2: STI Treatments

Question 1

Alternatives for PCN allergy:

1. Doxycycline 100 mg PO BID x 28 days
2. Tetracycline 500 mg PO QID x 28 days

Answer 1

1. Late Latent Syphilis
2. Latent Syphilis (unknown duration)

Question 2

1. Metronidazole 2gm PO now
2. Tindamax 2gm PO now

Answer 2

Trichomoniasis

Question 3

1. Acyclovir 400 or 800mg BID x 5d
2. Famcyclovir 125mg BID x 5d or 1000mg BID x 1d
3. Valacyclovir 500mg BID x 3/5d

Answer 3

Recurrent episodes of herpes.

Question 4

1. Cryotherapy Q1-2weeks
2. Imiquimod 5% cream HS TID x 1-16 weeks, washed off after 6-10 hours with mild soap and water (not in pregnancy).
3. Trichloroacetic acid or bichloroacetic acid (80-90%) until turn white (repeat weekly PRN)
4. Podofilox gel (Podophyllin resin) (not in pregnancy).
5. Sinecatechins
6. Surgical removal

Answer 4

HPV (Genital Warts)

Question 5

All of the following:

1. Clinda 900mg IV TID
2. Gent 2mg/kg IV loading
3. Gent 1.5mg/kg IV Q8hr
4. Then Doxy 100mg PO BID x 14d

Answer 5

Inpatient PID

Question 6

Benzathine penicillin G 2.4M units IM once

Answer 6

1. Primary
2. Secondary
3. Early latent <1yr syphilis

Question 7

1. One of the following:
   
   1. Cefotetan 2g IV Q12hr
   2. Cefoxitin 2g IV Q6hr at least 24hrs.
2. Then Doxy 100mg IV Q12hr, continue PO BID x 14 days

Answer 7

Inpatient PID

Question 8

• 1 of the below:
  
  1. Ceftriaxone 250mg IM once
  2. Cefixime 400mg once
• PLUS 1 of the below:
  
  1. Azithromycin 1gm PO once
  2. Doxycycline 100mg BID x 7 days

Answer 8

Gonorrhea

Question 9

1. Benzathine PCN G 7.2M units IM once
2. Plus 2.4M units IM weekly x 3 weeks

Answer 9

1. Late latent syphilis
2. Latent of unknown duration
3. Tertiary

Question 10

Alternatives for PCN allergy: Consult a specialist.

Answer 10

Tertiary Syphilis

Question 11

1. Acyclovir 400mg BID
2. Valacyclovir 500mg-1000mg QD
3. Famciclovir 250mg BID

Answer 11

Suppressive treatment of herpes.

Question 12

1. Needle aspiration and/or I/D of buboes
2. Azithromycin 1gm PO once
3. Ceftriaxone 250mg IM once
4. Cipro 500mg BID x 3d
5. Eryth 500mg QID x7d

Answer 12

Chancroid

Question 13

Alternatives for PCN allergy:

1. Doxycycline 100 mg orally BID x 14 days
2. Tetracycline 500 mg orally QID x 14 days

Answer 13

1. Primary Syphilis
2. Secondary Syphilis
3. Early Latent (<1 year) Syphilis

Question 14

1. Malathion .5% lotion for 8-12 hours at a time, then wash off.
2. Oral ivermectin (250 mcg/kg) taken initially and repeated in 2 weeks is another alternative regimen, although this medication has limited ovicidal activity.

Answer 14

For treatment of pediculosis pubis (lice) that did not go away with initial treatment.

Question 15

Antiviral drugs are used for chronic infx. No drugs for acute infx.

Answer 15

Hep B

Question 16

1. Acyclovir 400mg TID
2. Famcyclovir 250mg TID
3. Valacyclovir 1gm BID

All x7-10 days, may extend until lesions gone

Answer 16

1st episode of herpes.

Question 17

1. Combination of interferon and ribavirin with or without protease inhibitors.
2. New direct-acting antivrail (DAA) agents - target viral enzymes and proteins throughout the viral life cycle and have less complicated dosing and higher tolerability (sofosbuvir, simeprevir).

Answer 17

Hep C

Question 18

1. Surgery or laser treatment
2. Liquid nitrogen
3. Trichloracetic acid
4. Rx creams

Most sores will go away on own within 10mo, but may take 5yrs.

Answer 18

Molluscum

Question 19

1. Permethrin 1% cream rinse, applied and washed off after 10 minutes x 1 week.
2. Pyrethrins with piperonyl butoxide, applied and washed off after 10 minutes x 1 week.

Answer 19

Initial treatment pediculosis pubis (lice)

Question 20

1. One of the following:
   
   1. Ceftriaxone 250mg IM once
   2. Cefoxitin 2g IM once
2. Plus both of the following:
   
   1. Probenecid 1g orally and
   2. Doxy 100mg BID x 14 days

Answer 20

Outpatient PID

Question 21

1. Azithromycin 1gm PO once
2. Doxycycline 100mg BID x 7 days
3. Other options include erythromycin, levofloxacin, ofloxacin

Answer 21

1. Nongonococcal urethritis (NGU)
2. Chlamydia

Question 22

Immediate IM injection of immunoglobulin once.

Answer 22

Hep B

Question 23

Combination therapy with multiple antiretroviral drugs.

Answer 23

HIV

Question 24

What is EPT and when would it be allowed?

Answer 24

All of the woman’s sexual partners in the past 60 days should be referred for testing and possible treatment. If partners are unable or unwilling to be evaluated by a healthcare provider, expedited partner therapy (EPT) should be considered if permitted by state law. EPT is the practice of treating sexual partners of individuals who have been diagnosed with chlamydia by providing medication or prescriptions for medication to the individual to provide to the partner. Examination of the partner is not necessary

Question 25

Which STIs require a test of cure?

Answer 25

1. Chlamydia: Test of cure at 3-4 weeks for pregnant women. Retest all women at 3 months after treatment for reinfection (this is not a test of cure).
2. Gonorrhea: Test of cure is not necessary. Retest all women at 3 months for reinfection.
3. From chlamydia in the book, “A test of cure (3–4 weeks after treatment) is not necessary unless a woman is pregnant, has persistent symptoms, was unable to complete treatment, or may have been re-exposed or reinfected.”