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Dip GUM > Key Facts > Flashcards

Key Facts Flashcards

1
Q

Sexual health screening offered to asymptomatic patients

A

HIV and Syphilis

Chlamydia and Gonorrhoea

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2
Q

Which patients should be offered Hep A screening

A
  • MSM in the context of a local outbreak.
  • Injecting drug users.
  • Persons infected with HBV, HCV or HIV.
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3
Q

Which patients should be offered Hep B screening

A
  • MSM.
  • CSW.
  • Injecting drug users.
  • Persons infected with HCV or HIV.
  • Sexual assault victims.
  • Person born in (or sexual partner born in) a country with high prevalence of HBV.
  • Needlestick injury.
  • A sexual partner was infected with HBV or was at high risk of HBV.
  • Born to a mother infected with HBV.
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4
Q

Which patients should be offered Hep C screening

A
  • Injecting drug users.
  • HIV-infected MSM (and sex partners of).
  • Needlestick injury.
  • Born to a mother infected with HCV.
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5
Q

Which patients should be offered GC culture

A

GC NAAT positive cases, prior to treatment.

GC culture considered in patients who are contacts of GC if immediate epidemiological treatment is to be given

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6
Q

What sexual health screening is offered for patients reporting oral sex

A

Male Insertive Oral Sex = 1st pass urine GC/CT NAAT
Male receptive Oral Sex = Pharyngeal swab GC/CT NAAT

Female receptive fellatio = pharyngeal GC/CT NAAT

cunnilingus does not require a pharyngeal swab

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7
Q

What sexual health screening is offered for patients reporting oro-anal sex

A

Receptive oro-anal: - consider rectal swab GC/CT NAAT

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8
Q

What sexual health screening is offered for women who have sex with women

A

Test as per heterosexual female if any previous heterosexual contact
otherwise no testing is routinely recommended

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9
Q

What testing is recommended for patients presenting with genital ulcers

A

Screen ALL patients for GC, CT, HIV and STS
ALL patients with genital ulceration routinely tested for HSV - PCR using a swab from the ulcer

Perform dark ground microscopy immediately if available in addition to STS POCT / serology

MSM - consider LGV testing - chlamydia NAAT taken from the lesion followed by LGV test if CT +ve

Consider tropical genital ulcerative diseases (Chancroid / Donovanosis)

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10
Q

In what circumstances is testing from the female urethra recommended

A

Only if a culture is being taken for gonorrhoea in a woman who has had a hysterectomy

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11
Q

What testing is recommended for men with urethral symptoms

A
  • microscopy of urethral slide if urethral symptoms
  • 1st pass urine GC/CT NAAT
  • GC culture if GC strongly suspected
  • HIV and STS
    +/- HAV / HBV / HCV as indicated
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12
Q

What testing is recommended for patients with rectal symptoms

A
  • Rectal swab - GC/CT NAAT (and LGV CT if CT+ in HIV-positive MSM or if proctitis)
  • Rectal microscopy - if proctitis
  • Rectal - HSV PCR - if proctitis
  • consider rectal GC culture if GC suspected or contact
    + routine screening / other tests as indicated
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13
Q

Treatment of GC

A

Ceftriaxone 1g IM STAT - if antimicrobial susceptibility not known

Ciprofloxacin 500mg PO STAT - When antimicrobial susceptibility known prior to treatment

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14
Q

Treatment of GC if IM injection contraindicated or refused

A

Cefixime 400mg PO STAT
AND
Azithromycin 2g PO STAT

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15
Q

Treatment of GC PID

A 
Ceftriaxone 1g IM STAT
AND
Metronidazole 400mg BD PO 14/7
AND
Doxycycline 100mg BD 14/7
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16
Q

Treatment of GC epididymo-orchitis

A

Ceftriaxone 1g IM STAT
AND
Doxycycline 100mg PO BD 10-14 days

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17
Q

Treatment regimen for donovanosis

A

Azithromycin 1g PO weekly for 3 weeks or until lesions have fully healed

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18
Q

Treatment regimen for donovanosis in pregnancy

A

Erythromycin 500mg QDS PO
OR
Azithromycin could be used: 1 g weekly

both for 3 weeks or until lesions have fully healed

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19
Q

Treatment of GC in pregnancy

A 
Ceftriaxone 1g IM STAT 
or
Spectinomycin 2g IM STAT
or 
Azithromycin 2g PO STAT (if susceptible)

AVOID - quinolones - (ciprofloxacin, ofloxacin, levofloxacin and Moxifloxacin)
AVOID - Tetracyclines - (doxycycline, erythromycin, minocycline, rifampicin, streptomycin)

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20
Q

Treatment of Gonococcal conjunctivitis

A

Ceftriaxone 1g IM STAT

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21
Q

Treatment of disseminated gonococcal infection

A 
Ceftriaxone 1g IM or IV every 24 hours 
OR
Cefotaxime 1g IV every 8 hours
OR
Ciprofloxacin 500mg IV every 12 hours (if susceptible) 
OR
Spectinomycin 2g IM every 12 hours
Continue treatment for 7 days 
Switch to oral 24–48 hours after symptoms improve (check sensitivities) 
 - Cefixime 400mg BD 
 - Ciprofloxacin 500mg BD
 - Ofloxacin 400mg BD
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22
Q

Treatment of epididymo-orchitis

A

If most likely due to an STI:
Ceftriaxone 1g IM STAT single dose
AND Doxycycline 100mg PO BD for 10-14 days

If most likely due to CT or other non-gonococcal organism could consider:
Doxycycline 100mg PO BD 10-14 days
OR
Ofloxacin 200mg PO BD for 14 days

If most likely due to enteric organisms:
Ofloxacin 200mg PO BD for 14 days
OR
Ciprofloxacin 500mg PO BD for 10 days

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23
Q

Treatment of chlamydia

A

Doxycycline 100mg PO BD for 7 days
OR
Azithromycin 1g PO STAT followed by 500mg OD for 2 days

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24
Q

Treatment of chlamydia in pregnancy

A 
Azithromycin 1g PO STAT followed by 500mg OD for 2 days
OR
Erythromycin 500mg QDS for 7 days
OR
Erythromycin 500mg BD for 14 days
OR
Amoxicillin 500mg TDS for 7 days

AVOID doxycycline or ofloxacin

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25
Q

Alternative treatment of chlamydia if doxycycline and azithromycin are contraindicated

A

Erythromycin 500mg BD for 10–14 days
OR
Ofloxacin 200mg BD or 400mg OD for 7 days

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26
Q

When is a TOC indicated for chlamydia

A

treatment in pregnancy
if symptoms persist
if poor treatment compliance is suspected

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27
Q

When is a TOC indicated for gonorrhoea

A

For all patients

Minimum of 2 weeks after treatment

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28
Q

Treatment of first episode NGU

A

Doxycycline 100mg BD for 7 days

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29
Q

Alternative NGU treatment options if doxycycline is not suitable

A

Azithromycin 1g STAT then 500mg OD for 2 days
OR
Ofloxacin 200mg BD (or 400mg OD) for 7 days

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30
Q

TREATMENT OF RECURRENT OR PERSISTENT NGU

A

If treated with doxycycline regimen first line:
- Azithromycin 1g STAT then 500mg OD for 2 days
AND metronidazole 400mg BD for 5 days

If treated with azithromycin first line:
- Moxifloxacin 400mg OD for 10 days
AND metronidazole 400mg BD for 5 days

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31
Q

Treatment of mycoplasma genitalium causing uncomplicated urethritis or cervicitis

A

Doxycycline 100mg BD for 7 days
followed by azithromycin 1g PO STAT then 500mg PO OD for 2 days
OR
Moxifloxacin 400mg PO OD for 10 days if organism macrolide-resistant or azithromycin treatment failed

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32
Q

Treatment of mycoplasma genitalium causing complicated urogenital infection (PID, epididymo-orchitis)

A

Moxifloxacin 400mg PO OD for 14 days

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33
Q

When is a TOC indicated for mycoplasma genitalium

A

TOC at 5+ weeks for ALL patients diagnosed with M. gen

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34
Q

Treatment of trichomonas

A

Metronidazole 2g PO STAT
OR
Metronidazole 400-500mg BD daily for 5-7 days

Alternative regimen
Tinidazole 2g PO STAT

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35
Q

Treatment of trichomonas in pregnancy or breastfeeding

A

In pregnancy = Metronidazole 400-500mg BD daily for 5-7 days
(BNF advises against high dose regimens in pregnancy)

In breastfeeding = Metronidazole 2g PO STAT and discontinue feeds for 12-24 hours to reduce infant exposure
OR
Metronidazole 400-500mg BD daily for 5-7 days - but may affect milk taste

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36
Q

Treatment of BV

A 
Metronidazole 400mg BD for 5-7 days 
OR
Metronidazole 2g STAT 
OR
PV metronidazole gel (0.75%) OD for 5 days 
OR
PV clindamycin cream (2%) OD for 7 days
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37
Q

Management of recurrent BV

A

Suppressive 0.75% metronidazole vaginal gel 2x per week
OR
probiotic treatment with lactobacilli

Lactic acid gel - not adequately evaluated

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38
Q

Treatment of acute Vulvovaginal candida

A

Fluconazole capsule 150mg PO STAT
OR if oral therapy contraindicated:
Clotrimazole pessary 500mg STAT PV

clotrimazole 1% or 2% cream applied 2–3 times a day

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39
Q

Treatment of severe vulvovaginal candida

A

Fluconazole 150mg PO day 1 and 4

+/- clotrimazole 1% or 2% cream applied 2–3 times a day

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40
Q

Treatment of recurrent vulvovaginal candida

A

Induction: fluconazole 150mg PO every 72 hours x 3 doses

Maintenance: fluconazole 150mg PO once a week for 6 months

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41
Q

Treatment of acute Vulvovaginal candida in pregnancy

A

AVOID Fluconazole

Clotrimazole pessary 500mg PV at night for up to 7 consecutive nights
+/- clotrimazole 1% or 2% cream applied 2–3 times a day up to 10-14 days

Longer course recommended in pregnancy

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42
Q

Treatment of recurrent Vulvovaginal candida in pregnancy

A

Induction: topical clotrimazole 1% or 2% cream applied 2–3 times a day for 10-14 days

Maintenance: Clotrimazole pessary 500mg PV weekly

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43
Q

Treatment of acute Vulvovaginal candida whilst breastfeeding

A

Breastfeeding can be continued after a single dose of
Fluconazole 150mg PO STAT
AVOID breastfeeding with repeated or high doses of fluconazole

alternative = Clotrimazole pessary 500mg PV at night
+/- clotrimazole 1% or 2% cream applied 2–3 times a day

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44
Q

Treatment of acute vulvovaginal candida in diabetic women

A

Improve diabetic control

Fluconazole capsule 150mg PO STAT
OR if oral therapy CI:
Clotrimazole pessary 500mg STAT PV

+/- clotrimazole 1% or 2% cream applied 2–3 times a day

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45
Q

Management of first episode of genital herpes

A

. Saline bathing
. Analgesia
. Topical anaesthetic agents - e.g. 5% lidocaine ointment

Oral antiviral drugs indicated within 5 days of start of episode / while new lesions still forming / if systemic symptoms persist

Aciclovir 400 mg TDS for 5/7 (or 200mg 5x daily)
Valaciclovir 500 mg BD for 5/7
Famciclovir 250 mg TDS 5/7

46
Q

Management of recurrent genital herpes

A 
Episodic short course antiviral therapies:
. Aciclovir 800 mg TDS for 2 days
. Famciclovir 1g BD for 1 day
. Valaciclovir 500mg BD for 3 days
OR
suppressive antiviral therapy
. Aciclovir 400mg BD (or 200mg QDS)
. Famciclovir 250mg BD
. Valaciclovir 500mg OD
47
Q

Management of first episode of herpes in pregnancy

in the first and second trimester

A

First or second trimester acquisition (until 27 +6 weeks)

  • Paracetamol / topical lidocaine 2% gel / saline bathing
  • Plan for vaginal delivery unless delivery expected within the next 6 weeks
  • Daily suppressive aciclovir 400mg TDS from 36 weeks reduces HSV lesions and asymptomatic shedding at term

Aciclovir safe and well tolerated
Aciclovir 400 mg TDS

48
Q

Management of first episode of herpes in pregnancy

in the third trimester

A

from 28 weeks

Daily suppressive aciclovir 400mg TDS until delivery

Recommend caesarean, particularly if episode is within 6 weeks of expected delivery

Type-specific HSV antibody (IgG) testing advised to distinguish primary and recurrent genital HSV infections

49
Q

Management of pregnant women with recurrent genital herpes

A

Recurrences usually resolve within 7–10 days without antiviral treatment

Supportive measures - saline bathing / paracetamol / topical lidocaine
Vaginal delivery should be anticipated
Consider daily suppressive aciclovir 400mg TDS from 36 weeks

50
Q

Management of women with primary genital herpes at the onset of labour

A

History to ascertain if primary or recurrent episode
Viral swab from the lesion(s) - may influence management of the neonate
Inform neonatologist

Primary episode - recommend CS if possible
Benefit of CS may be reduced if membranes ruptured >4 hours - but may be some benefit

If VD: -
Consider maternal intrapartum IV aciclovir (5 mg/kg 8 hourly)
and neonatal IV aciclovir (20 mg/kg 8 hourly) until active infection is ruled out

51
Q

Management of babies born by spontaneous vaginal delivery in mothers with a primary HSV infection within the previous 6 weeks

A

High risk of HSV infection
Liaise with the neonatal team.

If baby is well:

  • swab skin, conjunctiva, oropharynx + rectum - HSV PCR
  • lumbar puncture is not necessary
  • IV aciclovir (20 mg/kg 8 hourly) until active infection is ruled out
  • Breastfeeding is recommended unless herpetic lesions around nipples

If baby is unwell / has skin lesions:

  • swab skin, conjunctiva, oropharynx + rectum - HSV PCR
  • lumbar puncture - even if no CNS features
  • IV aciclovir (20 mg/kg 8 hourly) until active infection is ruled out
52
Q

Treatment of early syphilis

primary, secondary and early latent

A

Benzathine penicillin G 2.4 MU IM STAT

53
Q

Alternative treatment regimens for early syphilis

primary, secondary and early latent

A

Procaine penicillin G 600,000 units IM daily 10 days

Doxycycline 100mg PO BD 14 days

Ceftriaxone 500mg IM daily 10 days

Amoxycillin 500mg PO QDS PLUS Probenecid 500mg QDS 14 days

Azithromycin 2g PO STAT
or
Azithromycin 500mg OD 10 days

Erythromycin 500mg PO QDS 14 days

54
Q

Treatment of late latent syphilis

A

Benzathine penicillin 2.4 MU IM weekly for 3 weeks

55
Q

Treatment of gummatous syphilis

A

Benzathine penicillin 2.4 MU IM weekly for 3 weeks

56
Q

Treatment of cardiovascular syphilis

A

Steroids - 40–60mg prednisolone OD for 3 days starting 24h before the antibiotics
+
Benzathine penicillin 2.4 MU IM weekly for 3 weeks

57
Q

Alternative treatment regimens for late latent syphilis

A

Doxycycline 100mg PO BD for 28 days

Amoxycillin 2g PO TDS + probenecid 500mg QDS for 28 days

58
Q

Treatment of neurosyphilis

A

Steroids - 40–60mg prednisolone OD for three days starting 24h before the antibiotics

Procaine penicillin 1.8 – 2.4 MU IM OD
AND probenecid 500mg PO QDS for 14 days
OR
Benzylpenicillin 1.8–2.4g IV every 4h for 14 days

59
Q

Treatment of Early syphilis in pregnancy

A

Trimesters one and two (up to and including 27 weeks):
- Benzathine penicillin G 2.4 MU IM. STAT

Trimester three (from week 28 to term):
 - Benzathine penicillin G 2.4 MU IM on days 1 and 8

AVOID - Erythromycin or Azithromycin - do not cross the placenta well and high rates of resistance

Alternative treatment options

  • Procaine penicillin G 600,000unit IM OD for 10 days
  • Amoxycillin 500mg PO QDS + probenecid 500mg PO QDS for 14 days
  • Ceftriaxone 500mg IM OD for 10 days
60
Q

Treatment of late latent / cardiovascular / gummatous syphilis in pregnancy

A

all three trimesters:
- Benzathine penicillin G 2.4 MU IM weekly on days 1, 8 and 15

+ Steroids for cardiovascular syphilis
- 40–60mg prednisolone OD for 2 days starting 24h before the antibiotics

61
Q

Treatment of Neurosyphilis in pregnancy

A

Steroids for Neurosyphilis syphilis
- 40–60mg prednisolone OD for 2 days starting 24h before the antibiotics

Procaine penicillin G 1.8–2.4 MU IM OD 14/7
PLUS probenecid 500mg PO QDS 14/7
or
Benzylpenicillin 1.8–2.4g IV every 4h for 14/7

62
Q

Treatment of congenital syphilis

A

Benzyl penicillin sodium 60–90 mg/kg daily IV
(in divided doses given as – 30 mg/kg 12 hourly)
in the first seven days of life
and 8 hourly thereafter for a further 3 days
for a total of 10 days

63
Q

What is the advice regarding drug interruptions during syphilis treatment

A

for late and congenital syphilis

if drug administration is interrupted for more than one day at any point during the treatment course
it is recommended that the entire course is restarted

64
Q

Treatment of LGV

A

First line:
Doxycycline 100mg PO BD for 21 days
or Tetracycline 2g PO OD 21/7
or Minocycline 300mg loading dose then 200mg BD 21/7

2nd Line: + TOC
Erythromycin 500mg PO QDS for 21 days
or Azithromycin 1g weekly for 3 weeks

Alternatives
Ofloxacin / moxifloxacin 2 weeks - expected to be effective (need TOC)

65
Q

Treatment of LGV in pregnancy / breastfeeding

A

Erythromycin 500mg PO QDS for 21 days

+ TOC

66
Q

Treatment of chancroid

A 
Azithromycin 1g PO STAT 
or
Ceftriaxone 250mg IM STAT
or
Ciprofloxacin 500mg PO BD for 3 days
or
Erythromycin base 500mg PO QDS for 7 days
67
Q

Treatment of chancroid in HIV positive patients

A

Ciprofloxacin 500mg PO BD for 3 days
or
Erythromycin base 500mg PO QDS for 7 days

68
Q

Treatment of chancroid in pregnancy or breastfeeding

A

Ceftriaxone 250mg IM STAT
or
Erythromycin base 500mg PO QDS for 7 days

69
Q

Treatment of PID

A 
Ceftriaxone 1g IM STAT 
AND 
Doxycycline 100mg PO BD 14 days
AND  
Metronidazole 400mg PO BD 14 days

or
Ofloxacin 400mg BD AND metronidazole 400mg BD 14/7
or
moxifloxacin 400mg PO OD 14/7

70
Q

Treatment of moderate / severe PID as an inpatient

A

IV therapy continued until 24 hours after clinical improvement then switch to oral

Ceftriaxone 2g IV daily
AND doxycycline 100mg IV BD (oral if tolerated)

Followed by:
Doxycycline 100mg PO BD 14 days
Metronidazole 400mg PO BD 14 days

71
Q

Management of SARA

A

self ­limiting disease in the majority of patients
Rest
NSAIDs
Cold / heat pads
Antibiotic treatment of any identified STI cause

+/- steroid injection of the joint
or systemic steroids if severe multi-joint pain

+/- Sulphasalazine / methotrexate / Azathioprine - if disabling symptoms persist >3m or erosive joint changes

72
Q

How to use PEPSE

A

Initiate ASAP after exposure
Considered up to 72h post exposure
Duration = 28 days
Truvada (tenofovir-DF and Emtricitabine) and Raltegravir

73
Q

Investigations before starting PEPSE

A

Medication history including OTC / herbal remedies and recreational drugs
4th generation HIV POCT + serology
Syphilis serology (+/- POCT)
STI screening + repeat @ window period
Hep B / Hep C tests if indicated
Ultra-rapid Hep B vaccination if indicated
EC or Pregnancy test if indicated
Creatinine
ALT
Urinalysis or Urine protein/creatinine ratio
Height, weight, BP

74
Q

Guidance on missed PEPSE doses

A

<24h elapsed since last dose = take missed doses immediately and subsequent doses at usual time

24–48 h elapsed since last dose = continue PEPSE

> 48hr elapsed since last dose = stop PEPSE

75
Q

Advice in the event of a further high-risk sexual exposure on the last two days of the PEPSE course

A

continue PEPSE for 48hr after the last high-risk exposure

76
Q

When is universal HIV testing recommended

A
  1. GUM or sexual health clinics
  2. antenatal services
  3. termination of pregnancy services
  4. drug dependency programmes
  5. healthcare services for those diagnosed with TB, hep B, hep C and lymphoma
77
Q

Which patients should HIV testing be routinely offered to?

A
  1. all patients where HIV, including primary HIV infection, enters the differential diagnosis
  2. all patients diagnosed with an STI
  3. all sexual partners of men / women known to be HIV positive
  4. all men who have sex with men
  5. all female sexual contacts of men who have sex with men
  6. a history of injecting drug use
  7. from a country of high HIV prevalence (>1%*)
  8. sexual contact abroad or in the UK with individuals from
    countries of high HIV prevalence
78
Q

How often should HIV testing be offered?

A
  1. Offer repeat tests if the initial test is negative but there has been a possible exposure within the window period
  2. MSM – annually or more frequently if clinical symptoms suggestive of seroconversion
  3. injecting drug users – annually or more frequently if clinical symptoms are suggestive of seroconversion
  4. antenatal care – offer at booking. If declined re-offer. If declined a 2nd time re-offer a 3rd time at 36 weeks. If declined again offer POCT in labour
79
Q

What do 4th generation HIV tests test for

A

HIV antibody AND p24 antigen simultaneously

80
Q

What do 3rd generation HIV tests test for

A

HIV antibody only

81
Q

Who should be offered PrEP

A
  • HIV-negative MSM at high risk of HIV - from condomless anal sex within 6 months and ongoing
  • Patients who have a HIV +ve partner (unless on ART for >6m with suppressed VL)
  • heterosexual men / women with factors putting them at high risk of HIV
  • HIV-negative trans-women at high risk of HIV from condomless anal sex within 6 months and ongoing

NOT recommended for IVDU

82
Q

How to take PrEP

A

On-demand dosing
= 2 tablets taken 2–24 hours before sex then one tablet OD until 48 hours after the last sexual risk.

Daily dosing
= one tablet every day - start 7 days before sex and continue OD - continue at least 7 days after last sexual risk

If the risk is from vaginal sex daily dosing is recommended
If the risk is from anal sex either regimen can be used

83
Q

Baseline testing for starting PrEP

A

4th generation HIV test - POCT and send serology
Hep B / Hep C test - if indicated
Syphilis POCT / serology
STI screening
Creatinine / eGFR
Urinalysis or Urine protein/creatinine ratio
Height, weight, BP

84
Q

What monitoring should be carried out for patients on PrEP

A

3 monthly HIV testing
3 monthly STI screening
3-monthly HCV testing in MSM, trans-women / others at on-going risk of HCV
Annual eGFR if baseline eGFR >90 and the person aged <40 y
6 monthly or more frequent eGFR if baseline eGFR 60–90 and/or aged >40 years and/or concomitant risk factors for renal impairment

85
Q

Which tests should be done if there is suspected HIV seroconversion whilst on PrEP

A

4th generation HIV test
AND viral load
Baseline resistance testing as soon as HIV confirmed

86
Q

Treatment of Molluscum contagiosum

A

Expectant management - no treatment

Some treatments may shorten the disease course
No treatment is advocated over another
Patient choice

  • Podophyllotoxin 0.5%. BD for 3/7 then 4/7 break and repeat for upto 4 weeks
  • Imiquimod 5% cream (unlicensed) 3x per week - non consecutive days - wash off 6–10h later - up to 16 weeks
  • Liquid nitrogen therapy
87
Q

Treatment of Molluscum contagiosum in pregnancy / breastfeeding

A

Liquid nitrogen therapy - Cryotherapy
Or other destructive methods are safe.

AVOID - Podophyllotoxin
AVOID - imiquimod

88
Q

Treatment of Molluscum contagiosum in immunocompromised HIV patients

A

Can be difficult to treat in late-stage HIV using conventional means
Usually responds to ARV initiation

An immune reconstitution inflammatory syndrome (IRIS) reaction to molluscum may occur when starting ARVs.

89
Q

Treatment of Phthirus pubis infestation

A

For all treatments a repeat application in 3-7 days is advised
• Malathion 0.5% - Apply to dry hair, wash out after 2 - 12hrs
• Permethrin 1% cream - Apply to damp hair, wash out after 10 minutes
• Phenothrin 0.2%. - Apply to dry hair, wash out after 2 hours
• Carbaryl 0.5 and 1% (unlicensed). Apply to dry hair, wash out after 12hrs

90
Q

Treatment of Phthirus pubis infestation of the eyelashes

A

• permethrin 1% lotion - keeping the eyes closed during the 10 minute application
OR
• inert ophthalmic ointment with a white or yellow paraffin base e.g. vaseline
applied to the eyelashes BD daily for 8-10 days
works by suffocating lice and avoids risk of eye irritation

91
Q

Treatment of Phthirus pubis infestation in pregnancy / breastfeeding

A

• Permethrin is safe during pregnancy and breastfeeding
1% cream - Apply to damp hair, wash out after 10 minutes
repeat in 3-7 days

92
Q

Treatment of scabies

A

Apply treatment to the whole body from chin / ears dow - special attention to between the fingers + toes / under nails.
Reapply after 1 week

• Permethrin 5% cream - Wash cream off after 8 to 12 hours
OR
• Malathion 0.5% aqueous lotion - wash the treatment off after 24 hours

93
Q

Treatment of crusted scabies

A

Combination regimen
- topical permethrin cream 5% OD for 7 days
then 2x weekly until cure
(Wash cream off after 8 to 12 hours)
AND
oral ivermectin - 200 mcg/kg on days 1, 2, 8, 9 and 15

94
Q

Treatment of scabies which is not responding to topical treatment alone

A

Ivermectin
200 mcg/kg
2 weeks apart
in patients weighing >15kg

95
Q

Management of post-scabetic itch

A

Crotamiton 10% cream - BD to TDS
OR
if the scabies mites have definitely been eradicated
use topical hydrocortisone 1%

Night time sedative antihistamine may help
Emollient if dry skin/eczema

96
Q

Treatment of scabies in pregnancy / breastfeeding

A

• Permethrin 5% cream - Wash cream off after 8 to 12 hours
OR
• Malathion 0.5% aqueous lotion - wash the treatment off after 24 hours

Breastfeeding mothers should remove the cream from the nipples before breastfeeding and reapply afterwards

97
Q

Treatment of anogenital warts

A

• Podophyllotoxin (Warticon® and Condyline®)
BD application for 3 days, then 4 days rest
Repeat for 4-5 weeks

  • Imiquimod 5% cream - Apply 3x weekly and wash off 6-10 hours later. For up to 16 weeks - apply on non consecutive days
  • Cryotherapy - liquid nitrogen - weekly for 4 weeks
  • Excision - Under local anaesthetic
  • Electrocautery / hyfrecation / monopolar surgery
98
Q

treatment of anogenital warts in pregnancy

A

Cryotherapy or Hyfrecation

99
Q

Transmission of Hepatitis A

A

Faeco-oral (via food, water, close personal contact)

Outbreaks previously reported in MSM, linked to oro-anal or digital-rectal contact / multiple sexual partners / anonymous partners / sex in public places / group sex

100
Q

Management of acute Hep A

A

bed rest
fluids

Notifiable disease - inform PHE

101
Q

Transmission of Hep B

A 
Sexual transmission 
Vertical 
Unscreened blood / blood products
Sharing injecting equipment
Occupational needlestick injuries 
non-sterile acupuncture or tattoo needles
102
Q

Management of chronic Hep B

A

Screen for Hep C, Hep D and Hep A immunity
Vaccinate for Hep A if non-immune
Refer chronic HBsAg+ve patients to a specialist

Decision to treat depends on pattern of disease, HBV DNA level + presence / absence of necro-inflammation and hepatic fibrosis.

Tenofovir-DF or tenofovir-AF
or entecavir
or pegylated interferon

103
Q

If a patient is on ART for HIV

which medications also suppress Hep B

A 
Lamivudine
Emtricitabine
Tenofovir DF
Tenofovir AF
will suppress hepatitis B viral replication
104
Q

Management of Hep B in pregnancy

A

Consider Tenofovir monotherapy
or pregnant women with HBV DNA >100,000,000 IU/ml
in the third trimester
to reduce risk of HBV transmission

Vaccinate infant at birth
+ Hepatitis B specific Immunoglobulin 200 i.u. IM given if the mother is highly infectious

105
Q

What is the Ultra rapid Hep B vaccination schedule

A

Ultra rapid = 0, 1, 3 weeks and 12 months

106
Q

What is the standard Hep B vaccination schedule

A

Standard = 0, 1, 6 months

107
Q

What is the rapid Hep B vaccination schedule

A

Rapid = 0, 1, 2 and 12 months

108
Q

Transmission of Hep C

A

Most = Parenteral

  • shared needles/syringes
  • unscreened blood / blood products
  • re-use of needles in healthcare / acupuncture / tattoos
  • needlestick injury
  • sharing razors
  • sharing straws / notes for snorting recreational drugs.

Sexual transmission is extremely unlikely in heterosexual relationships (<0.1% /10years)
rate increases if the index patient is also HIV infected

  • Vertical transmission occurs at a low rate ~5% or ~7% if F HIV co-infected
109
Q

Treatment of chronic Hep C

A

Direct acting antivirals

110
Q

empirical treatment of proctitis

A

Cover GC / CT and LGV

Ceftriaxone 1g IM STAT
AND doxycycline 100mg BD 3/52

111
Q

Treatment of GC in penicillin allergy

A

0.5 - 6.5% of penicillin sensitive patients will also be allergic to cephalosporins
Can use ceftraixone or cefotaxime if non severe allergy

If anaphylaxis use:
 - Gentamycin 240mg IM STAT
 \+ Azithromycin 2g STAT
or
 - Spectinomycin 2g IM STAT
\+ Azithromycin 2g PO STAT

Dip GUM (27 decks)

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