T2 - ID + STI Flashcards
What is Hutchinson’s sign?
A herpetic lesion on the nose that could indicate zoster involvement of ophthalmic branch of trigeminal nerve - refer!! Red flag!!
If your patient complains of prodromal burning eye pain, what should you do?
Be concerned about zoster and refer to ophtho.!!
T/F: you can have herpes zoster without eruptions.
True.
Pain management for acute zoster?
Tramadol, codeine.
NO Gabapentin, TCA or steroids.
when is antiviral benefit the best for herpes zoster?
Age >50 and <72hrs of symptom onset.
Herpes zoster tx
Valacyclovir 1000mg TID x7 days.
What is post herpetic neuralgia?
Pain that persists after the zoster lesions have disappeared. >90days .
How do you treat PHN?
Post herpetic neuralgia
Gabapentin, pregabalin, TCA (add for mod-severe pain)
When is herpes zoster infectious and what should you teach patients?
Infectious until lesions crust over. Stay away from pregnant people, babies and immunocompromised and keep your rash covered.
What vaccines are available for herpes zoster? Which is most effective? When can you get it?
Zostavax age >50, 51% effective for shingles and 67% for PHN
Shingrex is preferred (x2 dose for >50) 97% effective.
You can get shingrex if you’ve had the zostavax - just wait ______
8 weeks
Herpes zoster lesions usually crust in _________ and 2-3% develop a _________
7-10 days
Secondary bacterial infection.
What pathogens are most common cause of mono?
EBV and CMV.
What is the mono triad presentation?
Fever, pharyngitis and lymphadenopathy.
Your patient has fever, pharyngitis and lymphadenopathy. They have a fever of 104 that has lasted for over 2 weeks. You feel hepatomegaly on exam and the patient is very fatigued. What do you suspect?
Mono.
What labs can you draw to test for mono?
Heterophil antibodies serology 85% of cases are POs.
VCA, IgG, IgM POs in 1-2 weeks.
LFTs elevated in 80-90% of cases.
3-30% of patients with mono also have ________
GABH strep.
What happens if you treat a patient for strep but they actually have mono (either and)
They break out in a rash from taking the amoxicillin or ampicillin.
Management of mono
NSAIDS - no ASA, throat lozenges or lidocaine, bed rest, refrain from strenuous exercise or contact sports for 3-4 weeks to avoid splenic rupture.
How long does a tick need to be attached to transmit disease?
24-48hours
What are the stages of Lyme disease?
Stage 1 = early, localized, x1 EM where the tick bit 3-30 days post bite. Regional lymphadenopathy nd minor constitutional symptoms.
Stage 2 = Early disseminated infx, 3-5 weeks aft the tick bite. Multiple secondary EM, constitutional symptoms. Bell’s palsy, , meningitis etc can evolve if not treated.
Stage 3 = Late persistent = months after usually in winter, mono articular arthritis of large joints. Fatigue, keratitis, mental disorders, ataxic gait.
Tx for Lyme
Doxy 100mg BID x14 days.
ALT Amoxicillin (good for Kids and pregnant women). 500mg TID x14days.
If there are other system involvement - then 21-28 day therapy.
If there are neurological abnormalities or other serious complications from Lyme, then what is the treatment?
IV Ceftriaxone.
T/F: if there is a tick bite suspicious for Lyme, then you can give prophylactic treatment.
True. Single dose of doxy 200mg.
Babesiosis is a _____
Anaplasmosis is a _______
Ehrlichiosis is a _______
And RMSF is a ______
Protozoa
Bacteria
Bacteria
Bacteria
RMSF must begin treatment _______ or else may rapidly progress to fatal.
5 days.
Tx for babesiosis
Atovaquone and Azithromycin 7-10 days.
OR
clindamycin and quinine.
Tx for RMSF, anaplasmosis and ehrlichiosis,
Doxy 100mg BID x14days.
2nd line is amoxicillin (pregnant women and children)
3rd Cefuroxime.
S/s more specific to ehlichiosis
GI and AMS
S/s more specific to RMSF
High fever, edema around eyes and back of hands, GI symptoms
West Nile Virus, JEV, Dengue, Zika - all types of ______ virus transmitted by ______ and ______ are the reservoirs.
Flaviviridae
Mosquitos
Birds
“Bone break fever” refers to _______
Dengue
Triad of symptoms in Dengue
HA, eye pain and rash.
Do not give ______ for dengue. Why?
NSAIDS. Increased risk for bleeding.
While dengue and chikununya virus are similar and transmitted through the same mosquito, the S/s of chick usually primarily ________
Joint symptoms- bilateral, symmetric and debilitating.
Also have rash, HA, fever an eye pain
Zika and _____ are linked.
GBS
Acute diarrheal syndrome is ______ weeks. Tx is _____
<2 weeks
Supportive
What is tenesmus?
Anal retching - having to poop but nothing coming out.
Viruses, ETEC, C perfringens, Staph A, giardia cause a non-inflammatory ____________ bowel “acute watery diarrhea”
Proximal small bowel
Salmonella typhi causes _______ _____ ______ bowel diarrhea.
Penetrating distal small bowel
Campylobacter jejunum, shigella, EHEC, salmonella non-tynpi and C-diff are inflammatory ______ and are _______
Colon grossly bloody.
If there is any blood in diarrhea, or suspect EHEC, then ________ antibiotics.
Withhold - it could be EHEC which release shiga toxin when killed with abx and can cause HUS.
Salmonella - onset ________, lasts ________, TX: _________
12-36hours
5days -2weeks
Azithromycin, Ceftriaxone.
Tx for campylobacter jejuni
Macrolides. self-limited in healthy patients and resolves in 1 week.
Tx for giardia
Metronidazole
Watery, greasy stools with many GI cramping, belching, etc.
Traveler’s diarrhea is cause in large portion by _______.
ETEC.
Tx for traveler’s diarrhea.
Azithromycin
Loperamide.
When should you NOT use loperamide for diarrhea?
Not if febrile or grossly bloody stools
Use in caution with combination antibiotics.
Syphilis is contagious __________
During primary and secondary stage.
Syphilis prevention/tx in pregnancy
Screen at first prenatal visit, and beginning of 3rd trimester. Screen again at delivery if high risk.
Screening MSM for syphilis
Annually, or more frequently if high risk
For someone who has had syphilis, they’re _______ test will always be positive. For repeat infections, you look at ______
FTA-AB
RPR titre - would increase by at least 8-fold
You want to see a _________ decrease in RPR to show that syphilis is adequately treated
8-fold.
Treatment for syphilis:
Primary + secondary
Latent early/late
Tertiary
PCN Benzathine 2.4 for primary and secondary and early latent
PCN Benzathine 2.4mu (1weekly x3 weeks) for late latent and tertiary.
If someone has ocular syphilis or otosyphilis , what should you do?
Admit and give PCN G Benzathine IV.
What is a Jarisch-Herxheimer reaction
Fever, malaise, n/v, chills, exacerbation of secondary syphilis rash occurring a few hours to 24 hours after PCN administration.
T/F: a Jarisch-Herxheimer reaction is a type of allergic reaction
False. It is NOT an allergic reaction. treat with fluid and antipyretics. Resolves in 24 hours.
Patients who are treated for syphilis in primary and secondary should get follow up at ____ and _____ post treatment
6mo and 12mo
Patients who are treated for Latent syphilis should have follow up testing at ___________
6, 12 and 24mo.
When can someone who has syphilis resume sexual activity?
At least 7 days after COMPLETING syphilis tx AND all mucosal and skin lesions have resolved, AND sex partners have been treated for syphilis.
If you’re testing for syphilis, you should always test for _____ too.
HIV (and other STIs)
For patients positive with syphilis, you should notify all sexual partners in the past ________
90 days
When should you offer PrEP?
MSM who are positive for syphilis.
Tx for chlamydia?
100mg doxy BID x7 days (non pregnangt)
Pregnant Azithromycin 1gm x1 oral.
Tx for gonorrhea
Ceftriaxone 500mg IM x1. Co treat with doxy since G/C usually come together
Treatment for trichomoniasis.
Women: Metronidazole 500mg BID x7 days
Men: 2G orally single dose.
Tx for herpes
1st episode Acyclovir 400mg TIDx 7-10 days
Recurrent episodes: Acyclovir 800mg BID-TID x 2-5 days
