762 Module 3 3 Stds

Front 1

incidence of gonorrhea

Back 1

peaked in the 1940s and 1970s-1980s

Front 2

male presentation of gonorrhea

Back 2

• Urethritis (2-8 days post exposure)
• Urinary Sx
• Discharge (1-2 days later)

Front 3

female presentation of gonorrhea

Back 3

• Urethritis (within 10 days post exposure)
• Nonspecific Sx (UTI-like, discharge)
• Majority asymptomatic/minimal - PID

Front 4

DGI

Back 4

disseminated
babies acquire during birth

Front 5

Gram staining of N. gonorrhea

Back 5

• Gram (-) diplococci – kidney beans
• Sensitive and specific in male urethritis

Front 6

culturing of N. gonorrhea

Back 6

• Necessary in females
• rectal
• pharyngeal

Front 7

Treatment of choice for gonorrhea

Back 7

ceftriaxone 125 mg x 1

cefixime 400 mg PO x 1

NO FQs - RESISTANCE

Front 8

in gonorrhea also treat...

Back 8

Chlamydia
partners

Front 9

incidence of Chlamydia

Back 9

Incidence steadily rising since 1990 (requires reporting since 2000)

Front 10

male presentation of Chlamydia

Back 10

• Dysuria, frequency
• Mucoid discharge (7-21 days post exposure)
• ¼ asymptomatic

Front 11

female presentation of Chlamydia

Back 11

• Largely asymptomatic – PID

Front 12

diagnosis of Chlamydia

Back 12

(intracellular organism that isn’t culturable)
o Diagnosis – DFA, ELISA, NAAT (nucleic acid amplification test)

Front 13

treatments for Chlamydia

Back 13

o Doxycycline 100 mg BID x 7 days (cheap, effective)
o Azithromycin 1 g po x 1 (expensive, convenient)
o Erythromycin base or ethyl succinate (PREGNANCY)

Front 14

in Chlamydia, also treat

Back 14

partners
for Gonorrhea

Front 15

incidence of syphillis

Back 15

steadily decreasing since 1940s, with a spike around 1990 w/ HIV co-infection

Front 16

presentation of primary syphillis

Back 16

• chancre /ulcer (usually appears in 3 weeks)
• painless, disappears in 1-8 weeks without Tx

Front 17

presentation of secondary syphillis

Back 17

• Skin lesions (2-6 weeks after 1’)
• Palms of hands, soles of feet (unique location)
• Nonpruritic, disappears in 4-10 weeks without Tx

Front 18

presentation of latent syphillis

Back 18

• Asymptomatic
• Early < 1 year
• Late > 1 year

Front 19

presentation of tertiary syphillis

Back 19

• Neurologic, cardiac, systemic symptoms
• 2-30 years later in 30% of patients

Front 20

diagnosis of syphillis

Back 20

nontrepenomal tests
trepenomal test

Front 21

2 nontrepenomal tests

Back 21

• ***RPR – rapid plasma regain (nonspecific inflammatory response)
• VDRL – veneral disease research lab

Front 22

2 trepenomal tests

Back 22

• FTA-abs
• MHA-TP

tests positive for life

Front 23

preferred Tx for Primary, Secondary, Early Latent (<1 year) syphillis

Back 23

• 2.4 MU Benzathine Penicillin G IM x 1

Front 24

preferred Tx for Late Latent syphillis

Back 24

• 2.4 MU Benzathine Penicillin G IM QW x 3

Front 25

preferred Tx for Tertiary Syphillis

Back 25

• Aqueous Pen G IV 2-4 MU q4h x 10-14 d

Front 26

alternative treatments for syphillis

Back 26

• doxycycline 100 mg BID x 14 d
• doxycycline or tetracycline x 28 days
• Ceftriaxone 2 g IM/IV QD x 10-14 d (limited data)

Front 27

Jarish-Herxheimer RXN

Back 27

o Worry because it appears like an allergic reaction, and is rel. common
o Starts in 2-4 hours, peaks in 8 hours, gone in 24 hours
o Follow up
• Non-treponemal test (RPR or VDRL)
• 6 and 12 months
• 24 months if latent

Front 28

incidence of genital herpes

Back 28

office visits increasing since 1960s

Front 29

HSV-1

Back 29

oropharyngeal

Front 30

HSV-2

Back 30

genital

Front 31

stages of HSV infection

Back 31

• Cutaneous infection
• Nerve ganglia infected
• Latent infection
• Reactivation
• Recurrent infection

Front 32

diagnosis of HSV

Back 32

o Clinical appearance
o Tissue culture

Front 33

MoA of antivirals

Back 33

2 mechanisms

1) competes with DNA polymerase
2) terminates DNA chain

Front 34

describe acyclovir

Back 34

(PO, IV, topical)
• PO - well tolerated
• IV – nephrotoxicity and neurotoxicity

Front 35

describe valacyclovir

Back 35

(PO)
• Prodrug that has better absorption

Front 36

describe famciclovir

Back 36

(PO)
• Prodrug of penciclovir

Front 37

Treatment of first episode of HSV

Back 37

(Tx for 7-10 days)
• Acyclovir 400 mg PO TID
• Famciclovir 250 mg TID
• Valacyclovir 1 g BID

Front 38

treatment of reccurrent HSV

Back 38

daily suppressive therapy

Front 39

incidence of genital warts (HPV)

Back 39

incidence increasing due to increased screening

Front 40

presentation of genital warts

Back 40

o Anogenital location
o Hyperkeratotic
o 75% asymptomatic
o cervical cancer link

Front 41

diagnosis of genital warts

Back 41

o Physical exam
o Biopsy

Front 42

results of treatment of genital warts

Back 42

cosmetic only

• DOESN’T REMOVE VIRUS OR AFFECT CANCER

Front 43

3 provider applied therapies for genital warts

Back 43

• Cryotherapy (q1-2w)
• Podophyllin 10-25% solution (q w x 6)
• Trichloroacetic or bichloroacetic acid

Front 44

3 patient applied therapies for genital warts

Back 44

• Podofilox 0.5% solution BID x 3 days
• Imiquimod 5% cream TIW

Front 45

HPV 16 and 18 ass'd with

Back 45

o Cervical CA
o High/low grade cervical abnormalities
o Anal, genital CA
o Head and neck CA

Front 46

HPV 6 and 11 ass'd with

Back 46

o Low grade cervical abnormalities
o Genital warts

Front 47

Gardisil efficacy

Back 47

HPV 6/11/16/18

Front 48

Carvarix efficacy

Back 48

HPV 16/18

Front 49

incidence of Trichomoniasis

Back 49

increasing

Front 50

female presentation of Trichomoniasis

Back 50

• 50% asymptomatic, discharge, pruritis, dysuria

Front 51

male presentation of Trichomoniasis

Back 51

• Asymptomatic, self-limited

Front 52

treatment for trichomoniasis

Back 52

o Metronidazole 2 g po x 1 or 500 mg po BID x 7 d
o Tinidazole 2 g po x 1 (sole indication)

Front 53

f/u for trichomoniasis

Back 53

repeat if symptoms remain
treat partners

Front 54

incidence of PID

Back 54

office visits decreasing

Front 55

presentation of PID

Back 55

o Endometritis
o Salpingitis
o pelvic peritonitis
o tubovarian abscess

Front 56

causes of PID

Back 56

o N. gonorrhoeae
o C. trachomatis
o Anaerobes
o Gram (-) rods
o Streptococci

Front 57

risks of PID

Back 57

• Increased ectopic pregnancy and infertility risk

Front 58

diagnosis of PID

Back 58

o tenderness
• Lower quadrant
• Adnexal
• Cervical motion
o Tmax 38.3 C
o Cervical discharge
o Elevated ESR or CRP
o Gonorrhea or Chlamydia

Front 59

treatment duration for PID

Back 59

14 days

Front 60

IV option 1 for PID

Back 60

• Cefotetan 2 g IV q 12 h OR cefoxitin 2 g IV q 6 h
• AND doxycycline 100 mg PO/IV q 12 h

Front 61

IV option 2 for PID

Back 61

• Clindamycin 600 mg IV q8h
• AND gentamicin 1.5 mg/kg IV q 8 h

Front 62

PO conversion for PID

Back 62

after 24 hours and clinical improvement
• Doxycycline or clindamycin

Front 63

alternative (outpatient) tx for PID

Back 63

• Ceftriaxone 250 mg x 1
• AND doxycycline 100 mg PO BID
• +/- metronidazole PO BID

Front 64

with PID also consider

Back 64

STD evaluation
treating partners