STDs

Question 1

Which vaginal condition has a positive whiff test?

Answer 1

Bacterial vaginitis.

Question 2

Which vaginal disorder has discharge that is off-white in colour, frothy, and an unpleasant odor, with pH over 4.5?

Answer 2

Trichomonas

Question 3

Which vaginal disorder has a FISHY odor, with gray and milky thin discharge, with a vaginal pH of more than 4.5?

Answer 3

Bacterial vaginosis

Question 4

which vaginal condition typically has a negative whiff test?

Answer 4

vaginal candidiasis

Question 5

which vaginal condition typically has no odor, only white/clumpy discharge cottage-cheese like, which a vaginal pH of less than 4.5?

Answer 5

Vaginal candidiasis

Question 6

A patient presents to the pharmacy with vaginal candidiasis. When would you refer this patient to the doctor?

Answer 6

if first time with the symptoms, pregnant, diabetes, recurrence within less than 2 months, HIV, and age is < 12 years

Question 7

Amongst: BV, vaginal candidiasis and Trichomonas, which requires sexual partner to also be treated?

Answer 7

1. Trichomonas
   (and avoid sexual intercourse until treatment is finished for both partners + asymptomatic)
2. Recurrent yeast infxn (4 episodes / yr)

Question 8

Treatment for trichomonas?

Answer 8

Oral metronidazole: 2g single dose, OR 500 mg BID x 7 days

Question 9

Patient has trichomonas + is pregnant. What medication can she take for treatment?

Answer 9

metronidazole po.

Question 10

Patient has trichomonas + is breastfeeding. What medication can she take for treatment?

Answer 10

metronidazole po

Question 11

Treatment for BV?

Answer 11

1. metronidazole 500 mg bid x 7 days OR
2. clindamycin (vaginal)

Question 12

Patient has recurrent BV with 3+ episodes per year. What do you recommend?

Answer 12

metronidazole 500 mg BID x 10-14 days

Question 13

treatment options for vaginal candidiasis

Answer 13

1. internal creams - clotrimazole 1% x 6 days, 2% for 3 days, or 10% x 1 day
2. PO - fluconazole 150 mg stat

Question 14

DDI with fluconazole?

Answer 14

potent cyp2c9 and mod cyp3a4 inhibitor*

so all drugs that are 2C9/3A4 substrates

Question 15

What is considered a recurrent yeast infection?

Answer 15

at least 4 episodes per year

Question 16

Treatment for recurrent yeast infection?

Answer 16

fluconazole 150 mg once weekly x 6 months after induction therapy

Question 17

Treatment options for pregnancy + yeast infection?

Answer 17

clotrimazole or miconazole x 7-14 days***
*Vaginal preps are safe
*avoid fluconazole in pregnancy, NOT SAFE!

Question 18

non-pharms for prevention of yeast infection?

Answer 18

reduce sugar intake
eat yogurt (unsweetened)
cotton underwear
avoid tights every day
wipe from front to back
change wet/damp clothes asap
avoid irritants: sprays, douches, deodorants, tampons, bubble bath, perfumed toilet

Question 19

Treatment options for RECURRENT yeast infection (>4/yr)?

Answer 19

1. fluconazole 150 mg PO q 3 days , then once weekly for 6 months.
2. clotrimazole: treat acute ep for 10-14 days, then 500 mg pv qmonth x 6 months
3. itraconazole: 200-400 mg monthly x 6 months

Question 20

In what population is a single dose of fluconazole 150 mg PO suitable for?

Answer 20

pregnant, breastfeeding females, those without DDIs, and women > 12 yrs

Question 21

Causative bacteria for gonorrhea and chlamydia?

Answer 21

1. gonococcal - N. gonorrhea, chlamydia
2. Non-gonococcal - mycoplasma genitalium, ureaplasma urealyticam, T. vaginalis, HSV, herpes zoster virus, adenovirus

Question 22

What are the symptoms of Gonorrhea/chlam in men?

Answer 22

purulent discharge
severe dysuria

Question 23

Symptoms of gonorrhea/chlamydia in women?

Answer 23

vaginal discharge
severe dysuria

Question 24

1st line treatment for gonorrhea and chlamydia?

Answer 24

1. Cefixime 800 mg PO STAT OR Ceftriaxone IM 250 mg STAT (these cover gonorrhea)

AND

2. Azithromycin 1g STAT OR
   doxycycline 100 mg BID x 7 days (These cover for chlamydia)

Question 25

Alternative drug options if pt has anaphylactic allergies to beta lactams in gonorrhea/chlamydia?

Answer 25

1. doxycycline OR azithromycin + gentamycin

Question 26

If a patient comes to the clinic testing positive for gonorrhea and chlamydia, what should they be counselled on regarding sexual activity?

Answer 26

1. notify all partners, tracking back to 60 days prior
2. avoid sex for 7 days after treatment

Question 27

If a patient is pregnant + tested positive for gonorrhea/chlamydia, what is the best drug option?

Answer 27

ceftriaxone or cefixime 800 mg po stat + azithromycin 1g

Question 28

In gonorrhea/chlamydia, is a test of cure requirred?

Answer 28

Yes - for gonorrhea, 1-2 weeks post-treatment due to rising antibiotic resistance.
Chlamydia - recommended in pregnancy and if symptoms persist

Question 29

When is azithromycin 2g stat used to treat gonorrhea/chlamydia?

Answer 29

if a pt has severe allergies to cephalosporins, azithro 2g is an alternate monotherapy, or if N. gonorrheae shows resistance to cephalosporins.

Question 30

Bacterial causes of Syphilis?

Answer 30

Spirochete bacteria
Treponema pallidum

Question 31

Symptoms of syphilis?

Answer 31

single, big genital ulcer or chancres, or cancroid. painless.
chancre heals with scarring within 2-8 weeks

Question 32

1st line therapy for syphilis?

Answer 32

Benzathine penicillin G 2.4 million U x 1 IM

Question 33

alternative therapy for syphilis?

Answer 33

Doxycycline 100 mg BID x 14 ds OR
Benzyl penicillin G (for neurosyphilis)

Question 34

Therapy for syphilis + pregnancy?

Answer 34

Penicillin G

(If allergic to penicillin): Ceftriaxone + desensitization.

Question 35

Causes of genital warts?

Answer 35

HPV, anogenital warts

Question 36

Treatment for external anogenital warts?

Answer 36

Self-Treatment:
1. podophyllotoxin 0.5%
2. imiquimod cream

In-office treatment:
1. podophyllum resim
2. podophyllin 20%
3. dichloroacetic acid/trichloroacetic acid/sinecatechins (green tea extract)

Question 37

What are the preferred tx options in pregnancy + genital warts ?

Answer 37

trichloroacetic acid, cryotherapy, surgical incision.
-avoid podophyllotoxins and imiquimod

Question 38

Treatment for pelvic inflammatory disease?

Answer 38

cefoxitin 2g IM x 1 dose + probenecid 1 g PO

Question 39

What is the treatment duration for the outpatient management of pelvic inflammatory disease?

Answer 39

14 days