STI

Question 1

Syphilis pop

Answer 1

young men 20-29 y/o
black

Question 2

Chlamydia pop

Answer 2

Black, american indians
Women 15-24 > men

Question 3

Gonorrhea pop

Answer 3

Blacks
now more in men

Question 4

PID pop

Answer 4

women

Question 5

Syphilis transmission

Answer 5

direct mucocutaneous contact

Question 6

Syphilis Dx

Answer 6

Asx: screen if high risk

Sx: presumptive dx
1. nontreponemal test (rapid plasma reagin)
2. treponemal test (antibody)

Question 7

Syphilis stages of progression

Answer 7

1. Chancre at site of inoculation
2. rash, fatigue, sore throat, lymphadenopathy, fever, organ involvement
   Early latency 1-2 yrs, ASx
   Late latency progressive organ involvement, CV complications, cummatous lesions, brain/CNS involvement

Question 8

Syphilis tx

Answer 8

Primary/Secondary/early latent
- Benzathine Penicillin G 2.4 million units IM x1

Latent or tertiary w/ normal CSF (longer duration)
- Benzathine Penicillin G 2.4 million units IM QW for 3 weeks

CNS/ocular syphilis
- Aqueous crystalline Penicillin G 18-24 million units IV QD for 10-14 days (higher dose)
- Aqueous procain Penicillin G 2.4 million units IM QD + probenecid 500 mg PO QID

Question 9

Chlamydia presentation

Answer 9

Mostly asymptomatic
Women: cervix
Men: urethritis

Question 10

Chlamydia treatment

Answer 10

Doxycycline 100 mg PO BID x 7 days

ALT: discouraged
- Azithromycin 1g PO x 1 (OK if pregnant)
- Levofloxacin 500 mg PO QD x 7 days
Amoxicillin 500 mg PO TID x 7 days (OK for pregnant)

Question 11

Gonorrhea presentation

Answer 11

90% urethra colonization
Sx within 10 days, some ASx
Comp: bacteremia, arthritis, meningitis

Question 12

Gonorrhea tx

Answer 12

Ceftraixone 250 mg IM x 1
- PO: Cefixime 800 mg x 1
- Preg: Ceftriaxone 250 mg IM x1 + AZithro
- Disseminated: Ceftriazone 1g (IM or IV) Q 24 H x >7days , then PO cefixime 400 mg BID + PO AZ 1g x 1
Allergy: Azithromycin 2g PO x 1 + GENT 240 mg IM x 1

Disseminated

Question 13

PID treatment

Answer 13

Inpatient
* cefotetan IV, Cefoxitin IV + Doxy PO
Outpatient
* Ceftriaxone IM, Cefoxitin IM + Proben+ Doxy PO
Abcess
* + metronidazole

Question 14

Expedited partner therapy

Answer 14

Promote adherence for
1. chalmydia: AZ 1g PO x 1
2. gonorrhea: Cefixime 500 mg PO x1 + AZ 1g PO x 1

Unit dose packaging preferred