STDs and UTIs Flashcards
patho factors in UTI
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
goals of UTI treatmetn
eradicate causative organism is primary; relieve symptoms, prevent recurrence
meds used to treat UTI
many abx (TPM/SMZ, nitrofurantoin, flouroquinolones, cephalosporins, penicillins), cranberry to decrease reccurence of symptomatic UTI, analgesic (phenazopyridine)
patient ed for UTI
med as rx/complete abx, lifestyle (cranberry, no spermacide/diaphragm, void after sex, 200ml/d water, dont resist urge to pee)
UTI outcome eval
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
monitoring for UTI
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
lenght of treatmetn for UTI
3 days. longer if: child (10d), fever, chills, prego, DM, immunosupressed
first line treatment for UTI
need gram - coverage. emperical with TPM/SMX is first line when no complicating factors. alternative first line in adults is cipro
alternate or second line in UTI
cephalosporins (cephalexin, cefpodoxime, cefixime), nitrofurantoin
UTIs in children
treat for 10 days, fu culture to document successful tx, dx with cath specimin, febrile UTI treated agressively with parenteral ceftriaxone until afebrile,
cost and resistance of UTI abx
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
STI treatment goals
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
populations at risk for STI
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.
syphillis screen and treatment
screen high risk, all prego. Parenteral Penicillin G drug of choice (if allergy, 14d doxycycline or tetracycline)
Gonorrhea
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.
chlamydia testing
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.
chlamydia treatment
treat for GC also. azithromycin 1g PO once or doxycycline 100mg BID for 7 days . test of cure in prego (also test again 3mos)
canchroid testing
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.
canchroid treatment
azithromycin 1g PO once. ceftriaxone 250mgIM. cipro 500mg BID3d, erythro 500mg TID 7d.
BV
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
sexual assault and STI
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
MSM
frequent screening of high risk males every 3-6mos. Vaccine for Hep A and B, HPV. same treatment as heterosexual.
STI treatment for PCN allergy
drug of choice for neurosyphilis, congenital syphilis, prego syphilis, or HIV infected patients. Refer to allergy specialist for skin testing and desensitization.
STI monitoring
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
STI pt ed
treatment plan, reason for taking drugs, ADRs, partners for treatment, fu testing
vaginitis
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.
vaginitis goals, drug selection, monitoring , outcome eval.
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.
trichomoniasis
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.
