GU part 1 STI Flashcards
If someone is greater than 35, what is the likley causative organism for epididymitis
E-coli
if someone is less than 35 or they have multiple sex partners, what organisms are likley to cause epididymitis?
N. Gonorrhoeae
C. Trachomatis
if someone is greater than 35 with Epididymitis what are your first line abx?
Ciprofloxacin 500mg BID or 1g daily
Levofloxacin 500mg once daily
duration of therapy is 10-14 days unless otherwise indicated
if someone is LESS THAN 35 or has lots of sex partners and you are treating them for epididymitis what are your first lines ?
CEFixime 400-800 po
OR CEFtriaxone 250mg IM
AND both below
Azithromycin 1g single dose
Doxycycline 100mg BID X10days
if you are treating STI suspected epididymtis what are your second line treatments?
fluorquinolones
Ciprofloxacin 500mg single dose (not approved for kids less than 18)
Levofloxacin 500 mg single dose (not approved for kids less than 18)
and BOTH below
Azithromycin 1g single dose
Doxycycline 100mg BID X10 days
T/F
assess all sexual partners of patients with sexually aquired epididymitis from 60 days prior to symptom onset
true
what are first line tx for PID mild -moderate
Cefixime 800mg single dose OR
Ceftriaxone IM 250 single dose
AND +/- Either of those below
Doxy 100mg BID X14 days
Metronidazole 500mg 14 days
what are second line tx for PID?
levofloxacin 500mg X14 days or
Moxifloxacin 400mg X14 days
+/-
Metronidazole X14days
T/F
Fluoroquinolones and tetracyclines are contraindicated in pregnancy and breastfeeding
true
when do you re-assess someone with PID that you are treating?
48-72 hours, if not improving send to hospital
what are your first lines for urethritis gonococcal for individuals greater than 9 years of age
cefixime 400-800 mg single dose OR
ceftriaxone IM 250mg
PLUS ONE OF THE FOLLOWING BELOW
Azithromycin 1g single dose
Doxycycline 100mg X7 days
how long is the treatment for:
PID
epididymitis (sti)
urethritis gonococcal
Cervicitis
PID - 14 days
epididymitis - 10 days
U. gonococcal 7 days
Cervicitis 7 days
first lines are always cefixim/ceftriaxone plus something
When would you perform an STI test of cure for urethritis n.gonococcal tx?
test of cure should only be done if an alternate regime was used.
test of cure using CULTURES can be done 1-2 weeks post treatment
if using NAAT, you must wait 3-4 weeks post treatment for test of cure to avoid false positive
Repeat screening for individuals with gonococcal ingestion is recommended 6 months post-treatment
how would you treat gonococcal urethritis in children less than 9 years of age?
cefixime or
ceftriaxone
AND
Azithromycin 10-15mg one dose
what is first line treatment for nongonococcal urethritis greater than 9 years of age
Azithromycin 1g single dose OR (not advised to do the one day dose because it can increase macrolide resistance)
doxy 100mg BID X7 days
What are second line tx non gonococcal urethritis greater than 9 years of age?
erythromycin and if used repeat testing after tx is advised
what is first line for urethritis NON gonococcal child less than 9
azithromycin 10-15mg/kg single dose
What are the likely causative agents for cervicitis?
C.Trachomatis
N.gonorrhoeae
what are first line tx for cervicitis
cefixime 400-800mg single dose
AND ONE OF THE FOLLOWING
Azithromycin 1g single dose
doxycycline 100mg 7 days
when patients have genital HSV1/HSV2 when should they abstain from sexual activity?
when they have active lesions and prodromal symptoms
they should also be encouraged to tell their partner they have HSV1/HSV2
when would you provide prophylaxis treatment to a pregnant women with genital HSV?
for women with prior infection within the previous year prophylaxis at 36 week gestation is advised
which of the two options are more likley to cause transmission of HSV1/HSV2 during pregnancy (perinatal)
A. the PRIMARY outbreak in the first trimester
B. a RECURRENT outbreak in the first trimester
A. Primary outbreak in first trimester is more likley to cause perinatal transmission and increases if this outbreak occurs at the time of delivery so you should consider C-section
What is considered chronic genital HSV1/HSV2 outbreaks and what are the treatments?
if the patient has more than 6 episodes in one year, its considered chronic and your treatment would be 3-6 months
try to DC after one year and re-evaluate after 6-12 months
What are the indications to starting PREP
advised for MSM and transgender women who report condomless anal sex within the last six months AND have any of the following:
- STI in the last year
-recurrent us of nonoccupational post exposure prophylaxis (nPEP) more than once - ongoing sexual relationship with HIV positive partner
- high-incidence risk index greater than 11
when is prep not reccomended
in stable closed relationships with single partner with is either:
HIV-negative
partner is HIV positive, stable, undetectable HIV viral load AND on antiretroviral therapy
What medications are approved for PrEP?
Truvada once daily- tenovir DF/emtricitabine 300/200
Descovy once daily- Tenovir AF/emtricitabine 250mg/200
Which prep medication is associated with reduced bone density and disruption of vitamin D metabolism?
Truvada is associated with these side effects
if a pregnant women had an acute HIV infection during pregnancy or while breastfeeding what medication would you advise?
there is a very high risk of transmission if the pregnant women has an acute HIV infection
Truvada (tenovir DF/emtricitabine 300/200mg) has limited evidence but has been shown to have no increased risk of birth defects
THIS IS THE ONLY PREP ONE TO USE
what is the first line treatment of Trichonomiasis?
Metronidazole 2g PO once
or 500mg X7 days
TREAT ALL CASES AND PARTNERS REGARDLESS OF SYMPTOMS
what considerations should be made for vaginitis trichonomiasis treatment in pregnancy and breastfeeding?
you only treat if they have symptoms!! if asymptomatic dont treat (but still treat partner)
metronidazole is safe, if mom wants they can hold off on breastfeeding for 12-24 hours
When would you treat someone with bacterial vaginosis if they are asymptomatic?
- high risk pregnancy
- prior to IUD insertion
- prior to gyne surgery
- prior to induced abortion
- prior to any upper tract surgery
What are first line treatments for symptomatic bacterial vaginosis
- Metronidazole 7 days duration (can be taken once daily but this is SECOND LINE as it can relapse at 1 month)
- clinda cream (be careful with condoms, and with pregnancy)
- metronidazole cream
what is the preferred treatment for pregnant women with symptomatic candidiasis infection?
topical antifungal agent (any)
oral azoles are not recommended
if you patient was pregnant with symptomatic bacterial vaginosis and was in the first trimester, which med would be your first line?
topical metronidazole is recommended for first and second trimester
third trimester can have oral
