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ID exam 2
STI BECK
| Question | Answer |
|---|---|
| Gonorrhea Bacterium? What kind of Gram (-) | Neisseria gonorrhoeae -Gram (-) diplococci |
| Transmission of Gonorrhea can occur via? | sexual contact with penis, vagina, mouth or anus of an infected partner; Perinatally from mother to baby during childbirth |
| S/sx of Gonorrhea in men and women include? | Men: dysuria, white/yellow/green penile discharge, painful swollen testicles Women: dysuria, increased vaginal discharge, vaginal bleeding b/w menstrual bleeding |
| Who gets screened for Gonorrhea? | -All sexually active femails <25 yo -Older women who are at risk (new sex partner, more than 1 sex partner, or sex partner with sexually transmitted infection) |
| Gonorrhea treatment: For uncomplicated gonococcal infection of the cervix, uretra, pharynx, and/or rectum, Ceftriaxone is drug of choice: Doses are: | If < 150 kg: Ceftriaxone 500 mg IM x1 dose If > 150 kg: Ceftriaxaone 1000 mg IM x1 dose |
| Who is Gonorrhea's best friend? | Chlamydia |
| If Chlamydial co-infection CAN-NOT be EXCLUDED, what drug therapy on top of the Ceftriaxone needs to be give? what dose? | ADD doxycycline 100 mg PO BID x 7 days (or azithromycin 1g PO once if pt is PREGNANT) |
| What are Gonorrhea treatment alternatives if Ceftriaxone is not available? What is the PREFERRED option? | Preferred option: Gentamicin 240 mg IM x1 dose + Azithromycin 2000 mg PO x1dose Non-preferred: Cefixime ^1,2 800 mg PO x1dose |
| The non preferred alternative treatment option for Gonorrhea is Cefixime 800 mg PO x1dose. What should we know and consider about it? | Considered alternative due to lower bactericidal blood levels as a 500 mg IM dose of ceftriaxone; Limited efficacy for pharyngeal gonorrhea |
| For pts with IgE PCN allergy considerations, we will not dispense _____ or ______ and instead give the Genatmicin 250 mg IM in a single dose and Azithromycin 2000 mg PO x 1 dose | cetriaxone or Cefixime |
| For pts with Gonococcal infection of pharynx you need to: | Consult infectious disease specialst for alternative treatment *Beck: "Very hard to get rid of Gonorrhea in the throat, consult ID |
| What are consulting points that you need to tell your pt with gonorrohea treatment? | -All pts should be told to abstain from sex for 7 days after tx and until ALL PARTNERS are treated |
| Counseling point for gonorrhea treatment: If symptomatic, must practice ________ until symptoms resolve; Test for other STIs (HIV, Chlamydia, etc, If HIV negative--> consider offering ____ | abstinence; PrEP |
| Pt follow-up to Gonorrohea treatment: For urogenital or rectal gonorrhea--> No test or cure is ______ | Necessary |
| (Gonorrhea) Pharyngeal infection: culture or NAAT test of cure __-__ days after completing treatment | 7-14 days |
| Gonorrhea--> Retest after treatment ________ if they believe parter was treated | REGARDLESS |
| Critera for Gonorrhea Treatment Failure. Symptoms do not resolve __=__ days after tx and no sex contact during post-tx follow up period; Positive test culture > __ hours or + NAAT > __ days after completeing recommended tx w/ no sex during post-treatment period | 3-5 days; 72 hours |
| Consider ______ _______ (Gonorrhea) for persons w/ (+) culture w/ evidence of decreased susceptibility to Cephalosporin on susceptibility test (regardless of sexual contact during post-tx follow up period | treatment failure |
| Action item (Gonorrhea) ______ all isolates suspected to be treatment failures to the ____ for susceptibility testing | REPORT; CDC |
| New drugs in the pipeline for Super Gonorrhea include: Other tx for super gonorrhea? | Zoliflodacin; Gepotidacin -DoxyPEP |
| Key points: Drug resistance gonorrhea is becoming more______; remember tx options: ______ monotherapy unless chlamydia co-infection can not be ruled out. | Prevalent; Ceftriaxone |
| (Gonorrhea) _______ more likely than treatment failure but if ______ persist after treatment, take cultures and test for susceptibilities | Reinfection; symptoms |
| Syphilis is a ________ from the bacterium Treponema pallidum | Spirochete |
| Transmission of Syphilis occurs when mucocutaneous syphilitic ________ are present | lesions |
| Transmission can come from sex via direct contact of _______ as well as through mother to baby during child ________ | ulcer; delivery |
| Who should be screened for Syphilis? | -All pregnant women at first prenatal appt (retest at 28 weeks gestation if high risk pt) -MSM (men who have sex with men) annually -Asymptomatic men or women <29 yo that are high risk |
| What are the stages of Syphilis? | -Primary (lesions on genitalia) -Secondary (going systemic--> spots on hand and soles of feet) -Tertiary (deeper into the skin, form Goomas onto organs) -Latent (Quiet) -Neurosyphilis (syphilis in the brain, get into eyes affecting vision) |
| What is my gold standard treatment option for Syphilis? Brand name? | Parenteral Penicillin G (contains Benzathine) Bycillin LA *Benzathine Penicillin (generic) |
| Which brand name should we reject during verification because it doesnt contain enough dose needed to wipe out syphilis? | Bicillin C-R *Salt formation matters |
| Who gets treated for syphilis? | -PREGNANT WOMEN -People who had sexual contact with a person who received diagnosis of primary, secondary, or early latent syphilis |
| During a drug shortage, who gets top preference for treatment? Why is there a shortage? | PREGNANT WOMEN; Pfizer cant keep up with demand of Bycillin LA (*thank you stewardship programs) |
| when a pt gets reaction to the Bycillin-LA, do we write it down in their chart as an allergy? | No, its not a Penicillin allergy. Its known as a Jarish-Herxheimer Reaction |
| What should you tell your pt when taking this injection of elmer's glue (Penicillin G) | -They will feel like garbage; worst flu of their life; warn pts of the rxn (Jarish-Herxheimer rxn) -Might induce early labor or cause fetal distress in pregnant women but this should not prevent or delay therapy |
| How can symptoms of the Jarish Herxeimer rxn be managed? | Antipyretics can be used to manage symptoms but are not proven to efficacious in preventing rxn. |
| Treatment for Syphilis and follow up period? | Benzathine Penicillin G (2.4 million units IM in a single dose) Follow up: within 6-12 months after treatment |
| Treatment failure in syphilis can more likely occur due to? | reinfection, or Failure of nontreponemal test titers to decrease 4 fold w/in 12 months after therapy might be indicative of tx failure |
| What are my alternatives for a Pen allergy? (Syphilis Treatment) | -Doxycycline 100 mg PO BID x 14 days (not for pregnancy) OR -Tetracycline 500 mg PO QID x14 days -Ceftriaxone 1 g IM/IV daily for 10 days (admitted only for neuro syphilis, would otherwise be treated out-pt) -Azithromycin 2g PO single dose (there is resistance and may not work in curing syphilis |
| If a pregnant pt has a PCN allergy and we want to give them the best option we can and not an alternative, what do we do? | DESENSITIZE pt to PCN (micro-doses of PCN but not enough to get anaphylaxis and eventually give pt the full dose) |
| Pt comes in with latent symptoms of Syphilis. What is latency? Is it transmissible during this period? Tx options? | characterized by seroactivity w/o evidence of primary, secondary, or tertiary syphilis; acquired during last 12 months; not transmitted sexually so purpose is to prevent complications of syphilis; Tx doesnt change (Pen G 2.4 million units IM x1 dose) |
| Early latent Syphilis tx is 2.4 million units IM in a _______ dose. Late or syphilis of unknown duration gets a total of ____ million units in a span of 3 weeks. | single; 7.2 |
| Follow up period for latent syphilis treatment follows a _________ nontreponemal serological test repeated at months __, ___, ___ months | Quantitative; 6, 12,24 |
| In Late latent dosing there is _______ ________ on what to do. Clinicians indicate that an interval of __-___ days b/w doses of benzathine Penicillin before RESTARTING the sequence | limited evidence; 10-14 |
| If a pt waits more than 14 days (i.e. day 15) and comes in for their next dose, do they get the dose or restart? | RESTART the 3 star shot series |
| What is the time interval for pregnant women during Late Latent syphilis? | Time window between doses is 9 days. If they wait more than 9 days b/w shots, they must repeat the full course |
| For late latent syphilis (perhaps a year ago) treatment is extended from 14 days to 28 days for which meds? (*due to a PEN allergy) | Doxycycline 100 mg PO BID x28 days Tetracycline 500 mg PO QID x28 days |
| What is the treatment dosing for Tertiary Syphilis? | Must have "normal" CSF examination (so no Goomas in brain) -Benzathine Penicillin G 7.2 million units total, administered as 2.4 million units IM as 3 doses once a week) |
| Ok, so Goomas are in my brain and syphilis is rampant in my body, this is known as _______ | Neurosyphilis |
| What are my treatment options for Neurosyphilis? | Aqueous crystalline pen G 18-24 million units per day adminsitered 3-4 million unts IV Q4h or continueous infusion for 10-14 days |
| Neurosyphilis for PCN allergy treatment option is? | Ceftriaxaone 1-2g IM/IV daily for 10 days |
| What is my follow up time after Neurosyphilis treatment? | If CSF (+) initially--> CSF examination repeated every 6 months until cell count is normal |
| What if the treatment for neurosyphilis didn't work? should the treatment be repeated? | "Re-treat" if cell count is not decreased after 6 months or if CSD cell count or protein not normal after 2 years |
| What is Chlamydia? | Obligate intracellular parasite from the bacterium Chlamydia trachomatis |
| how does a pt get diagnosed with chlamydia? | urethra swab or first void urine |
| What symptoms occur among men and women? | usually asymptomatic Men: dysuria, penile discharge Women: dysuria, vaginal discharge |
| Chlamydia complications include: | PID, ectopic pregnancy, and infertility |
| Who gets screened for Chlamydia? | sexually active women < 25 yo; older women at high risk of infection |
| What are the treatment goals of Chlamydia? | -Prevent adverse reproductive health complications and continued sexual transmission -Treating Sex partners -Prevent reinfection -Prevent transmission to baby during birth |
| What is the recommended tx option for Chlamydia? | Doxycyline 100 mg PO BID for 7 days |
| What is the alternative tx option for Chlamydia? | Azithromycin 1000 mg PO x 1 dose OR Levofloxacin 500 mg PO daily for 7 days |
| What does a pt need to hear while on the Chlamydia treatment? | Abstain from sexual activity for 7 days after single dose therapy or until completion of 7 day regimen and resolution of symptoms (if present) |
| When should a pt re-test for cure status? | Test of cure not recommended (repeat testing 3-4 weeks after completing therapy) unless symptoms still persist or re-infection is suspected |
| According to BECK, if your pt is pregnant what drug and dose is recomennded? Is there an alternative? | Azithromycin 1g PO as a single dose (Recommended) Amoxicillin 500 mg PO TID for 7 days (Alternative) |
| What are the key points that Beck wanted us to know about Syphilis? | pts will usually be asymptomatic but should screen <25 yo sexually active females annually -1st line tx: doxycycline 100 mg PO x 7days |
| What is my STI PEP option? (Prevent Bacterial STIs Post Exposure) | Bacterial STI POST-EXPOSURE -Doxycycline 200 mg PO x 1 w/in 72 hours of exposure |
| Who gets STI PEP? | gay, bisexual, MSM, trans women w/ history of bacterial STI (especially syphilis, gonorrhea, and chlamydia) during last 12 months |
| Bacterial Vaginosis comes from _______ bacteria. *not necessarily an STI | anaerobic |
| List the species of anaerobic bacteria that can cause Bacterial vaginosis | G. vaginals; Provotella species; Mobiluncas species; A. Vaginae |
| How does one get diagnosed with Bacterial Vaginalis? | Nugent score or Amsel Diagnostic criteria: -homogenous discharge -Clue cells (epithelial cells studded with adherent bacteria) -pH of vaginal fluid >4.5 - (+) WHIFF TEST |
| What is the main diagnosis for Bacterial Vaginosis to get seen? | (+) WHIFF TEST |
| What symptoms would an individual experience when dealing with bacterial vaginosis? | vaginal discharge, itching, burning, or ODOR |
| Give me the risk factors for Bacterial vaginosis | Non-monogamous relationship, new sex partner, lack of condom use, douching, and HSV infection |
| What are my first line preferred treatment options for bacterial vaginosis? | -Metronidazole 500 mg PO BID for 7 days -Metronidazole gel 0.75% --> 1 applicatorful (5g) Intravaginally daily for 5 days -Clindamycin cream 2%--> 1 applicatorful (5g) intravaginally QHS for 7 days |
| What are my Alternative treatment options for bacterial vaginosis? | -Clindamycin 300 mg PO BID for 7 days -Clindamycin ovules 100 mg intravaginally QHS for 3 days -Secnidazole 2g PO daily x 1dose -Tinidazole 2g daily x2days -Tinidazole 1g daily x5days |
| What are my counseling points for pt taking metronidazole for bacterial vaginosis? | NO ALCOHOL during treatment |
| If a pt drinks alcohol while taking metronidazole, what side effects should they be told about? | Metronidazole has to be absorbed systemically. if pt drinks, they will get the disulfiram rxn (get violently ill) |
| What are my counseling points for pt taking Clindamycin for bacterial vaginosis? | Cream/ovules formulation: oil based and may weaken latex condoms and diaphragm for 5 days after use so back up with contraception if engaging in sexual activity; Other side effects would be diarrhea with PO option |
| What is the box warning with PO Clindamycin? | Box warning--> C. Diff diarrhea, pt will get diarrhea even if they dont have C.Diff. (the longer you take it, the more diarrhea you get) |
| What are my counseling points for pt taking Secnidazole for bacterial vaginosis? | Medication comes in granules that can be sprinkled into unsweetened applesauce, yogurt or pudding before ingestion. Make sure pt does not chew or break up the granules |
| Encourage pt to _____ from sexual activity during treatment | abstain |
| What is the Jarish-Hexheimer reaction? | Acute febrile reaction accompanied by headache, myalgia, fever within 24 hours of treatment |
Created by:
Xander635
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