STDs Flashcards
Which vaginal condition has a positive whiff test?
Bacterial vaginitis.
Which vaginal disorder has discharge that is off-white in colour, frothy, and an unpleasant odor, with pH over 4.5?
Trichomonas
Which vaginal disorder has a FISHY odor, with gray and milky thin discharge, with a vaginal pH of more than 4.5?
Bacterial vaginosis
which vaginal condition typically has a negative whiff test?
vaginal candidiasis
which vaginal condition typically has no odor, only white/clumpy discharge cottage-cheese like, which a vaginal pH of less than 4.5?
Vaginal candidiasis
A patient presents to the pharmacy with vaginal candidiasis. When would you refer this patient to the doctor?
if first time with the symptoms, pregnant, diabetes, recurrence within less than 2 months, HIV, and age is < 12 years
Amongst: BV, vaginal candidiasis and Trichomonas, which requires sexual partner to also be treated?
- Trichomonas
(and avoid sexual intercourse until treatment is finished for both partners + asymptomatic) - Recurrent yeast infxn (4 episodes / yr)
Treatment for trichomonas?
Oral metronidazole: 2g single dose, OR 500 mg BID x 7 days
Patient has trichomonas + is pregnant. What medication can she take for treatment?
metronidazole po.
Patient has trichomonas + is breastfeeding. What medication can she take for treatment?
metronidazole po
Treatment for BV?
- metronidazole 500 mg bid x 7 days OR
- clindamycin (vaginal)
Patient has recurrent BV with 3+ episodes per year. What do you recommend?
metronidazole 500 mg BID x 10-14 days
treatment options for vaginal candidiasis
- internal creams - clotrimazole 1% x 6 days, 2% for 3 days, or 10% x 1 day
- PO - fluconazole 150 mg stat
DDI with fluconazole?
potent cyp2c9 and mod cyp3a4 inhibitor*
so all drugs that are 2C9/3A4 substrates
What is considered a recurrent yeast infection?
at least 4 episodes per year
Treatment for recurrent yeast infection?
fluconazole 150 mg once weekly x 6 months after induction therapy
Treatment options for pregnancy + yeast infection?
clotrimazole or miconazole x 7-14 days***
*Vaginal preps are safe
*avoid fluconazole in pregnancy, NOT SAFE!
non-pharms for prevention of yeast infection?
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
Treatment options for RECURRENT yeast infection (>4/yr)?
- fluconazole 150 mg PO q 3 days , then once weekly for 6 months.
- clotrimazole: treat acute ep for 10-14 days, then 500 mg pv qmonth x 6 months
- itraconazole: 200-400 mg monthly x 6 months
In what population is a single dose of fluconazole 150 mg PO suitable for?
pregnant, breastfeeding females, those without DDIs, and women > 12 yrs
Causative bacteria for gonorrhea and chlamydia?
- gonococcal - N. gonorrhea, chlamydia
- Non-gonococcal - mycoplasma genitalium, ureaplasma urealyticam, T. vaginalis, HSV, herpes zoster virus, adenovirus
What are the symptoms of Gonorrhea/chlam in men?
purulent discharge
severe dysuria
Symptoms of gonorrhea/chlamydia in women?
vaginal discharge
severe dysuria
1st line treatment for gonorrhea and chlamydia?
- Cefixime 800 mg PO STAT OR Ceftriaxone IM 250 mg STAT (these cover gonorrhea)
AND
- Azithromycin 1g STAT OR
doxycycline 100 mg BID x 7 days (These cover for chlamydia)
Alternative drug options if pt has anaphylactic allergies to beta lactams in gonorrhea/chlamydia?
- doxycycline OR azithromycin + gentamycin
If a patient comes to the clinic testing positive for gonorrhea and chlamydia, what should they be counselled on regarding sexual activity?
- notify all partners, tracking back to 60 days prior
- avoid sex for 7 days after treatment
If a patient is pregnant + tested positive for gonorrhea/chlamydia, what is the best drug option?
ceftriaxone or cefixime 800 mg po stat + azithromycin 1g
In gonorrhea/chlamydia, is a test of cure requirred?
Yes - for gonorrhea, 1-2 weeks post-treatment due to rising antibiotic resistance.
Chlamydia - recommended in pregnancy and if symptoms persist
When is azithromycin 2g stat used to treat gonorrhea/chlamydia?
if a pt has severe allergies to cephalosporins, azithro 2g is an alternate monotherapy, or if N. gonorrheae shows resistance to cephalosporins.
Bacterial causes of Syphilis?
Spirochete bacteria
Treponema pallidum
Symptoms of syphilis?
single, big genital ulcer or chancres, or cancroid. painless.
chancre heals with scarring within 2-8 weeks
1st line therapy for syphilis?
Benzathine penicillin G 2.4 million U x 1 IM
alternative therapy for syphilis?
Doxycycline 100 mg BID x 14 ds OR
Benzyl penicillin G (for neurosyphilis)
Therapy for syphilis + pregnancy?
Penicillin G
(If allergic to penicillin): Ceftriaxone + desensitization.
Causes of genital warts?
HPV, anogenital warts
Treatment for external anogenital warts?
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)
What are the preferred tx options in pregnancy + genital warts ?
trichloroacetic acid, cryotherapy, surgical incision.
-avoid podophyllotoxins and imiquimod
Treatment for pelvic inflammatory disease?
cefoxitin 2g IM x 1 dose + probenecid 1 g PO
What is the treatment duration for the outpatient management of pelvic inflammatory disease?
14 days
