STD's

• 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

• Maternal antibody is passed to the baby
• with no prenatal treatment only 20-30% will be truly infected but 100% will have antibody positive

• PCR for HIV DNA
• HIV RNA assays

• 14-21 days
• 1-2 mo
• 4-6 mo
• confirm with antibody test at 12-18 mo

• Chronic Candidiasis
• Parotitis
• Persistent lymphadenoopathy
• Hepatosplenomegaly

• <12 mo < 750 CD4 (<15 %)
• 1-5 yrs < 500 CD4 (< 15 %)
• >6 yrs < 200 CD4 (<15 %)

Pneumocystis jirovenci (carinii)

• 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.

• 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 %

TMP/SMX three times a week or Dapsone 100mg one daily if cant tolerate TMP/SMX.

Check for G6PD deficiency if using dapsone

• 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 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

• 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.

• 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.

• 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

• If the fluid was bloddy and the skin integrity was compromised
• give ZDV,3TC +/- lopinavir/ritonavir for 4 weeks

Thayer Martin or Chocolate agar

• 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

• 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.

Fitz-Hugh-Curtis

• Leading cause of acute septic arthritis in young adults
• Menstruation may trigger dissemination
• Terminal complement deficiencies at increased risk.

• 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.

• Outpatient;
• Ceftriaxone 250mg IM x 1 dose
• plus
• doxycycline 100mg bid x 14 days

• 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

• 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

leukocyte urethral exudate with >4 PMN's on Gram Stain of urethral swab without organism is correlated with Chlamydial NGU

• 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.

• 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

• 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

• 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

• 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

• "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.

same as chlamydia

• 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.

• hematogenous dissemination of treponema pallidum
• fever, malaise, generalized lymphadenopathy
• rash- macular, papular, annular, or follicular
• alopecia, condylomata lata mucous patches

• 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.

• meningeal syphilis
• hearing loss, facial weakness, visual disturbances
• meningovascular syphilis
• Focal CNS ischemia or stroke.