Clincial Approach To STDs In Males

Question 1

Risk factors for STDs

Answer 1

Being diagnosed with a STI within the past year

Not using condoms

Having multiple sex partners or having a partner at risk for STId

Being part of any of the following populations

• gender minorities
• HIV positive
• using IV drugs
• prostitution
• being in a correctional facility

Question 2

Tests to get for STDs

Answer 2

Serologic testing for syphills is

Culture and antigen testing for HSV

Dark field examination for treponema pallidum

Serologic testing for HIV

NAAT for chlamydia and gonorrhea

Special tests for haemophilus ducreyi (chancroid)

Question 3

What is the best way to deliver group counseling for StIs:

Answer 3

Involve more than 120 minutes and are delivered in several sessions

also may be just as effective in a single 30 minute session but studies suggest the later shows the best improvement

Question 4

Treatment for HSV and syphills

Answer 4

Herpes

• 1st line = acyclovir 400 mg or famciclovir 250 mg 3-5x a day for 7-10 days
• 2nd line = valacyclovir 1g 2 times per day for 7-10 days

Syphills = penicillin G IM once (if primary or secondary) and IM weekly for 3 weeks if tertiary

Question 5

Proctocolitis

Answer 5

Is a chlymida or gonorrhea infection of the rectum due to anal sex usually

Produces

• anorectal pain
• bloody rectal discharge
• not usually any systemic symptoms
• will show ulcerations of the anus also

Tests = CBC/CMP/CRP/ESR/HIV/Stool cultures (all are to rule out other causes

• get a NAAT for ruling in chlymida or gonorrhea
• also get colonoscopy if you suspect worse condtions

Question 6

Prevention guidelines in gay men

Answer 6

Offer vaccinations for hepatitis A and B and for HPV in all men under then age of 26

Offer meningococcal vaccine also if they also have 1 additional risk factor (medical occupation, lifestyle, etc)

Offer prophylaxis for HIV if risky lifestyle exists

Screen for STIs at least annually

• *if in a monogamous relationship and uses condoms consistently = offer HIV testing and STI, and ONLY Hep A/B and HPV vaccinations if they haven’t gotten them and are younger than 26 yr**
• dont offer HIV prophylaxis unless high risk behavior (can still screen though if the patient wants)**

if high risk behavior and oral intercourse only = oral NAAT screening for STD s only

**if receiving or inserting anally in high risk patients = screen for anal and oral NAAT

Question 7

HIV preexposure prophylaxis

Answer 7

Fixed dose of 300 mg Tenofovir + 200 mg emtricitabine (Truvada)
- contraindications = current renal failure (GFR<45) or have a acute or chronic HIV

Question 8

HIV post exposure proylaxis

Answer 8

High antiretroviral therapies (multiple different)

• need to intiate ASAP and no later than 72 hrs after exoposoure (wont work after this)
• dont do this if no exposure!!

Question 9

Treatment of chlamydia and gonorrhea in all populations

Answer 9

In any male or non pregnant female with no drug allergies
- 1g PO 1x period azithromycin + 100 mg PO 2x daily doxycycline for 7 days

In any male or non pregnant female with allergies to doxycycline
- replace doxycline with 500mg PO 2x daily levofloxacin for 7 days

In pregnant women
- azithromycin 1g PO 1x period azithromycin + 500mg PO 3x daily amoxicillin for 7 days