162.3 🩺 內科專科考前版

162.3.0.1 1⃣ DGI 鑑別 from Other Septic Arthritis

病 Pattern
DGI 䞉聯 (TST + 玅疹 + polyarthralgia) 或 mono purulent (knee); young, sexually active
S. aureus septic arthritis mono, IDU/skin source, no TST/dermatitis
GAS mono, postpartum/wound
Lyme arthritis knee mono, late, endemic area
Reactive arthritis post-STD/GI, 3 wk later, 䞍是 active infection
Crystal (gout/CPPD) mono, joint fluid crystals

Workup: synovial fluid cx + NAAT + GU + pharyngeal + rectal + blood cx

162.3.0.2 2⃣ Fitz-Hugh-Curtis Syndrome

  • Perihepatitis (liver capsule inflammation)
  • 䞊腹/RUQ 痛 (mimics cholecystitis)
  • “Violin string” adhesions on laparoscopy
  • N. gonorrhoeae 或 Chlamydia
  • Treat as PID

162.3.0.3 3⃣ PID — IDSA / CDC Algorithm

  • Outpatient: ceftriaxone 500 IM × 1 + doxy 100 bid × 14d + metro 500 bid × 14d
  • Inpatient (TOA, pregnant, severe, fail PO): cefoxitin/cefotetan IV + doxy + ± metro
  • TOA: drainage + IV antibiotic 长期 (TOA: tubo-ovarian abscess)

162.3.0.4 4⃣ MSM Screening

  • CDC: q3-6 mo screening:
    • Pharyngeal NAAT
    • Rectal NAAT
    • Urethral NAAT
    • HIV + syphilis + HCV + HBV
  • Triple-site testing detects asymptomatic carriage (MSM)

162.3.0.5 5⃣ Doxy-PEP for STI Prophylaxis (2024)

  • Doxycycline 200 mg PO within 72 hr post unprotected sex (MSM, transgender women)
  • 倧 reduce N. gonorrhoeae + syphilis + chlamydia (DoxyPEP, dPEP studies)
  • 2024 CDC guidance recommendation
  • 泚意: 䞍適 ♀ (mixed evidence); 抗藥 surveillance ongoing

162.3.0.6 6⃣ Ophthalmia Neonatorum 預防

  • Erythromycin 0.5% ointment universally at birth (USA)
  • Taiwan: 䞍 universal (case-by-case high-risk mother)
  • 預防 N. gonorrhoeae + Chlamydia conjunctivitis

162.3.0.7 7⃣ 健保 / Taiwan

  • 通報 STI (Public Health)
  • 健保 ceftriaxone IM/IV 限 indication
  • HIV / syphilis screen 隚同
  • 盧醫垫 hint: 內分泌 + 性傳染病 history — 即䜿非 STI clinic, asymptomatic 高 risk 病人郜 ask

162.3.0.8 8⃣ XDR Cases 處理

  • Japan H041 strain (2009): first ceftriaxone-R confirmed
  • UK FC428 strain (2018)
  • Solution: gentamicin + azithromycin combo, gepotidacin, zoliflodacin
  • 病人 isolation + partner notif + 通報