Therapeutics ID Gable Flashcard

STI Risk Factors

  • Age: teens – 20
  • # of sexual partners
  • Prostitution
  • Illicit drug use
  • Sexual preference

Uncomplicated Gonorrhea: Clinical Presentation

  • Urethral infection — dysuria and urinary frequency, purulent discharge
  • Anorectal infection — severe rectal, pruritus, bleeding
  • Pharyngeal infection — mild pharyngitis
  • Abnormal vaginal discharge, uterine bleeding

 

Complicated Gonorrhea: Clinical Presentation

Pelvic Inflammatory Disease

Disseminated gonorrhea

 

Uncomplicated Gonorrhea Treatment: w/o allergies to beta-lactam

Ceftriaxone 125 mg IM x 1 dose

OR

Cefixime 400 mg PO x 1 dose

+

Azithromycin 1 g x 1 dose

Uncomplicated Gonorrhea Treatment: With allergies to beta-lactam

Azithromycin 2 g PO x 1 dose (emerging resistance)

 

Complicated Gonorrhea Treatment: Disseminated
Ceftriaxone IV or IM until improvement begins, then Ceftriaxone PO regimen x 7 days
Complicated Gonorrhea Treatment: Pregnancy

Cephalosporin

OR

Azithromycin

Primary Syphilis: Clinical Presentation

Incubation

10-90 days

 

Site of infection

External genitalia, perianal region, mouth, throat

 

Signs/Symptoms

Chancre sore, regional lymphadenopathy

Secondary Syphilis: Clinical Presentation

Incubation

2-8 weeks


Site of Infection

Multisystem involvement


Signs/Symptoms

Pruritic or nonpruritic rash, mucocutaneous lesion, flu-like symptoms

Latent Syphilis: Clinical Presentation

Incubation

4-10 weeks (after secondary)

 

Site of Infection

Multisystem involvement (dormant)

 

Signs/Symptoms

Asymptomatic

Tertiary Syphilis: Clinical Presentation

Incubation

10-30 years

 

Site of Infection

CNS, heart, eyes, bones, joints

 

Signs/Symptoms

Cardiovascular syphilis, gumma lesions present, neurosyphilis

Primary Syphilis: Treatment/Follow up

Benzathine PCN G IM

 

RPR at 6 and 12 months

Secondary Syphilis: Treatment/Follow up

Benzathine PCN G IM

 

RPR at 6 and 12 months

Early Latent Syphilis: Treatment/Follow up

Benzathine PCN G IM

 

RPR at 6 and 12 months

Late Latent Syphilis: Treatment/Follow up

Benzathine PCN G IM weekly x 3 weeks

 

OR

 

Aqueous crystalline PCN G IV infusion x 10-14 days

 

RPR at 6, 12, and 24 months

Neurosyphilis: Treatment/Follow up

Benzathine PCN G IM weekly x 3 weeks

 

OR

 

Aqueous crystalline PCN G IV infusion x 10-14 days

 

CSF examination q 6 months until clear

Jarisch-Herxheimer Reaction

  • Acute febrile reaction of unknown MOA
  • NOT an allergic reaction
  • Flu-like symptoms: HA, myalgias, tachypnea, malaise
  • Develops 2-24 hrs post PCN dose
  • Tx: antipyretics, analgesics, and rest

Primary Syphilis Treatment: PCN Allergic Patients

Doxycycline

OR

Tetracycline

OR

Ceftriaxone

Secondary Syphilis Treatment: PCN Allergic Patients

Doxycycline

OR

Tetracycline

OR

Ceftriaxone

Early Latent Syphilis Treatment: PCN Allergic Patients

Doxycycline

OR

Tetracycline

OR

Ceftriaxone

Late Latent or Unknown Duration Syphilis Treatment: PCN Allergic Patients

Doxycycline

OR

Tetracycline

OR

Ceftriaxone

Uncomplicated Chlamydia: Clinical Presentations

  • Usually asymptomatic
  • Urethral discharge (watery)
  • Abnormal vaginal discharge
  • Dysuria
  • Mild pharyngitis

Complicated Chlamydia: Clinical Presentations

PID

Infertility

Reiter Syndrome

Uncomplicated Chlamydia: Treatment

Azithromycin 1 g PO x 1 dose

OR

Doxycycline 100 mg PO BID x 7 days

 

Abstain from sexual intercourse x 7 days post treatment

Pelvic Inflammatory Disease: Risk Factors

Young Age

Use of IUD

Poor socioeconomic status

Pelvic Inflammatory Disease: Clinical Presentations

Results from untreated chlamydia or untreated gonorrhea

  • Pelvic pain
  • Lower abdominal tenderness
  • Cervical motion tenderness
  • Oral Temp > 101 F
  • Abdominal Cervical / Vaginal Discharge
  • Elevated erythrocyte sedimentation rate
  • Elevated C reactive protein
  • LAb verification of Chlamydia or Gonorrhea

 

Pelvic Inflammatory Disease: Treatment

PO Outpatient Regimens

 

Ofloxacin x 14 days

OR

Levofloxacin x 14 days

 

+


Metronidazole x 14 days

 

OR

 

Ceftriaxone x 1 dose

+

Doxycycline x 14 days

 

Parenteral Inpatient Regimen

 

Cefoxitin IV + Doxycycline IV

HSV Cycle

  1. Primary mucocutaneous infection
  2. Infection of the ganglia
  3. Establishment of latency
  4. Reactivation (through physical/emotional stress)
  5. Recurrent infection

Genital Herpes: Clinical Presentation

  • Asymptomatic (primary infection)
  • Prodrome: mild burning, itching, tingling
  • Multiple painful pustular or ulcerative lesions (usually heal in 2-4 weeks)
  • Flu-like symptoms (fever, HA, malaise)

Genital Herpes: Treatment of First Clinical Episode

Palliative (not curative)

 

 

Acyclovir x 7-10 days

OR

Famciclovir x 7-10 days

OR

Valacyclovir x 7-10 days

 

Genital Herpes: Treatment of Recurrent Infections

Chronic Suppressive Tx (> 6 episodes/year):

 

Acyclovir

OR

Famciclovir

OR

Valacyclovir

Genital Herpes: Episodic Treatment

Acyclovir 400 mg PO TID x 5 days

OR

Acyclovir 800 mg PO BID x 5 days

OR

Acyclovir 800 mg PO TID x 2 days

OR

Famciclovir 125 mg PO TID x 5 days

OR

Valacyclovir 500 mg PO BID x 5 days

OR

Valacyclovir 1 g PO QD x 5 days

Genital Herpes: Resistance to 1st Line Antivirals
Foscarnet
Herpes Antivirals: MOA, AEs

MOA

  • Inhibit DNA synthesis and viral replication of herpes virals
  • Only active against replicating virus

AE

Famciclovir: N/D, HA, fever, dizziness fatigue

Valacyclovir: N/V/D, HA, abdominal pain, dizziness

Acyclovir: N/V/D, HA, lethargy, dizziness, rash, nephrotoxicity

Uncomplicated Trichomoniasis: Clinical Presentation

Females:

Scant to copious, malodorous vaginal discharge

Pruritis

 

Males:

Often asymptomatic

Urethral discharge (clear to mucopurulent)

Complicated Trichomoniasis: Clinical Presentation

  • PID
  • Premature labor
  • Infertility (male and female)
  • Cervical neoplasia

Trichomoniasis: Treatment

Metronidazole 2 g PO x 1 dose

OR

500 mg Po BID x 7 days

 

OR

 

Tinidazole 2 g PO x 1 dose

Metronidazole: Counseling, AE, CI

  • May take with food to decrease GI upset
  • Use 7 day course in those with severe GI complaints
  • Treat sexual partners simultaneously

AE

  • N/V/D
  • Abdominal pain
  • HA
  • Dizziness
  • Dry mouth
  • Metallic taste

 

Avoid EtOH:

  • During treatment and 3 days post completion of therapy
  • Can Cause Disulfiram-Like Rxn: N/V, HA, flushing, abdominal cramps

Tinidazole: Uses, AE

  • Consider with metronidazole-resistant trichomoniasis
  • Better tolerated than metronidazole

AE

  • Nausea
  • Dyspepsia
  • Metallic/bitter taste

 

Avoid EtOH:

  • During treatment and 3 days post completion of therapy
  • Can Cause Disulfiram-Like Rxn: N/V, HA, flushing, abdominal cramps

Human Papillomavirus 6 is associated with:
Development of genital warts
Human Papillomavirus 11 is associated with:
Development of genital warts
Human Papillomavirus 16 is associated with:
Increased risk of cervical neoplasia
Human Papillomavirus 18 is associated with:
Increased risk of cervical neoplasia
HPV: Treatments

Cryotherapy with liquid nitrogen or surgical removal for external warts

 

Patient Applied Therapy:

Podofilox sol’n or gel

Imiquimod cream

Gardasil: Uses

  • HPV Vaccine
  • Marketed for females (9-26 yrs)
  • Stimulates antibody protection against 4 types of HPV (6, 11, 16, 18)

;

Gardasil: AE

  • Injection site reactions (pain and swelling)
  • HA, fever, fatigue
  • Fainting
  • VTE: risk factors include concurrent OC uses, genetic predisposition to blood clots
  • Not recommended in pregnant patients

Expedited Partner Therapy

  • Eligible patients: lab evaluation indicates + Chlamydia or Gonorrhea, sexual partner exposure within 60 days
  • Re-testing: 3 months after treatment
  • Treatment Recommendations:

Azithromycin

OR

Cefixime

Herpes Simplex Virus (HSV) – 1
Oropharyngeal disease
Herpes Simplex Virus (HSV) – 2
Genital disease

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