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What are sx of lower UTI?
- Dysuria
- Frequent urination
- Urgency
- occasionally gross hematuria
- occasionally foul smelling urine
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What is the most common cause of recurrent cystitis?
Reinfection
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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
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What constitutes as pyruira and bacteriuria?
- pyuria: >5-10WBC
- bacteriuria: >102 CFU/ml
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What is the #1 agent in uncomplicated cystitis?
Bactrim
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Why don't we use Molaxactin for UTIs?
It's hepatically metabolized, and not secreted in urine very well
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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
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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
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How do you tx UTIs in pregancy?
- 7 days
- Amoxicillin, Nitrofurantoin
- Cephalxin
- Bactrim
- AVOID:
- fluoros, tetra, aminoglycosides, bactrim in 3rd trimester
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How do you treat a relapse?
Assess for pharm reason for failure, then tx longer 2-6w weeks UNLESS they have a cath
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How do yout tx reinfection, 2 or less UTIs in a year?
Use pt initiated therapy for sxmatic episodes, 3 day course
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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
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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
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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)
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How do you tx complicated UTIs?
Fluoro, aminoglycoside (FOR NON RENAL FAILURE), extended spectrum beta lactam for 10-14 days
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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
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How do you tx UTIs when there is a long-term cath involved?
7 days to prevent resistance, cath replacement may be indicated
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How do you tx acute bacterial prostatitis?
- 4 week therapy
- Bactrim, Cipro, cephalosporin
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How do you tx chronic bacterial prostatitis?
1-4 mo with Bactrim and fluoros
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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)
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How do you tx epididymitis <35 years?
- Most likely secondary to STD
- Ceftriaxone IM once plus doxy BID for 10 days
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How effective is initial HSV infection tx?
It partically controls sx and does not affect recurrences
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When is recurrent HSV infection tx successful?
Within 1 day (6 hours) of lesion onset
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Which STD pts get daily suppressive therapy?
Pts with >6 episodes per year
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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
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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
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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)
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What is primary syphilis?
10-90 days after exposure (mean 21 days), chancre resolves spontaneously 2-6 weeks
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What is secondary syphilis?
Disappears in 4-10 weeks
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When do you see lymphadenopathy and skin lesions on the palms/soles?
Secondary syphilis
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When does late latent syphilis occur?
>1 or 2-4 years after exposure, possibly noninfectious
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What are sx of Tertiary syphilis?
gummas, aortic insufficiency, aortitis
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Describe course of Jarish Herxheimer
Onset 2-4 hours, peak 8 hours, duration 12-24 hours
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How do you tx primary syphilis?
Benzathine PCN G x 1, doxycycline x 14 days
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How do you tx secondary syphilis?
Benzathine PCN G x 1, doxy BID x 14 days
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How do you tx late latent syphilis?
- Benzathine pCN q week x 3
- Doxy BID x 4 weeks
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How do you tx tertiary syphilis?
- Benzathine pCN q week x 3
- Doxy BID x 4 weeks
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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
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What is primary tx for chlamydia?
Azithromycin 1 gm single PO dose or doxy BID x 7 days
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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)
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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
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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
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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
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