STD Flashcards
Chlamydia is transmitted
Sexually, prenatally at birth from cervix to neonate
Chlamyida is most frequently seen in
F <25yo, screen this population annually
Other populations to consider screening for chlamydia
males in high prevalent areas
MSM
F >25yo who are high risk
Screening for males
first catch urine, urethral swab- pharynx and rectum
Screening for females
first catch urine, cervical swab- pharynx and rectum
Symptoms of Chlamydia in females
vaginal discharge, mucopurulent cervicitis with edema and friability urethritis PID ectopic pregnancy infertility endometriosis
Symptoms of Chamydia in males
Thin, clear discharge
dysuria
Pearls of Chlamydia
1/2 have no SS
Symtoms of Chlamydia in infants and neonates
1-3mos old: Presents in mucous membranes of eyes, oropharynx, CU tract and rectum as subacute, afebrile PNA.
neonates: asymptomatic infections of oropharynx, GU, rectum
Most commonly presents as conjunctivitis 5-12d after birth
Chlamydia treatment
Azithromycin ( macrolide) works in the bacterial cell.
1g PO x 1 dose OR Doxycycline 100mg PO BID x 7d
abstain from sexual relations for 7 days post finishing abx treatment
When should repeat testing be done for chlamydia
Not recommended unless:
doubt in adherence
if SS return
if the alternate medication is used
Chlamydia in pregnancy
Do not use Doxycycline
Azythromicin 1g PO x one dose OR Amoxicillin 500mg TID x 7 days
repeat testing in 3-4 weeks, then at 3 months
abstain from sexual relations for 7 days post finishing abx treatment
High risk populations for chlamydia
adolescents women 15-24yo multiple partners those who utilize family planning clinics or abortion facilities juvenile detention centers
Gonorrhea
usually co infects with Chalmydia, routinely both are treated
increased resistance to FQ
Some TCA resistance
abstain from sexual relations for 7 days post finishing abx treatment
Gonorrhea Treatment
Ceftiraxone 250mg IM once AND azythromycin 1g PO once
Alternative Cephalosporins for Gonorrhea
not as effective on pharyngeal infection
ceftoximine 500mg IM once
cefoxitin 2g IM c Probenecid 1g PO
cefotaxime 500mg IM
cefixime 400 mg PO, not as effective - hard to maintain bactericidal levels
When should a pt follow up for Gonorrhea
Follow up in 14d only if :
given an alternative treatment
if repeat test is positive, CS is needed
Syphilis - three clinical stages are
Primary
Secondary
Tertiary
Primary syphilis
painless ulcerations/chanchers in genital area
Secondary syphilis
rash on palms and soles, possible lymphopathy
tertiary syphilis
internal- cardiac issues, brain lesions
Other stages of Syphilis
latent - early, late, or unknown
Screening for Syphilis
Screening is primary risk and symptom based
Annual screening in active MSM and persons who are HIV+
Testing is paired
Syphilis Treatment for Primary or Secondary or Early Latent
2.4 million U B Pen G IM single dose
Syphilis treatment Tertiary or Late latent or Unknown
2.4 million U B Pen G IM x3 dose- one dose a week
Neurosyphilis Treatment
14 days of 18-24 million U Pen G IV per day
Alternative Syphilis Treatment in non pregnant primary or secondary
doxycycline 100mg PO BID x 14 d
tetracycline 500mg PO QID x 14 d
Alternative Syphilis Treatment in latent
doxycycline 100mg PO BID x 28 d
tetracycline 500mg PO QID x 28 d
PCN allergic patients with uncertain compliance and pregnant patients get what treatment for syphilis
desensitize to PCN for treatment
Herpes, HSV-1, HSV-2
chronic viral infection
HSV-2 is most common in genital herpes, increase in prevalence of HSV-1
PCR testing is most sensitive
Treatment for first episodes of HSV 1 and 2:
acyclovir 400mg PO TID x7d-10d
acyclovir 200mg PO 5xd for 7-10d
valacyclovir 1g PO BID x7-10days
famiciclovir 250mg PO TID x 7-10 d
Treatment for first episodes of HSV 1 and 2:
acyclovir 400mg PO TID 7-10d
acyclovir 200mg PO 5 times a day 7-10d
valacyclovir 1g PO BID 7-10d
famiciclovir 250mg PO TID 7-10d
Treatment for established Herpes Supressive therapy
Suppressive helps reduce outbreaks and transmission
acyclovir 400mg PO TBID
valacyclovir 500mg PO daily
valacyclovir 1g PO daily
famiciclovir 250mg PO BID
Treatment for established Herpes Episodic therapy
Episodic should be initiated during prodromal period or within one day of lesion onset
acyclovir 800mg PO BIDx5d
valacyclovir 500mg PO BID x 3d
valacyclovir 1g PO daily x 5d
Treatment for established Herpes Suppressive therapy
Suppressive helps reduce outbreaks and transmission
acyclovir 400mg PO TBID
valacyclovir 500mg PO daily
valacyclovir 1g PO daily
famiciclovir 250mg PO BID
What is -cycline
ex doxycycline or tetracycline
a tetracycline antibiotic
