RESISTANT TRICHOMONAS

Transcription

1 RESISTANT TRICHOMONAS Metronidazole Furazolidone intravaginally Nonoxynol-9 intravaginally Betadine suppositories Nitazoxanide cream Metronidazole/miconazole/lidocaine cream KMnO4 intravaginally Tinadazole: : 1 gm PO TID x 14 days Paramomycin vaginal cream: 3.5 gms in 70 gms vaginal cream, 5 gms PV qhs x 14 days

2 Evaluation of PCR, Culture, Wet Mount, and Pap Test for the Diagnosis of Trichomoniasis Sensitivity (% ) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 100.0% PCR (ref. standard) 78.7% 65.6% 60.7% Culture Wet Mount Pap Test Lobo, 2003 Sexually Transm. Dis.

3 Syphilis The most disowned infection in history.

4 The Great Pox The French called it the Neopolitan disease The English, Germans and Italians called it the French disease The Russians blamed it on the Poles The Poles blamed the Germans The Dutch, the Belgians and the Portuguese blamed the Spanish India and Japan blamed the Portuguese

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7 HOW NOT TO DO IT 2000: Ruptured appendix taking 9 months to heal Complicated by post-op abcess with drainage 2005: Genital HSV : 3 episodes of shingles 2007: Oral thrush 2007: Esophageal candidiasis 2008: Non- healing HSV-2 for 4 months 2008: HIV test: 1 st TIME EVER DONE: +

8 HSV2/HIV CONNECTION HSV2+/HIV- 4x higher rate of HIV acquisition than HSV2- HSV2+/HIV+ 5x higher rate of HIV transmission than HSV2-

9 HSV-2 Seroprevalence v > 12 Years of Age 25 National Health and Nutrition Examination Survey Prevalence by age (%) % 17.0% NHANES III NHANES IV This study was funded exclusively by the U.S. Centers for Disease Control and Prevention.

10 28.3% of adult New Yorkers* are infected with HSV-2 20 years of age 1,393,613 New Yorkers *Excluding incarcerated persons and those living in nursing homes

11 NYC US NYC HANES > 20 years of age 28.3% US NHANES IV >12 years of age 17% ADJUST TO: > 20 years of age

12 The Prevalence of HSV-2 in NYC is Higher Than the National Average *Estimate of the NYC Health and Nutrition Examination survey (HANES), which was modeled closely on the National HANES. Survey was based on interviews with 1622 NYC residents 20 years old who had HSV results and audio-computer asisted selfinterview data.¹ Results derived from the National Health and Nutrition Examination Survey conducted from (NHANES ) with participants, when compared to U.S. census data.² ³ 1. Schillinger JA et al. Findings from the New York City Health and Nutrition Examination Survey. Poster presetned at: National STD prevention conference; May 10, 2006; Jacksonville, Fla. 2. Xu,F et al. In program and abstracts of the 42 nd Annual Meeting of IDSA; September 30-October 3, 2004; Boston, Mass. 2004;56 Abstract Annual estimates of the population by sex and five-year age groups for the United States: April 1, 2000 to July 1, Available at: EST xlx. Accessed August 7, 2006.

13 70 60 HSV-2 seroprevalence* in persons>20 years, by race/ethnicity, sex, NYC, % HSV-2 Positive Male Female 0 White,NH Black,NH Hispanic *Age-adjusted to the Year 2000 U.S. Standard Population

14 The Clinical Spectrum of HSV-2 Recognized Infection HSV-2 Seroprevalence 14.3% 85.7% Unrecognized or Asymptomatic Infection Mertz GJ. Infect Dis Clin North Am. 1993;7:

15 ATYPICAL PRESENTATIONS Excoriations Folliculitis/furunculosis Erythema Urethral symptoms

16 50% CDC GUIDELINES : 2010

17 Type of Test HerpeSelect TM 1 ELISA IgG HerpeSelect TM 2 ELISA IgG Genital Herpes: FDA-Approved Type-Specific Serologic Tests Time to Sensitivity* Specificity* Seroconversion** (%) (%) (median days) ~17 ~21 HerpeSelect TM Immunoblot 1 and 2 biokit HSV-2 Sure-View HSV ND Office Based Tests HerpeSelect Express *Based on comparison with the results of Western blot test. Percentages given for HerpeSelect, Immunoblot, and biokit are for HSV-2 antibodies. **Median days for HerpeSelect assays are from preliminary unpublished data and may change.nd=not determined. HerpeSelect TM is a trademark of Focus Technologies Inc. biokit is a registered trademark of BioKit USA Inc. Adapted from Ashley RL. Sex Transm Infect. 2001;77:

18 gg1 gb gg2 gb HSV-1 HSV-2 gd gd gg-1 (glycoprotein G-1) : type-specific for HSV-1 gg-2 (glycoprotein G-2) : type-specific for HSV-2 Stephen L. Sacks MD

19 2.50

20 2.50

21 $156.25

22 When a man knows that he has a urethra he has urethritis JD Oreil M.D.

23 VZV INFECTION Previous infection with chicken pox Usually unilateral Very painful Large area Multiple stages simultaneously

24 TOLD THEY HAD HERPES BUT THEY DON T Anxiety Depression Loss of self-esteem Impact on current relationships Difficulty starting new relationships Unnecessary courses of medication

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26 CDC GUIDELINES : 2002

27 VSTK deficient