STDs

Question 1

Chlamydia

Answer 1

• Screen in sex active women < 24 or older women w/ inc risk
• Can cause PID, ectopic pregnancy, infertility, cervisitis, epididymitis, urethritis or pharyngitis
• Testing
  
  • Directly from cervix, pharynx or urethra
  • NAAT from urine
• Tx - 1 g single dose azitrhomycin OR doxy 2x/day for 7 days

Question 2

Gonorrhea

Answer 2

• Often urethral infection in men - dysuria and penile d/c; often asymptomatic until complications like PID in women
• Screen in sex active women < 24 or older women w/ high risk
• Same diagnostic steps as chlamydia
• Tx - co treat for chlamydia + 1 dose IM ceftriaxone

Question 3

Syphilis

Answer 3

• 3 Symptoms Stages
  
  • Primary - painless ulcer or chancre
  • Secondary - skin rash, neuro symptoms, optho
  • Tertiary - cardiac or gummas (granulomas)
• Latent - no symptoms
• Screening - for all pregnancy women, those w/ another STD or those w/ high risk
• Diagnosis
  
  • Serological - RPR or VLDR (both non-treponemal)
  • Confirm w/ FTA-ABS (fluorescent treponemal antibody)
• Tx - PCN G (if allergic use doxy, tetracycline or ceftriaxone)

Question 4

Herpes

Answer 4

• Painful vesicles or ulcers
• Dx - cx or PCR of sample from lesion
• Tx - anti-viral therapy during symptomatic outbreaks and when asymptomatic to reduce frequency of outbreaks
  
  • If preg … give anti-vitals late in pregnancy to dec chance of outbreak around time of delivery
  • If ulcers present must do C section

Question 5

HIV Dx

Answer 5

ELISA then confirm w/ western blot

Question 6

HIV Initial Labs

Answer 6

• RNA - viral load
• CD4 and CD8 counts
• Look for other STDs - urine cx for chlamydia or gonorrhea, RPR for syphilis
• CBC, CMP, UA at baseline and repeated occasionally to look for complications and med side effects
• Hep A and Hep B vaccination if not immune
• PPD test

Question 7

4 Clinical Stages of HIV

Answer 7

• 1- No AIDS illnesses; CD4 > 500 or >29% total lymphocytes
• 2- No AIDS illnesses; CD4 200-499 or 14-28% total lymphocytes
• 3- AIDS; CD4 < 200 OR <14% total lymphocytes w/ AIDS defining illness
• 4- unknown lab parameters but have AIDS defining illness

Question 8

HIV PPX at Various CD4 Counts

Answer 8

• TMP-SMX for PJP at < 200 CD4 count

* Azithromycin or clarithromycin for MAC at < 50 CD4 count