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Infectious Disease > STI's > Flashcards

STI's Flashcards

1
Q

STI Bacterial Infections

A 
Gonorrhea – Neisseria gonorrhoeae
Chlamydia – Chlamydia trachomatis
Bacterial Vaginosis
Syphilis – Treponema pallidum
Chancroid - Haemophilus ducreyi
Pelvic Inflammatory Disease***
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2
Q

Urethritis and Cervicitis

A

Frequent co-infection so use drug regimens effective against both gonorrhea and chlamydia unless diagnostic point-of-care testing

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3
Q

Organism(s): Neisseria gonorrhoeae

A

Gram negative diplococci

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4
Q

Organism(s): Neisseria gonorrhoeae

Clinical Presentation:

A 
Often asymptomatic (especially in females)
Dysuria
Green or white discharge from urethra or cervix
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5
Q

Gonorrhea

A

Ceftriaxone 250 mg IM x 1 plus
azithromycin 1 g PO x 1
Administer on the same day & together

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6
Q

Disseminated Gonococcal Infection

A

Skin lesions (red or purple spot)
Asymmetric arthralgia or septic arthritis
Endocarditis (rare)
Meningitis (rare)

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7
Q

Disseminated Gonococcal Infection

Diagnosis

A

Nucleic Acid Amplification Tests (NAAT)

and/or cultures

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8
Q

Disseminated Gonococcal Infection

Treatment

A

Ceftriaxone 1 g IM/IV Q24H for at least 7 days

plus azithromycin 1 g PO x 1

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9
Q

Organism(s): Chlamydia trachomatis

A

Gram negative obligate intracellular parasite

Highest prevalence: age <24 years

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10
Q

Organism(s): Chlamydia trachomatis: Diagnosis

A

Nucleic Acid Amplification Tests (NAAT)

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11
Q

Organism(s): Chlamydia trachomatis: Treatment

A

Azithromycin 1 g PO x 1

Doxycycline 100 mg PO BID x 7 days

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12
Q

Bacterial Vaginosis: Organism(s):

A

Polymicrobial clinical syndrome
Result of normal flora being replaced by an overgrowth of anaerobes

Clinical Presentation:
Asymptomatic or malodorous discharge

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13
Q

Bacterial Vaginosis: Diagnosis

A

Amsel’s Criteria require 3 of following 4:

  1. ) Homogeneous, thin, white discharge
  2. ) Clue cells (vaginal skin cells with bacteria “stuck” to edges) on microscopy
  3. ) pH >4.5
  4. ) Whiff test positive (fishy odor to discharge before or after addition of 10% KOH)
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14
Q

Bacterial Vaginosis Treatment:

A
  1. ) Metronidazole 500 mg PO BID x 7 days
  2. ) Metronidazole gel 0.75%, 5 g intravaginally once daily x 5 days
  3. ) Clindamycin cream 2%, 5 g intravaginally at bedtime x 7 days
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15
Q

Syphilis Organism(s):

A

Treponema pallidum

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16
Q

Syphilis Diagnosis:

A

Darkfield microscopy

Visualization of spirochete is definitive diagnostic

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17
Q

Syphilis Diagnosis: Treponemal Tests

A

Used for confirmation
Less sensitive, but highly specific
Most patients remain reactive for rest of life
NOT used to assess treatment response

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18
Q

Syphilis Diagnosis: Nontreponemal Tests

A

Used for screening
Highly sensitive, but less specific
Venereal Disease Research Laboratory (VDRL)
Rapid Plasma Reagin (RPR)
Reported quantitatively as antibody titer
4-fold change in titer (e.g. 1:16 to 1:4) is considered clinically significant

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19
Q

Types of Syphilis

A 
Primary
Secondary
Latent
Early latent
Late latent
Tertiary
Neurosyphilis
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20
Q

Primary Syphilis

Timing:

A

10-90 days after infection
Average = 21 days

Clinical Presentation: 
Single, painless ulcer or chancre 
Localized to where bacteria entered body
External genitalia
Vagina
Anus
Rectum
Mouth
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21
Q

Secondary Syphilis

Timing:

A

2-8 weeks after initial infection
Occurs primarily in untreated individuals

Clinical Presentation: Systemic symptoms
Skin rash (painless)
Mucocutaneous lesions
Lymphadenopathy
Genital warts
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22
Q

Latent Syphilis Timing:

A

If occurred within 1 year, then early latent

If occurred >1 year ago or unknown, then late latent

Clinical Presentation:
Serologic activity without signs/symptoms of disease

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23
Q

Tertiary Syphilis Timing:

A

10-30 years after initial infection
May damage the brain, nerves, eyes, heart, blood vessels, liver, bones, or joints and lead to death

Clinical Presentation:
Difficulty coordinating muscles or paralysis
Numbness
Gradual blindness
Dementia 
Gumma = soft, inflammatory masses
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24
Q

Neurosyphilis Timing:

A

May occur during any stage

Clinical Presentation:
Early signs = cranial nerve dysfunction, meningitis, stroke, acutely altered mental status, auditory or visual abnormalities
Late signs = tabes dorsalis, muscle weakness

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25
Q

Syphilis Treatment

Primary, secondary, and early latent syphilis

A

Benzathine penicillin G 2.4 million units IM x 1

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26
Q

Syphilis Treatment

Tertiary, late latent syphilis, syphilis of unknown duration

A

Benzathine penicillin G 2.4 million units IM weekly x 3 doses

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27
Q

Syphilis Treatment

Neurosyphilis or Ocular Syphilis

A

Aqueous crystalline penicillin G 3-4 million units IV Q4H x 10-14 days

Aqueous crystalline penicillin G 18-24 million units IV continuous infusion x 10-14 days

28
Q

Penicillin notes

A

T. pallidum can reside in sequestered sites (e.g., the CNS) that are poorly accessed by some forms of penicillin.
Oral penicillins are NOT appropriate for syphilis.
Combinations such as Bicillin C-R are NOT appropriate for syphilis.

29
Q

Penicillin dosage forms

A 
IV Formulation
Penicillin G (Aqueous)
IM Formulations
Penicillin G Benzathine (Bicillin L-A)
Penicillin G Procaine
Penicillin G Benzathine and Penicillin G Procaine (Bicillin C-R)
PO Formulation
Penicillin V Potassium
30
Q

Jarisch-Herxhelmer Reaction

A

As bacterial cells die, endotoxins are released more quickly than the body can process
Fever, headache, myalgia, tachycardia
May occur in first few hours after administration of penicillin for syphilis treatment
Manage with antipyretics, but do not change syphilis treatment regimen

31
Q

Penicillin Allergy in pregnancy

A

Pregnant with any stage of syphilis: Penicillin desensitization
Neurosyphilis: Penicillin desensitization

32
Q

Penicillin Allergy in Primary & secondary syphilis:

A

Doxycycline 100 mg PO BID x 14 days
Tetracycline 500 mg PO four times daily x 14 days
Ceftriaxone 1-2 g IM/IV daily x 10-14 days

33
Q

Penicillin Allergy in Latent syphilis alternatives:

A

Doxycycline 100 mg PO BID x 28 days

Tetracycline 500 mg PO four times daily x 28 days

34
Q

Syphilis follow-up:

A

Primary or secondary syphilis: 6 and 12 months
Early or late latent syphilis: 6, 12, and 24 months
Neurosyphilis: CSF exam every 6 months until CSF WBC count is normalized

35
Q

Pregnancy and Syphilis

A

Only penicillin is currently recommended

Desensitization required for β-lactam allergic pregnant patients
Some experts recommend a second dose of benzathine PCN G 2.4 million units IM 1 week after the initial dose for primary, secondary, early latent syphilis in pregnancy

36
Q

Chancroid Organism(s):

A

Haemophilus ducreyi

Gram negative coccobacillus

37
Q

Chancroid Treatment:

A

Azithromycin 1 g PO x 1
Ceftriaxone 250 mg IM x 1
Ciprofloxacin 500 mg PO BID x 3 days

Follow Up: 3-7 days

38
Q

HPV Genital warts Prevention:

A 
Bivalent vaccine (Cervarix): 
-Types 16 &amp; 18
Quadrivalent vaccine (Gardasil): 
-Types 6, 11, 16, &amp; 18
9-Valent vaccine (Gardasil-9): 
-Types 6, 11, 16, 18, 31, 33, 45, 52, &amp; 58

All are 3-dose series given over 6 months
Use same product for entire 3-dose series

39
Q

Genital Herpes treatment:

1st episode

A

First Episode
Acyclovir 400 mg PO TID x 7-10 days
Valacyclovir 1 g PO BID x 7-10 days

40
Q

Genital Herpes treatment:

suppresive therapy

A

Acyclovir 400 mg PO BID
Valacyclovir 1,000 mg PO daily
Famciclovir 250 mg PO BID

41
Q

Genital Herpes treatment:
Episodic Therapy

Initiate within 1 day of onset or during prodrome
Regimens:

A 
Acyclovir 400 mg PO TID x 5 days
Acyclovir 800 mg PO BID x 5 days
Acyclovir 800 mg PO TID x 2 days
Valacyclovir 500 mg PO BID x 3 days
Valacyclovir 1 g PO daily x 5 days
Famciclovir 125 mg PO BID x 5 days
Famciclovir 1 g PO BID x 1 day
Famciclovir 500 mg x 1, 250 mg BID x 2 days
42
Q

Organism(s): Trichomonas vaginalis

A

Clinical Presentation:
Males: urethritis, epididymitis, prostatitis

Females: diffuse, malodorous discharge
Complications: increased risk for HIV acquisition, preterm birth, PID

43
Q

Organism(s): Trichomonas vaginalis

Diagnosis

A

Diagnosis:
NAAT
Culture
Wet mount microscopy

44
Q

Organism(s): Trichomonas vaginalis

Treatment:

A

Treatment:
Metronidazole 2 g PO x 1
Tinidazole 2 g PO x 1

Follow Up: 3 months in women
Re-infection rate of 17% at 3 months

45
Q

Vulvovaginal Candidiasis

Organism(s):

A

Candida spp.
Usually Candida albicans but may be other yeast

Clinical Presentation:
Pruritus, vaginal soreness, painful intercourse, dysuria, abnormal discharge

46
Q

Classification of VVC

Uncomplicated VVC:

A 
Sporadic or infrequent
AND
Mild to moderate
AND
Likely to be Candida albicans
AND
Non-immunocompromised women
47
Q

Classification of VVC

Complicated VVC

A 
Recurrent
OR
Severe
OR
Non-albicans Candida
OR
Women with DM, immunocompromised or debilitation
48
Q

Uncomplicated VVC Diagnosis:

A

Signs/symptoms of vaginitis with:
1. Wet prep or Gram stain with yeast or hyphae
2. Culture positive for yeast species
Normal vaginal pH (<4.5)

49
Q

Uncomplicated VVC Treatment:

A

OTC agents

  • Clotrimazole cream
  • Miconazole cream or vaginal suppository
  • Tioconazole ointment

Rx agents

  • Fluconazole 150 mg PO x 1
  • Butoconazole cream
  • Terconazole cream or vaginal suppository

Follow Up: Not required

50
Q

Complicated VVC
Diagnosis:

Treatment:

Follow Up:

A

Diagnosis: Vaginal culture to confirm diagnosis and check for non-albicans species

Treatment: Topical therapy x 7-14 days
Fluconazole 150 mg PO Q72H x 2 doses

Follow-up: Not required

51
Q

Risk assessment

Five P’s:

A 
Partners, 
Practices, 
Pregnancy prevention, 
Protection, 
Past history
52
Q

Prevention via Male Condoms

A

May reduce the risk of developing pelvic inflammatory disease (PID) in women

53
Q

Pelvic Inflammatory Disease (PID)

A

Definition: Ascending infection of the female genital tract involving the fallopian tubes

54
Q

Salpingitis:

A

type of PID, inflammation of the fallopian tube

55
Q

Tubo-ovarian abscess:

A

Late complications of PID that can be life-threatening if the abscess ruptures and results in sepsis
Consists of an encapsulated or confined “pocket of pus” with defined boundaries during an infection of a fallopian tube and ovary
Should be managed inpatient initially

56
Q

PID is:

A

spontaneous ascension of microbes from the cervix or vagina to the endometrium, fallopian tubes or adjacent structures

57
Q

PID: Common Pathogens

A 
N. gonorrhoeae
C. trachomatis
Anaerobes
Gram-negative bacteria
Streptococcus species
58
Q

PID: Clinical Presentation

A

Tenderness in the lower abdomen, cervical motion, and adnexal area
Abnormal discharge and menorrhagia
Fever
Dysuria
Elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)

59
Q

PID Complications:

A

Complications: Abscess formation, occlusion, fibrosis, ectopic pregnancy, infertility

60
Q

Who can be treated outpatient?

A 
Temp < 38oC
WBC < 11,000/mm3
Minimal evidence of peritonitis
Active bowel sounds 
Able to tolerate oral nourishment
61
Q

PID Outpatient Treatment Options

A

Ceftriaxone 250 mg IM x 1, plus doxycycline 100 mg PO BID x 14 days
Cefoxitin 2 g IM x 1, plus probenecid 1 gram PO x 1, plus doxycycline 100 mg PO BID x 14 days
Metronidazole 500 mg PO BID x 14 days can be added for further anaerobic coverage

62
Q

PID Inpatient Treatment Options

A

Beta-lactam regimens

  • Cefotetan 2 g IV q12h + Doxycycline 100 mg IV/PO q12h
  • Cefoxitin 2 g IV q6h + Doxycycline 100 mg IV/PO q12h

Beta-lactam free regimens
- Clindamycin 900 mg IV q8h + gentamicin IV/IM 2-mg/kg loading dose followed by 1.5 mg/kg q8h (or 3-5 mg/kg once-daily dosing)

63
Q

PID Treatment Recommendations

IV to PO Switch

A

Patients can be switched from IV to PO therapy after the patient has been clinically stable for 24-48 hours

64
Q

PID Treatment Recommendations

Treatment failure:

A

Check for Mycoplasma genitalium

Start Moxifloxacin 400 mg PO daily x 14 days

65
Q

PID Treatment Recommendations

General considerations

A

Fluoroquinolones no longer recommended because of increasing resistance
DOT
CDC recommends 14 days of therapy regardless of administration route of therapy

Infectious Disease (56 decks)

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