STI Pharmacotherapy Dr. Dowling Flashcards
EXAM 2
What are the common strains of the HPV virus?
Genital wart strain
-> most regress spontaneously within 1-2 years
Cervical neoplasia strain
->also non-cervical malignanceis (throat cancer)
Which disease that is caused by HPV can be self-treated?
Genital warts
-Cryotherapy
-topical wart removal
-surgery
-> destruction of lesions
What is the only available HPV vaccine?
9-valent HPV vaccine
Gardasil 9
How does Herpes simplex (HSV) present in a patient?
-often asymptomatic
-painful lesions
When do lesions start to develop in HSV-infected patients?
develop over 7-10 days and last 2-4 weeks
Which cells are involved in the long-term persistance (latency) of HSV?
Ganglia (neurons in the brain)
HPV vaccine schedule
CDC guideline
-can start at 9
-routine vaccines at 11-12y -> through 26 if not previously vaccinated
-administer to age 27-48y if not previously vaccinated and at risk for HPV (shared clinical decision-making)
How many doses should patients from the age of 9-14 receive?
2-dose series
at 0 and 6-12 months
How many doses of the HPV vaccine should patients from the age of 15 and older receive?
3 dose series
at 0
1-2 months and
6 months
Which type of Genital warts (HPV) may be treated by the patient?
External anogenital warts (anus, genitals)
-> with self-applied topical treatments or through in-office procedures
-Imiquimod 5%
-Podofilox 0.5%
-Sine catechins (Veregen) 15%
What are the treatment options for the first clinical episode of Genital herpes?
Acyclovir
Valacyclovir
Famciclovir
duration: 7-10 days
What are the treatment approaches for :recurring: Genital herpes?
Episodic Tx:
start within 6-12 hours of prodrome and no more than 24h after the lesion appears
-> patient should have the drug ready, and get a refill after using it to have it ready again
Suppressive Tx: indefinite, patients are taking it until instructed to stop
Which patient population benefits from the suppressive Tx?
-patients with frequent recurrences and severe episodes
-reevaluate after 1 year and see if they have any outbreaks and how severe they are
-consider transfer to Episodic Tx if no recurrence
What is the drug treatment duration for recurrent infection of Genital Herpes?
different schedules
up to 5 days!
How are initial Trichomoniasis infections treated in men and women?
men: single dose of Metronidazole
women: 7 days BID of Metronidazole
if persistent/recurrent: 7 days Metro
When should patients with a Trichomoniasis, Chlamydia or Gonorrhea infection get retested?
after 3 months
What factor determines treatment in Genital Herpes?
First clinical episode
or recurrent infection
episodic Tx
suppressive Tx
What factor determines treatment for a Trichomoniasis infection?
Male or female
and
Initial treatment or persistent/recurrent infection (truly treatment failure, most of the time recurrent infections are reinfection from the partner)
What is the recommended treatment for Chlamydia?
Doxycycline 100 mg BID for 7 days
What is the time of symptom onset for Gonorrhea?
2-10 days
What determines the treatment of a Gonorrhea infection?
the patient’s weight
<150 kg or >150 kg
What are the treatment options to treat Gonorrhea?
<150 kg: Ceftriaxone 500 mg single dose
OR Gentamicin 240 mg + Azithromycin 2g
> 150 kg: Ceftriaxone 1g IM single dose
OR Cefixime 800 mg single dose
Which drug should be added to the Gonorrhea treatment regimen?
if chlamydia infection has not been ruled out:
Doxycycline 100 mg BID for 7days
Which other STI often presents with Syphilis?
HIV
test for HIV when infected with Syphilis and vice versa
What is the incubation time and disease presentation in the primary stage of Syphilis?
10-90 days after exposure
present with a single lesion (Chancre) and with lymphadenopathy (lymph swelling)
How does the patient present in the secondary stage of untreated Syphilis?
2-8 weeks after the primary stage -> it goes systemic
rash, lesions, lymphadenopathy -> can occur throughout the body
after 4-10 weeks of systemic symptoms: latent phase -> it can disappear and come back anytime within 4 years
How does the patient present in the tertiary stage of untreated Syphilis?
appears 10-30 years in 30% of untreated individuals
severe cardiac and neuro involvement (can have non-reversible effects or life-threatening), with “gumma” lesions
What is the recommended treatment of primary, secondary, and early latent (< 1 year) stages of Syphilis?
Benzathine penicillin G IM, single dose
(latency: positive test result but no symptoms)
What is the recommended treatment for late latent (>1 year), latent, latent unknown or tertiary (without CNS) stage of Syphilis?
Benzathine penicillin G IM, once weekly for 3 weeks
(latency: positive test result but no symptoms)
What is the recommended treatment for CNS tertiary (neuro, ear, ocular syphilis) stage of Syphilis?
Aqueous crystalline penicillin G IV, every 4 hr
or continuous infusion for 10-14 days
What is the pharmacokinetic difference between IM and the IV formulation of penicillin G?
IM has a very slow release but hangs around in the system for a prolonged time
also pretty slow peak though
Which type of skin reaction can be observed when treating Syphilis or other spirochetal infections?
Jarisch-Herxheimer reaction (body reaction to spirochetes dying off and releasing toxins)
-benign and self-limiting
-flu-like symptoms and aggravation of lesions
-occurs 2-4h after initiating therapy and subsides after 12-24h
How is the Jarisch-Herxheimer reaction treated?
symptomatic support with antipyretics
What is the recommended treatment for HSV Genital herpes in pregnant women?
1st line:
Acyclovir or Valacyclovir
start suppressive tx after 36 weeks
What is the recommended treatment for Chlamydia in pregnant women?
Azithromycin
alternative: Amoxicillin
Why don’t we use doxycycline for Chlamydia in pregnant women, since it is actually the first line?
because tetracyclines are contraindicated in pregnant women
