STI Flashcards
AC is a 32yof with a past medical history of asthma, non-insulin dependent type 2 diabetes, and obesity who presents to hospital with anal pruritis, bleeding, discharge, and pain. She has recently been newly sexually active with one new partner. Her partner does not always use a condom when they have sex.She is diagnosed with uncomplicated gonococcal infection of the rectum and ruled out chlamydia infection. She has no known drug allergies and is not pregnant.
Weight 162kg - BP 132/75 - HR 85 – RR 15 – Afebrile
Which would be the best treatment option?
A.) Ceftriaxone 500 mg IM x1 dose
B.) Ceftriaxone 1000 mg IM x1 dose
C.) Gentamicin 240 mg IM x1 dose PLUS doxycycline 100mg PO BID x 7 days
D.) Ceftriaxone 1000 mg IM x1 dose PLUS azithromycin 1000 mg PO x 1 dose
B
Treatment:Uncomplicated gonococcal infection of the pharynx
Based on weight, pregenant, and if patient has had testing to confirm they dont have chlamydia
All patients will get ceftriaxone IM x1 dose
Dosing of ceftriaxone is different based on dosing
<150kg: Ceftriaxone 500mg IM x1
> or equal to 150kg: Ceftriaxone 1000mg IM x 1
if patient has not ruled out chlamydia with testing or are positive for chlamydia ADD doxycycline 100mg PO x 7 days
If patient is pregnant ADD azithromycin 1gm PO x1
*Test-of-cure recommended 7-14 days after initial treatment, regardless of treatment regimen
Treatment (Primary and secondary syphilis)
Benzathine penicillin G 2.4 million units IM x 1 dose
If patient is allergic to PCN
Doxycycline 100 mg PO BID x 14 days
OR
Tetracycline 500 mg PO QID x 14 days
OR
Azithromycin 2 g PO x 1 dose - not really used to do high resistance and treatment failure
Treatment (EARLY LATENT syphilis)
Early latent syphilis (< 1 year duration)
Benzathine penicillin G 2.4 million units IM x 1 dose
If patient is allergic to PCN
Doxycycline 100 mg PO BID x 14 days
OR
Tetracycline 500 mg PO QID x 14 days
Treatment (LATE LATENT syphilis)
Late latent (> 1 year duration) or unknown duration
Benzathine penicillin G 2.4 million units IM once weekly x 3 WEEKS
If patient is allergic to PCN
Doxycycline 100 mg PO BID x 28 days
OR
Tetracycline 500 mg PO QID x 28 days
Treatment (tertiary syphilis)
Benzathine penicillin G 2.4 million units IM once weekly x 3 WEEKS
If patient is allergic to PCN
Doxycycline 100 mg PO BID x 28 days
OR
Tetracycline 500 mg PO QID x 28 days
Treatment (NEUROsyphilis)
Aqueous crystalline penicillin G 3-4 million units IV q4h x 10-14 days (or 18-24 million units per day as a continuous infusion
if patient has PCN allergy
May administer benzathine penicillin 2.4 million units IM once weekly x 3 weeks after completion of IV therapy
OR
Ceftriaxone 2 g IM or IV daily x 10-14 days - depends on the severity of the allergy
Treatment of syphilis in those HIV positive
If patient has Primary, secondary, or early latent syphilis: Benzathine penicillin G 2.4 million units IM x 1 dose
If patient has late latent or unknown duration: Benzathine penicillin 2.4 million units IM once weekly x 3 weeks
If patient has neurosyphillis:Aqueous crystalline penicillin G 3-4 million units IV q4h x 10-14 days (or 18-24 million units per day as a continuous infusion
Syphilis treatment in pregnant patients
Penicillin only
if patient is allergic must do desensitization
KC is a 52yom with PMH of IV drug use who presents to hospital with altered mental status. He was diagnosed with syphilis about 8 years ago but had left the hospital against medical advice. Lab results show elevated C-reactive protein (measure of inflammation or infection) and was diagnosed with tertiary (late) syphilis. He has no known drug allergies.
Weight 87kg - BP 141/74 - HR 102– RR 17– Afebrile
Which would the best treatment option?
A.) Benzathine penicillin G 2.4 million units IM once weekly x 3 weeks
B.) Aqueous crystalline penicillin G 4 million units IV Q4h x 10-14 days
C.) Benzathine penicillin G 2.4 million units IM x 1 dose
D.) Doxycycline 100mg PO BID x 14days
A
Chlamydia treatment
Doxycycline 100mg PO BID x 7 days
Alternative
- azithromycin 1g PO x 1 dose
- levofloxacin 500mg PO q24h x 7 days
Chlamydia treatment for pregnant patients
Standard
- azithromycin 1g PO x 1 day
alternative
- amxoicillin 500mg PO TID x 7 days
Mycoplasma genitalium
Macrolide-susceptible
Doxycycline 100 mg PO BID x 7 days followed by azithromycin 1 gram PO x 1 followed by 500 mg PO daily x 3 additional days (total azithromycin 2.5 grams)
Mycoplasma genitalium
Macrolide-resistant OR testing not available
Doxycycline 100 mg PO BID x 7 days followed by moxifloxacin 400 mg PO daily x 7 days
Initial TREATMENT HSV
First clinical episode of genital herpes (same treatment for HIV patients)
Acyclovir 400 mg PO TID
OR
Famciclovir 250 mg PO TID
OR
Valacyclovir 1 g PO BID
treatment for 7-qo days
RECURRENT TREATMENT HSV
Acyclovir 800 mg PO BID x 5 days
OR
Famciclovir 125 mg PO BID x 5 days
OR
Valacyclovir 500 mg PO BID x 3 days
Notice that duration is shorter than initial therapy
Daily suppressive therapy
HSV
Reduces frequency of recurrences by 70-80% in patients who have frequent recurrences (≥ 6/year)
Acyclovir 400 mg PO BID
OR
Famciclovir 250mg PO BID
OR
*Valacylovir 500 mg PO daily
OR
Valacyclovir 1 g PO daily
HSV treatment for pregnancy
Start suppressive therapy at 36 weeks gestation
Acyclovir 400 mg PO TID
Valacyclovir 500 mg PO BID
HSV treatment for acyclovir resistant HSV
If acyclovir resistant HSV → foscarnet 40-80 mg/kg/dose IV q8h or cidofovir 5 mg/kg IV once weekly
AD is a 18yof with PMH of anxiety and depression who presents to hospital with flu-like symptoms and lesions on external genitalia. A virologic test is performed and it is determined that AD has genital HSV. She states that she has never had HSV before. She has no known drug allergies.
Weight 65kg - BP 137/82 - HR 102– RR 17– Tmax 100.3 F
Which would the best treatment option?
A.) Valacyclovir 1000 mg PO daily x 5 days
B.) Acyclovir 400mg PO BID for life
C.) Acyclovir 800mg PO BID x 5 days
D.) Acyclovir 400mg PO TID x 10 days
D
Trichomoniasis treatment
for women
Metronidazole 500mg BID x 7 days
alternative: tinidazole 2g PO x 1 dose
Trichomoniasis treatment
for men
Metronidazole 2g PO x 1 dose
Alternative: tinidazole 2g PO x 1 dose
- metronidazole dose increase and duration of therapy shortened
- alternative therapy is same as women
Trichomoniasis treatment
HIV + patients
Metronidazole 500mg PO BID x 7 days
- same regimen for non HIV women
JT is a 34yom with no pertinent PMH who presented to hospital today with urethral discharge and pruritis. He was examined for STIs and was found to have trichomoniasis and HIV.
Weight 100kg - BP 136/81 - HR 93– RR 15– Afebrile
Which would the best treatment option?
A.) Metronidazole gel topically BIDx 7 days
B.) Metronidazole 500 mg PO BID x 7 days
C.) Metronidazole 2000 mg PO x 1 dose
D.) Tinidazole 2000 mg PO x 7 days
B
