STD

Question 1

Chlamydia treatment

• Pregnant 1st and 2nd line tx
• Non pregnant 1st and 2nd tx

Answer 1

Pregnant
1st line: azithromycin 1g oral x1
2nd line: amoxicillin 500mg TID x 7d

Non pregnant
1st line: doxycycline 100mg BID x 7d
2nd line: (same as 1st line for pregnant counterpart) OR levofloxacin 500mg once daily x7d

Question 2

Gonorrhea treatment

• now based on ____.
• list standard tx and case of allergic patient

Answer 2

Now based on patient weight (and excludes azithromycin co-treatment due to increased antibiotic resistance)

Standard tx: 500mg CTX IM x 1 for weight < 150 kg; OR 1000mg CTX IM x 1 for weight > or = 150kg

For allergy: gentamicin 240 mg IM x 1 with azithromycin 2g PO x 1 OR cefixime 800mg PO x 1

Question 3

Mycoplasma treatment

- list standard tx

Answer 3

(Note: macrolide resistance testing recommended but not available at our center)

Therefore, tx empirically with doxycycline 100mg BID x 7d + moxifloxacin 400mg once daily x 7d

Question 4

Syphilis

• tx of primary/secondary stage
• tx of latent stage
• tx of third stage
• tx of neurosyphilis

Answer 4

• primary/secondary: Benzathine PCN G 2.4 million units IM x 1
• latent: Benzathine PCN G 2.4 million units IM x 3, once weekly (7.2 million units total)
• third: same as latent
• neuro: Aqueous crystalline PCN G 18-24 million units IV q4h or cont infusion for 10-14 days

Question 5

BV

• Amsel’s criteria
• gold standard diagnosis
• treatment

Answer 5

Amsel’s criteria

1. homogenous, milky discharge
2. clue cells
3. pH > 4.5
4. fishy odor with 10% KOH (+whiff test)

Gold standard: vaginal gram stain

Treatment: metronidazole 500 mg BID oral x 7d OR metrogel 0.75% (5g) QHS x 5d OR clindamycin cream 2% (5g) QHS x 7d

Question 6

Trichomonas treatment

Answer 6

Metronidazole 500 mg BID oral x 7d or metronidazole 2g oral x 1 (men) or tinidazole 2g oral x 1 (less GI effects)

Question 7

Chancroid

• presentation
• treatment

Answer 7

Presentation: 1+ deep and painful ulcers +/- inguinal lymphadenopathy

Tx: (several options) 
Azithromycin 1g oral x 1
OR
CTX 250mg IM x 1
OR
Ciprofloxacin 500mg BID x 3d
OR
Erythromycin base 500mg BID x 7d

Question 8

Granuloma inguinale (Donovanosis)

• presentation
• treatment

Answer 8

Presentation: slow developing, painless ulcers without inguinal lymphadenopathy

Tx: azithromycin 1g oral once weekly for >3 weeks until lesions resolved (alternative doxycycline 100mg BID oral for >3 weeks) OR erythromycin 500mg QID same

Question 9

Lymphogranuloma venereum (LGV)

• presentation
• treatment

Answer 9

Presentation: tender inguinal or femoral UNILATERAL lymphadenopathy

Tx: similar to donavanosis; doxycycline 100 mg BID oral for 3 weeks or azithromycin 1g oral once weekly same (for latter + retest C. trachomatis NAAT in 4wks) OR erythromycin 500mg QID same

Question 10

STDs that should be reported to CDC:

Answer 10

HIV 
Chlamydia
Gonorrhea
Chancroid 
Syphilis