Term
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Definition
Caused by Neisseria gonorrhoeae (Gram-Neg cocci); Presentation (may be asymptomatic): Men - purulent discharge, painful/swollen testicles, pain during urination; - Women: cervicitis, urethritis, increased discharge, dysuria, abdominal pain; Complications: PID, disseminated dx, neonatal conjunctivitis; Diagnosis: Gram-stain, culture; |
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Term
General Principles of Treatment for Gonorrhea |
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Definition
Commonly co-infected w/ Chlamydia, should receive empiric therapy for both; - Fluoroquinolones (most resistance) & broad-spectrum cephalosporins (least resistance) have best activity; DO NOT USE fluoroquinolones in MSM, pts w/ recent foreign travel, or pts acquiring infections in CA or HA; |
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Term
Treatment of Uncomplicated cervical, urethral, or rectal gonorrhea infection |
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Definition
Ceftriaxone 125 mg IM x 1 dose OR cefixime 400 mg PO x 1 dose; - use fluoroquinolones ONLY if susceptability tests have been performed --> levofloxacin 250 mg PO x 1 dose or ciprofloxacin 500 mg PO x 1 dose; In pts who have MSM or recent travel: - ceftriaxone IM OR cefixime PO x 1 dose |
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Term
Treatment of Uncomplicated Gonorrhea Infection of Pharynx |
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Definition
ceftriaxone IM (preferred) or ciprofloxacin PO (requires susceptibility testing) |
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Term
Treatment of Gonorrhea in Pregnant Women |
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Definition
ceftriaxone IM (preferred) OR cefixime PO OR spectinomycin 2 g IM (not available in US); - CANNOT use FQ's |
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Term
Last line Treatment of Gonorrhea Infections |
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Definition
azithromycin 2 g PO x 1 dose (NOT effective in pharyngeal infections) - use if pts have allergy to cephalosporins &/or FQ resistance --> also covers Chlamydial infection |
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Term
Disseminated Gonococcal Infections |
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Definition
arthritis dermatitis syndrome: migratory polyarthralgia w/ or w/o tenosynovitis, maculopapular or pustular lesions; gonococcal arthritis of knee; meningitis or endocarditis (rare) |
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Term
Risk Factors for Disseminated Gonococcal Infection |
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Definition
complement deficiency; female sex (menses); pharyngeal infection; pregnancy; |
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Term
Treatment of Disseminated Gonococcal Infection |
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Definition
Ceftriaxone 1 g IM/IV q24 hrs OR cefotaxime 1 g IV q8 hrs (preferred drugs) OR levofloxacin 250 mg IV q24 hr OR spectinomycin 2 g IM q48 for at least 24-48 hrs; - continue for up to 7 days in pts w/ arthritis if possible; Follow with: cefixime 400 mg PO BID to complete 7 day course (use FQ's [cipro 500 mg BID or levofloxacin 500 mg qday] if susceptible) |
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Term
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Definition
gonococcal or chlamydial infection caused by transmission during passage through birth canal; Prophylaxis: erythromycin 0.5% ophthalmic ointment Neonates born to mothers w/ UNTREATED gonococcal infections --> ceftriaxone 50 mg/kg IV or IM x 1 dose |
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Term
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Definition
Caused by: Chlamydia trachomatis; Presentation: - asymptomatic, may develop S/Sx after 7-21 days; - Women: tender cervix, watery discharge - Men: watery discharge; Complications: epididymitis (men), PID (women), neonatal conjunctivitis or pneumonia, increased risk of HIV transmission; Diagnosis: culture, monoclonal antibody tests; ***ASSUME AND TX CONCOMITTANT GONOCOCCAL INFECTION*** |
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Term
Treatment of Uncomplicated Urethra, Endocervical, or Rectal Chlamydial Infection |
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Definition
PREFERRED: azithromycin 1 g PO x 1 dose - doxycycline 100 mg PO BID x 7 days (avoid in pregnancy); Alternative: erythromycin 500 mg QID or levofloxacin 500 mg qday x 7 days; ***ASSUME AND TX CONCOMITTANT GONOCOCCAL INFECTION*** |
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Term
Treatment of Chlamydial Infections in Pregnant Women |
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Definition
Azithromycin 1 g TID x 7 days OR amoxicillin 500 mg TID x 7 days; Alternative: erythromycin ***ASSUME AND TX CONCOMITTANT GONOCOCCAL INFECTION*** |
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Term
Pelvic Inflammatory Disease (PID) |
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Definition
Caused by C. trachomatis and N. gonorroeae; More common in women under age 25; Presentation (vague): - lower abdominal pain, malodorous vaginal discharge, abnormal bleeding, dysparenuia, dysuria, N/V/D, fever; Complications (severe): - ectopic pregnancy, infertility, tubo-ovarian abscess, chronic pelvic pain; Diagnosis (based on clinical presentation): - uterine tenderness, cervical motion tenderness, adnexal tenderness + temp >101 F, abnormal cervical or vaginal discharge, WMCs in vag secretions, elevated ESR or CRP |
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Term
Treatmnet for Pelvic Inflammatory Disease |
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Definition
IV (severe Sx): - cefotetan 2 g q12 hrs or cefoxitin 2 g q6 hrs + doxycycline 100 mg PO/IV q12 hrs; - clindamycin 900 mg q8 hr + gentamicin; - levofloxacin 500 mg q24 hr +/- metronidazole 500 mg q8hr; - ampicillin-sulbactam 3 g q6hr + doxycycline IV/PO; Oral (non-severe Sx): ceftriaxone 250 mg IM x 1 dose + doxycycline BID +/- metronidazole BID; - levofloxacin 500 mg qday +/- metronidazole 500 mg BID Generally Tx for 14 days |
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Term
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Definition
Caused by Treponema pallidum; **DETERMINE Sexual partners*** Diagnosis: - Nontreponemal (VDRL slide test, RPR card test) --> 1st line - Treponemal (FTA-ABS, ELISA, TPHA) --> used as confirmatory, more sensitive |
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Term
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Definition
appearance of chancre on cutaneous or mucocutaneous tissue; Develops 3 wks after exposure; Highly infectious; Heals spontaneously after 1-8 wks if untreated; Treatment: - benzathine penicillin G 2.4 MU IM x 1 dose (Bicillin L-A); ALternates: - doxycycline 100 mg PO BID or tetracycline 500 mg PO QID x 14 days (if allergic to PCNs); Follow-up (IMPORTANT): - quantitative nontreponemal testing q6 & 12 months |
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Term
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Definition
Mucocutaneous, nonpuritic rash (generalized or localized); Fever, fatigue, lymphadenopathy, anorexia; If untreated, disappears after 4-10 wks but lesions may recur at any time within 4 yrs; Treatment: - benzathine penicillin G 2.4 MU IM x 1 dose (Bicillin L-A); ALternates: - doxycycline 100 mg PO BID or tetracycline 500 mg PO QID x 14 days (if allergic to PCNs); Follow-up (IMPORTANT): - quantitative nontreponemal testing q6 & 12 months |
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Term
Jarisch-Herxheimer Reaction |
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Definition
benign, self-limiting flu-like rxn after tx for primary or secondary dx; - HA, fever, chills, malaise, arthralgia, tachycardia, aggravation of syphilitic lesions; **INDEPENDENT of Drug & dose used** - confused for PCN allergy; Begins after 2-4 hrs, peaks @ 8 hrs, resolves after 12-24 hrs; Symptomatic management |
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Term
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Definition
positive serologic test w/ no evidence of Dx; Early: <1 yr from onset of infection - potentially infectious; Treatment: - benzathine penicillin G 2.4 MU IM x 1 dose (Bicillin L-A); ALternates: - doxycycline 100 mg PO BID or tetracycline 500 mg PO QID x 14 days (if allergic to PCNs); Follow-up (IMPORTANT): - quantitative nontreponemal testing q6 & 12 months & FOLLOW-UP at 24 MONTHS; Late: >1 yr from onset - noninfectious - if untreated, most pts will have no other S/Sx (except for 25-30%); Treatment: - benzathine penicillin 2.4 MU IM q week x 3 doses; - Alternative: doxycycline or tetracycline PO x 28 days; Follow-up: serologic testing at 6,12, & 24 months; |
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Term
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Definition
develops 10-30 yrs after initial infection; May affect CNS, heart, eyes, bone, & joints; Tx & Monitoring: - benzathine penicillin G 2.4 MU IM x 1 dose (Bicillin L-A); ALternates: - doxycycline 100 mg PO BID or tetracycline 500 mg PO QID x 14 days (if allergic to PCNs); Follow-up (IMPORTANT): - quantitative nontreponemal testing q6 & 12 months & FOLLOW-UP at 24 MONTHS; Late: >1 yr from onset - noninfectious - if untreated, most pts will have no other S/Sx (except for 25-30%); Treatment: - benzathine penicillin 2.4 MU IM q week x 3 doses; - Alternative: doxycycline or tetracycline PO x 28 days; Follow-up: serologic testing at 6,12, & 24 months; |
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Term
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Definition
CSF abnormalities consistent w/ CNS infection --> perform lumbar puncture (LP); Most common in HIV-infected pts; Treatment: - aqueous crystalline penicillin G 18-24 MU IV (3-4 MU q4 hrs) x 10-14 days - OR procaine PCN G 2.4 MU IM daily + probenecid 500 mg PO QID x 10-14 days; - follow up w/ benzathine G 2.4 MU IM weekly x 1-3 wks; Follow-UP: - CSF exam q6 months until cell count near normal; Consider retreatment if not decreased at 6 months or normal at 2 yrs follow-up |
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Term
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Definition
fetus infected w/ T. pallidum due to hematogenous spread from infected mother or direct contact w/ genitalia; Can result in fetal death, prematurity or congenital dx (Sx occur anywhere from birth to adolescence); Diagnosis: - clinical Lab or radiographic evidence; - maternal nontreponemal titers at delivery compared to neonatal titers - neonatal titers > 4x maternal titer = confirmatory for dx |
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Term
Treatment of Congenital Syphilis |
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Definition
Asymptomatic: benzathin penicllin G 50,000 units/kg IM x 1 dose; Symptomatic: aqueous crystalline PCN G 50,000 units/kg IV q12 hr during 1st 7 days of life & q8 hr for next 3 days (10-day course); Alternative: procaine PCN G 50,000 units/kg IM daily x 10 days; Follow-UP: Observation of clinical & serological clearance for 6 months |
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Term
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Definition
Caused by HSV-1 & -2; Diagnosis: Confirmatory lab testing - tissue culture - serologic tests, PCR assays Clincal Findings: - dark-field-neg, vesicular or ulcerative genital lesions; - prior hx of similar lesions or sexual contact w/ infected person; Presentation: - cluster of painful vesicles on erythematous base (1st episode develops over 7-10 days & heals w/in 2-4 wks) - itching, burning, tingling, urinary frequency, flu-like prodrome; Complications: 2ndary infections, disseminated infection, extragenital lesions, meningitis, neonatal transmission (50% fatality rate); |
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Term
Treatment for Genital Herpes |
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Definition
NO CURE - Goal: relieve Sx & shorten course, prevent recurrence, decrease transmission; 1st Episode: PO acyclovir, famciclovir, valacyclovir; Alternative: acyclovir IV followed by PO; Episodic Therapy: - REQUIRES INITIATION W/IN 24 HRS of LESION ONSET OR DURING PRODROME FOR EFFICACY; - acyclovir, famciclovir, or valacyclovir PO x 5 days; Side Effects: HA, confusion, N/V, thrombocytopenia, renal insufficiency, rash, pruritis, hallucinations, depression |
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Term
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Definition
Caused by Human Papillomavirus (HPV); Presentation: - most are asymptomatic; - rough, thick, cauliflower-like lesions, keratotic warts w/ thick, horny surface, anogenital pruritis, burning, vaginal discharge or bleeding; Complications: - cervical cancer, other cancers; Diagnosis: - DNA/RNA capsid protein detection, clinical presentation |
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Term
Treatment of Genital Warts |
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Definition
Goal: remove visible warts & reduce infectivity; Pt-applied Tx: - podofilox 0.5% gel/soln BID x 3 days, repeat after 4 days if wart still visible; - imiquimod 5% cream qHS 3x/wk for up to 16 wks OR QOD x 3 applications; Physician-applied Tx: - podophyllin resin 10-25% - bicholroacetic & tricholoacetic acids 80-90% (may be used in pregnancy); Ablative therapy: cryotherapy, surgical removal, vaporization |
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Term
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Definition
HPV vaccine -recommended for women age 9-26 - protects against strains 6, 11, 16, & 18 - approved for men age 9-26 for genital wart prevention |
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Term
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Definition
HPV vaccine recommended for women age 10-25; - protects against strains 16 & 19 - no recommendation for use in men |
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Term
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Definition
Caused by: Haemophilus ducreyi; Most common in South Atlantic states; Presentation: - genital ulcer w/ ragged & poorly defined edge; - erthematous papule develops 4-7 days after infection that progresses to pustule stage that ruptures |
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Term
CDC Recommendations for Tx of Chancroid |
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Definition
- erithromycin 500 mg PO TID-QID x 7 days; - azithromycin 1 g x 1 dose; - ciprofloxacin 500 mg BID x 3 days; |
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Term
WHO Recommendations for Tx of Chancroid |
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Definition
erythromycin 500 mg PO TID-QID x 7 days; ceftriaxone 250 mg IM x 1 dose; ciprofloxacin 500 mg x 1 dose; spectinomycin 2 g IM x 1 dose |
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Term
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Definition
Caused by Trichomonas vaginalis; Most common curable STI; Presentation: - women: asymptomatic, vaginal erythemia, foul-smelling yellow-green discharge, dysuria; - Men: asymptomatic, urethral discharge or irritation; Complications: premature labor, decreased sperm viability; |
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Term
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Definition
Metronidazole 2 g x 1 dose or 500 m BID x 7 days, use 2 g dose if pregnant; - C/I in 1st trimester; Alternative: tinidazole 2 g |
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Term
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Definition
Caused by: Anaerobic overgrowth [Gardenella vaginalis, Prevotella, Mycoplasma hominis, Mobiluncus]; More common in sexually active women; Presentation: - fishy-smelling vag discharge, may be asymptomatic; Diagnosis (Amsel criteria [3 of 4]): - thin, white, homogenous discharge - clue cells on microscopy - pH >4.5 - release of fishy odor upon addition of alkali to vaginal sample - Gram-stain vaginal smear; |
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Term
Treatment of Bacterial Vaginosis |
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Definition
Metronidazole 500 mg PO BID x 7 days Metronidazole 0.75% gel --> 5 g intravaginally daily x 5 days; Clindamycin 2% cream --> 5 g intravaginally qHS x 7 days |
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