Sexual health

Question 1

Gonorrhoea abx?

Answer 1

500mg Ceftriaxone in 2mL 1% Lignocaine IM PLUS 1g PO Azithromycin

Question 2

Gonorrhoea pharyngeal infection

Answer 2

500mg Ceftriaxone in 2mL 1% Lignocaine IM PLUS 2g PO Azithromycin

2G azithro (BIGGER DOSE OF AZITHRO)

Question 3

Gonococcal Conjunctivitis management

Answer 3

OPHTHAL EMERGENCY - CONTACT OPHTHAL

In 1 month or older:

Ceftriaxone 1g (50mg/kg) IM or IV stat
Or
Cefotaxime 1g (50mg/kg) IM or IV stat

PLUS Azithro PO 1g (20mg/kg) stat

Question 4

Chlamydia Conjunctivitis Management

Answer 4

Azithromycin 1g (20mg/kg) stat PO

Question 5

Chlamydia treatment

Answer 5

Doxycycline 100 mg, BD 7 days

2nd line:
1g Azithro PO stat

• No sex for 1 week
• Test of cure 3 weeks

Question 6

Men who have sex with men 3 monthly testing (asymptomatic) …

Answer 6

Swabs:
chlaymdia AND gonorrhoea PCR from:
- Anorectal
- FPU
- Oropharyngeal

Bloods
- HIV antibody/antigen
- Syphillis serology
- HCV (test ONCE per year if HIV+ve, IVDU, on PreP)
- HAV- test if not vaccinated
- HBV - test if not vaccinated

Question 7

Gonorrhoea testing

Answer 7

Culture important if discharge and prior to treatment

FPU NAAT- good for men & if swab can’t be taken

Penile swab culture - if discharge

Endocervical NAAT +/- culture -best!

Self collected vaginal NAAT
*Add culture if symptmatic *

Anorectal swab NAAT
*Add culture if symptmatic *

Pharyngeal swab NAAT +/- culture
Collect for all MSM and for multiple sexual partners

Question 8

PrEP Counselling

Answer 8

• Daily dosing
• Requires baseline tests and 3 monthly testing
• Safe in pregnancy and breast feeding
• Need full STI screen prior
• Renal function >60GFR
• Exclude nephrotoxic drugs (eg high dose NSAIDS)
• May affect liver/kidney/bone health
• Nausea and headache s/e

Question 9

PrEP Baseline Testing

Answer 9

• HIV testing (and assess for symptoms)
• Hep A
• Hep B
• Hep C
  (then yearly)
• STI (then 3 monthly)
• EUCs- eGFR (then 6 monthly)
• urine PCR (protein: creatinine)
  (then 6 monthly)
• Pregnancy test

Question 10

PrEP when covered?

Answer 10

Receptive anal sex within 7 days
Receptive vaginal sex & IVDU within 21 days

No data yet for insertive

Question 11

Syphilis diagnosis

Answer 11

1. Serology (Repeat 2 weeks if highly suspicious )
   - Lab will do EIA
   then if positive will do
   - TPPA/TPHA and
   - RPR/VDRL
2. Swab of ulcer: NAAT

NOTE: RPR marker or active disease (post treatment will revert to neg)

TPPA/TPHA=Treponema pallidum particle agglutination /heamagglutinin test
RPR: Rapid plasma reagin

Question 12

Syphilis treatment

Answer 12

Benzathine benzylpenicillin 2.4million units IM STAT

(allergy: doxy 100mg BD 14 days)

PLUS TEST OF CURE at 3 MONTHS, 6 MONTHS & 12 MONTHS - want a 4 fold drop

Question 13

Counselling for Syphilis treatment

Answer 13

• Jarisch- Herxheimer reaction: flulike illness <12 hrs post treatment, self limiting
• No sex 7 days
• NOTIFY
• No sex with previous partners from last 3 months (primary) 6 months (secondary)
• Contact tracing
  3 months primary
  6 months secondary
  12 months early latent

Question 14

Genital wart treatment

Answer 14

Imiquimod (aldara) 5% 3 times weekly until warts gone (8-16 weeks)

OR

Podophyllotoxin 0.5% paint BD for 3 days then 4 day break. repeat weekly for 4-6 weeks

OR cryotherapy

Question 15

PID treatment (pharmacological)

Answer 15

Ceftriaxone 500mg

Doxycycline 100mg BD 14 days

Metronidazole 400mg BD 14 days

Question 16

Do you need test of cure for chlamydia?

Answer 16

YES (4 weeks) if:
pregnant or
rectal infection

otherwise no BUT test of reinfection at 3months

Question 17

Contact tracing timeframe for chlamydia

Answer 17

6 months

Question 18

Criteria for Post exposure prophylaxis for HIV (hint 3 criteria)

Answer 18

1:
- Condomless receptive or insertive sex
OR
- Contaminated injecting equipment
2. Known HIV
or high risk eg (MSM, IVDU, High prevalence HIV country, sexworker outside australia)
3. <72 hours

Question 19

Window period for HIV

Answer 19

3 months

Question 20

AIDS PULMONARY illness

Answer 20

-Pneumocystis (pneumocystis jirovecii)
-TB
-Kaposis sarcoma
-non hodgkins lymphoma

PLUS CAP or atypicals

Question 21

PJP (pneumocystis jirovecii pneumonia) treatment

Answer 21

Trimethoprim + sulfamethoxazole 480+2400mg 8 hourly 21 days

Question 22

Advice general for STIs

Answer 22

• Contact tracing (6 months for chlamydia)
• No sex for 7 days
• Fact sheet
• Notification
• No sex with anyone within contact tracing time frame unless tested and treated)
• Test of reinfection 3 months

Question 23

Counselling for hepatitis C treatment

Answer 23

• EtOH max 10std/week
• Not safe during pregnancy or breastfeeding
• Able to still work as medical professional but no exposure prone procedures
• Notifiable

Question 24

Drug interactions for Hep C treatment

Answer 24

• PPI
• COCP with ethinyloestradiol
• Anti-epileptics
• Statins
• St Johns wort

Question 25

In Gonorrhoea…

a) What infections need test of cure?

b) What is the time frame

Answer 25

a)
- Pharyngeal
- Anal
- Cervical

B)
- 3 weeks (2 weeks post treatment)

Question 26

Syphilis… Presumptive therapy or not?

Answer 26

YES