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50 Cards in this Set
- Front
- Back
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What are the 5 P's to ask a patient being evaluated for an STD?
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Partners
Prevention of Pregnancy Protection from STD's Practices Past history of STDs |
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What are the main prevention methods to counsel all patients with STDs?
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Prevention =
Reduction in sex partners Vaccinations Condoms Emergency Contraception Post-exposure prophylaxis for HIV |
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What are the main prevention/control methods to counsel all patients with STDs?
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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. |
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What are the main methods of managing sex partners?
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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 |
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What do you want to counsel every patient with STD?
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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 |
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Describe the treatment of Gonorrhea (Drugs, Doses, Frequencies, Durations)
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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 |
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What do you do if the patient has a PCN allergy?
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Desensitize them?
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If Gonorrhea is suspected, what treatment would you add?
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Uncomplicated Chlamydia --> Azithromycin 1g PO once
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What are the side effects of Ceftriaxone? (7)
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Injection site reaction
Diarrhea Rash Eosinophilia/Thrombocytosis/Leukopenia Hemolytic Anemia Increased Transaminase Biliary Obstruction |
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What are the side effects of Cefixime? (7)
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Diarrhea
Nausea Abdominal Pain Dyspepsia Flatulence Pruritis Rash |
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How do you want to monitor Gonorrhea?
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You re-evaluate only if symptoms persist or recur utilizing a culture and sensitivity testing
No need to test for cure |
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How is Chlamydia treated?
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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 |
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What are the side effects of Azithromycin?
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NVD, HA, Abdominal Pain
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What are the side effects of Doxycycline?
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GI upset, Photosensitivity
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How do you monitor for Chlamydia?
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Re-evaluate if symptoms persist or recur
Test of cure no necessary |
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What is special to counsel the patient on in Chlamydia?
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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 |
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Describe the clinical presentation in primary syphilis.
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single painless chancre that resolves spontaneously
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Describe the clinical presentation of secondary syphilis.
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Systemic spread leading to diffuse rash, flu-like symptoms that resolves with or without treatment
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Describe the clinical presentation of tertiary syphilis.
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Gummas
CV Involvement CVS Involvement --> Neurosyphilis |
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Describe the goals of treatment in primary, secondary, tertiary and neurosyphilis.
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1/2/3 syphilis --> Clinical resolution, Prevent sequelae, Eradicate organism
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Describe the goals of treatment in Latent syphilis.
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Prevent sequelae
4-fold decrease in quantitative, non-treponemal titers over 6 months |
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Describe the goals of treatment in Neurosyphilis.
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Decrease neurologic manifestations
Decrease vascular lesions Decrease CSF WBC's or protein levels |
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What tests are used in the diagnosis of syphilis?
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Dark-field microscopic exam
or Serologic testing |
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Describe the different serologic tests.
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Non-specific antibody tests - Quantitative screening tool (VDRL, RPR)
Specific antibody tests - Qualitative confirmatory test (FTA-ABS, TP-PA) |
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What is the preferred treatment for 1/2 syphilis?
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Benzathine Penicillin G 2.4 million units IM once
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What is the preferred treatment in HIV patients that present with HIV?
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Benzathine Penicillin G 2.4 million units IM once/week x 3 weeks
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What is the preferred treatment in PCN allergic patients that present with 1/2 syphilis?
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Azithromycin 2g PO once
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What is the course of action in pregnant patients that present with syphilis and a PCN allergy?
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Desensitize the patient, then give the Penicillin
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What is the preferred therapy for a patient with latent(early) syphilis? Latent (late)?
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Benzathine Penicillin G 2.4 million units IM once
Benzathine Penicillin G 2.4 million units IM once/week x 3 weeks |
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What is the preferred therapy in a Latent (early) patient with a PCN allergy? Latent (late)?
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Azithromycin 2g PO once
Doxycycline 100 mg PO Bid x 28 days |
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What is the preferred treatment in a patient with tertiary syphilis?
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Benzathine Penicillin G 2.4 million units IM weekly x 3 weeks
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What is the preferred treatment in a patient with tertiary syphilis and a PCN allergy?
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Doxycycline 100 mg PO Bid x 28 days
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What are the side effects of Benzathine Penicillin G?
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Rash
Urticaria N/V Eosinophilia Fatigue Fever Confusion/Somnolence Jarish-Herxheimer reaction (acute fever, HA, myalgia, chills in first 24 hours) |
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What are the side effects of Azithromycin?
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N/V/D, HA, Abdominal Pain
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What are the side effects of Doxycycline?
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GI upset
Photosensitivity |
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What is the preferred therapy in Neurosyphilis?
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Aqueous crystalline Penicillin G 24 million units/day Continuous Infusion
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What unique counseling points do you want to include in syphilis?
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Abstain from sex until lesions heal
Plan for Lab-followup Jarisch-Herxheimer Reaction Use caution in tasks that require alertness |
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Describe how you would evaluate outcomes in syphilis.
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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 |
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Continuation of previous answer
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Tertiary syphilis - varies, recommend ID specialist
Neurosyphilis - CSF exam every 6 months until cell count is normal |
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How do you designate treatment failure?
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If symptoms persist, recur or worsen, there is a 4-fold increase in non-treponemal test titer
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What are the treatment goals in Herpes?
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Relieve symptoms
Shorten clinical course Prevent complications/recurrence Decrease disease transmission |
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List 4 supportive care measures you can take in herpes.
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Warm saline baths
Analgesics Antipyretics Good Genital Hygeine |
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How do you treat a first episode of Herpes?
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Valacyclovir 1g PO Bid x 10 days
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Describe episodic vs suppressive therapy.
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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 |
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Continuation of previous answer
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Suppressive Therapy = Continuous, reduces frequency in those with frequent occurrences (>6/year)
Treatment = Valacyclovir 1 g PO daily |
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What are the side effects of Valacyclovir?
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Increase Transaminases
Nasopharyngitis Depression Renal Impairment Rash N/V, HA Abdominal Pain Fatigue |
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How do you want to counsel on Herpes?
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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 |
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What are the recommended regimens to treat Trichomoniasis?
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Metronidazole 2g PO once
Tinidazole 2g PO once |
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What are the side effects of metronidazole?
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Anorexia
NVD Bitter metallic taste Dizziness/HA Vaginal Candida Infection Vaginal Discharge |
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What is unique to counsel in these patients?
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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 |
