Assignment Three Student: Nursing 785

Patient Profile 25 year old MSM UPSI – receptive and provider 4/52 ago, anal and oral intercourse 10/7 developed urethral discharge Presents with generalised unwellness, no rash, sore throat Med Hx – stroke age 12 years, known epileptic controlled with Carbazamine. Last blood drug levels 12/12 ago. Previous positive result and treatment for gonorrhoea and syphilis in 2012 (documented). Allergy: Documented anaphylaxis to Penicillin OE; purulent penile discharge and mild lymphadenopathy, throat NAD Tested for PCR Gonorrhoea/Chlamydia Throat and FVU and anal swab General Throat Swab and anal swab

……Patient Profile Bloods testing Syphilis & HIV Identified as positive contact with MSM syphilis TIME LAPSE due to delay at laboratory Weak Positive Syphilis and gonorrhoea PCR urine, anal swab results positive, no sensitivities available for gonorrhoea

Pathophysiology of Disease: Syphilis: Organism Treponema Pallidum Person to Person sexual intercourse, crosses placenta causing congential disease Fragile Bacterium, Spirochete, thin and moves by flexing Diagnosed by dark stain microscopy or serology Stages: Primary - localised infection Secondary – disseminated infection Teritary or Late Syphilis – Vascular or neurologic symptoms

….pathophysiology of Disease Gonnorrhoea Bacteria Neisseria Gonorrhoea (1-14/7 incubation) Discharges from infected mucous membranes Urethritis with profuse pus and dysuria Can be asymptomatic

Presenting Issues UPSI behaviour Positive Gonorrhoea – awaiting sensitivities Positive contact Syphilis – awaiting repeat testing weakly positive EIA. Contact tracing of partners

Pharmacotherapy: ISSUE: Anaphylaxis to Penicillin Meds: Carbazamine 400mg BD Treat gonorrhoea resistant to ciprofloxacin and intermediate sensitivity to ceftriaxone Treat syphilis TREATMENT: 2 gram dose of Azithromycin

Management Plan Discussed sexual behaviour and explore non condom usage Retest syphilis in 1/12, 6/12, 12/12 Retest for cure in 14 days for gonorrhoea clearance 3/12 BBV testing (window period) Contact tracing

References: NZ Formulary - V on 1 September Stockleys Interaction Alerts as cited in NZ Formulary.Tegretol and Azithromycin. retrieved 2 September 2014, from Medsafe.(2010).Azithromycin.New Zealand Data Sheet.Retrieved 3 September2014, from Gutierrez, K. (2008) Pharmacotherapeutics: Clinical Reasoning in Primary Care, 2nd Edition, Saunders Elsevier, Missouri Hook, E, et al (2009) A Phase III Equivalence Trial of Azithromycin versus Benzathine Penicillin for Treatment of Early Syphilis. Journal of Infectious Diseases 2010: 201 pg Medsafe (2012). Tegretol.New Zealand Data Sheet. Retrieved 3 rd September 2014, from Medsafe. ( 2014).Ciprofloxacin.New Zealand Data sheet. retrieved 2 September, 2014, from Tortora, G., & Derrickson, B. (2012). Principles of Anatomy & Physiology (13th Edition ed.). United States of America: John Wiley & Sons. BPAC Inc. (2011) Syphilis: The Great Imitator Available from: retrieved 1 September The New Zealand Sexual Health Society (NZSHS). Syphilis. NZSHS: Auckland; Available from: (Accessed Sept, 2014).