STD's

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Anonymous
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34951
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STD's
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2010-09-15 17:03:52
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Pediatric board review
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STD's pediatric board review
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  1. Prevalence of HIV published in CDC 2008 (1999-2006)
    • Adults aged 18-49 yrs: 5/1000
    • Men 7/1000
    • Women 2/1000
    • Non Hispanic black population:2/100
    • Men 2.6/100
    • Womem 1.5/100
    • Mexican American population; 3/1000
  2. AIDS in prenatal setting
    • Maternal antibody is passed to the baby
    • with no prenatal treatment only 20-30% will be truly infected but 100% will have antibody positive
  3. What study is good to diagnose AIDS in neonates?
    • PCR for HIV DNA
    • HIV RNA assays
  4. What is the best time to test for neonates?
    • 14-21 days
    • 1-2 mo
    • 4-6 mo
    • confirm with antibody test at 12-18 mo
  5. When do you suspect HIV in infants 1st year of life?
    • Chronic Candidiasis
    • Parotitis
    • Persistent lymphadenoopathy
    • Hepatosplenomegaly
  6. What is evidence of severe immunesuppression in infants?
    • <12 mo < 750 CD4 (<15 %)
    • 1-5 yrs < 500 CD4 (< 15 %)
    • >6 yrs < 200 CD4 (<15 %)
  7. what is the most common opportunistic infection in HIV pts?
    Pneumocystis jirovenci (carinii)
  8. Xray finding in Pneumocytis jirovenci?

    treatment?
    • minimal to diffususe interstitial disease
    • Dx; finding cysts or trophozoites forms in BAL or induced sputum specimens

    tx; TMP/SMX for 21 days (15-20mg/kg/d div q6h IV or PO)

    if PaO2 less than 70 mmHg give Prednisone 1mg/kg PO BID and taper after 5 days.
  9. Who needs prophylaxis for PCP?
    • Any prior history of PCP
    • birth to 4-6 weeks, HIV exposed; no prophylaxis
    • 4-6 weeks to 4mo HIV inderterminate or +; prophylaxis
    • 4-12 mo
    • HIV indeterminate:prophylaxis
    • HIV infection reasonably excluded; NO prophylaxis
    • 1-5 yrs infected:CD4 + < 500 or <15 %
    • 6yrs- adult HIV infected: CD4 + <200 or 15 %
  10. What medicine you use for prophylaxis?
    TMP/SMX three times a week or Dapsone 100mg one daily if cant tolerate TMP/SMX.

    Check for G6PD deficiency if using dapsone
  11. Tuberculosis and HIV
    • PPD > 5mm induration= + PPD
    • IF negative never rules out infection

    • treat TB the same as in non HIV patients
    • 4 DRUG REGIMEN (INH, RIF,PZA and etambutol or streptomycin)
  12. Criteria for initation of antiretroviral therapy based on age of the Child
    • < 12 mo TREAT ALL
    • 1 to 5 years symptomatic or CD4 <25% and HIV RNA > 100,000
    • 5 years: Symptomatic or CD4 < 350
    • Consider for asymptomatic and CD4 > 350 and HIV RNA > 100,000
  13. Most common side effects of antiretroviral therapy?
    • Lamivudine 3TC- pancreatitis
    • ddI- pancreatitis
    • Abacavir- hypersensitivity reaction
    • If any of these occur on therapy you must STOP
    • and NEVER rechallenge patient; Causes DEATH
    • Screen for HLA B*5701
    • Nevirapine- rash
    • Efavirenz- teratogenic...DO NOT use around pregnancy.
    • Adolescent female must stop.
  14. Bottom line in treatment of HIV to remember...
    • throw out any answer that has ZDV(AZT)/D4T combined
    • ddC in the answer
    • monotherapy
    • except an infant born to a mother with HIV positive ZDV(AZT) unless the child is proven to be HIV-infected, then use the standard 3-drug therapy.
  15. When to swith medicines in HIV?
    • clinical progression
    • DRUG TOXICITY
    • laboratory markers of disease progression
    • inability to suppress viral load to undetectable levels after 4-6mo of therapy
    • return of detectsble viral load after being undetectable for a period of time
    • decline in CD4 cells
  16. when you need post exposure prophylaxis for HIV?
    • If the fluid was bloddy and the skin integrity was compromised
    • give ZDV,3TC +/- lopinavir/ritonavir for 4 weeks
  17. Neisseria Ghonorrhoeae medium of growth
    Thayer Martin or Chocolate agar
  18. gonorrhoea features in Men
    • 2-7 days after exposure develop discharge
    • urethral irritation, erythema, dysuria
    • assymptomatic infection in 5-60% and can persists if untreated
    • local manisfestations can include epididymitis, prostatitis, periurethral abscess and penile lymphangitis
  19. Gonorrhoea features in female;
    • 1-14 days incbation period
    • Endocervix is most frequent primary site
    • assymptomatic infection is more common
    • Endocervical discharge, dysuria,urinary frequency, mestrual irregularities
    • Cervical erythema, friability, mucopurulent discharge on exam.
  20. what is called the perihepatitis of ghonorreal infxn?
    Fitz-Hugh-Curtis
  21. Disseminated Gonococcal Infection (DGI)?
    • Leading cause of acute septic arthritis in young adults
    • Menstruation may trigger dissemination
    • Terminal complement deficiencies at increased risk.
  22. Ghonorrheae treatment?
    • Urethral, Cervical, Rectal
    • Ceftriaxone 125 mg IM x 1 dose
    • allergic pts; spectinomycin

    • Bacteremia, Arthritis, Disseminated
    • Ceftriaxone 1g IV daysx 7-10 days or for 2-3 days followed by either;
    • cefexime 400mg PO bid or
    • cefpodoxime 400mg PO bid; to complete 7-10 days of therapy.
  23. PID treatment?
    • Outpatient;
    • Ceftriaxone 250mg IM x 1 dose
    • plus
    • doxycycline 100mg bid x 14 days
  24. PID guidelines for Hospitalization?
    • Surgical emergencies
    • Suspected pelvic/tubo-ovarian abscess
    • pregnancy
    • uncertain diagnosis
    • N/V precluding oral therapy
    • failure to respond to oral agents in 24-48 hrs
  25. chlamydia facts...
    • chlamydia in 20-30% of men with GC
    • Chlamydia causes 30-50% of non-gonoccocal urethritis
    • Chlamydia causes 2/3 of epididymitis in young men
    • Chlamydia in 30-60% of women co-infected with GC
    • Chlamydia in 1/3 of cervix and/or fallopian tubes of laparoscopically verified PID
  26. Diagnosis Chlamydia infections?
    leukocyte urethral exudate with >4 PMN's on Gram Stain of urethral swab without organism is correlated with Chlamydial NGU
  27. what is lymphogranuloma venerum?
    • 3 days to 3 weeks of exposure
    • a small painless vesicle or papule/ulcer appears at the site of initial contact (1/3 of patients only)

    • 2-6 weeks after exposure;
    • regional lymphadenopathy develops. Painful periadenitis occurs with matted nodes and inflamed overlying skin
    • supuration occurs with fistula formation.
  28. Describe 2nd and 3rd stage of lymphogranuloma venerum?
    • 2nd stage;
    • Fever, Chills, headache, myalgias,
    • Can get aseptic meningitis, meningoencephalitis, conjunctivitis, hepatitis,arthritis

    • 3rd stage;
    • Chronic ulcerative/infiltrative local structures, fibrosis, strictures, impaired lymphatic flow with resulting genital elephantiasis
  29. Describe Mucopurulent Cervicitis (chlamydia)
    • yellow or creamy discharge from cervix
    • gram stain + for WBCs
    • Similar symptoms to GC
    • > 10 PMN's/HPF on Gram stained smear of cervical mucous correlates with Chlamydia if GC is ruled out

    PID- probably as common as a cause as GC
  30. Diagnosis of Chlamydia?
    • Culture
    • Detection of elementary bodies by giemsa or immunofluorecent staining with monoclonal antibody; most sensitive
    • Chlamydiazyme and MicroTrak; rapid assays for detection of Chlamydia in clinical specimens
    • Serologic 4 fold rise in antibody titer or IgM
  31. Treatment of Chlamydia?
    • Urethritis, Cervicitis, Conjunctivitis, Proctitis
    • azithromycin 1 gm x 1 dose or doxycycline 100mg PO Bid x 7 days
    • Pregnant women
    • azithromycin 1 gm x 1 dose or amoxicillin 500 mg tid x 7 days

    • LVG
    • Doxycycline 100 mg PO bid x 21 days
  32. Mycoplasma infxns; Ureaplasma Urealyticum
    • "fried egg" appearance on solid media
    • found in 50% healthy adults
    • non gonococccal urethritis; most likely the etiology
    • Prostatitis; both found in symptomatic men
    • PID; M. hominis in 10% of acute salpingitis.
  33. how to treat mycoplasma hominis?
    same as chlamydia
  34. painless skin lesion; chancre?
    • primary syphilis
    • develops at site of inoculation on average 21 days after exposure
    • incubation period can range from 10-90 days
    • Skin lesions are painless.
  35. Secondary syphilis
    • hematogenous dissemination of treponema pallidum
    • fever, malaise, generalized lymphadenopathy
    • rash- macular, papular, annular, or follicular
    • alopecia, condylomata lata mucous patches
  36. diagnosis of syphilis
    • VDRL or RPR for initial screen
    • confirm; FTA ABS (fluorescent treponemal ab absorbed)
    • MHA-TP (microhemagglutination assay for ab to T pallidum
    • Darkfield microscopy showing T pallidum from a clinical specimen.
  37. Central Nervous system syphilis
    • meningeal syphilis
    • hearing loss, facial weakness, visual disturbances
    • meningovascular syphilis
    • Focal CNS ischemia or stroke.

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