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D&D Infectious Disease FINAL > Therapeutics - STIs part 2 > Flashcards

Therapeutics - STIs part 2 Flashcards

1
Q

syphilis is caused by what organism

A

treponema pallidum - a gram (-) spirochete

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2
Q

syphilis is divided into stages based on what?

A

clinical findings

the stage of disease determines what treatment is given

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3
Q

most new cases of syphilis in the US are in which population?

A

MSM

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4
Q

how is syphilis acquired

A

by sexual contact with infected mucous membranes or skin lesions

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5
Q

how many stages of syphilis are there and what are they

A

primary - 21 days after initial infection

secondary - 4-8 weeks after primary infection. ulcer appearance

tertiary - 1-20 years after initial infection

latent - divided into early and late
early - first year after resolution of lesions
late - unknown duration or more than a year

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6
Q

the time period for primary syphilis is 21 days after initial infection. what are the symptoms?

A

painless ulcer in the mouth, genitals, rectum, or skin

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7
Q

time period for secondary syphilis is 4-8 weeks after the ulcer from the primary infection has appeared

what are the symptoms??

A

head to to body rash, headache, fever, fatiguw

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8
Q

differentiate between the symptoms of early latent syphilis (1 year after primary or secondary lesions have resolved) and late latent syphilis (unknown or greater than 1 year)

A

early - signs and symptoms usually have dissapeared

late - CV, neuro syphilis, meningitis

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9
Q

what is the preferred drug for treating ALL STAGES OF SYPHILIS

A

parenteral penicillin G

(the preparation/dose/duration depends on the stage)

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10
Q

preferred treatment for primary, secondary, and EARLY latent syphilis

A

benzathine penicillin G 2.4 million units IM x1

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11
Q

preferred treatment for tertiary syphilis WITHOUT neurologic involvement, and for late latent syphilis

A

benzathine penicillin G 2.4 million units IM ONCE A WEEK FOR 3 WEEKS!!!

not just 1 like for primary, secondary, and early latent

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12
Q

preferred treatment regimen for NEUROSYPHILIS

A

aqueous crystalline penicillin g 18-24 million units/day IV DIVIDED every 4 hours for 10-14 days

alternative:

procaine penicillin 2.4 million units/day IM + probenecid 500mg PO QID for 10-14 days

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13
Q

as mentioned, parenteral penicillin G is the preferred drug for ALL STAGES OF SYPHILIS

what if the patient has a penicillin allergy?
name 3 alternatives

A

confirm the allergy. pencillin is still preferred, even in cases of allergy, because it works so well for syphilis.
consider desensitizing the patient, especially if they are pregnant or have neurologic involvement

3 alternatives:
doxy 100mg PO Q12 for 28 days

tetracycline 500mg PO QID 28 days

ceftriaxone IM or IV daily 8-10 days (if MILD allergy only)

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14
Q

true or false

even in cases of penicillin allergy, penicillin is still the drug of choice for pregnant patients with syphilis

A

TRUE

it works so well. consider desensitizing if they have an allergy

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15
Q

what is the “syphilis Jarisch Herxheimer Reaction?”

what is it caused by?

when does it most often occur and why?

what is the treatment?

A

acute rxn – fever, headache, myalgia within the 1st 24 hrs after starting syphilis treatment

happens bc as we kill the organism, toxic components of T. pallidum are released

the reaction occurs most often in early syphilis because of the high amount of bacteria

the treatment is just supportive care. but imp to let patients know they may feel worse before they get better!!!

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16
Q

explain the follow up procedure for syphilis

A

-follow up testing every 3, 6, 9, 12, and 24 months after primary and secondary syphilis. 4-fold reduction in antibody titer

-should get HIV test

-ppl exposed to primary, 2ary, or early latent should be referred fro clinical evalutation

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17
Q

anyone (+) for syphilis should get what test

A

HIV test

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18
Q

pt is 39 with diffuse rash and generalized lymphadenopathy.
painless ulcer on penis that resolved on its own around 5 weeks ago.
diagnosed with syphilis and NKA

what therapy is appropriate?

A

resolved on its own 5 weeks ago, so this is SECONDARY SYPHILIS

benzathine penicillin G 2.4 million units IM as a single dose

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19
Q

true or false

genital herpes is a CHRONIC viral infection

A

TRUE

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20
Q

2 causes of genital herpes

A

HSV1 and HSV2

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21
Q

true or false

HSV1 causes most cases of recurrent genital herpes

what are the symptoms?

A

FALSE

HSV2

mild infections - can’t even be recognized - but intermittenly shed virus

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22
Q

most genital herpes infections are transmitted by what kind of people?

A

ppl that are unaware they are even infected

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23
Q

explain the 5 components of the genital herpes infection cycle

A

primary infection
ganglia infection
lifelong latency
periodic reactivation
recurrent infection

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24
Q

incubation of genital herpes

A

2-14 days

25
Q

explain the clinical presentation in the 1ST EPISODE of a genital herpes infection

A

there will be severe, painful, pus lesions on the external genitalia. local discharge, itching, burning

pt will have flu like symptoms

26
Q

as mentioned, in the 1st episode of genital herpes infection, there are severe painful pustular or ulcerative lesions on the external genitalia

this usually develops over a period of….

A

7-10 days

27
Q

differentiate between the length of viral shedding in the 1st episode vs recurrent infection of genital herpes

A

1st - virus shedding lasts around 12 days

recurrent - virus shedding lasts around 4 days

28
Q

true or false

MAJORITY of pts have RECURRENT genital herpes infections

A

true

29
Q

explain the clinical presentation of recurrent genital herpes infection

(which comes first - prodrome or lesions)

A

PRODROME symptoms come BEFORE the lesions appear

pt may get mild burning or itching - this means they’re about to have an outbreak

30
Q

which has MORE lesions - primary genital herpes infection or recurrent?

which lesions are there for longer?

A

primary has more lesions and also lasts longer

31
Q

recurrences and asymptomatic shedding in genital herpes infection are more common in HSV1 or HSV2 infection

A

HSV2

32
Q

GOAL for treating the initial episode of a genital herpes infection

A

to relieve the symptoms and shortern the duration

33
Q

treatment for initial episode of genital herpes infection

A

acyclovir 400mg TID for 7-10 days

famciclovir 250mg TID 7-10 days

valcyclovir 1gm BID 7-10 days

ALL HAVE SAME OUTCOME, but val is only BID

34
Q

explain the treatment for genital herpes infection, in which we are treating a RECURRENT INFECTION

A

we can either give suppressive therapy OR episodic therapy - 2 different ways of dealing with it

in suppressive, pt takes antiviral on continuous basis in hopes to reduce the number of recurrences and reduce trasnmitting to partners

in episodic, pt gets supply of drug and takes immediately when symptoms begin (PRODROME HAPPENS BEFORE LESIONS) with the goal to lessen and shorten the duration

35
Q

differentiate between when suppressive vs episodic genital herpes therapy would be given to a patient

A

suppressive - given to patients who have more frequent outbreaks or have partners - want to prevent transmission

episodic - for patients with mild or infrequent recurrences

36
Q

differentiate between the length of therapy/dosing for episodic vs suppressive recurrent genital herpes treatment

A

episodic - shorter durations but higher dosing

suppressive - DAILY dosing, but lower doses

37
Q

important counseling points for patients with genital herpes

A

-counsel the infected person AND sex partner(s). let them know that even if they’re asymptomatic, they can still transmit HSV

should avoid sex with uninfected partner when the lesions or prodrome is present

38
Q

can condoms eliminate the risk for transmitting genital herpes

A

NO

can reduce the risk, but not eliminate

39
Q

name 3 STI’s that are characterized by vaginal discharge

A

bacterial vaginosis
trichomoniasis
vulvovaginal candidiasis

40
Q

in baterial vaginosis, how does the infection happen?

A

the vaginal flora is replaced with anaerobic bacteria like ureaplasma, mycoplasma, G. vaginalis

41
Q

what are some risk factors for getting BV (bacterial vaginosis)

A

multiple sex partners, not using comdoms, new sex partner, lack of vaginal lactobacilli

42
Q

true or false

since bacterial vaginosis associated bacteria can be found in the male genitalia, treating a male sex partner can help to prevent the recurrence of bacterial vaginosis

A

FALSE

while BV-associated bacteria is found there, treating the male is not beneficial

43
Q

true or false

BV treatment is only recommended for women with symptoms

A

TRUE

44
Q

3 potential recommended regimens for patients with bacterial vaginosis

A

metronidazole 500mg BID for 7 days

OR

metro gel 0.75% 1 full applicator (5g) intravaginal QD for 5 days

OR

Clindamycin cream 2% 1 full apllicator (5g) intravaginal at bedtime x 7 days

45
Q

counseling point for each of the 3 potential regimens for bacterial vaginosis

A

metro oral AND gel - NO ALCOHOL

clindamycin cream - it’s OIL BASED. can weaken latex condoms

FOR ALL — REFRAIN FROM SEX OR USE CONDOMS CONSISTENTLY AND CORRECTLY DURING TREATMENT

46
Q

Trichomoniasis is caused by what bacteria

A

trichomonas vaginalis

47
Q

true or false

most patients with a trichomoniasis infection have symptoms

A

FALSE

most have minimal-no symptoms, so it’s possible the infection can last months to years, and can easily be spread to partners EVEN IF ASYMPTOMATIC

48
Q

true or false

while treating the male is NOT helpful in preventing bacterial vaginosis in women, treating the male IS beneficial in preventing trichomoniasis in women

A

TRUE

49
Q

as mentioned, patients with trichomoniasis infections typically have minimal-no symptoms
do we still treat them with antibiotics?? why or why not

A

YES bc trichomoniasis infection is associated with 2-3x risk of getting HIV and having adverse pregnancy outcomes

50
Q

goals of treating trichomoniasis

A

reduce the symptoms and signs of infection – and to reduce transmission

51
Q

recommended regimen for trichomoniasis in:

-women
-men

-alternative for women and men

A

women - metro oral 500mg BID for 7 days

men - metro 2g orally x1

alternative for both men and women - tinidazole 2g oral x1

AVOID ALCOOHL FOR ALL! ALL ARE NITROIMIDAZOLES

52
Q

Counseling points when giving trichomoniasis treatment

when should they be retested?

A

NO ALC

no sex until patient AND THE PARTNER are treated

retest within 3 months of initial tretment to ensure infection is gone

53
Q

vulvovaginal candidiasis is most commonly caused by what?

A

candida albicans

54
Q

vulvovaginal candidiasis can be classified as……

what is this based on?

A

complicated or uncomplicated

complicated - recurrent, severe, nonalbicans, or immunocompromised

uncomplicated - sporadic/infrequent, mild-moderate, caused by Candida albicans, nonimmunocomp

55
Q

treatment for uncomplicated vulvovaginal candidiasis treatment

A

OTC regimens - antifungal creams

if they fail OTC - prescription antifungal creams (intravaginal) or fluconazole 150mg x1

56
Q

when counseling a patient being treated for vulvovaginal candidiasis, how long should you tell them the symptoms will take to go away?

A

around 3 days after starting treatment

57
Q

a patient’s symptoms are persisting after trying OTC treatment for vulvovaginal candidiasis OR has a recurrence of symptoms within 2 months after treatment

what is recommendation?

A

see provider. dont try another OTC - need prescription

58
Q

important counseling point for patients with vulvovaginal candidiasis using creams and suppositories

A

they are oil-based - may wekaen latex condoms or diaphragms

59
Q
A

D&D Infectious Disease FINAL (21 decks)

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