Office- Infections & antibiotics, Syphillis Flashcards
What is the treatment for gonorrhea?
Ceftriaxone 500mg IM
What is the treatment for chlamydia?
Doxycycline 100mg BID for 7 days
What is the treatment for trichomonas?
flatly 500mg BID for 7days
What is the treatment for endometritis/PID outpatient?
Ceftriaxone 500mg IM + doxycycline 100mg BID for 14 days + flagyl 500mg BID for 14 days
What is the treatment for endometritis/PID inpatient?
Ceftriaxone 1g q 24hrs + doxycycline 100mg BID + flagyl 500mg BID
or
Cefoxitin 2g q6hr + doxy
or
Cefotetan 2g q12hr + doxy
Send home to complete 14 day course of doxy and flagyl
What is the treatment for BV infection?
Flagyl 500mg BID for 7 days
Metrogel for 5 days
Clindamycin cream 5gm x 7 days intravaginally
What is the treatment for UTI?
Bactrim 100/800mg BID for 3 days
or
Macrobid 100mg BID for 7 days
or
Fosfomycin 3gm x 1
What is the treatment for pyelonephritis?
Ceftriaxone 1gm IV q24hrs, then po meds for 7-10 days
What is the treatment for primary syphillis?
Benzathine penicillin 2.4mil IM x 1
What is the treatment for unknown syphillis?
Benzathine penicillin 2.4mil u IM week x 3 weeks
What is the criteria to diagnose PID?
Lower abdominal pain/pelvic pain in a sexually active female and 1 major criteria
Cervical motion tenderness
Uterine tenderness
Adnexal tenderness
What are minor or supporting evidence for PID diagnosis?
Fever >38
Mucopurulent discharge
Positive GC/Chlamydia
Gram + diplococci on gram stain
WBC count >10
elevated C reactive protein
Elevated ESR
WBC on wet prep
When do you give inpatient management for PID?
Cannot excluded surgical emergencies
Pregnant
No response to outpatient therapy
Patient unable to follow or tolerate outpatient regime
Patient has severe illness, N/V, high fever
TOA
What is the potential longterm sequela of PID?
Chronic pelvic pain
Infertility
Increased risk of ectopic pregnancy
What is the presentation for primary syphillis?
Cold painless ulcer with clear margins and punched out crater like appearance
What is the presentation for secondary syphillis?
Condylomata lata
Maculopapular rash (torso, palms, soles)
What is the presentation for tertiary syphillis?
Lesions (Gumma, cardiac lesion)
Tabes dorsalis
Argyll Robinson pupil
What is the incubation period for primary syphillis?
Days to weeks
What is the incubation period for secondary syphillis?
Weeks to months
What is the incubation period for tertiary syphillis?
years
What is the screening test for syphillis?
VDRL
STS
RPR
What is the confirmatory test for syphillis?
FTA antibody
TPHA
TPI
What are the causes of a false positive RPR?
Autoimmune disease
Small pox vaccination
Malaria
Mycoplasma pneumonia
Aging
What happens to the screening test after treatment for syphillis?
Typically return normal but can remain positive for life
What happens to the confirmatory test after treatment for syphillis?
Remain positive for life
What is the treatment for syphillis If there is a PCN allergy?
Erythromycin unless pregnant then desensitize
What causes syphillis?
Infection with treponema palladium
What causes chancroid?
Infection with hemophilus ducreyi
What is the difference between a chancroid and primary syphillis ulcer?
Chancroid has multiple lesions
Lesions are painful
Lymph nodes are painful
lesion is hot
Vague margins
What is the differential for a vulvar ulcer?
- HSV
- Syphilis
- Chancroid
- LGV
- Granuloma inguinale
- Bechets
- Vulvar carcinoma
What is the management for bartholin abscess?
Incision and drainage
word catheter 4-6 weeks
When should you biopsy or excise the gland in case of bartholin abscess?
Patient >40 years old
Recurrent cysts or infections
What are the alternative treatments for bacterial vaginosis?
Clindamycin 300mg PO BID for 7 days
Clindamycin ovules 100mg intravaginally for 3 days
Secnidazole 2g x 1 dose
Tinidazole 2g PO daily for 2 days
Tinidazole 1g PO daily for 5 days
What is the treatment for cervicitis?
Recommended: doxycylcine 100mg BID for 7 days
Alternative: Azithromycin 1g PO x 1 dose
What is the alternative treatment for Chlamydia infection in adults and adolescents?
Azithromycin 1g PO x 1 dose
Levofloxacin 500mg daily for 7 days
What is the treatment for chlamydia in pregnancy?
Recommended: Azithromycin 1g PO x 1 dose
Alternative: Amoxicillin 500mg PO TID for 7 days
What is the alternative treatment for gonorrhea infection?
If a allergy: Gentamicin 240mg IM + azithromycin 2g PO x 1 dose
If not available: Cefixime 800mg x 1 dose
What is the alternative treatment for trichomonas?
Tinidazole 2g PO x 1 dose
