190.3 🩺 內科專科考前版

190.3.0.1 1⃣ 2021 CDC Update Doxy > Azithro

  • Multiple trials showed doxy superior cure (especially rectal)
  • Azithro single-dose effectiveness wane in past decade
  • IDSA/CDC aligned
  • Pregnancy + adherence concerns still favor azithro

190.3.0.2 2⃣ MSM Rectal Screening

  • CDC guidance: pharyngeal + rectal + urethral NAAT q3-6 mo high-risk MSM
  • Triple-site testing catches asymptomatic carriers
  • Treatment: doxy 100 bid × 7d (rectal CT) or × 21d (LGV)
  • HIV + syphilis + HCV + HBV concomitant

190.3.0.3 3⃣ Fitz-Hugh-Curtis Syndrome

  • Perihepatitis — RUQ pain mimicking cholecystitis
  • N. gonorrhoeae or C. trachomatis
  • Diagnosis: PID context + RUQ pain + ↑ ESR/CRP, LFTs may be normal
  • Laparoscopy: “violin string” adhesions liver-diaphragm
  • Treat as PID

190.3.0.4 4⃣ Tubo-Ovarian Abscess (TOA)

  • Severe PID complication
  • Imaging (transvaginal US, CT)
  • Treatment: hospitalize + IV antibiotics + drainage (percutaneous or surgical)
  • Continued antibiotics × 14-21d after defervescence

190.3.0.5 5⃣ Reactive Arthritis Workup

  • Post-STD (Chlamydia, Gonorrhea, Shigella, Salmonella, Campylobacter, Yersinia)
  • HLA-B27 + (50-90%)
  • Asymmetric oligoarticular lower extremity
  • Enthesitis common
  • Treatment: NSAID, intra-articular steroid; chronic — DMARD
  • Treat underlying infection

190.3.0.6 6⃣ Trachoma Elimination Progress

  • 17 countries verified by 2024 (Ghana, Iran, Mexico, etc.)
  • Mass azithromycin distribution (MDA) campaigns
  • Verification: < 0.2% trichiasis prevalence in 15+ + active trachoma < 5%

190.3.0.7 7⃣ 健保 / Taiwan

  • 通報 (STI)
  • 健保 azithromycin / doxycycline / ceftriaxone covered
  • NAAT testing 健保
  • MSM screening — sexual health clinics

190.3.0.8 8⃣ Resistance + Future

  • Chlamydia resistance to standard agents — rare clinically
  • Antibiotic stewardship (avoid azithro 1 g for multiple STIs simultaneously — selects resistance)
  • New agents: lefamulin (pleuromutilin), zoliflodacin