What are sx of lower UTI?
- Frequent urination
- occasionally gross hematuria
- occasionally foul smelling urine
What is the most common cause of recurrent cystitis?
What is the difference between relapse and reinfection?
- relapse: infection with the same organism within 14 days of stopping abx for the preceeding UTI
- reinfection: infection with a completely different organism
What constitutes as pyruira and bacteriuria?
- pyuria: >5-10WBC
- bacteriuria: >102 CFU/ml
What is the #1 agent in uncomplicated cystitis?
Why don't we use Molaxactin for UTIs?
It's hepatically metabolized, and not secreted in urine very well
When is single dose therapy used and not used?
- Used: reduced cure rates when compared to 3 or 7 day regimen
- Not used: pts with occult upper tract involvment
How do you tx pts with bacteriua in urine but are asx?
You don't tx UNLESS they are pregnant men getting urinary tract procedures
How do you tx UTIs in pregancy?
- 7 days
- Amoxicillin, Nitrofurantoin
- fluoros, tetra, aminoglycosides, bactrim in 3rd trimester
How do you treat a relapse?
Assess for pharm reason for failure, then tx longer 2-6w weeks UNLESS they have a cath
How do yout tx reinfection, 2 or less UTIs in a year?
Use pt initiated therapy for sxmatic episodes, 3 day course
How do yout tx reinfection, 3 or more UTIs in a year, related to sexual activity?
Use post-intercourse prophylaxis with Bactim, cephalexin, or nitrofuantoin
How do yout tx reinfection, 3 or more UTIs in a year, NOT related to sexual activity?
Use daily or 3x/week prophylaxis with trimethroprim, Bactrim, cephalexin, norfloxacin, or nitrofurantoin
How do you tx uncomplicated pyelonephritis outpt therapy?
- If pt is not immunocompromised or does not have N/V they are uncomplicated
- Tx with Bactrim, cipro for 7-14 days (14 if Bactrim)
How do you tx complicated UTIs?
Fluoro, aminoglycoside (FOR NON RENAL FAILURE), extended spectrum beta lactam for 10-14 days
How do you tx UTIs when there is a short term cath involved?
- No preventative therapy
- Don't tx asx pts
- 7-10 day tx with cath removal
- 5-7 day tx if cath can't be removed
How do you tx UTIs when there is a long-term cath involved?
7 days to prevent resistance, cath replacement may be indicated
How do you tx acute bacterial prostatitis?
- 4 week therapy
- Bactrim, Cipro, cephalosporin
How do you tx chronic bacterial prostatitis?
1-4 mo with Bactrim and fluoros
How do you tx epididymitis >35 years?
10 days to 4 week therapy with Bactrim and fluoros (most likely caused by guy sitting in dirty hot tub)
How do you tx epididymitis <35 years?
- Most likely secondary to STD
- Ceftriaxone IM once plus doxy BID for 10 days
How effective is initial HSV infection tx?
It partically controls sx and does not affect recurrences
When is recurrent HSV infection tx successful?
Within 1 day (6 hours) of lesion onset
Which STD pts get daily suppressive therapy?
Pts with >6 episodes per year
How do you tx an initial HSV infection?
- Acyclovir 400 mg PO TID x 5-10 days
- Acyclovir 200 mg PO 5x/day for 7-10 days
- Famciclovir or valacyclovir x 7-10 days
How do you tx a recurrent HSV infection?
- Acyclovir 200 mg PO 5x/day x 5 daysAcyclovir 800 mg PO TID x 2 days
- Famciclovir 1000mg PO BID x 1 day
- Valacylcovir 500 mg PO BID x 3 days
What is daily suppressive therapy for recurrent HSV infections?
- Acycovir 400mg PO BID
- Fmacilcovir 250 mg PO BID
- Valacyclovir 1000 mg PO daily (500 mg<9 recurrences)
What is primary syphilis?
10-90 days after exposure (mean 21 days), chancre resolves spontaneously 2-6 weeks
What is secondary syphilis?
Disappears in 4-10 weeks
When do you see lymphadenopathy and skin lesions on the palms/soles?
When does late latent syphilis occur?
>1 or 2-4 years after exposure, possibly noninfectious
What are sx of Tertiary syphilis?
gummas, aortic insufficiency, aortitis
Describe course of Jarish Herxheimer
Onset 2-4 hours, peak 8 hours, duration 12-24 hours
How do you tx primary syphilis?
Benzathine PCN G x 1, doxycycline x 14 days
How do you tx secondary syphilis?
Benzathine PCN G x 1, doxy BID x 14 days
How do you tx late latent syphilis?
- Benzathine pCN q week x 3
- Doxy BID x 4 weeks
How do you tx tertiary syphilis?
- Benzathine pCN q week x 3
- Doxy BID x 4 weeks
How do you tx neurosyphilis?
- PCN G 3-4 million units IVq4hr x 10-14 days
- Procaine PCN 2.4 million units IM daily plus probenacid QID x 10-14 days
- Ceftriaxone 2 grams IV/IM daily x 10-14 days
What is primary tx for chlamydia?
Azithromycin 1 gm single PO dose or doxy BID x 7 days
What is alternative therapy for chlamydia?
- Erythro 500 base or 800 mg EES QID x 7 days OR
- levofloxacin 500 mg daily x 7 days
- (Erythro is longer acting but has those GI problems)
How do you tx gonorrhea?
- Ceftriaxone IM single dose OR
- Cefixime plus tx of chlamydia
- Fluoros have resistance in MSM, CA, HI, West Coast, so only use if it has been proven sensitive
How do you tx a disseminated gonococcal infection?
Ceftriazone 1gm IV daily 24-48 hours after improvement has been noted, then finish 7 day therapy with PO meds
What are signs of trich in each sex?
How do you treat trich?
- Men: asx, women: yellow green vaginal discharge and irritation
- Flagyl 7x daily x 2mg500 grams PO single dose or Tinidazole