Pharmacology of Infectious Dz of Repro Tract PDF

Pharmacology of Infectious Dz of Repro Tract STD Men have higher incidence of STDs Women have frequent and severe complications (serious effects on maternal and infant during pregnancy) Damage reproductive organs, increased risk of cancer, transmission to fetus Most neonatal infections are acquired...

Pharmacology of Infectious Dz of Repro Tract STD Men have higher incidence of STDs Women have frequent and severe complications (serious effects on maternal and infant during pregnancy) Damage reproductive organs, increased risk of cancer, transmission to fetus Most neonatal infections are acquired at birth after infant passes through an infected cervix or vagina o Syphilis transmitted transplacentally (infected mother to fetus) = congenital syphilis o Serious health problems for baby (stillbirth, premature birth, low birth weight, birth defects, longterm neurological issues) STD Bacterial Vaginosis Chlamydia Gonorrhea Hepatitis Herpes genitalis HIV/AIDs HPV Pelvic Inflammatory Dz Syphilis Trichomoniasis Species Anaerobic bacteria: Gardnerella vaginalis, Mycoplasma hominis, Ureaplasma spp, etc. Chlamydia trachomatis Neisseria gonorrhoeae Hepatitis A, B, C, D, and E viruses Herpes simplex virus, types I and II Human immunodeficiency virus Human papillomavirus Chlamydia trachomatis, Neisseria gonorrhoeae, bacterial vaginosis Treponema pallidum Trichomonas vaginalis Bacterial Vaginosis Common infection caused by an imbalance of naturally occurring bacteria in the vagina High concentrations of anaerobic bacteria Asymptomatic otherwise vaginal discharge or malodor Fishy odor, thin, greyish-white vaginal discharge, vulvar irritation Risk: multiple partners, lack of condom use, lack of vaginal lactobacilli Increased risk for: o HIV o Gonorrhea o Chlamydia o HSV-2 o Complications of pregnancy o Recurrence of BV Recommended Regimens o Metronidazole o Clindamycin Routine treatment of sex partners is not recommended Treatment is recommended in all symptomatic pregnant women Metronidazole (Flagyl) Inhibits nucleic acid synthesis by disrupting DNA Spectrum: o Protozoa (Trichomonas vaginalis) o Anaerobes o H pylori Adverse effects: o Leukopenia o Thrombocytopenia o Metallic taste o Neurotoxic effects (stop the drug) § Ototoxicity § Neuropathy o Alcohol causes disulfiram reaction (nausea, vomiting, tachycardia, shortness of breath) Clindamycin (Cleocin) Suppresses protein synthesis by binding to 50S ribosomal subunits Spectrum: o Gram + o Some gram – o Anaerobes Use: anaerobic infections, abscesses, pelvic inflammatory disease Side effects: diarrhea, pseudomembranous colitis, nausea, vomiting, abdominal pain or cramps and/or rash Safe in pregnancy Chlamydia Chlamydia trachomatis Most common bacterial STDs Women: abnormal vaginal discharge, burning urination Men: Penis discharge, burning urination, pain swelling in one or both testicles Risk: o Reproductive complications o Continual transmission o Congenital chlamydia (conjunctivitis, pneumonia, sepsis, no symptom) Recommended Treatment: o Azithromycin (Preferred in Pregnancy) o Doxycycline Alternative Regimens o Amoxicillin, Erythormycin (Pregnancy safe) o Levofloxacin (Levaquin®) o Ofloxacin (Floxin®) Pregnant women should be tested 3-4 weeks after completion of therapy and retested 3 months after treatment Chlamydia in Neonates and Infants Recognized by conjunctivitis 5-12 days after birth or subacute pneumonia 1-3 months o Ophthalmia neonatorum: Erythromycin, Alternative: azithromycin > 6 months (Topical tx alone is unnecessary) o Infant Pneumonia: Erythromycin, Alternative: azithromycin > 6 months Gonorrhea Neisseria gonorrhoeae Gram-negative cocci Primarily affects the genital tract. Can infect the rectum, throat, and eyes MEN: Urethral discharge and testicular pain WOMEN commonly asymptomatic o Abnormal genital discharge (yellowish or greenish) o Pain or burning during urination o Genital itching or irritation Antimicrobial-Resistant N. gonorrhoea Antimicrobial-resistant N. gonorrhoeae is a significant public health concern Resistance to multiple antibiotics: penicillin, tetracyclines, macrolides, and fluoroquinolones Resistance has reported: cefixime (Suprax®) and ceftriaxone (Rocephin®) Now starting to see resistance to azithromycin Dual therapy to combat resistance Last option is cephalosporins (CDC has not reported any treatment failures with ceph-) Recommended Regimen: Ceftriaxone + Azithromycin Alternative Regimen (IF CEFTRIAXONE NOT AVAILABLE): Cefixime + Azithromycin Azithromycin allergy: use doxycycline Monotherapy with high-dose azithromycin can be effective but is not recommended due to resistance Ophthalmic Gonococcal Infections in Neonates Results from perinatal exposure to mother’s infected cervix Manifests 2-5 days after birth Prevention: prophylactic agent instilled into both eyes of all newborn infants (required by law in most states) o Erythromycin ophthalmic ointment o Should be done whether vaginal or delivered by cesarean section Pelvic Inflammatory Disease Spectrum of inflammatory disorders of upper female genital tract Can be caused by sexually transmitted organisms (esp. N. gonorrhoeae, and C. trachomatis, Bacterial vaginosis) Treatment must be empiric: broad-spectrum coverage o All regimens must include N. gonorrhoeae and C. trachomatis o Bacteroides fragilis can cause tubal and epithelial destruction o Bacterial vaginosis is present in many women with PID o Regimens should include anaerobes Sex partners should be tested and treated (chlamydia and gonorrhea) Pregnant women has a risk maternal morbidity and preterm delivery Recommended Regimens: o Cefotetan + Doxycycline o Clindamycin + Gentamicin Clindamycin or metronidazole (anaerobic bacteria) Ceftriaxone or cefotetan (gonorrhea and anaerobic bacteria) Doxycycline or azithromycin (chlamydia) Cephalosporins Inhibit bacterial cell wall synthesis (similar to penicillin) Broad-spectrum antibiotics Leading to cell wall lysis and death of bacteria Hepatitis STD and Viral Hepatitis Hepatitis A o Transmission occurs due to fecal-oral contact or contamination o Condoms do not prevent HAV transmission (Vaccination does) Hepatitis B o 10-40% of adults seeking treatment at an STD clinic have past or current HBV infection Hepatitis C o Can be transmitted through sexual activity but not commonly o Multiple partners, other STDs, sex with trauma Herpes Genitalis NO CURE Treatment reduces symptoms and decreases transmission HSV-1 (oral transmission) HSV-2 (sexual transmission; MOST COMMON) Partners should be evaluated and counseled Treatment inhibits viral DNA synthesis Acyclovir (Zovirax®) Valacyclovir (Valtrex®) Famciclovir (Famvir®) Side Effects: nausea, vomiting, diarrhea, and headache. Human Papillomavirus (HPV) Prevention: HPV Vaccine Bivalent vaccine: covers HSV 16 and 18 (Cervarix®) Quadravalent: covers HSV 6, 11, 16, 18 (Gardasil®) 9-valent covers: HSV 6, 11, 16, 18, 31, 33, 45, 52, 58 (Gardasil 9®) o 16 and 18 account for 66% of all cervical cancers o 9-valent protects against 5 additional which account for 15% of cervical cancer o 6 and 11 account for 90% of genital warts Treatment directed to genital warts removal or precancerous lesions caused by HPV Syphilis Caused by Treponema pallidum Highly contagious Can be transmitted from mother to child during pregnancy or childbirth Can increase the risk of acquiring HIV Sexual partners should be tested and treated Stages of Infection: o Primary: Sore or ulcer at infection site (PAINLESS) o Secondary: Weeks after primary. Skin rash, mucocutaneous lesions and lymphadenopathy o Latent: infection is asymptomatic and not contagious, but the bacteria remain in the body o Tertiary: Years later after initial infection; Cardiac, neurosyphilis, gummatous lesions in any organ or tissue Saddle nose deformity occurs when the bridge of the nose collapses, it is most common in patients with untreated congenital syphilis or tertiary syphilis. Treatment Penicillin G benzathine in all stages of syphilis The dosage depends on the stage of syphilis Penicillin allergy: data is limited doxycycline, ceftriaxone, azithromycin Pregnant women who are penicillin allergic: o Desensitize them to penicillin and give penicillin G o If desensitization is not feasible, give ceftriaxone or azithromycin Trichmoniasis Vaginalis Protozoan parasite Women with trichomoniasis are 3 times more likely to have gonorrhea Men with trichomoniasis have gonorrhea Most women with HIV also have trichomoniasis Yellow-green or gray-white vaginal discharge with a strong odor Concurrent treatment of sex partners is required Treatment: metronidazole or tinidazole