STIs/HPV/OCs/Transgender Meds Flashcards
Gonorrhea Pathophys
- Bacteria attach to the mucosal epithelium
- Penetrate through the epithelial cells and enter the submucosa within 24-48 hours
- Neutrophils get activated
- causes sloughing of epithelium
- microabscesses of submucosa form
- exudate forms
Gonorrhea: Presentation & Diagnosis
-
Men:
- Sxs:
- urethritis, dysuria, urethral purulent discharge, orchitis
- Sxs:
-
Women:
- mostly ASYMPTOMATIC
- urethritis, dysuria, cervicitis, increased vaginal discharge, spotting between periods, abd pain
-
Dx:
- Positive gram stain = diagnostic; negative stain does not r/o
- gram negative diplococci
- Culture: endocervical, vaginal or urethral
- DNA Hybridization Probe
- NAAT (nucleic acid amplification test)
- Non-amplified test
- Positive gram stain = diagnostic; negative stain does not r/o
Gonorrhea Dual Tx
Chlamydia general info, sxs, dx, & goals of tx
-
Chlamydia trachomatis
- Gram neg diplococci
- high infx rate < 25 yo
- resembles both a bacteria and virus
- Major membrane → similar to gram neg but LACKS A PEPTIDOGLYCAN CELL WALL → cannot be stained
- requires cellular components from host for replication
- Gram neg diplococci
-
Sxs:
- most women are asymptomatic
- beefy red cervix that is friable
- urethral discharge → watery, less purulent
- complications:
- men: epididymitis; women: PID
-
Dx:
- specimens: cx
- enzyme immunoassay
- NAAT
-
Goals of Tx:
- prevent complications
- PID, infertility, ectopic pregnancy, epididymitis
- Reduce transmission
- resolve sxs
- prevent reinfection
- prevent complications
Tx of Chlamydia
Chlamydia Tx for Recurrent Urethritis
Syphilis General Info
-
Treponema pallidum
- Spirochete
- difficult to stain b/c it is too thin
- Spirochetes tend to be gram negative
- Rapidly penetrates into intact mucus membranes
- causes microscopic dermal abrasions
- Spirochete
Latent Syphilis Info
Diagnostic Studies of Syphilis DFM & Non-Treponemal Tests
Treponemal Tests and Algorithms for Dx of Syphilis
Tx of Syphilis Algorithm
- Why is probenecid added to procaine penicillin for for neurosyphilis?
- because it prolongs the action of the abx by preventing elimination of the abx in the urine
- originally used in gout to promote excretion of uric acid in the urine
- because it prolongs the action of the abx by preventing elimination of the abx in the urine
Monitoring Syphilis Therapy
Syphilis Summary
Trichomoniasis Overview
- Caused by Trichomonas vaginalis
- protozoan
- more common than GC or CT
- protozoan
-
MOA:
- attaches to host cells which triggers inflammation
- causes direct damage to epithelium
- micro-ulcerations form and discharge with lots of leukocytes is produced
- causes direct damage to epithelium
- attaches to host cells which triggers inflammation
-
Trichomoniasis Dx:
- Wet mount of vaginal/urethral fluid
- looking for disease causing parasite
- Wet mount of vaginal/urethral fluid
-
Tx:
- metronidazole/tinidazole
Tx of Trichomoniasis
- Disulfiram-like Rxn with EtOH with metronidazole!!
- **Watch out for Robitussin or Phenergan Cough Syrup too → will also cause this rxn**
-
Neuropathy with high dosage and extended use.
- neurotoxicity
Genital Warts Overview
-
Human Papillomavirus (HPV)
- >20M ppl affected
- very contagious!
- may resolve or become chronic infx
- HPV 16 & 18 = cervical cancer (>70%)
- HPV 6 & 11 = genital warts
- wart formation → active viral replication is occurring
- Clinical Presentation
- Condyloma acuminata → cauliform keratotic with thick horny surface
- flat warts appear on outer layer of skin
-
Dx:
- DNA/RNA/Capsid Protein detection
- tissue biopsy → only if you are uncertain of dx
Tx of Genital Warts
-
Podofilox (Condylox) 0.5% gel
- arrests formation of mitotic spindle which prevents cell division
- BID 3days on 4 days off, max of 4 weeks (1 month)
- SEs: local redness, swelling, erosions
- Not for pregnancy, vaginas, or anus
-
Imiquimod (Aldara) 5% cream
- cell-mediated immune response modifier
- wash it off after 6-10 hours
- b/c it can cause burns deeper in the tissue if left on for too long
- APPLY TIW HS X 16 wks (4 months)
- SEs: erythema → indicates therapeutic levels
-
Sinecatechins (Veregen) 15% ointment
- green tea extract
- Do not wash off
- avoid sexual contact
- avoid applying to open wound
- apply TID until clear or max of 16 weeks (4 months)
- Can apply vaseline to the surrounding tissue to prevent burns
Monitoring of Genital Warts & Prevention (Vaccination)
Genital Herpes Overview & Dx
Tx of HSV Overview
SEs of Acyclovir
Tx of HSV (V & F)
Bacterial Vaginosis: def, dx, & tx
Pelvic Inflammatory Disease: S/sxs & Tx
Mechanisms of Oral Contraception
- prevents ovulation
- delays sperm transport
- reduces penetration of eggs by sperm
- reduces implantation of egg
Oral Contraceptives: types of Estrogen (3) & types of Progestins (9)
SEs of Estrogen & Progestin
Adverse Drug Effects of Estrogens & Progestins (Long lists from slide)
Benefits of Combination Oral Contraceptives
Basic Hormonal Contraception Flow Chart
Hormonal Contraception PO Combination: Mono & Biphasic
Hormonal Contraception PO Combination: Triphasic & Quadriphasic
Estrogens are metabolized by which enzyme?
3A4
- Be Cautious with:
- anticonvulsants, benzodiazepines, Corticosteroids, Penicillins, rifampin/rifabutin, selegiline, st. John’s wort, theophylline
What do you do for unscheduled bleeding/spotting for a person on contraception?
- if unscheduled bleeding during follicular phase → can use estrogen
- if unscheduled bleeding during luteal phase → can use progestin
Summary of Estrogen
Summary of Progestins 1st & 2nd gen
Summary of Progestins 3rd & 4th gen
Pubertal Suppression Therapies
Feminizing Hormone Therapy/Masculinizing Hormone Therapy
