Viral Infections and Antiviral Treatments

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Questions and Answers

Which antiviral medication is a prodrug form of acyclovir, approved for oral administration?

Ribavirin

Ganciclovir

Valacyclovir (correct)

Famciclovir

What is a common adverse effect associated with ganciclovir?

Nausea

Headache

Thrombocytopenia (correct)

Fatigue

Simeprevir is indicated for the treatment of which type of hepatitis?

Hepatitis D

Hepatitis B

Hepatitis C (correct)

Hepatitis A

Which of the following drugs is an NS5A inhibitor used for hepatitis C treatment?

Daclatasvir Signup and view all the answers

Which antiviral drug is indicated for cytomegalovirus infections?

Valganciclovir Signup and view all the answers

What is a potential adverse effect of the combination treatment of ribavirin and interferon alfa?

Pulmonary complications Signup and view all the answers

What type of drug is penciclovir cream used for?

Cold sores Signup and view all the answers

Which of the following hepatitis viruses can be transmitted through blood exchange?

Hepatitis C Signup and view all the answers

What serious complication can be caused by lamivudine?

Severe hepatomegaly Signup and view all the answers

Which of the following vaccines is NOT one of the types available for influenza?

Protein subunit vaccine Signup and view all the answers

What is a common adverse effect of oseltamivir (Tamiflu)?

Nausea Signup and view all the answers

Which antiviral drug is indicated for treatment of COVID-19 infection?

Remdesivir Signup and view all the answers

What is a primary concern associated with the use of adefovir?

Nephrotoxicity Signup and view all the answers

Which mRNA vaccine is manufactured by Pfizer-BioNTech?

BNT162b2 Signup and view all the answers

What type of syndrome is associated with peginterferon alfa-2a?

Flu-like syndrome Signup and view all the answers

Which of the following is a monoclonal antibody used for preventing RSV infection?

Palivizumab Signup and view all the answers

Match the following classes of antiretroviral drugs with their primary mechanism of action:

NRTIs = Inhibit reverse transcriptase NNRTIs = Bind to and inhibit reverse transcriptase PIs = Inhibit HIV protease INSTIs = Inhibit integrase enzyme Signup and view all the answers

Match the following antiretroviral drugs with their specific examples:

Tenofovir = NRTI Efavirenz = NNRTI Atazanavir = PI Dolutegravir = INSTI Signup and view all the answers

Match the following terms with their descriptions related to antiretroviral therapy:

HAART = Highly active antiretroviral therapy NRTI = Requires phosphorylation for activity NNRTI = Active against HIV-1 only INSTI = Inhibits integration of viral material Signup and view all the answers

Match the following antiretroviral drugs with their class designations:

Lamivudine = NRTI Rilpivirine = NNRTI Darunavir = PI Bictegravir = INSTI Signup and view all the answers

Match the following classes of drugs with their common characteristics:

NRTIs = Requires phosphorylation NNRTIs = Does not require phosphorylation PIs = Targets polyprotein cleavage INSTIs = Target integration process Signup and view all the answers

Match the following treatments to the conditions they address:

Acyclovir = Genital herpes Doxycycline = Nongonococcal urethritis Ceftriaxone = Pelvic inflammatory disease Levofloxacin = Acute sexually transmitted epididymitis Signup and view all the answers

Match the following antibiotics to their recommended use:

Azithromycin = Alternative for nongonococcal urethritis Doxycycline = First-line for pelvic inflammatory disease Ceftriaxone = Treatment for proctitis Valacyclovir = Suppressive therapy for genital herpes Signup and view all the answers

Match the following conditions to their symptoms:

Genital herpes = Viral shedding and outbreaks Nongonococcal urethritis = Urethral discharge Pelvic inflammatory disease = Chronic pelvic pain Acute epididymitis = Scrotal pain and swelling Signup and view all the answers

Match the following treatment regimens to their duration:

Doxycycline = 10 days for acute epididymitis Cefuoxime = Single dose for proctitis Signup and view all the answers

Match the following treatment considerations to their corresponding conditions:

Abstinence for 7 days = Nongonococcal urethritis Intravenous acyclovir = Severe genital herpes Scrotal support = Acute epididymitis Treatment of partners = Pelvic inflammatory disease Signup and view all the answers

Match the following infectious agents to their related conditions:

Chlamydia trachomatis = Nongonococcal urethritis Treponema pallidum = Proctitis Neisseria gonorrhoeae = Pelvic inflammatory disease Herpes simplex virus = Genital herpes Signup and view all the answers

Match the following prevention strategies to their corresponding treatments:

Consistent condom use = Genital herpes Counseling for sexual abstinence = Nongonococcal urethritis Follow-up within 72 hours = Pelvic inflammatory disease Evaluation of sexual partners = Acute epididymitis Signup and view all the answers

Match the following treatments to their routes of administration:

Doxycycline = Oral Ceftriaxone = Intramuscular Acyclovir = Intravenous Valacyclovir = Oral Signup and view all the answers

Match the following conditions to their diagnostic criteria:

Genital herpes = Viral testing Nongonococcal urethritis = Polymorphonuclear leukocytes Pelvic inflammatory disease = Clinical findings Acute epididymitis = Scrotal ultrasound Signup and view all the answers

Match the following guidelines to their respective conditions:

Prompt treatment initiation = Genital herpes Sexual partner treatment = Nongonococcal urethritis Intravenous antibiotics = Severe pelvic inflammatory disease Abstinence until treatment completion = Acute epididymitis Signup and view all the answers

Match the following drug treatments with their corresponding infections:

Isoniazid and Rifampin = Drug-susceptible tuberculosis Amphotericin B and Flucytosine = Cryptococcal meningitis Acyclovir = Varicella zoster virus infection Azithromycin or Doxycycline = Chlamydial infections Signup and view all the answers

Match the following drug types with their indications:

Fluoroquinolones = Multidrug-resistant TB Oral Azole antifungals = Systemic candidiasis Intravenous Acyclovir = Severe VZV infections in immunocompromised patients Single intramuscular Ceftriaxone = Uncomplicated gonococcal infections Signup and view all the answers

Match the following medication administration routes with the corresponding drugs:

Intravenous Amphotericin B = Cryptococcal meningitis treatment Oral Fluconazole = Maintenance therapy for cryptococcal meningitis Topical Nystatin = Mucosal candidiasis treatment Oral Acyclovir = Chickenpox and shingles Signup and view all the answers

Match the following drug conditions with their monitoring requirements:

Amphotericin B = Nephrotoxicity monitoring Flucytosine = Bone marrow suppression monitoring Acyclovir = Prompt initiation for HSV Oral Fluconazole = Chronic suppressive therapy Signup and view all the answers

Match the following infections with their common symptoms:

Chlamydial infections = Abnormal vaginal discharge Gonococcal infections = Dysuria and conjunctivitis Cryptococcal meningitis = Life-threatening condition in immunocompromised Herpes simplex virus = Oral and genital lesions Signup and view all the answers

Match the following medications with their descriptions:

Valacyclovir = Higher dose for shingles Famciclovir = Alternative oral treatment for VZV Ceftriaxone = Recommended for uncomplicated gonorrhea Fluconazole = Commonly used for vulvovaginal candidiasis Signup and view all the answers

Match the following infections with their treatment strategies:

Varicella zoster virus = Early initiation of antiviral therapy Candidiasis = Topical agents for mucosal treatment Chlamydial infections = Prompt treatment of partners Gonococcal infections = Routine screening of high-risk groups Signup and view all the answers

Match the following drug resistance information with the relevant infections:

Gonococcal infections = Increasing antibiotic resistance MDR TB = Requires second-line agents Candidiasis = Potential for recurrent infections Herpes simplex virus = Episodic or suppressive therapy needed Signup and view all the answers

Match the following phases of TB treatment with their duration:

Intensive phase = 2 months Continuation phase = 4 months Treatment for MDR TB = 18-24 months Initial cryptococcal treatment = Indefinitely with fluconazole Signup and view all the answers

Match the following infections with their potential complications:

Chlamydial infections = Pelvic inflammatory disease Gonococcal infections = Infertility concerns Cryptococcal meningitis = Life-threatening in the immunocompromised Herpes simplex virus = Transmission prevention necessities Signup and view all the answers

Match the following drug types with their forms of administration:

Amikacin = Injectable for MDR TB Flucytosine = Oral medication Nystatin = Topical agent for mucosal candidiasis Valacyclovir = Oral treatment for shingles Signup and view all the answers

Match the following drug considerations with the respective patient scenarios:

Nephrotoxicity monitoring = Amphotericin B Bone marrow suppression monitoring = Flucytosine Return for recurrent infections = Candidiasis treatment Routine screening = Chlamydial and gonococcal infections Signup and view all the answers

Match the following medications with their specific effects:

Acyclovir = Suppresses HSV symptoms Ceftriaxone = Cures uncomplicated gonorrhea Fluconazole = Effective for vulvovaginal candidiasis Amphotericin B = Used for cryptococcal infection Signup and view all the answers

Match the following HIV treatment classes with their mechanisms of action:

Protease Inhibitors (PIs) = Prevent cleavage of viral proteins Fusion Inhibitors = Block viral envelope from fusing with host cell Entry Inhibitors = Block CCR5 co-receptor on CD4 cells Integrase Inhibitors = Block viral DNA integration into host genome Signup and view all the answers

Match the following HIV medications with their specific characteristics:

Ritonavir = Boosts other PIs by inhibiting CYP3A4 Enfuvirtide = Administered subcutaneously twice daily Maraviroc = Requires tropism test for CCR5-tropic HIV Cabotegravir = Long-acting injectable option for PrEP Signup and view all the answers

Match the following side effects with the corresponding antiretroviral class:

Protease Inhibitors (PIs) = Gastrointestinal intolerance and hyperlipidemia Fusion Inhibitors = Injection site reactions Entry Inhibitors = Potential for drug interactions Integrase Inhibitors = Generally well tolerated with few side effects Signup and view all the answers

Match the following prophylactic measures with their descriptions:

PrEP = Daily antiretroviral medication for high-risk individuals nPEP = 28-day treatment after potential HIV exposure Tropism Testing = Confirms CCR5 co-receptor use before maraviroc Combination Therapy = Using multiple antiretrovirals to reduce resistance risk Signup and view all the answers

Match the following HIV opportunistic infections with their treatments:

Pneumocystis pneumonia = Trimethoprim/sulfamethoxazole (TMP/SMZ) Cytomegalovirus retinitis = Ganciclovir or valganciclovir Mycobacterium tuberculosis = Multi-drug regimen for extended duration Fungal infections = May require intravenous pentamidine in severe cases Signup and view all the answers

Match the following terms with their appropriate definitions:

HAART = Highly active antiretroviral therapy CYP450 = Enzyme system metabolizing many drugs CD4 cells = Targeted by HIV to enter the immune system Injection site reactions = Common adverse effect of enfuvirtide Signup and view all the answers

Match the following medications with the patient populations they are meant for:

Enfuvirtide = Reserved for treatment-experienced patients Maraviroc = Indicated for CCR5-tropic HIV-1 strains Cabotegravir = Emerging PrEP option for high-risk populations TMP/SMZ = First-line treatment for Pneumocystis pneumonia Signup and view all the answers

Match the following sexually transmitted infections with their primary characteristics:

Syphilis = Caused by Treponema pallidum and progresses through distinct stages Bacterial Vaginosis = Overgrowth of anaerobic bacteria causing malodorous discharge Trichomoniasis = Caused by Trichomonas vaginalis, may cause vaginitis or urethritis Genital Herpes = Chronic infection with painful blisters caused by herpes simplex virus Signup and view all the answers

Match the following antiretroviral therapies with their delivery methods:

Enfuvirtide = Subcutaneous injection Ganciclovir = Intravenous administration Valganciclovir = Oral administration Maraviroc = Oral administration with dose adjustments Signup and view all the answers

Match the treatments with the corresponding sexually transmitted infections:

Syphilis = Penicillin G benzathine intramuscular injection Bacterial Vaginosis = Oral metronidazole or clindamycin Trichomoniasis = Metronidazole 500 mg orally twice daily for 7 days Genital Herpes = Acyclovir or valacyclovir for symptom reduction Signup and view all the answers

Match the type of drug therapy with its targeted infection:

Ganciclovir = Cytomegalovirus retinitis TMP/SMZ = Pneumocystis pneumonia Pentamidine = Severe cases of Pneumocystis pneumonia Multi-drug regimen = Mycobacterium tuberculosis Signup and view all the answers

Match the stages of syphilis with their corresponding characteristics:

Primary Syphilis = Painless chancre sore Secondary Syphilis = Skin rashes and flu-like symptoms Latent Syphilis = No visible symptoms Tertiary Syphilis = Neurological and cardiovascular complications Signup and view all the answers

Match the follow-up testing recommendations with the infections:

Syphilis = Follow-up testing at 6 and 12 months post-treatment Bacterial Vaginosis = Re-testing with culture and sensitivity after persistent cases Trichomoniasis = Test of cure at 3 months after treatment Genital Herpes = Counseling on outbreaks and prevention Signup and view all the answers

Match the following adverse effects to their associated drugs:

Ganciclovir = Bone marrow suppression TMP/SMZ = Rash and hepatotoxicity Maraviroc = Potential drug interactions Enfuvirtide = Fever and nausea from hypersensitivity Signup and view all the answers

Match the following terms with their relevance in HIV treatment:

Induction phase = Initial treatment period to control infection Maintenance therapy = Long-term treatment to prevent relapse Subcutaneous administration = Method for enfuvirtide delivery CCR5 co-receptor = Target of maraviroc's action Signup and view all the answers

Match the antibiotic alternatives for syphilis treatment with the conditions:

Doxycycline = For penicillin-allergic patients in early stages Penicillin desensitization = Preferred for neurosyphilis or pregnancy Clindamycin = Used for bacterial vaginosis treatment Tinidazole = Alternative for Trichomoniasis treatment Signup and view all the answers

Match the side effects to the respective antibiotics or treatments:

Metronidazole = Avoid alcohol due to disulfiram-like reaction Penicillin = Potential allergic reactions Doxycycline = Photosensitivity Clindamycin = Possible gastrointestinal upset Signup and view all the answers

Match the following drugs with their specific targets in HIV therapy:

Ritonavir = CYP3A4 enzyme inhibitor Cabotegravir = Long-acting PrEP treatment Enfuvirtide = HIV envelope glycoprotein gp41 Maraviroc = CCR5 co-receptor on CD4 cells Signup and view all the answers

Match the age of the infection with the recommended treatment schedule:

Early Syphilis = Single dose of Penicillin G benzathine Late latent syphilis = Three weekly doses of Penicillin G Recurrent Bacterial Vaginosis = Re-testing and potential re-treatment Trichomoniasis = Single 2 g dose of Metronidazole for men Signup and view all the answers

Match the following regimens with their clinical use:

Truvada = FDA-approved PrEP regimen Descovy = Another FDA-approved PrEP regimen nPEP regimen = Three-drug combination after high-risk exposure TMP/SMZ = Treatment of choice for Pneumocystis pneumonia Signup and view all the answers

Match the following vaginal discharge characteristics with their associated infections:

Bacterial Vaginosis = Thin, grayish, malodorous discharge Trichomoniasis = Possible greenish discharge Genital Herpes = Discharge with painful ulcers Syphilis = No discharge, but presents with sores Signup and view all the answers

Match the following monitoring aspects with their importance in HIV treatment:

Adherence monitoring = Essential for PrEP and nPEP Tropism testing = Required before starting maraviroc Regular follow-up testing = Crucial for effectiveness of antiretrovirals Monitoring adverse effects = Important for safe usage of enfuvirtide Signup and view all the answers

Match the infections with their treatment administration routes:

Syphilis = Intramuscular injection of Penicillin G Bacterial Vaginosis = Oral or vaginal antibiotics Trichomoniasis = Oral administration of Metronidazole or Tinidazole Genital Herpes = Oral antiviral medications such as Acyclovir Signup and view all the answers

Match the recommended follow-up actions with the related treatments:

Penicillin-allergic patients = Penicillin desensitization for neurosyphilis Trichomoniasis treatment = Treat sexual partners to prevent reinfection Bacterial Vaginosis = Treat symptomatic cases promptly Genital Herpes = Continuous counseling on outbreak management and prevention Signup and view all the answers

Match the treatment regimens with their duration:

Metronidazole for BV = 7 days oral therapy Clindamycin for BV = 7 days vaginal cream Tinidazole for Trichomoniasis = 1 g orally for 5 days Acyclovir for Herpes = Episodic or daily suppressive therapy Signup and view all the answers

Match the diagnosis with its associated symptomatology:

Syphilis = Chancre sore and systemic symptoms Bacterial Vaginosis = Malodorous discharge and elevated pH Trichomoniasis = Possible vulvar irritation and discharge Genital Herpes = Painful blisters and systemic symptoms during first infection Signup and view all the answers

Match the treatment options to their respective concerns:

Metronidazole = Alcohol interaction caution Penicillin = Desensitization for allergic individuals Clindamycin = May weaken latex barrier Tinidazole = Alternative for Trichomoniasis or BV treatment Signup and view all the answers

Study Notes

Herpes Simplex Viruses, Varicella-Zoster Virus, and Cytomegalovirus Infections

Antivirals inhibit viral replication.
Acyclovir is a prototype drug for HSV and VZV infections.
Valacyclovir (Valtrex) is a prodrug form of acyclovir, used orally for herpes labialis, varicella, herpes zoster, and genital herpes.
Famciclovir is a prodrug for herpes zoster and genital herpes.
Penciclovir cream and docosanol cream are topical treatments for herpes labialis.
Trifluridine and ganciclovir are topical drugs for ocular herpes.
Ganciclovir treats CMV, but it can cause granulocytopenia and thrombocytopenia, so it's primarily used in immunocompromised patients.
Valganciclovir, cidofovir, and foscarnet treat CMV, HSV, and VZV with unique mechanisms, uses, and side effects.
Acyclovir is the drug of choice for varicella-zoster virus (VZV) infections like chickenpox and shingles.
For chickenpox in children and healthy adults, oral acyclovir is effective if started within 24 hours of rash onset.
For shingles in older adults, higher doses of oral acyclovir or valacyclovir are recommended.
In immunocompromised patients with disseminated or severe VZV infections, intravenous acyclovir is preferred.
Famciclovir is another option for oral treatment.
For herpes simplex virus (HSV) infections like oral/genital herpes, acyclovir, valacyclovir, and famciclovir are used.
These medications cannot cure HSV but can reduce symptoms and viral shedding.
For initial episodes, oral or IV antivirals are given for 7-10 days.
For recurrent outbreaks, episodic therapy with antivirals for 1-5 days or daily suppressive therapy can be used.
Acyclovir ointment is an option for topical treatment of oral herpes lesions.
Counseling on transmission prevention through abstinence during outbreaks and consistent condom use is also important.

Viral Hepatitis

Viral hepatitis is a liver disorder caused by six viruses (A, B, C, D, E, G); spread through blood exchange.
Simeprevir is a treatment for chronic HCV genotype 1 or 4, with potential side effects like headache, nausea, and fatigue.
Daclatasvir is an NS5A inhibitor for chronic HCV genotype 1 or 3.
Sofosbuvir inhibits NS5B for chronic HCV genotypes 1, 2, 3, or 4.
Ribavirin, combined with interferon alfa, treats HCV, but has significant side effects including autoimmunity, infections, hypersensitivity, pulmonary complications, and psychiatric issues.
Hepatitis B (HBV) spreads primarily through blood or semen.
Peginterferon alfa-2a (Pegasys) and nucleoside analogs (lamivudine, adefovir, entecavir, tenofovir AF) treat chronic HBV.
Peginterferon side effects include a flu-like syndrome (fever, fatigue, myalgia, headache, chills).
Lamivudine treats HBV or HIV, with rare risks of lactic acidosis, pancreatitis, and severe hepatomegaly.
Adefovir causes nephrotoxicity (kidney damage) as a potential concern.
Entecavir is a well-tolerated nucleoside analog for HBV with infrequent issues like dizziness, headache, fatigue, and nausea.
Tenofovir AF and tenofovir DF treat HBV in adults, and stopping treatment can worsen hepatitis.

Influenza, RSV, and COVID-19

Influenza involves a serious respiratory infection, and vaccines (IIV, RIV, LAIV) are available with rare serious side effects.
Oseltamivir (Tamiflu) treats influenza in patients over 1 year old, with mild side effects like headache, nausea, and vomiting.
Zanamivir and peramivir are neuraminidase inhibitors for influenza prevention.
Baloxavir marboxil treats influenza in patients 12 years and older with symptoms for 2 days or less.
Palivizumab is a monoclonal antibody to prevent RSV in premature infants and those with chronic lung disease.
COVID-19 uses mRNA (Pfizer-BioNTech’s BNT162b2, Moderna’s mRNA-1273), and subunit (Novavax’s NVX-CoV2373) vaccines.
Nirmatrelvir/ritonavir (Paxlovid), remdesivir (Veklury), and molnupiravir (Lagevrio) treat COVID-19.
Convalescent plasma is sometimes considered for COVID-19 treatment but is not the primary recommendation.

HIV Infections

Antiretroviral Drug Classes

Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs) inhibit HIV reverse transcriptase. Examples: tenofovir, abacavir, lamivudine
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) bind to and inhibit HIV reverse transcriptase differently than NRTIs. Examples: efavirenz, rilpivirine, doravirine
Protease Inhibitors (PIs) block viral protease, producing immature, non-infectious viral particles. Examples: atazanavir, darunavir, lopinavir
Integrase Strand Transfer Inhibitors (INSTIs) inhibit HIV integrase. Examples: dolutegravir, raltegravir, bictegravir
Entry/Fusion Inhibitors prevent HIV entry into cells by blocking viral attachment or fusion. Examples: enfuvirtide, maraviroc

NNRTIs Pharmacology

NNRTIs are not related to nucleosides and don't require phosphorylation.
They directly bind to reverse transcriptase, altering its shape and inhibiting its activity, preventing viral RNA to DNA conversion and blocking viral replication.
Used in combination with other antiretrovirals in HAART regimens.
Active only against HIV-1, not HIV-2.
Side effects include rash, hepatotoxicity, dizziness, and vivid dreams.

PIs Pharmacology

PIs inhibit HIV protease.
They bind to protease's active site, preventing polyprotein cleavage into functional proteins required for viral maturation.
PIs are potent and used in combination with other drugs in HAART.
Metabolized by the CYP450 system, leading to drug interactions (ritonavir can boost other PI levels by inhibiting CYP3A4).
Common side effects include gastrointestinal issues, hyperlipidemia, insulin resistance, and body fat redistribution.

Enfuvirtide Pharmacology

Enfuvirtide is an entry inhibitor.
It prevents the viral envelope from fusing with the host cell membrane.
Binds to gp41 of the HIV envelope glycoprotein, blocking membrane fusion.
Administered subcutaneously twice daily, reserved for treatment-experienced patients with multidrug-resistant HIV-1 infection.
Used in combination with other antiretrovirals.
Side effects include injection site reactions, hypersensitivity reactions (fever, nausea, rash), and rarely immune-mediated conditions.

Maraviroc Pharmacology

Maraviroc is an entry/fusion inhibitor.
Blocks HIV-1 entry by binding to the CCR5 co-receptor on CD4 cells, making it non-functional for CCR5-tropic HIV strains.
Used in combination with other antiretrovirals.
Requires a tropism test to confirm CCR5-tropic HIV-1 infection before initiating use.
Metabolized by CYP3A4, requiring careful consideration of drug interactions.

HIV Prevention

Preexposure prophylaxis (PrEP) involves daily antiretroviral medications to reduce HIV acquisition risk.
- Examples: tenofovir disoproxil fumarate/emtricitabine (Truvada) and tenofovir alafenamide/emtricitabine (Descovy), Cabotegravir.
Postexposure prophylaxis (nPEP) involves a 28-day course of antiretroviral therapy after potential exposure within 72 hours.
- Preferred regimens typically include an integrase inhibitor.

Other Infections

Pneumocystis pneumonia (PCP)

Trimethoprim/sulfamethoxazole (TMP/SMZ) is the first-line treatment for PCP.
Intravenous pentamidine for severely immunocompromised patients.

Cytomegalovirus (CMV) retinitis

Ganciclovir or valganciclovir (oral prodrug) is first-line induction and maintenance.
Foscarnet for ganciclovir-resistant or intolerant cases.
Cidofovir reserved for cases failing ganciclovir or foscarnet.
Lifelong maintenance therapy to prevent relapse with effective antiretrovirals.

Mycobacterium infections (e.g., TB)

Multi-drug regimen (isoniazid, rifampin, ethambutol, pyrazinamide) for 2 months (intensive phase) followed by isoniazid and rifampin for 4 months (continuation phase.)
Second-line agents for MDR/XDR TB, including fluoroquinolones, injectable drugs, or cycloserine/ethionamide.
Prolonged treatment (18-24 months).
TB/HIV co-infection requires special care due to drug interactions and immune reconstitution inflammatory syndrome.
Directly observed therapy (DOT) and adherence monitoring crucial to prevent resistance.

Cryptococcal meningitis

Amphotericin B plus flucytosine is the treatment.
Oral fluconazole maintenance after initial infection control.
Close monitoring for adverse effects (nephrotoxicity, bone marrow suppression).

Bacterial Infections

Chlamydial infections

Chlamydia trachomatis causes asymptomatic infections often leading to pelvic inflammatory disease (PID) and infertility complications.
Azithromycin or doxycycline are used in treatment.
Routine screening of sexually active individuals crucial for early diagnosis.

Gonococcal infections

Neisseria gonorrhoeae can cause asymptomatic infections and are now treated with a single IM dose of ceftriaxone.
Previously, dual therapy with ceftriaxone and azithromycin was used, but it is not preferred anymore.
Prompt treatment crucial to prevent complications and evaluate sexual partners.
Follow-up testing.

Syphilis

Treponema pallidum causes syphilis presenting in stages: primary (painless chancre), secondary (skin rashes), latent (asymptomatic), tertiary (neurological/cardiovascular complications).
Congenital syphilis possible from vertical transmission.
Penicillin G is the preferred treatment, with alternative options like doxycycline for penicillin-allergic patients and desensitization preferred for neurosyphilis or pregnancy.
Follow-up at 6 and 12 months after treatment to ensure cure.

Bacterial vaginosis (BV)

Overgrowth of anaerobic bacteria like Gardnerella vaginalis causing thin, grayish, malodorous vaginal discharge, elevated pH, and clue cells on microscopy.
Associated with sexual activity, but not strictly a sexually transmitted infection.
Metronidazole, clindamycin, or tinidazole (oral or vaginal) used to treat.

Trichomoniasis

Trichomonas vaginalis causes vaginitis and urethritis.
Many cases are asymptomatic.
Metronidazole (oral twice daily for 7 days for women, or a single 2 g dose for men) or tinidazole (single dose) is used.
Alcohol avoidance for at least 3 days after treatment due to disulfiram-like reaction.

Nongonococcal urethritis (NGU)

Inflammation of the urethra caused by organisms other than Neisseria gonorrhoeae (e.g., Chlamydia trachomatis, Ureaplasma urealyticum, Trichomonas vaginalis, Mycoplasma genitalium.)
Diagnosed by urethral discharge and polymorphonuclear leukocytes (PMNs) with a negative gonorrhea test.
Doxycycline, azithromycin, or levofloxacin are commonly used.

Pelvic inflammatory disease (PID)

Combination antibiotic therapy (e.g., ceftriaxone plus doxycycline) to cover various pathogens including chlamydia, gonorrhea, and anaerobes.
Outpatient treatment or intravenous antibiotics for severe cases or lack of response.
Sexual partners need treatment to prevent reinfection.
Follow-up crucial and in severe cases.

Acute sexually transmitted epididymitis

Antibiotic combination to cover chlamydia and gonorrhea (ceftriaxone 500mg IM plus doxycycline 100mg orally twice daily for 10 days).
Levofloxacin added for insertive anal intercourse.

Proctitis

Antibiotic combination to cover potential causative organisms (e.g., ceftriaxone plus doxycycline).
Prolonged treatment for bloody discharge, tenesmus, and positive chlamydia tests.
Treatment also for herpes if perianal ulcers are present.

Candidiasis

Topical agents (nystatin, clotrimazole, miconazole) for mucosal candidiasis.
Oral azole antifungals (fluconazole, itraconazole, ketoconazole) for systemic candidiasis.
Fluconazole is often used.
Duration depends on site and infection severity.
Chronic suppressive therapy in immunocompromised patients.

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Description

This quiz covers herpes simplex viruses, varicella-zoster virus, and cytomegalovirus infections, as well as antiviral treatments. It focuses on different antiviral drugs, their mechanisms, applications, and applicable viral hepatitis types. Test your knowledge on these important viral infections and treatment options.