STDs and UTIs

Question 1

patho factors in UTI

Answer 1

behavior (sexually active, resisting urge to void), microbial (e coli attaches to bladder mucosa), host (women/girls shorter urethra, prego, incomplete bladder emptying, repeated UTIs from altered bladder epithelial cells that facilitate bacterial adherence) . males have increased risk with enlarged prostate

Question 2

goals of UTI treatmetn

Answer 2

eradicate causative organism is primary; relieve symptoms, prevent recurrence

Question 3

meds used to treat UTI

Answer 3

many abx (TPM/SMZ, nitrofurantoin, flouroquinolones, cephalosporins, penicillins), cranberry to decrease reccurence of symptomatic UTI, analgesic (phenazopyridine)

Question 4

patient ed for UTI

Answer 4

med as rx/complete abx, lifestyle (cranberry, no spermacide/diaphragm, void after sex, 200ml/d water, dont resist urge to pee)

Question 5

UTI outcome eval

Answer 5

infants/child <5: consider anatomical problems like VUR. adults who need workup and poss referral if gross hematuria, persistent UTI, symptoms of obstruction, symptomatic prego, fever or dehydration

Question 6

monitoring for UTI

Answer 6

acute UTI in women, symptoms should resolve in 48h, get culture if symptoms persist. if recurrent infections, get culture, get post treatment UA to rule out persistent infection. <5 get culture, reculture at end of rx, may need raiological workup. prego: need fu culture every 2 weeks until delivery. prego have asymptomactic bacterureia, need routine screening . older risk for asymptomatic, treat based on C&S

Question 7

lenght of treatmetn for UTI

Answer 7

3 days. longer if: child (10d), fever, chills, prego, DM, immunosupressed

Question 8

first line treatment for UTI

Answer 8

need gram - coverage. emperical with TPM/SMX is first line when no complicating factors. alternative first line in adults is cipro

Question 9

alternate or second line in UTI

Answer 9

cephalosporins (cephalexin, cefpodoxime, cefixime), nitrofurantoin

Question 10

UTIs in children

Answer 10

treat for 10 days, fu culture to document successful tx, dx with cath specimin, febrile UTI treated agressively with parenteral ceftriaxone until afebrile,

Question 11

cost and resistance of UTI abx

Answer 11

TMP/SMZ least expensive. cipro also cheap (generic). resistance of e coli to TMP/SMZ 15-20% similar for cipro and levo. amoxicillin NOT ok for emperical therapy because up to 1/3 are resistant

Question 12

STI treatment goals

Answer 12

education on high risk behaviors especially 15-25y/o. prevent l/t sequelae of unsafe sex. chose most specific, cost effective drug that has best regimen for adherence. reduce morbidity, provide comfort

Question 13

populations at risk for STI

Answer 13

highest rate GC/chalmydia females 15-24 (black women 8x risk from white women, black men 12x risk from white men). 50mill genital HSV. HPV cervical CA leading cause of female CA deaths worldwide.

Question 14

syphillis screen and treatment

Answer 14

screen high risk, all prego. Parenteral Penicillin G drug of choice (if allergy, 14d doxycycline or tetracycline)

Question 15

Gonorrhea

Answer 15

treat for both GC and chlamydia. screen. treat sex partners. resistant to flouros. DRUG OF CHOICE: Ceftriaxone 250mg IM once (may use cefipime 400mg PO once). repeat screen of women 3-6mos after treatment.

Question 16

chlamydia testing

Answer 16

all sexually active women <25 yearly. all women with multiple or new sex partners. if pos, sex partners of past 60 days should be tested. pos prego need retest for cure and retest at 3mos.

Question 17

chlamydia treatment

Answer 17

treat for GC also. azithromycin 1g PO once or doxycycline 100mg BID for 7 days . test of cure in prego (also test again 3mos)

Question 18

canchroid testing

Answer 18

positive and needs treatment if 1+ painful ulcers (neg for syphillis and HSV) and suppurative inguinal adenopathy. HIV test also. Reexamine 3-7d after rx started. Sex partner exam and treat if sex w/person past 10 days.

Question 19

canchroid treatment

Answer 19

azithromycin 1g PO once. ceftriaxone 250mgIM. cipro 500mg BID3d, erythro 500mg TID 7d.

Question 20

BV

Answer 20

most prevalent vaginal infection. assoc w/multiple partners, douching, lack of lactobacilli. all symptomatic women should be treated with metronidazole PO 500mg BID x7d or gel 0.75% one applicator x5d. or clindamycin cream 2% one applicator bedtime x7d

Question 21

sexual assault and STI

Answer 21

most common infections trichomonaisis, BV, GC, chlamydia. Routine prophylaxis for STI recommended. Post exposure hep B IG and hep B vaccine. screen for date rape drugs

Question 22

MSM

Answer 22

frequent screening of high risk males every 3-6mos. Vaccine for Hep A and B, HPV. same treatment as heterosexual.

Question 23

STI treatment for PCN allergy

Answer 23

drug of choice for neurosyphilis, congenital syphilis, prego syphilis, or HIV infected patients. Refer to allergy specialist for skin testing and desensitization.

Question 24

STI monitoring

Answer 24

fu with patients who are treated, especially if on regimens multiple daily. test of cure and re screening for some. most must report to health dept locally, so must inform pt. partner treatment

Question 25

STI pt ed

Answer 25

treatment plan, reason for taking drugs, ADRs, partners for treatment, fu testing

Question 26

vaginitis

Answer 26

STI or not STI. must examin area to dx and microscope secretions (for any discharge and vulvular conditions this is needed). cytolytic vaginitis: overgrowth lactobacillus late in menstrual cycle; treatmetn with intravaginal sodium bicarb caps twice wekly in last week of menstrual cycle. atrophic vaginitis with secondary infection: cultures guide treatment.

Question 27

vaginitis goals, drug selection, monitoring , outcome eval.

Answer 27

treat infection/inflammation, prevent reinfection, prevent complications. accurate dx essential, phone not always accurate. use correct drug for pathogen, consider resistance, cost (OTC antifungals cheap), prego may affect treatment choice, drug variables (intravaginal fewest drug intercations) . no oingoing monitoring unless chornic. if pt doesnt respond to therapy consider referral.

Question 28

trichomoniasis

Answer 28

protozoa, women may have symptoms, men may have in prostate gland. treat partners. DONT use topical treatment, use oral. rescreen 3 mos (prego 1 mos). metronidazole 2mg PO x1 or tinadazole 2g POx1. also ok metronidazole 500mg BID x7d. no alcohol on metronidazole.