STI

Question 1

Treatment for Gonorrhea

Answer 1

*also treat for chlamydia
1. Ceftriaxone 500 mg IM x1 and Azithromycin
2. Ceftriazone (Or cefixime) and Doxycycline

Gentamicin +Azithro or doxy

Question 2

Chlamydia Treatment

Answer 2

Doxycycline 100 mg po bid x 7 days
Azithromycin 1 g po x1 (safe in pregnancy)

Question 3

Treatment for Syphillis

Answer 3

Penicillin G IM x1 ( primary, seconday or early latent)
Pen G IM weekly x 3 weeks (tertiary)
Neurosyph=IV Penicillin

Question 4

Treatment of trich

Answer 4

Metro
Treat the partner

Question 5

Counseling around STI treatment

Answer 5

Treat
Abstain for 7 days
Track and treat partners (within 2 months, C+G, and 90 days for syphilis)
Report to public health
Discuss future safe sex
Consider Hep A/B vaccinations
Follow up Syphilis at 1, 3, 6, and 12 months

Question 6

Risks for epididymitis

Answer 6

Risks for STI
Instrumentation
Hx of UTI
Strenuous exercise

Question 7

Female lower pelvic pain ddx and how to diferentiate

Answer 7

Ectopic (HCG, US, spotting)
PID (Temp, discharge, cervical motion tenderness, WBC and elevated ESR)
Ovarian Torsion (nausea, vomiting, ultrasound)
Appendicitis (McBurney’s point, fever, nausea, diffuse to local tenderness, peritonitis)
Ovarian cyst (US, rule out others)
Constipation
Diverticulitis (LLQ, diarrhea, peritonitis)
Cystitis (Urine dip, frequency, urgency)

Question 8

Treatment of PID

Answer 8

Ceftriaxone and Doxy, think about adding Metro
Consider clinda and gentamycin in severe
Treat partner within 2 months

Question 9

Genital lesion ddx

Answer 9

Chancroid
HSV
Syphillis
HPV
Cyst
Folliculitis
Abscess
SCC

Question 10

When should you screen for BV and yeast

Answer 10

You shouldn’t
Not even during pregnancy
Only screen these specifically if symptoms
But can screen for STI

Question 11

What to think if vaginitis in children

Answer 11

Foreign body
STI
Contact irritant

Unlikely to be yeast

Question 12

DDX. for vaginitis

Answer 12

Exzema
Lichen sclerosis
Lichen simplex chronicus
Neoplasm
Atrophic caginitis
Contact dermatitis
Trich
Bacterial vaginosis
Yeast

Question 13

Test to do for vaginitis

Answer 13

Swabs for STI, BV, and yeast
KOH

Wet mount:
Look for clue cells-Bacteria
Psedohyphae-Yeast

Question 14

Treatment of genital warts

Answer 14

Cryotherapy
Trichoroacetic acid
Excision cautery laser

Can use imiquirmod or podofilox if on external skin and not pregnant

Question 15

Treatment of lice and scabies

Answer 15

Wash everything
Treat partners
Permetrin cream

Pubic lice: Just to affected area x 10 minutes and repeat in 1 week
Scabies : Head to toe and leave for 8-14 hours

Can use oral ivermectin for scabies

Scabies has that burrows and affects the finger webs
Public lice has more erythema and small blue spots

Question 16

A woman comes in with terrible RUQ pain. She’s also had some vaginal discharge and a new partner a few weeks go. What does she have

Answer 16

Fitx hugh curtis from C or G