Infectious Disease Update: Clinical Pearls

Ted Rosen, MD

At MauiDerm Fall NP+PA 2014, Dr Rosen provides us with an update on infectious diseases and his clinical pearls…

  1. STDs are globally epidemic. In the US, 50% of those 15-25 have or have had an STD
  2. STDs are so common due to the “multiplier” effect of sex partners of sex partners
  3. Syphilis is on the rise last three years in USA, now at 5.3/100,000 population
  4. Multi-drug resistant GC (including resistance to drugs of choice, cephalosporins) is here
  5. Topical three months regimen of 4% zinc sulfate soaks for active genital herpes benficial
  6. External genital warts: NEW treatment ideas
    • 5% KOH daily x 3 months
    • Single application of ingenol mebutate (either strength)
    • Thermotherapy with 440C for 30 min x 3 days, each of two consecutive weeks
  7. Leishmaniasis being brought back to USA from Iraq and Afghanistan
    • Rx: Pentavalent antimonial IV, IM from CDC; Quite toxic.
    • Thermotherapy (ThermoMed device): 1300F; Painful and blisters
    • New drug: Miltefosine 100-150mg/day PO (Impavido™) available 2015
      • Lecithin derivative
      • Safe and effective for Old and New World Leishmaniasis
  8. Treatments for MRSA have expanded with three new drugs
    • All new drugs have LONG T1/2 which allows less frequent dosing
    • Oritivancin: Single 1200mg dose
    • Dalbavancin: 1000mg, then 500mg a week later
    • Tedizolid: 200mg QD x 5-7 days
  9. Chikungunya virus
    • Used to be Africa/Asia, Now worldwide
    • Most cases imported from trip (especially from Caribbean)
    • Now, virus-carrying mosquitoes in Caribbean and USA
    • Fever, arthralgia, myalgia, headache, petechial to purpuric rash
    • Like Dengue but not as bad
    • No vaccination, No specific Rx. Supportive therapy, as needed.