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50 Cards in this Set

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What are the 5 P's to ask a patient being evaluated for an STD?
Partners
Prevention of Pregnancy
Protection from STD's
Practices
Past history of STDs
What are the main prevention methods to counsel all patients with STDs?
Prevention =
Reduction in sex partners
Vaccinations
Condoms
Emergency Contraception Post-exposure prophylaxis for HIV
What are the main prevention/control methods to counsel all patients with STDs?
Changing sexual behavior
Identification of infected persons unlikely to seek treatment
Effective diagnosis/treatment
Pre-exposure vaccination for those at risk
All those seeking evaluation/treatment of an STD should be screened for HIV.
What are the main methods of managing sex partners?
Urge patient to contact partners
Expedite partner therapy
Intervene in sexual/social networks
Providers/Public health authorities use info from STD patients about their partners to help arrange for evaluation and treatment
What do you want to counsel every patient with STD?
1) STD prevention/control
2) Side Effects
3) Finish course of therapy
4) Refer all partners within last 60 days
5) Contact your clinician if s/s persist, worsen, recur
6) Management of sex partners
Describe the treatment of Gonorrhea (Drugs, Doses, Frequencies, Durations)
Uncomplicated Gonorrhea --> Ceftriaxone 125 mg IM once

Disseminated Gonorrhea --> Ceftriaxone 1g IM daily x 2 days, THEN Cefixime 400 mg PO Bid x 7 days
What do you do if the patient has a PCN allergy?
Desensitize them?
If Gonorrhea is suspected, what treatment would you add?
Uncomplicated Chlamydia --> Azithromycin 1g PO once
What are the side effects of Ceftriaxone? (7)
Injection site reaction
Diarrhea
Rash
Eosinophilia/Thrombocytosis/Leukopenia
Hemolytic Anemia
Increased Transaminase
Biliary Obstruction
What are the side effects of Cefixime? (7)
Diarrhea
Nausea
Abdominal Pain
Dyspepsia
Flatulence
Pruritis
Rash
How do you want to monitor Gonorrhea?
You re-evaluate only if symptoms persist or recur utilizing a culture and sensitivity testing

No need to test for cure
How is Chlamydia treated?
Recommended Treatment = Azithromycin 1g PO once
or
Doxycycline 100 mg PO Bid x 7 days

Pregnancy = Azithromycin 1g PO once
or
Amoxicillin 500 mg PO Tid x 7 days
What are the side effects of Azithromycin?
NVD, HA, Abdominal Pain
What are the side effects of Doxycycline?
GI upset, Photosensitivity
How do you monitor for Chlamydia?
Re-evaluate if symptoms persist or recur

Test of cure no necessary
What is special to counsel the patient on in Chlamydia?
Abstain from sex for 7 days

Azithromycin - Taken with or without food. DO NOT take with Mg or Al antacids

Doxycycline - Take with a full glass of water/remain upright to prevent esophageal irritation.
Take with food if irritation occurs
Take at least 2 hours before or 4 hours after Al, Ca, Mg
Describe the clinical presentation in primary syphilis.
single painless chancre that resolves spontaneously
Describe the clinical presentation of secondary syphilis.
Systemic spread leading to diffuse rash, flu-like symptoms that resolves with or without treatment
Describe the clinical presentation of tertiary syphilis.
Gummas
CV Involvement
CVS Involvement --> Neurosyphilis
Describe the goals of treatment in primary, secondary, tertiary and neurosyphilis.
1/2/3 syphilis --> Clinical resolution, Prevent sequelae, Eradicate organism
Describe the goals of treatment in Latent syphilis.
Prevent sequelae
4-fold decrease in quantitative, non-treponemal titers over 6 months
Describe the goals of treatment in Neurosyphilis.
Decrease neurologic manifestations
Decrease vascular lesions
Decrease CSF WBC's or protein levels
What tests are used in the diagnosis of syphilis?
Dark-field microscopic exam
or
Serologic testing
Describe the different serologic tests.
Non-specific antibody tests - Quantitative screening tool (VDRL, RPR)

Specific antibody tests - Qualitative confirmatory test (FTA-ABS, TP-PA)
What is the preferred treatment for 1/2 syphilis?
Benzathine Penicillin G 2.4 million units IM once
What is the preferred treatment in HIV patients that present with HIV?
Benzathine Penicillin G 2.4 million units IM once/week x 3 weeks
What is the preferred treatment in PCN allergic patients that present with 1/2 syphilis?
Azithromycin 2g PO once
What is the course of action in pregnant patients that present with syphilis and a PCN allergy?
Desensitize the patient, then give the Penicillin
What is the preferred therapy for a patient with latent(early) syphilis? Latent (late)?
Benzathine Penicillin G 2.4 million units IM once

Benzathine Penicillin G 2.4 million units IM once/week x 3 weeks
What is the preferred therapy in a Latent (early) patient with a PCN allergy? Latent (late)?
Azithromycin 2g PO once

Doxycycline 100 mg PO Bid x 28 days
What is the preferred treatment in a patient with tertiary syphilis?
Benzathine Penicillin G 2.4 million units IM weekly x 3 weeks
What is the preferred treatment in a patient with tertiary syphilis and a PCN allergy?
Doxycycline 100 mg PO Bid x 28 days
What are the side effects of Benzathine Penicillin G?
Rash
Urticaria
N/V
Eosinophilia
Fatigue
Fever
Confusion/Somnolence
Jarish-Herxheimer reaction (acute fever, HA, myalgia, chills in first 24 hours)
What are the side effects of Azithromycin?
N/V/D, HA, Abdominal Pain
What are the side effects of Doxycycline?
GI upset
Photosensitivity
What is the preferred therapy in Neurosyphilis?
Aqueous crystalline Penicillin G 24 million units/day Continuous Infusion
What unique counseling points do you want to include in syphilis?
Abstain from sex until lesions heal
Plan for Lab-followup
Jarisch-Herxheimer Reaction
Use caution in tasks that require alertness
Describe how you would evaluate outcomes in syphilis.
Non-HIV patients - Re-examine clinically and serologically at 6 and 12 months

HIV patients - Re-examine clinically and serologically at 3,6,9,12, and 24 months

Latent syphilis --> Re-examine clinically and serologically at 6,12, (18 if HIV+), and 24 months
Continuation of previous answer
Tertiary syphilis - varies, recommend ID specialist

Neurosyphilis - CSF exam every 6 months until cell count is normal
How do you designate treatment failure?
If symptoms persist, recur or worsen, there is a 4-fold increase in non-treponemal test titer
What are the treatment goals in Herpes?
Relieve symptoms
Shorten clinical course
Prevent complications/recurrence
Decrease disease transmission
List 4 supportive care measures you can take in herpes.
Warm saline baths
Analgesics
Antipyretics
Good Genital Hygeine
How do you treat a first episode of Herpes?
Valacyclovir 1g PO Bid x 10 days
Describe episodic vs suppressive therapy.
Episodic = Improved symptoms, shorter duration of lesions
Initiate within 1 day of lesion onset (supply the drug ahead of time)
Treatment = Valacyclovir 1g PO x 5 days
Continuation of previous answer
Suppressive Therapy = Continuous, reduces frequency in those with frequent occurrences (>6/year)
Treatment = Valacyclovir 1 g PO daily
What are the side effects of Valacyclovir?
Increase Transaminases
Nasopharyngitis
Depression
Renal Impairment
Rash
N/V, HA
Abdominal Pain
Fatigue
How do you want to counsel on Herpes?
History of Disease
Episodic vs Suppressive Therapy
Inform sexual partner
Abstinence during lesions
Risk of transmission during pregnancy
Supportive Care
Valacyclovir --> Adequate hydration to avoid renal toxicity, Take with or without food
What are the recommended regimens to treat Trichomoniasis?
Metronidazole 2g PO once
Tinidazole 2g PO once
What are the side effects of metronidazole?
Anorexia
NVD
Bitter metallic taste
Dizziness/HA
Vaginal Candida Infection
Vaginal Discharge
What is unique to counsel in these patients?
Avoid alcohol during course and 24 hours after completion with Metronidazole.

May turn your urine reddish-brown color

Avoid activities that require mental alertness until dizziness is assessed