STDs

Question 1

Prevention of STDs

Answer 1

abstain from oral, vaginal, or anal sexual activity

maintain long term mutually monogamous relationship with uninfected partner

pre-exposure vaccination against HPV

even condoms do not provide complete protection

Question 2

Syphilis

Answer 2

caused by Treponema pallidum

primary and secondary syphilis will eventually resolve without treatment, but tx with abx to prevent progression to later stage infection

PCN G 2.4 million units as single IM dose, then recheck nontreponemal titer in 6mo, if not declined by 2 dilutions extend treatment to 2.4 million units IM weekly x3 weeks

alternative tx for PCN allergy: doxycycline 100mg po BID x14days, or Ceftriaxone 1gm IV daily x14days

tertiary tx: benzathine PCN G 2.4 million units IM weekly x3 weeks OR doxycycline 100mg po BID x28 days

for pregnancy: desensitize any PCN allergy and treat

for neuro sx: eval for neurosyphilis with CSF exam; if positive, treat with aqueous PCN G 3-4 million units IV q4hr or continuous x10-14days (desensitize if allergic)

Question 3

Jarisch-Herxheimer reaction

Answer 3

ADR to syphilis (not an a drug allergy)

acute fever, HA, myalgias

counsel patients- usually occurs in 24 hours

risk for premature labor and fetal distress, esp. during second half of pregnancy

Question 4

Treatment protocol of sexual partners of someone with syphilis

Answer 4

provide treatment if: contact within 3 months of diagnosis of primary syphilis, within 6 months of diagnosis of secondary syphilis, or within one year of Latent syphilis diagnosis

Question 5

Trichomoniasis

Answer 5

caused by Trichomonas vaginalis protozoa; most common curable STD worldwide

characterized by frothy yellow-green discharge and strong odor, may experience urinary discomfort or itching or lower abd pain in women (men rarely have sx, some with penile dc or irritation)

tx with Nitroimidazoles (single 2gm dose of metronidazole or tindazole), secondary tx Metronidazole 500mg BID x7 days, tertiary tx metronidazole or tindazole 2gm daily x5 days

take with food to minimize GI upset, no alcohol during abx treatment (careful with cough syrup/mouthwash)

abstain from sex until both partners are treated

Question 6

Gonorrhea

Answer 6

Aerobic, gram negative Neisseria gonorrhoeae

may be symptomatic or asymptomatic (females- pain or burning on urination, vaginal dc, bleeding between periods; men- burning on urination, white yellow or green dc from penis; rectal infection- anal itch, dc, painful BM, bleeding)

untreated can lead to PID, infertility, ectopic pregnancy, epididymitis, sterility (may also to spread to blood or joints)

co-infxn w/chalmydia is common- tx for both infxns: Ceftriaxone 250mg IM x1 dose and Cefixime 400mg po x1 dose + Axithromycin 1gm po x1 dose (alternative: Doxycylcine 100mg po BID x7 days)

Question 7

Chlamydia

Answer 7

atypical Chlamydia trachomatis

“silent disease”; same s/sx gonorrhea, untreated consequence same as gonorrhea but male complications are rare

high incidence in people less than 25yo

tx with: Axithromycin 1gm x1 dose and Doxycycline 100mg BID x7 days (alternative: Erythromycin 500mg q6hr x7 days, OR levaquin 500mg daily x7 days)

Question 8

Genital Herpes

Answer 8

Herpes Simplex 1 and 2 sx: painful/itchy ulcerative lesions, painful urination, vaginal or urethral dc, fever, HA, malaise, flu-like sx

treatment prevents flare-ups; use systemic antivirals to control incidence of greater than 6 flares/year (stop yearly to re-assess); initiate tx within 24hr of symptoms starting

acyclovir, valacyclovir, famicyclovir (acyclovir is by far the cheapest)

topical antivirals may be used adjunctively but not alone (lesions do not respond well, need systemic tx)

couples should always use daily systemic suppressive therapy and condoms

take meds with food to minimize GI SE, stay hydrated to prevent HA/dizziness, evaluate effect on alertness before driving, etc

“cyclovir” resistance- continued or persistent lesions with treatment; consider foscarnet or cidofovir or both