Sexually Transmitted Diseases and UTIs

Question 1

What is the treatment for urethritis and cervicitis

Answer 1

Gonorrhea: Ceftriaxone
Chlamidya: Azithromycin single dose or doxycycline for a week

Pregnant patients: Only ceftriaxone and azithromycin (not doxycycline)

If someone gets recurrent gonorrhea, think about terminal complement deficiency

Question 2

What is the best initial test and most accurate test for PID

Answer 2

Best initial test: Pregnancy test, cervical culture, DNA probe
Most accurate test: Laparoscopy

Pregnancy test is always done first because we have to rule out ectopic pregnancy in a woman with abdominal pain

Question 3

What is the treatment for PID

Answer 3

Ceftriaxone and doxycycline (not azithromycin)

Question 4

What antibiotics are safe during pregnancy

Answer 4

1. Penicillins
2. Cephalosporins
3. Nitrofurantoin
4. Aztreonam
5. Erythromycin
6. Azithromycin
7. Acyclovir

Question 5

How does epididymo-orchotis present differently from testicular torsion, and what is the treatment depending on age

Answer 5

Testes are in normal position

Treatment
<35 years: Ceftriaxone and doxycycline
>35 years: Fluoroquinolone

Question 6

Ulcers: What are the diseases that present with ulcers in the genital region (six)

Answer 6

1. Chancroid - caused by haemophilius ducreyi
2. Lymphogranuloma venerem
3. HSV type 2 (genital)
4. Syphilis
5. Granuloma inguinale
6. Genital warts

Question 7

For chancroid caused by haemophilis ducreyi, it is actually painful. How do you diagnose it, and how do you treat it

Answer 7

Diagnosis: Gram stain swab - will show gram negative coccobacilli, also do culture under special Nairobi or Mueller hinton

Treatment: Ceftriaxone shot or single oral dose azithromycin (third gen cephalosporin because gram negative)

Question 8

What is lymphogranuloma venereum disease and how do you treat it

Answer 8

Has an ulcer caused by chlamidya in addition also has large lymph nodes

Treatment: Aspirate lymph nodes, treat with doxycycline/azithromycin (since it’s an atypical)

Question 9

If someone presents with multiple ulcers, what will you do

Answer 9

Treat directly (this is HSV 2), no need to do tzanck smear or serologies for accurate diagnosis

First line: Acyclovir or valacyclovir
Second line: Foscarnet