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39 Cards in this Set
- Front
- Back
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what are male condoms protective against (4)
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1. HIV
2. chlamydia 3. gonorrhea 4. trichomoniasis |
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what are diaphragms protective against (3)
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1. gonorrhea
2. chlamydia 3. trichomoniasis |
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when is screening for chlamydia recommended for all sexually active women 25 years or less of age
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annually
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when is screening recommended for gonorrhea for all sexually active women at risk for infection
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annually
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1. Characterized by urethral inflammation resulting from both infectious and non-infectious
causes 2. Symptoms, when present, include: discharge of mucopurulent or purulent material, dysura, or urethral pruritis; asymptomatic infections are common 3. Three predominant infectious casuses a. N. gonorrhoeae b. C. trachomatis c. Mycoplasma genitalium |
urethritis
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If a patient has sx of urethritis what should they be tested for? (2)
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1. gonorrhea
2. chlamydia |
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1. Two predominant signs which characterize cervicitis
a. Purulent or mucopurulent endocervical exudates visible in the endocervical canal b. Sustained endocervical bleeding easily induced by passage of a cotton swab through the cervical os 2. Many patients are asymptomatic; some women complain of abnormal vaginal discharge and intermenstrual vaginal bleeding (i.e. – after intercourse) 3. Etiology a. N. gonorrhoeae and C. trachomatis are the two leading causes b. May also see trichomoniasis and genital herpes c. Most cases fail to identify an organism |
cervicitis
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In women, _____ infections are often causes of Pelvic Inflammatory Disease (happens in up to 40% of untreated women), infertility, and ectopic pregnancy
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chlamydial
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treatment options for chlamydia (5)
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1. *Azithromycin 1 gram x 1 dose
2. *Doxycycline 100 mg BID x 7 days 3. Erythromycin base 500 mg QID x 7 days OR EES 800 mg QID x 7 days 4. Ofoxacin 300 mg BID x 7 days 5. Levofloxacin 500 mg QD x 7 days |
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signs of gonorrhea in symptomatic men (3)
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1. dysuria
2. urinary frequency 3. purulent white/yellow/green urethral discharge |
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signs of gonorrhea in symptomatic women (3)
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1. increased vaginal discharge
2. painful/burning sensation with urination 3. vaginal bleeding between periods |
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what is given as prophylaxis for opthalmia neonatorum (gonococcal opthalmalogic infection occuring in newborns as a result of passage through the vaginal canal)
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Prophylaxis with topical silver nitrate or erythromycin 0.5% ointment (preferred) is
required by law in most states |
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thus infants born to infected moms (with gonorrhea) should also receive parenteral _______
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ceftriaxone
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treatment options for gonococcal infections (cervicitis, urethritis, rectal) (1 preferred, 1 alternative, and 1 for allergy to preferred)
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1. *Ceftriaxone 250 mg IM x 1 dose
PLUS Azithromycin 1 g orally in a single dose or doxycycline 100 mg twice daily for 7 days 2. Alternative regimens: if ceftriaxone is not availble Cefixime 400 mg in a single dose PLUS Azithromycin 1 gram orally in a single dose or doxycycline 100 mg twice daily for 7 days PLUS Test-of-cure in one week 3. If patient has severe cephalosporin allergy: Azithromycin 2 grams orally in a single dose |
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treatment options for disseminated gonococcal infection (DGI)
1 preferred, 2 alternatives |
Preferred
o Ceftriaxone 1 gm IM/IV q 24 hours Alternatives o Ceftizoxime 1 gm IV q 8 hours o Cefotaxime 1 gm IV q 8 hours IV abx are continued for 24-48 hours after improvement and patient may then be switched to oral cefixime 400 mg BID to complete at least one full week of therapy |
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SYPHILIS---This is a systemic disease caused by _______ and patients may seek medical attention in various different stages of the disease
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Treponema pallidum
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Which stage of syphilis?
painless ulcers or chancre at the site of infection; often persist for 1-8 weeks and healing may be spontaneous |
primary infection
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Which stage of syphilis?
→ rash, lymphadenopathy, mucocutaneous lesions occur as T pallidum undergoes hematogenous and lymphatic spread; malaise, fever, headache, arthralgias also commonly occur; untreated lesions abate within 4-10 weeks |
secondary infection
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Which stage of syphilis?
cardiac, neurologic, opthalmic, auditory, or gummatous lesions; these may result from untreated progression of the disease |
tertiary infection
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syphilis
Treatment of sexual partners a. People who were exposed within ____ preceding the diagnosis of either primary, secondary, or early latent syphilis in a sex partner should be treated presumptively regardless of serology |
90 days
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Acute febrile condition accompanied by headache,
myalgia, and other symptoms which may occur within the 1st 24 hours after any therapy for syphilis → advise patients |
Jarisch-Herxheimer reaction:
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treatment options for syphilis
1 preferred, 3 alternatives for allergies |
1. Parenteral penicillin G is the preferred drug for all stages of syphilis
. If pregnant or have neurosyphilis → desensitization to PCN is recommended *Benzathine penicillin G 2.4 million units IM x 1 dose -Preferred option -Benzathine used due to slow multiplication of T. pallidum -Oral PCN or combination of benzathine/procaine are not viable options 2. If penicillin allergy: o Tetracycline 500 mg QID x 14 days o Doxycycline 100 mg BID x 14 days o Ceftriaxone 1 gram IM/IV QD x 8-10 days -If PCN allergy and non-compliant patient, best to desensitize and give PCN -Pregnant women with PCN allergy should undergo desensitization and treated with PCN as above |
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for primary, secondary, and early latent syphilis what happens if titers do not decrease 4x by 6 months after treatment for primary and secondary?
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retreat with benzathine PCN G 2.4 mu IM q week x 3 weeks
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recommended regimen for first episode of genital herpes (4)
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1. Acycloivir 200 mg 5x/day x 7-10 days
2. Acyclovir 400 mg TID x 7-10 days 3. Famciclovir 250 mg TID x 7-10 days 4. Valacyclovir 1000 mg BID x 7-10 days acyclovir 5x/day not used much anymore due to compliance tx can be extended if healing is not complete after 10 days of therapy tx with topical agents is less effective vs. oral and use is discouraged |
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recommended regimen for episodic treatment for recurrent genital herpes (8)
**requires initiation within 1 day of lesion onset or during the prodrome that precedes the outbreaks |
1. Acyclovir 800 mg BID x 5 days
2. Acyclovir 800 mg TID x 2 days 3. Acyclovir 400 mg TID x 5 days 4. Famciclovir 125 mg BID x 5 days 5. Famciclovir 1000 mg BID x 1 day 6. Famciclovir 500 mg once, followed by 250 mg BID x 2 days 7. Valacyclovir 500 mg BID x 3 days 8. Valacyclovir 1000 mg QD x 5 days |
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recommended regimen for suppressive therapy for recurrent genital herpes (4)
*recommended for patients who have 6+ recurrences per year *discontinuation can be considered after 1 year of suppressive therapy (frequency of outbreaks will diminish over time thus need to reassess continued need) |
1. Acyclovir 400 mg BID
2. Famciclovir 250 mg BID 3. Valacyclovir 500 mg QD 4. Valacyclovir 1000 mg QD *valacylcovir less efficacious in those with 10+ outbreaks/year |
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treatment options for chancroid (4)
*sexual partners need to be examined regardless of sx if they have had sexual contact with the patient during the 10 days preceding the patient's onset of sx |
Ceftriaxone 250 mg IM single dose
Azithromycin 1 gm single dose Ciprofloxacin 500 mg orally BID x 3 days Erythromycin base 500 mg po QID x 7 days |
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recommended regimens for bacterial vaginosis (BV)
3 recommended, 4 alternative |
Metronidazole 500 mg BID x 7 days
Metronidazole gel 0.75% 1 appl vaginally BID x 5 days Clindamycin cream 2% 1 appl vaginally q HS x 7 days Alternative Regimens Tinidazole 2 grams once orally once daily for 2 days OR Tinidazole 1 gram orally once daily for 5 days OR Clindamycin 300 mg orally twice daily for 7 days OR Clindamycin ovules 100 grams intravaginally HS x 3 days |
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recommended regimen for trichomoniasis
2 recommended 1 alternative |
Metronidazole 2 grams orally x 1 dose
Tinidazole 2 grams orally x 1 dose Alternative Regimen Metronidazole 500 mg BID x 7 days |
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recommended parenteral treatment for PID
2 regimens 1 alternative |
Regimen 1:
-Cefotetan 2 gm IV q 12 hours OR Cefoxitin 2 gm IV q 6 hours PLUS -Doxycycline 100 mg IV/po q 12 hours Regimen 2: -Clindamycin 900 mg IV q 8 hours PLUS -Gentamicin 2mg/kg load → 1.5 mg/kg IV q 8 hours; may substitute single daily dosing Alternative parenteral regimens -Ampicillin/Sulbactam 3 g IV q 6 hours PLUS -Doxycycline 100 mg PO/IV q 12 hours |
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recommended oral treatment for PID
2 regimens |
Regimen 1:
-Ceftriaxone 250 mg IM x 1 dose PLUS -Doxycycline 100 mg PO BID WITH OR WITHOUT -Metronidazole 500 mg PO BID Regimen 2: -Cefoxitin 2 gm IM single dose and probenecid 1 gram orally administered in single dose PLUS -Doxycycline 100 mg PO BID WITH OR WITHOUT -Metronidazole 500 mg PO BID |
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recommended regimens for HPV (patient applied)
3 regimens |
External genital warts (patient applied):
-Podofilox 0.5% solution/gel - BID x3 days; then 4 days off; may repeat up to 4 cycles as needed OR -Imiquimod 5% cream – Apply q HS 3 times/week for up to 16 weeks; treatment area should be cleansed 6-10 hours after application OR Sinecatechines 15% oinitment 3 times/day for up to 16 weeks |
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recommended regimens for HPV (provider applied)
4 regimens |
External genital warts (provider applied):
-Cryotherapy – repeat q1-2 weeks prn OR -Podophyllin resin 10-25% OR -Trichloracetic acid (TCA) OR -Surgical removal Internal warts → therapy selected by the provider within reason |
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1. Men presenting with this usually have testicular pain and tenderness that is unilateral
a. Hydrocele and palpable swelling of the epididymis are also commonly present 2. Treatment regimens will depend on the likely causative organism |
epididymitis
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treatment for epididymitis for gonococcal or chlamydial infection
2 components -Initial therapy for men <35 years of age -Bedrest, scrotal elevation, and analgesics may be added to either regimen |
Gonococcal or chlamydial infection:
-Ceftriaxone 250 mg IM x 1 dose PLUS -Doxycycline 100 mg orally BID x 10 days |
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treatment for epididymitis for infection (enteric organisms or allergic to other regimen)
2 components Initial therapy for men ≥ 35 years of age |
For enteric organisms or allergic to above regimen:
-Ofloxacin 300 mg orally BID x 10 days OR -Levofloxacin 500 mg PO QD for 10 days |
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treatment regimens for ectoparastatic infections (pubic lice)
2 regimens 2 alternatives |
Permethrin 1% crème rinse – apply to affected area and wash off after 10 minutes aka Nix
Pyrethrins with piperonyl butoxide applied to affected area washed off after 10 minutes Alternative regimens Malthion 0.5% lotion applied for 8-12 hours and washed off -Flammable when wet Ivermectin 250 mcg/kg orally x 1 dose; repeat in 2 weeks |
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treatment for scabies
2 regimens 1 alternative |
Permethrin cream 5%– apply to all areas of the body from the neck down and wash off after 8-14 hours
Ivermectin 200 mcg/kg orally x 1 dose; repeat in 2 weeks Alternative regimen Lindane 1% - apply thin layer to all areas of the body from the neck down and thoroughly wash off after 8 hours |
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treatment for sexual assault (usually will cover primary infections)
3 components |
Ceftriaxone 250 mg IM x 1 dose
OR Cefixime 400 mg orally X 1 dose PLUS Metronidazole 2 gm orally x 1 dose PLUS Azithromycin 1 gm orally x 1 dose OR doxycycline 100 mg orally BID x 7 days |
