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
|
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
|
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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