STI Antibiotics

Question 1

Chlamydia

Answer 1

Doxycycline 7 days

2nd line: azithromycin 1g day 1, then 500mg for 2 days

Question 2

Vulvovaginal candidiasis

Answer 2

Oral fluconazole single dose + cotrimazole cream
OR
Clotrimazole pessary and clotrimazole cream

Question 3

Bacterial vaginosis

Answer 3

1st line: metronidazole 7 days

2nd line: clindamycin cream 7 days or dequalinium vaginal tablets for 6 days.

Question 4

Trichomoniasis

Answer 4

Metronidazole 7 days or 2g single dose

Question 5

First episode genital herpes

Answer 5

Oral aciclovir 5 days

Question 6

Recurrent genital herpes

Answer 6

Symptomatic treatment if non-severe

If severe then oral aciclovir

Question 7

When would you consider suppressive therapy for genital herpes?

Answer 7

If >6 recurrences a year and highly symptomatic.

Question 8

How long do you give suppressive therapy for genital herpes?

Answer 8

12 months then treatment interruption

Await >2 recurrences before considering restarting

Question 9

Genital warts

Answer 9

Podophyllotoxin cream (unlicensed for perianal warts)
Imiquimod cream (can be used on external genital and peri-anal warts, not recommended for internal use)

Question 10

What effect does podophyllotoxin and imiquimod have on condoms?

Answer 10

Latex condoms may be weakened.

Question 11

If an NAAT is positive for gonorrhoea, what should then be done?

Answer 11

Another NAAT looking for a different target.

Question 12

Gonorrhoea

Answer 12

First line: ceftriaxone 1g IM

Second line: cefixime 400mg and azithromycin 2g oral (only if IM not suitable or refused)

Question 13

After treating gonorrhoea, what should you do?

Answer 13

Test of cure

Question 14

Syphilis serological tests

Answer 14

Non-treponemal: VDRL (venereal disease research laboratory), RPR (rapid plasma reagin)
Treponemal: ELISA/EIA (screening test)

Question 15

Early and late syphilis management

Answer 15

2.4 MU (IM) benzathine penicillin x1

Late is x3

Question 16

How to follow up syphilis?

Answer 16

Serologically (RPR)

Question 17

What will the RPR decrease by in 3-6 months in treatment of early syphilis?

Answer 17

Four-fold

Question 18

When would you confirm a serological relapse or reinfection of syphilis?

Answer 18

When the RPR titres increase by fourfold.