STI's and Vaginitis Flashcards
Low Risk <25 age screening
GC/Chlam
High Risk
HIV/Syphilis
HSV/Trich
Reportable diseases
GC/Chlam, Syphilis, Chancroid, HIV
Chlam treatment
Azithromycin po x1
Doxycycline 100 mg BIDx 7 days
Alternatives: Erythromycin
base, Ofloxacin, Levofloxacin
7 days
Lymphogranuloma venereum Doxy 100 mg BID or Eryth 21D
Pregnancy- Amoxicillin 500 mg orally three times a day for 7 days
Systemic chlam
Lymphogranuloma venereum (LGV) systemic infx, unilateral lymphadenopathy, ulcer
Gonorrhea treatment
Ceftriaxone 250 mg IM ; Azithromycin po x 1or Doxycycline 100 mg BID x7 days
Same day, direct observation
Alternative (EPT):
Cefixime 400 mg po ; Azithromycin po x1
Persistent infection:
More likely treatment failure/reinfection: repeat Tx
Consult ID/CDC, susceptibility testing (culture & NAAT)
Gemifloxacin; Azithromycin po x1
Gentamicin IM ; Azithromycin po
Ceftriaxone IM ; Azithromycin po
Disseminated Gonorrhea
Ceftriaxone IM/IV daily, 48hrs clinical improvement
Azithromycin po x1
Then Cefixime po 7 days
Conjunctivitis Gonorrhea
Ceftriaxone IM & Azithromycin po x1
PID treatment
Screen for HIV, treat partner (Gc/Chl)
Ceftriaxone IM ,and Doxycycline +/- Metronidazole po 14 days
Gonorrhea negative and allergy
levo 500 mg daily and Flagyl
Hospitalize 24-48hrs with: pregnancy, surgical
emergency, IM/oral failure (72hrs), severe
illness/pain/fever, TOA
Inpt Tx IV until 24-48hr improvement
Parenteral: Cefotetan2 gm q12 IV Doxycycline 100 mg q 12 IV/po
◦ Clindamycin 900mg q 8, Gentamycin 3-5mg/kg daily IV
◦ Ampicillin/Sulbactam IV 3gm q6 ,Doxycycline IV/po
Home: Doxycycline , Metronidazole po 14 days
Clindamycin & Doxy po 14 days (TOA 14-21D)
Mycoplasma genitalium
Emerging issue”, associated with urethritis in men
Difficult to Dx and Tx (NAAT)
Moxifloxacin po 14 days
TOA
75% of pt with TOA respond to IV Abx
TOA fails to respond in 72 hrs needs drainage
> 8cm
Continued failure laparotomy (4 days)- remove IUD
Primary HSV
systemic flulike syndrome
(25% aseptic meningitis)
2-14D incubation
Disseminated HSV→hepatitis ; coagulopathy
HSV supression
Suppression: ↓ recurrence 80%, ↓ transmission 48%
Treatment for HSV
Acyclovir
primary 400 TID 7-10 days
Recurrance 400 TID 5 days
Supression 400 BID
Valtrex
Primary 1000 BID 7-10 days
Recurrance 1000 5 day
Supression 500-1000 daily
Severe acyclovir 5-10/kg IV q 8 hr
Syphilis Primary Secondary Tertiary Latent
Primary – (10-90 D), painless ulcer/chancre
if HIV neg, repeat test 3 mo
Secondary – (6wks-6mo) rash, mucocutaneous lesions,
lymphadenopathy
Tertiary – cardiac/ophthalmic (aortitis, iritis, uveitis),
auditory, gummatous lesions
CSF-VDRL evaluation (also if HIV +)
Latent – asymptomatic (early <1yr)
Consider CSF evaluation (high titer, >1:32)
Diagnosis of Syphilis
Most labs doing automated treponemal
- higher false positive
F/U with RPR or VDRL (non-trep)
- 1-3 weeks till + from chancre
titer- 4 fold titer change is significant
20% can be negative for both tests
Treatment for syphilis
Benzathine Penicillin G IM
Once for 1°, 2° and early latent
Weekly x3 for 3°, late latent and retreatments
- 9 days late start over
Jarisch-Herxheimer rxn: fever, HA, myalgia w/in 24hrs (early
disease)
Desensitize in pregnancy, 3°, neurosyphilis
Clinical ; serologic exam 6, 12, 24mo
Persistent symptoms/titer increase: Retreat, check CSF and
HIV
Failure of titer decline +/- retreat
Alternatives: for 1°/2° (28D for latent)
Doxycycline 100 mg BID po 14 days
Ceftriaxone IM/IV 10-15 days
Neurosyphilis: aqueous crystalline penicillin G IV
10-14 days
Treat all partners from <90D, notify/test/treat up to
one year
Chancroid
Painful ulcer(s) + inguinal adenopathy
Haemophilus ducreyi, gram - streptobacillus
Culture sensitivity <80%, limited availability
Co-infection HSV, HIV and Syphilis
If HIV/Syphilis neg repeat test 3 mo
See improvement with 3-7D treatment
Large nodes may require drainage
Azithromycin po x1 Ceftriaxone 250mg IM x1 Ciprofloxacin po 3 days Erythromycin base po 7 days Tx Partners last 10D
Ulcer what is your differential
1) Chancroid: short incubation, last weeks
2) Granuloma Inguinale (Donovanosis) : long incubation, painless, rare in
US, regional lymph (Klebsiella-doxy)
3) HSV: short incubation, last days
4) LGV: longer incubation, painless single ulcer, lasts days
5) Syphilis: longer incubation, painless, lasts weeks
PH of vaginitis
BV
Candida
Trich
BV- 5-6
Candida 4-5
Trich 6-7
Normal 3.8-4.5
Amsel’s Criteria
Clue Cell >20%
ph >4.7
Thin discharge
+ Whiff
Treatment of BV
Flagyl- oral 7 days, vaginal 5 day
Tinidazole
Clindamycin
Recurrent: metro get 10 days than twice weekly x 6 mo
Candida diagnosis
DNA probes 81%
Recurrent Yeast treatment (>4 times per year)
Fluconazole x3 doses
Itraconazole x 3 doses
Candida Glabrata
Itraconazole x 14 days
Boric Acid x14 days
Flucytosine x 14 days
Trich on Pap
treat
metronidazole BID x 7-14 days
Tinidazole
Condyloma Treatment
Podofilox 3 days on/4 off; 4 cycles Imiquimod 3x/wk; max 16 weeks Sinecatechins oint TID; 16wks max May weaken condoms/diaphragm Trichloroacetic acid (TCA) q wk Cryotherapy qwk repeat q1-2 wks Surgery
Molluscum treatment
Self-limited (6-9mo)
Curettage, cryo,
excision, TCA,
Imiquimod
pudiculosis pubis
Permethrin 1% cream; 10min Pyrethrins 10 min Malathion 0.5% lotion; 12hrs
Scabies
Permethrin cream 5%; 14hrs Ivermectin po; repeat in 2 wks Lindane 1% cream/lotion; 8hrs (for failures)
Post-exposure ppx for Hep B
HBIG and vaccine
Hep C testing for what ages?
Test adult born 1945-65 for Hep C
If patient has Hep C what other screening is needed?
HIV testing annually
syphilis in pregnancy
placentomegaly, hepatomegaly, ascites, hydrops
HIV in pregnancy
avoid efavirenz
Gartner duct cysts
Wolffian remant -lateral vagina
only remove with infection, or acute change
