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KFP > STI/sexual health > Flashcards

STI/sexual health Flashcards

1
Q

Genital herpes - Treatment, drug dose duration for:
a- initial episode
b- recurrent episodes
c- suppressive tx

A

a - Initial episode:

  • valaciclovir 500mg po bd for 5-10days, or
  • aciclovir 400mg po tds for 5-10days

b - recurrent episodes:

  • valaciclovir 500mg po bd for 3days, or
  • famciclovir 1g po bd for 1 day

c - suppressive tx:

  • valaciclovir 500mg po od for 6/12
  • famciclovir 25omg po bd for 6/12
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2
Q

Genital warts - Treatment, drug dose and duration:

A
  • podophyllotoxin 0.5% paint, bd for 3 days, then 4 days off, repeated weekly for 4-6cycles until resolution
  • imiquimod 5% cream, nocte, 3 times per week, for 16/52 until resolution
  • cryotherapy, repeated weekly until resolution
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3
Q

Pelvic inflammatory disease - key features clinical presentation (5)

A
  1. lower abdo/pelvic pain
  2. dyspareunia
  3. vaginal/cervical discharge
  4. abnormal vaginal bleeding - IMB, PCB, menorrhagia
  5. +/- fever, nausea + vomiting (severe infections)
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4
Q

Pelvic inflammatory disease - mild-moderate severity.
Treatment setting and
Rx - drugs dose and duration (3)

A 
Outpatient tx with:
1. ceftriaxone 500mg in 2ml 1% lignocaine IMI stat
PLUS 
2. metronidazole 400mg bd for 14days
PLUS
3. doxycycline 100mg bd for 14 days 
OR
azithromycin 1g PO stat, repeat dose in 7 days (preg/BF/concerns re: patient compliance with doxycycline)
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5
Q

Pelvic inflammatory disease - severe or complicated infection.
Treatment setting and
Rx - drugs dose and duration (3)

A 
Refer for inpatient management
with:
1. ceftriaxone 2g IV daily
PLUS 
2. metronidazole 500mg IV bd 
PLUS
3. azithromycin 500mg IV daily
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6
Q

Pelvic inflammatory disease - mild-moderate severity, pregnant/BF women:
Treatment setting and
Rx - drugs dose and duration (3)

A

Outpatient tx with:
1. ceftriaxone 500mg in 2ml 1% lignocaine IMI stat
PLUS
2. metronidazole 400mg bd for 14days
PLUS
3. azithromycin 1g PO stat, repeat dose in 7 days

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7
Q

Suspected pelvic inflammatory disease - Ix for all women reproductive age with new onset abdominal pain:

  • Initial Ix (4)
  • additional Ix to consider (2)
A
  1. urine bHCG
  2. endocervical swab PCR - chlamydia, gonorrhoea, mycoplasma genitalium
  3. endocervical swab MCS - gonorrhoea
  4. urine analysis - nitrates, leukocytes.

+/- urine MCS (exclude/confirm UTI if dysuria+/-frequency)

+/- Pelvic TVUSS - urgently for bHCG positive

  • diagnosis uncertainty: detect alternative cause for pain
  • detect complications: abscess/pelvic collection
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8
Q

STI - Standard asymptomatic check up for:

  1. all sexually active people <30yrs, no risk factors (1)
  2. sexually active people, with risk factors (4)
  3. sexually active people, MSM, ATSI, returned travellers from overseas (5)
A

** take sexual hx to determine risk

  1. chlamydia PCR
    (male - FVU, female - endocervical or SOLVS +/- anorectal swab)
  2. chlamydia PCR, PLUS
    HBV serology
    HIV serology
    syphilis serology
3. chlamydia PCR, PLUS
HBV serology
HIV serology
syphilis serology, PLUS
gonorrhoea PCR and MCS (FVU and swabs)
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9
Q

Infective Proctitis - key features hx (8)

A 
systemic symptoms - fever, malaise
anorectal pain
anal discharge - bloody, mucopurulent
tenesmus and/or continual urge to defecate
painful defecation
constipation/diarrhoea
sexual history -  anal sex recipient preceding days-weeks
lumps/bumps/lesions on anus
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10
Q

Infective Proctitis - key features ex (6)

A

lower abdo tenderness to palpation
groin lymphadenopathy - inguinal +/or femoral
discharge - vaginal/urethral
genitoanal lesions - pustules, erosions, ulcers
fever

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11
Q

Infective Proctitis - key Ix (4)

A

Anorectal swabs for:

  • PCR - chlamydia, gonorrhoea, HSV
  • MCS - gonorrhoea

Bloods - serology for:
- syphilis, HIV, HBV, HCV

Pharyngeal swabs for:
- PCR chlamydia, gonorrhoea

Endocervical swabs for:

  • PCR - chlamydia, gonorrhoea, HSV
  • MCS - gonorrhoea
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12
Q

Infective Proctitis - key features management (11)

A
  1. Empirical treatment for HSV, gonorrhoea and chlamydia
  2. advise to abstain sex for 2/52 after treatment or until symptoms resolved
  3. sitz baths
  4. simple analgesia
  5. stool softener if constipated
  6. review in 72hrs for response to treatment and results of Ix
  7. contact tracing (CT, NG) all partners 2months before onset of symptoms
  8. counsel on safe sex and prevention of contracting
  9. Suggest vaccination - HBV, HAV
  10. HIV PrEP if high risk or MSM
  11. Perform POC tests 1month after treatment
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13
Q

Infective Proctitis - empirical tx - drugs, dose, duration (3)

A 
1. ceftriaxone 500mg in 2ml 1% lignocaine IMI stat
PLUS 
2. doxycycline 100mg bd for 7 days 
PLUS
3.  aciclovir 400mg tds for 10 days, OR 
famciclovir 250mg tds for 10 days
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KFP (14 decks)

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