Transcript

Lee Tetreault:

Welcome to frequently asked questions from the session Doctor's Lounge Infectious Disease. We are joined by Dr. Sax. Before we begin with these questions, doctor, would you be able to reiterate a few key pointers from today's session to our audience?

Dr. Sax:  

Sure. The session today started with a case presentation by Dr. Domino of a man who presented to his office who had a new ulcerative lesion on his penis, shortly after leaving a long-term, stable, relationship and having several new sexual partners. He's a gay man, so these were sexual encounters with other men. And the differential diagnosis of ulcerative skin lesions, genital lesion, was discussed in detail. The most common cause by far would be herpes simplex virus, but this was a painless lesion. The second most common would be that this is the lesion of primary syphilis or a chancre. Treatment of syphilis these days is with penicillin, as it has been for decades. And diagnostic tests to make the diagnosis of syphilis have changed somewhat, that the most common screening test now is an enzyme immunoassay for Treponema pallidum rather than RPR. The RPR is still used to give us a sense of how active the disease in the early phases of the treatment, picking secondary syphilis, and as I mentioned, people with syphilis do all get treated with penicillin.

Lee Tetreault:

Great, let's get into some questions. As an infectious disease doc, what are your three 'don't leave home without it' antibiotics and or anti-viral meds that you take with you when traveling, especially to out-of-the-way destinations?

Dr. Sax:  

Well, probably the most common antibiotic we recommend for people traveling to the tropics is to take something for treatment of travelers diarrhea, and the options here would be azithromycin or a quinolone like, such as ciprofloxacin or levofloxacin. Very short courses of these antibiotics, just a day or two, can shorten the duration of this diarrheal illness substantially. And so they really can get people feeling better more quickly. The other thing always to remember, when you are traveling to a tropical region, is that some places are highly endemic for malaria, and we give malaria preventive therapy to anyone going to these countries and the recommendations of what anti-malarial therapy to take vary depending on what part of the region people are going to. For much of Africa, for example, where they have chloroquine-resistant malaria, we recommend that people take either the combination tablet of atovaquone/proguanil or so-called Malarone or they take mefloquine. For people who are traveling to the Americas, where there isn't as much chloroquine resistance, we often recommend using chloroquine.

Lee Tetreault:

Why do we need to culture an abscess?

Dr. Sax:  

I recommend that people who have soft tissue abscess have this sent for culture because they can then assess whether it is caused by methicillin-sensitive or methicillin-resistant Staph aureus. For a while, MRSA was so common that we could assume that people had MRSA unless proven otherwise, but actually the incidence of MRSA has dropped dramatically. And so, now, a significant fraction of these abscesses are caused by MSSA, and that increases the range of different antibiotics that you can use for treatment.

Lee Tetreault:

What is the clinical benefit of getting liver elasticity test?

Dr. Sax:  

So liver elastography or the so-called FibroScan test is particularly useful and validated in people with chronic hepatitis C. It's a very good way of assessing whether people have F3 or F4 level of fibrosis in their liver. People with F3 or F4 are of course, at risk for getting secondary complications of advanced liver disease even after their hepatitis C is treated. So as a result, finding out the fibrosis status of a patient's liver is really critical for their follow-up.

Lee Tetreault:

And lastly, do you give shingles vaccine to someone who had the chicken pox vaccine?

Dr. Sax:  

If people receive the chicken pox vaccine during childhood, they probably are not old enough yet to require the shingles vaccine. Remember, with the new more effective adjuvanted zoster vaccine, it's not recommended until people turn 50 or older. So as a result, generally the answer is no, however, if the question is, will at one point people who receive the chickenpox vaccine be old enough to be eligible for the zoster vaccine, the answer is yes, they will. People who get the chickenpox vaccine can get herpes zoster in the future.

Lee Tetreault:

This is great information, doctor, thank you so much for your time.

Dr. Sax:  

You're welcome




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