ITSS Flashcards
N Gonorrhea tx
1st chocie tx:
Ceftriaxone 500 mg IM in a single dose
OR
2nd choice tx:
cefixime 800 mg PO as a single dose AND azithromycin 2 g PO as a single dose
(Iness 2025)
Chlam trochomatis tx (+ LVG)
1ST CHOICE: doxycycline 100 mg PO BID x 7 days (preferred for rectal!)
2ND CHOICE : azithromycin 1 g PO as a single dose
IF LGV genotype:
doxycycline 100 mg PO BID for a total of 21 consecutive day
high risk pt with sx…. when do you treat infection
immediately - do not wait for lab results to come out!
STIs hx 5P
Partners (past year)
Practices (vaginal, oral, anal, other)
Prevention
STI - condom use, Hep A/B vaccination
Pregnancy/contraception
Previous STI testing
gono chlam test
first catch urine TAAN
swabs - urethral, vaginal, cervical, pharymx, rectal
+ Gono culture (re: resistance)
other tests than gono chlam
VDRL (syphillis) EIA
HIV serum EIA (enzyme immunoassay)
HBV:
HBsAg, HBsAb
HCV Ab (IVDU or MSM)
when to restest for HIV
at 6 mo and 12 mo
HBsAg, HBsAb meaning
HBsAg = antigen - person is infected currntly
HBsAb = antibody - person WAS infected or was vaccinated
if persistent sx and gono-chlam negative
which other pathogens to consider
Mycoplasma genitalium
Trichomonas vaginalis (strawberry cervix)
Syphillis tx
Pen G 2.4 Million units x1
for Primary, secondary, and early latent syphilis:
Trichomoniasis tx
Metronidazole 2g PO x1
Treat partner
Bacterial STI or trichomonas should abstain from unprotected sex until 7d after treatment of both partners complete
hsv 1 or hsv 2
Acyclovir 400mg PO TID
HPV
Imiquimod 5% cream qHS 3/week x 15w, wash off after 6-10h
Podofilox 0.5% solution BID x3d then none x4d, repeat PRN x4
Cryotherapy
bacterial vaginosis tx
Metronidazole 500mg PO BID x7-14d or gel
Candidiasis
fluconazole 150 PO x 1 or cream
SUspect PID if
sx of STIs
+ pelvic/lower abdominal pain and one of: Adnexal, cervical motion, uterine tenderness
Abnormal cervical or vaginal mucopurulent discharge or cervical friability
Positive Chlamydia/Gonorrhea
Oral T>38.3
PID tx
Mild-moderate with Ceftriaxone 500mg IM x1 + Doxycycline 100mg PO BID x 14d (+/- Metronidazole 500mg PO BID x 14d for T vaginalis or anaerobic coverage for recent instrumentation)
Severe or complicated (eg. tubo-ovarian abscess) with Clindamycin 900mg IV q8h + Gentamicin 1.5mg/kg IV q8h x 14d (step down to Doxycycline)
Consider treating male partners if sexual contact 60d prior (or if >60d, most recent) to patient’s onset of symptoms (eg. Ceftriaxone 250mg IM, PLUS Azithromycin 1g PO x1 or Doxycycline 100mg PO BID x 7d)
Avoid sex until patient and partners adequately treated and asymptomatic
Re-assess if need to remove IUD 3d post -treatment
