferred PID outpatient treatment regimen C

A

Cefotaxime/Ceftizomine IV
PLUS
Doxycycline x 14 days
w/ or w/out metronidazole x 14 days

22
Q

Syphilis

A

caused by a spirochete: Treponema pallidum, which is highly infectious, especially in early stages (chancre)

23
Q

Primary syphilis

A

Average incubation period = 21 days
Chancre develops at site of inoculation as a painless papule which becomes ulcerated and indurated; non tender and filled with spirochetes
Lasts 1-5 weeks, resolves on its own

24
Q

Secondary syphilis

A

Rash (hands, feet), lymphadenopathy, alopecia, H/A, weight loss
Lasts 2-6 weeks, fever
1st year of disease = highly infectious

25
Q

Latent Syphilis

A

No clinical manifestations

Serologic evidence only

26
Q

Early latent

A

< 1 year duration

Infectious

27
Q

Late latent

A

> 1 year duration

Not infectious

28
Q

Tertiary syphilis

A

Late manifestations (skin, bone, CNS, heart)
May be asymptomatic or accompanied by manifestations
Must examine the CSF with a lumbar puncture to see if CNS is involved

29
Q

Early definitive diagnostic test

A

Direct fluorescent antibody (DFA) test of lesion exudates or tissue

30
Q

Nontreponemal tests

A

Venereal disease research laboratory (VDRL) and rapid plasma reagin (RPR)

31
Q

Treponemal tests

A

Fluorescent treponemal antibody absorbed (FTA-ABS) and T pallidum particle agglutination (TP-PA)

32
Q

Early stage syphilis treatment

A

Benzathine PCN G 2.4 mU IM x 1

33
Q

Late stage syphilis treatment

A

If no abnormal findings:

Benzathine PCN G 2.4 mU IM qweek x 3 weeks

34
Q

Neurosyphilis

A

Aqueous PCN G 18-24 mU IV/day x 10-14 days (given as 3-4 mU q4h or continuous infusion)
FOLLOWING TREATMENT:
Benzathine PCN G 2.4 mU/week IM x 3 weeks

35
Q

Syphilis in pregnancy

A

According to stage; must desensitize PCN if pregnant and allergic to PCN

36
Q

Adverse Drug Reactions during syphilis treatment

A

Jarisch-Herxheimer reactions: within 2-3 hours of PCN injection
Acute, febrile reaction (HA, myalgias) within 24 hours after treatment of syphilis
NOT AN ALLERGIC RXN
Give APAP/fluids

37
Q

HSV primary infection

A

Mucocutaneous lesion: resolves in 2-3 weeks
Virus moves into ganglia (latency period)
1st episode is most severe, associated with systemic symptoms
Symptoms usually start ~1wk after initial exposure with prodromal symptoms of tingling, itching, burning
Can have multiple leasions
Local pain, itching and urethral or vaginal discharge lasts 11-14 days, with complete disappearance of lesion in 3-6 weeks
Virus sheds, can be spread to other areas

38
Q

Prodromal stage

A

Hrs-days
Vesicles appear
Vesicles erupt
Painful genital ulcers

39
Q

HSV contagious period

A

When virus is shedding

Most contagious during ulcerative stage

40
Q

HSV treatment: first clinical episode

A

7-10 days
Acyclovir
Famciclovir
Valacyclovir

41
Q

HSV treatment: episodic recurrent infection

A

1-5 days
Acyclovir
Famciclovir
Valacyclovir

42
Q

HSV treatment: daily suppressive therapy (for pts with >/= 6 recurrences/yr)

A

Use daily for a year. Stop then re-evaluate
Acyclovir
Famciclovir
Valacyclovir

43
Q

HSV and pregnancy

A

Infant is a risk of life-threatening infection when it passes through the canal, especially if the mom is having 1st episode
Risk is lower with recurrent episodes
Latent herpes: less risk, therefore doesn’t indicate C-section and method of delivery is up to the physician

44
Q

Bacterial vaginosa

A

Polymicrobial clinical syndrome resulting from replacement of the normal H2O2 producing lactobacillus sp. in the vagina with high concentrations of anaerobic bacteria

45
Q

Common causes of bacterial vaginosa

A

Associated with having multiple sex partners, a new sex partner, douching and lack of vaginal lactobacilli

46
Q

Bacterial vaginosa diagnostic considerations

A

Can be diagnosed by the use of clinical criteria or gram stain
Thin, white discharge that smoothly coats the vaginal walls
Presence of “clue cells” on microscopic examination
pH of vaginal fluid > 4.5
Fishy odor of vaginal discharge before or after addition of 10% KOH

47
Q

Bacterial vaginosa preferred treatment

A
  1. flagyl 500mg PO BID x 7 days
  2. metro gel 0.75% intravaginally qhs x 5 days
  3. clinda cream 2% intravaginally qhs x 7 days
48
Q

Trichamoniasis causative organism

A

Protozoan Trichomonas vaginalis

49
Q

Trichomoniasis diagnosis

A

Microscopy of vaginal secretions

Culture

50
Q

Trichomoniasis

A

Sex partners with T. vaginalis should be treated

Patients should be instructed to avoid sex until they and their sex partners are cured

51
Q

Trichomoniasis preferred treatment

A

Metronidazole 2g PO x 1
or
Tinidazole 2g PO x 1

infectious disease (19 decks)

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