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36 Cards in this Set
- Front
- Back
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Gonorrhea
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Cause
-Gram negative intracellular diplococci -Sex Presentation -Males: discharge and dysuria -Females: dysuria, vaginal discharge or both...abdominal pain does not occur until has spread to cause PID -Several other presentations: eyes, joints, skin, brain, heart Diagnosis -Gram stain smear will see gram negative diplococci -Culture (Gold Standard) -Nucleic acid amplification tests--better than cultures -Need culture to diagnose organisms from areas other than vagina or penis Treatment -start as soon as diagnosis suspected -Ceftriaxone 250mg IM + Chlamydia Rx Dispo -urogenital infection normally can go home -treatment of sexual contacts -abstinence -if symptoms persist after treatment rec to pt that they get a f/u culture -test for syphilis in pts treated for gonorrhea Outcome/Prognosis |
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Rectal discharge in msm pts?...think what?
Symptoms |
Rectal gonorrhea
Sx: discharge, rectal pain, tenesmus, constipation |
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Gonococcal pharyngeal infection symptoms?
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normally assymptomatic
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Gonococcal conjunctivitis presentation (3 parts)
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copious purulent discharge, conjunctival injection, unilateral
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Hematogenous dissemination of Gonorrhea presentation
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-Joint disease: consider in any young pt with joint dz; classic presentation is a fever, rash, multiple joint pain including tenosynovitis
-Endocarditis -Sepsis -Meningitis |
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Septic arthritis from Gonorrhea classic presentation
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-fever
-rash -multiple joint pain (pts can also have tenosynovitis) |
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skin lesions typicl of Gonococcemia?
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erythematous macules or pustules with a necrotic or purpuric center; pt also with petechiae
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Gold standard for diagnosing Gonorrhoeae
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Culture
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Sensitivity of Gonorrhoeae culture for nucleic acid amplification tests
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-culture sensitivity:60-80%
-DNA: greater than 90% DNA is also 99% specific |
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Pts with G that have C?
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45%
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Most common STD
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chlamydia
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epididymitis in males less than 35 without discharge most likely dx?
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Chlyamydial
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Treatment for Gon in pt allergic to standard med
-what if pregnant? |
-Cefixime 400mg PO single dose
Quinolones: Cipro 500mg PO single dose -high resistance in MSM -contraindicated in pregnancy and children -several areas in country and also Asia areas where this should never be given as high resistance Spectinomycin 2gms IM (Mn -Pt pregnant and can't take ceftriaxone |
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admit or dc gon conjunjuntivitis?
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dc
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Syphilis
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Cause
-Treponema pallidum: spirochete -sex -congenital -blood transfusion Presentation -Primary Syphilis: papule at site of inoculation >>>painless idurated ulcer (present for 3-6 weeks); can also have inguinal lymphadenopathy called buboes during primary phase that develops 4 weeks after presentation -Secondary Syphilis: Constitutional signs and symptoms and a rash on palms and soles (red) appearing 4-8 weeks after chancre -Tertiary: after latent period of several years; cardiovascular and neurologic disorders such as thoracic aneursm, dementia and tabes dorsalis Dx -Scraping from chancre examined under dark field microscopy shows corkscrew like treponemes -Serologic tests often negative during primary syphilis....will be positve during secondary Rx (primary, secondary and early latent -Penicillin G 2.4 million units IM -if allergic Doxycycline 100mg PO bid for 14 days -if allergic and pregnant: Ceftriaxone 1gm IM/IV qd for 8-10 days (Cardio syphilis) -PCN G dose above 1x weekly for 3 weeks -Doxycycline dose above for 4 weeks (Neuro syphilis) -Aqueous crystalline PCN G 3-4 million units IV q4 x 10-14 days -Procaine PCN G 2.4 million units IM plus probenecid 500mg PO qid for 10-14 days -allergic pts require desensitization or ceftriaxone 2gm qd x 10-14 days |
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syphilis rash vs rocky mountain spotted fever rash
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syphilis: erythematous macules , papules or plaques
RMSF: fine pink (not red) interspersed with macules can differentiate by VDRL or RPR |
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what to consider in HIV pt with neuro complaint
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neurosyphilis
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Jarisch Herxheimer reaction
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-1-2 hours after abx therapy started and treated with antipyretics and bedrest
-fever, headache, myalgias, rash intensification |
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name for rash that can occur after medication for rash?
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Jarisch Herxheimer reaction
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Chancroid
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Cause:
-Hemophilus ducreyi -Gram negative from sexual contact Presentation -small papule that breaks down into 1 or more painful chancres -Pain triad: painful necrotic chancre, painful urination; painful inguinal lymphadenopathy associated with tissue destruction, bubo formation with rupture Dx -gram stain and culture from inguinal bubo: will show school of fish on gram stain.....short, gram negative bacilli in a linear or parallel formation -positive culture confirms; negative culture does not exclude dx Rx -Azithromycin 1gm orally in a single dose -Ceftriaxone 250mg IM single dose |
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Lymphogranuloma Venereum
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Cause
-Chlamydia trachomatis Presentation -usually unilateral -tenderness inguinal or femoral lymphadenopathy -men 20-40 years -small painless vesicle or ulcer appears 3-21 days after exposure>>>>>after this localized tender lymphadenopathy develops>>>>if nodes enlarge or ulcerate constitutional symptoms can occur -groove sign above and below inguinal ligament Dx -LGV complement fixation test -culture -leukocytes with intracellular inclusion bodies from aspirates of infected tissues as many centers don't have above 2 technologies Rx -asap without waiting for lab confirmation -Doxycycline 100mg PO bid x 3 weeks -Erythromycin 500mg orally qid x 3 weeks if pregnant |
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Trichomoniasis
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Cause
-Trichomonas vaginalis -sex Presentation -malodorous, itchy, vaginal discharge that is frothy or foamy -discharge is yellow or gray-green -Vaginal mucosa and cervix have a stippled punctate strawberry appearance -Vaginal pH is 5.5 Dx -wet mount with visualization of motile trichomonads...pear shaped and several flagella -culture more sensative Rx -Flagyl 2gm single dose or 500mg x7days -if rx failure use 2gms po qd for 3-5 days |
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vaginal PH in trich
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5.5
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avoid pts being treated with flagyl to avoid what?
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avoid alcohol as can have antabuse rxn (flushing, headache, nausea, vomiting, palpitations and abdominal discomfort)
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Granuloma Inguinale
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Cause
-Klebsiella granulomatis -also known as Donovanosis Presentation -painless papule/vesicle -Beefy red/velvety ulcers with rolled border on the genital and or anal regions -subcutaneous granulomas in inguinal nodes over next few months -tissue destruction that can lead to Squamous cell carcinoma Dx -biopsy -Donovan bodies: monocytes engulfing clusters of organisms that resemble microscopic safety pins Rx -Bactrim DS bid for 3 weeks or -Doxycycline 100mg bid for 3 weeks or -Erythromycin 500mg orally qid or -Azithromycin 1g orally x 3 weeks |
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Dispo for AIDS
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consult ID
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years when pts at largest risk for getting HIV from blood transfusions
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1978-1985
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screening and confirming HIV
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screening: ELISA
confirming: Western blot |
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PCP
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Causes
-Pneumocystis jirovecii -Aids illness less than 200 Presentation -Fever, nonproductive cough, -little to no findings on chest exam Dx -ABGS: early will have mild hypoxemia with PO2 of 70-90 and later disease will have progressive hypoxemia with respiratory alkalosis -CXR: early will have no findings; later will have bilateral interstitial infiltrates (not always symetric and not always bilateral) -sputum gram stain:60% sensitive -Bronchoscopy: 90% sensitive with BAL -Gallium lung scan: can show parenchymal disease, but is nonspecific Rx -O2 and fluids as needed -Bactrim or Pentamidine -Corticosteroids if pO2 less than 70 or A-a gradiant is greater than 35 |
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Cryptococcal meningitis
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Cause
-Hiv: most common cause of meningitis in HIV pts -less than 50 Presentation -Fever, HA, photophobia, seizures, cranial nerve palsies Dx -CT scan first to exclude intracranial mass -CT negative then do an LP with usual studies, but also add India ink prep and/or fungal cultures -Cryptococcal antigen titer (can be sent from LP, but serum actually has highest sensitivity) Rx -Amphotericin B with or without flucytosine -ID consult |
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CNS toxoplasmosis
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Cause
-less than 100 Presentation -Fever, HA, focal neuro signs (most common cause of focal findings in HIV pts), AMS, seizures Dx -CT w/ contrast: shows ring enhancing lesions (signet ring sign) -MRI: lesions in basal ganglia are suspective -Brain biopsy if CT and MRI are negative Rx -Pyrimethamine and Sulfadiazine -Folinic acid (reduces risk or hematologic toxicity |
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Kapsi's Sarcoma
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Cause
-aids -HHV8 Presentation -most common cancer in aids pts -second most common opportunistic infection -reddish brown or bluish red subcutaneous nodules commonly found on the face, genitalia and feet -painless, non-pruritic with spongy texture from several millimeters to several centimeters Rx: -Oncology consult |
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Candidiasis Oral
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Cause
-cd4 less than 400 -also called thrush Presentation -sore or dry mouth and examinatinon reveals raised white lacy plaques on the tongue and buccal mucosa Dx -KOH prep Rx -Clotrimazole troches or nystatin suspension |
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painful swallowing in HIV pt
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-suggestive of candidal esophagitis which if present confirms dx of AIDS....endoscopic verification should be obtained
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dermatomal rash in hiv pts
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-think shingles
-Rx is Acyclovir |
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CMV retinitis
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Cause
-HIV -CD4 less than 50 Presentation -most common ocular complaint in HIV and if not treated can cause blindness Rx -Foscarnet or ganciclovir |
