STI

Question 1

What patient populations should chlamydia AND gonorrhea screening occur?

Answer 1

• sexually active women < 25
• Women 25+ at increased risk of infection (new sex partner, more than one sex partner, sex partner with concurrent partners)
• Pregnancy
• MSM
• Correctional facilities

Question 2

What is first line therapy for Chlamydia?

Answer 2

• Azithromycin 1 g PO x1 (preferred in pregnancy)

- Doxycycline 100 mg PO BID x 7 days

Question 3

When should test of cure be done for chlamydia?

Answer 3

Pregnancy (3-4 weeks after tx)

Question 4

What counseling point should you instruct a patient after chlamydia AND gonorrhea treatment?

Answer 4

Abstain from sex for 7 days after treatment

Question 5

When should patients repeat test for chlamydia and gonorrhea?

Answer 5

3 months (to test for re-infection)

Question 6

What is the CDC recommended first line therapy for uncomplicated gonococcal infections?

Answer 6

Preferred: CTX 250 mg IM x 1 + Azithromycin 1 g PO x 1
Alternative: Cefixime 400 mg PO x 1 + Azithromycin 1 g PO x 1

Question 7

What is the dosing regimen for gonococcal conjunctivitis?

Answer 7

CTX 1 g IM x 1 + Azithromycin 1 g PO x 1

Question 8

What is the dosing regimen for gonococcal arthritis and arthritis-dermatitis syndrome?

Answer 8

CTX 1 g IV or IV Q24H x 7 days + Azithromycin 1 g PO x 1

Question 9

What does CDC recommend for gonorrhea if there is a beta lactam allergy?

Answer 9

Gentamicin 240 mg IM + Azithromycin 2 g PO x 1

Question 10

When should test of cure occur for gonorrhea? In what conditions?

Answer 10

• For patients not treated with CTX
• Persistent symptoms
• 14 days after treatment
• Include antimicrobial susceptibility testing for positive cultures

Question 11

How far back would you need to go back when counseling about sexual partners getting treatment due to a sexual partner with gonorrhea?

Answer 11

60 days

Cefixime 400 mg PO x 1 and azithromycin 1 g x 1

Question 12

How is latent syphilis defined as? What about late latent?

Answer 12

Lacking clinical manifestations, and are detected by serologic testing

Late latent is acquired a year or more prior (or unknown duration)

Question 13

What patient populations should syphilis be screened?

Answer 13

• Pregnant women - first prenatal visit
• Correctional facilities
• MSM

Question 14

What is first line therapy for primary, secondary and early latent syphilis?

Answer 14

Benzathine G 2.4 million units IM x 1

Question 15

What is the first line therapy for late latent syphillis and latent syphillis of unknown duration?

Answer 15

Benzathine G 2.4 million units IM x3 on a weekly basis

Question 16

What is the first line therapy for neurosyphilis and ocular syphilis?

Answer 16

Aqueous crystalline penicillin G 18-24 million units per day, administered 3-4 million units IV every 4 hours or continuous infusion x 10-14 days

(Also used for retreatment)

Question 17

What is a preferred alternative therapy in non-desensitized beta-lactam allergy for primary syphilis? latent syphillis?

Answer 17

Doxycycline 100 mg PO BID x 14 days

Doxycyline 100 mg PO BID x 28 days

Question 18

What is the Jarisch-Herxheimer Reaction?

Answer 18

Can occur first 24 hours of treatment for spirochetal diseases due to reaction to treatment (SHOULD CONTINUE THERAPY)

Reaction: fever, rigors, sweats, hypotension and skin rashes

Question 19

What serology result would be considered to demonstrate clinically significant response?

Answer 19

Fourfold decrease in titer (1:16 to 1:4 or 1:32 to 1:8)

Question 20

When should follow up for syphilis treatment occur?

Answer 20

6-12 months after treatment

Question 21

What is the first line therapy for pelvic inflammatory disease?

Answer 21

Cefotetan 2 g IV Q12H + Doxycycline 100 mg PO/IV Q12H x 14 days

Cefoxitin 2 g IV Q6H + Doxycycline 100 mg PO/IV Q12H x 14 days

*Add anaerobic coverage due to high involvement of of bacterial vaginosis in PID

Question 22

How do you treat epididymitis?

Answer 22

Due to chlamydia and gonorrhea
- CTX 250 mg IM x 1 + Doxycycline 100 mg PO BID x 10 days

Due to chlamydia, gonorrhea and enteric organisms (men who practice insertive anal sex)
- CTX 250 mg IM x 1 + levofloxacin 500 mg PO Q24H x 10 day or ofloxacin 300 mg PO BID x 10 days

Due to enteric organisms
- Levofloxacin 500 mg PO Q24H x 10 days or ofloxacin 300 mg PO BID x 10 days

Question 23

What is the recommended treatment for external anogenital warts due to HPV?

Answer 23

• Imiquimod 3.75% cream applied QHS x 16 weeks or 5% TIW x 16 weeks
• Podofilox 0.5^ solution/gel applied to warts BID x 3 days, followed by 4 days of no therapy

Question 24

What is the CDC recommendation for HPV immunization?

Answer 24

9-valent HPV for females and males

• Start 11-12 yo (but as early as 9 years)
• Up to 26 years if not previously immunized
• Up to 45 years with shared clinical decision making

Question 25

What considerations should be made for HPV immunization for patients up to 45 years?

Answer 25

HPV vaccine efficacy is high among persons who have not been exposed to vaccine-type HPV

Vaccine effectiveness might be lower among persons with risk factors for HPV infection or disease (adults with multiple lifetime sex partners and likely previous infection with vaccine type HPV)

Question 26

How do you treat first clinical episode of genital herpes? What dosing strategies are there?

Answer 26

Acyclovir 400 mg PO TID
Acyclovir 200 mg PO 5x/day
Valacyclovir 1 g PO BID
Famciclovir 250 mg PO TID

Duration: 7-10 days (longer for first episode)

Question 27

How do you treat recurrent episodes of genital herpes? What doses strategies are there?

Answer 27

Acyclovir 400 mg PO TID x 5 days
Acyclovir 800 mg BID x 5 days
Acyclovir 800 mg TID x 2 days

Valacyclovir 500 mg BID x 3 days
Valacyclovir 1 g PO QD x 5 days

Famciclovir 125 mg BID x 5 days
Famciclovir 1 g daily x 1 day
Famciclovir 500 mg x 1, 250 mg BID x 2 days

Question 28

What are there preferred suppression regimens for HSV genital herpes?

Answer 28

Acyclovir 400 mg PO BID
Valacyclovir 1 g PO QD
Famciclovir 250 mg BID

Pregnancy:
Acyclovir 400 mg PO TID
Valacyclovir 500 mg BID