Drugs & Doses: Sexual/Men's/Women's Health

Question 1

Cystitis (women)

Answer 1

Trimethroprim 300mg PO daily for 3/7 OR Cephalexin 500mg PO Q12H for 5/7
Paeds dosing: Trimeth 4mg/kg BD or cephalic 25mg/kg TDS both for 3/7
If pregnant - nitrofurantoin 100mg Q6H for 5/7

Question 2

Cystitis (men)

Answer 2

1. Trimethroprim 300mg orally x 7 days – OR

2. Cephalexin 500mg oral 12 hrly x 7 days

Question 3

Pyelonephritis

Answer 3

Cephalexin 500mg 6 hrly x 10-14 days

Question 4

Nocturnal enuresis

Answer 4

Desmopressin 200mg for events

Question 5

Bacterial Vaginosis

Answer 5

Metronidazole 400mg oral, 12 hrly x 5 days

OR metronidazole gel 0.75% nocte for 5/7

Question 6

Thrush (vaginal)

Answer 6

1. Clotrimazole 1% cream intravaginally nocte x 6 nights (or 2% x 3 nights)
   OR / if not working
2. Fluconazole oral 150mg STAT (if not pregnant)

Question 7

Trichomoniasis

Answer 7

Metronidazole 2gm oral , single dose – If RELAPSES needs:

Metronidazole 400mg oral, 12 hrly x 5 days

Question 8

Chlamydia

Answer 8

Azithromycin 1gm oral STAT

Question 9

Gonorrhoea

Answer 9

Azithromycin 1gm oral STAT

PLUS Ceftriaxone 500mg in 2ml 1% lidocaine IM injection

Question 10

Pelvic Inflammatory Disease (NON SEXUALLY Acquired)

Answer 10

1. Amoxycillin + Clavulanate 875+125mg (Aug DF) oral 12 hrly for 14 days AND
2. Doxycycline 100mg 12 hrly for 14 days

Question 11

Pelvic Inflammatory Disease (SEXUALLY Acquired)

Answer 11

1. Ceftriaxone 500mg in 2ml of 1% lidocaine IM injection AND
2. Azithromycin 1gm oral STAT AND
3. Metronidazole 400mg oral 12 hrly for 14 days PLUS
4. Doxycycline 100mg 12 hrly for 14 day
   OR Azithromycin 1gm oral STAT one week later (pregnant or non compliant to doxy)

Question 12

Prostatitis

Answer 12

1. Sexually acquired - As for PID but without Metronidazole
2. Non sexually acquired - trimethoprim 300mg for 2/52 or cephalex 500mg Q6H for 2/52

Chronic prostatitis

1. Ciprofloxacin 500mg Q12H for 4/52
2. OR trimethoprim 300mg for 4/52 OR norfloxacin 400mg Q12H for 4/52

Question 13

Syphilis

Answer 13

1. Benzathine penicillin 1.8gm(2.4 million units) IM STAT dose OR
2. Doxycycline 100mg oral BD x 14 days

Question 14

Genital Herpes

Answer 14

1. Initial – Valaciclovir 500m BD x 5 days
2. Recurrence – Valaciclovir 500mg BD x 3 days
3. Suppression – Valaciclovir 500mg daily x 6 months

Question 15

Genital Warts

Answer 15

1. Imiquimod 5% 3x/wk until resolved (~8-16 weeks) OR

2. Podophyllotoxin 0.5% paint, BD for 3/7, then 4/7 day break (~4-6 cycles)

Question 16

Erectile dysfunction

Answer 16

1. Sildenafil (Viagra) (PDE5 inhibitor) 50mg one hour before sex (one dose per 24 hours)
2. Tadalafil (Cialis) 10mg pre sex once per 24 hours OR 2.5-5mg daily as a regular dose

Question 17

Premature ejaculation

Answer 17

1. Dapoxetine 30mg 1-2hrs before sex

2. Topical lignocaine + prilocaine 2.5+2.5% 10-20mins before sex

Question 18

Priapism

Answer 18

1. 2 hrs - pseudoephedrine 120mg
2. 4 hrs - repeat above
3. 6hrs - aspiration + drainage of corpora cavernosum

Question 19

MRT

Answer 19

1. PO or Transdermal oestrogen +/- cyclical or continuous progesterone or IUD
   • Aim use short term (<5yrs) as uncertain benefits outweigh risks - EXCEPT for premature menopause
   • Transdermal less risk of VTE/hypertriglyc/stroke
   • CI - >60yo, previous VTE/stoke/ACS, oestrogen dependent cancer, uncontrolled HTN, high risk breast Ca, active liver disease
2. OR venlafaxine / paroxetine / gabapentin / clonidine

Question 20

Lichen sclerosus

Answer 20

Clobestasone 0.05%

Question 21

Vaginal atrophy

Answer 21

Topical oestrogen 1mg/g - nocte daily for 2-3 weeks, then 1-2x/week

Question 22

BPH

Answer 22

1. Tamsulosin (alpha blocker) – once daily OR
2. Prazosin (alpha blocker) OR a combo
3. Tamsulosin 400mcg /Dutasteride 500mcg (5 a-reductase inhibitor) – once daily

Question 23

Menorrhagia

Answer 23

1. NSAIDS – Ibuprofen 400mg TDS
   • Tranexamic Acid – 1 to 1.5g oral, 3-4 times daily for first 3-5 days of period
2. Mirena (best results) or Implanon
3. OCP
4. Oral progesterone – Norethisterone 5mg TDS on days 1-21 of cycle for up to 6 months
   • Can also use this starting a few days before period to avoid it eg. young girls on holiday

Question 24

Mastitis

Answer 24

Flucloxacillin (or Cephalexin) 500mg oral 6 hrly x 5 days

Question 25

Urinary incontinence

Answer 25

1. Non selective antimuscarinic - oxybutynin 5mg TDS
2. M3 selective antimusc - solifenacin (vesicare)
3. Beta adrenergic agonists - mirabegron (betmiga) 25mg daily

Question 26

Emergency contraception

Answer 26

1. Copper IUD within 5 days (>99%)
2. Levonorgestrel within 72 hrs (~85%), repeat if vomit within 2 hrs
3. Ulipristal within 120hrs (~85%) - cannot BF for a week, repeat if vomit within 3 hrs

Question 27

Antiepileptics that do not affect contraception

Answer 27

gabapentin, Na valproate, levetiracetam, lamotrigine
Use OCP if must, increase ethinyloestradiol dose to 50mcg or greater. Tricycling regimen with shorter 4/7 hormone free interval
Otherwise, use copper IUD, Mirena, depo provera