STI Treatment

Question 1

Which STIs require a TOC

Answer 1

GC
M gen
Syphilis
Chlamydia in pregnancy
Rectal chlamydia

Question 2

What is the recommended treatment for chlamydia

Answer 2

Doxycycline 100mg bd 7 days (avoid in pregnancy)

Azithromycin 1g stat followed by 500mg od for 2 days

Question 3

What are alternative treatments for chlamydia?

Answer 3

Erythromycin 500mg bd for 10-14 days

Ofloxacin 200 mg bd or 400mg od for 7 days

Question 4

What is the recommended treatment for rectal chlamydia?

Answer 4

Doxycycline 100mg bd for 7 days

Alternative
Azithromycin 1g stat then 500mg od for 2 days

Question 5

What is the treatment for first episode NGU?

Answer 5

Doxycycline 100mg bd 7 days

Alternative :
Azithromycin 1g stat then 500mg od 2 days
or
Ofloxacin 200mg bd or 400mg od 7 days

Question 6

What is the treatment for recurrent NGU?

Answer 6

If doxy first then:
Azithromycin 1g stat then 500mg od for 2 days plus metronidazole 400mg bd for 5 days

If Azithromycin first then:
Moxifloxacin 400mg od 10days plus metronidazole 400mg bd for 5 days
Alternative :
Doxycycline 100mg bd for 7 days plus metronidazole 400mg bd 5 day’s

Question 7

What is the treatment for M Gen?

Answer 7

Doxycycline 100mg bd 7 days followed by
MRAM neg - Azithromycin 3 days
MRAM pos - Moxifloxacin 400mg od 10 days

Azithromycin 3 days followed by
MRAM neg - TOC
MRAM pos - Moxifloxacin 400mg od 10 days

Question 8

Treatment for TV?

Answer 8

Metronidazole 2g stat
or
Metronidazole 400-500mg bd for 5-7 days

Alternative :
Tinidazole 2g stat

Question 9

Treatment for non responsive TV?

Answer 9

Repeat course of 7 day metronidazole therapy

Then increase dose:
Metronidazole or Tinidazole 2g daily for 5-7 days
or
Metronidazole 800mg tds 7 days

Then
Tinidazole 1g bd or tds for 14 days plus intravaginal Tinidazole 500mg bd for 14 days

Question 10

Treatment for phthirus pubis?

Answer 10

Malathion 0.5% to dry hair for 2-12 hrs
Permethrin 1% cream rinse damp hair 10 mins (safe in pregnancy)
Phenthrin 0.2% dry hair 2 hours
Carbaryl 0.5% dry hair 12 hours

Eyelashes Permethrin 1% 10 mins. Keep eyes closed
or
Inert opthalmic ointment with paraffin bd 8-10 days

Question 11

Treatment for scabies

Answer 11

Permethrin 5% cream whole body chin down 8-12 hrs rpt after 1 week

Malathion 0.5% aq lotion whole body for 24 hrs rpt after 1 week

Question 12

Treatment for crusted scabies

Answer 12

Permethrin cream od 7 days then twice weekly until cure PLUS

Ivermectin 200mcg/kg days 1,2,8,9,15

Question 13

Treatment for HCV

Answer 13

Direct-acting antiviral agents DAAs target nonstructural proteins preventing viral replication

Question 14

Treatment for chronic HBV

Answer 14

Normally given to adults with DNA>2000 IU/ml or presence or absence significant necro inflammation and fibrosis

Tenofovir disoproxil fumerate TDF
Tenofovir alafenamide TAF
Entecavir
Pegylated interferon

Question 15

Treatment for HBV in HIV

Answer 15

Risk of antiretroviral resistent HIV of monotherapy lamivudine, TDF, TAF, entacavir
Use as triple ART

Question 16

Treatment of HAV

Answer 16

Supportive measures
Mild/moderate manage as OP rest and hydration
Severe with vomiting dehydration and hepatic decompensation admit to hospital

Question 17

First line treatment for GC?

Answer 17

Ceftriaxone 1g stat IM

If cipro susceptible then:
Ciprofloxacin 500mg PO stat

Question 18

Alternative treatments for GC?

Answer 18

Cefixime 400mg PO + Azithromycin 2g stat

Gentamycin 240mg IM + Azithromycin 2g stat

Spectinomycin 2g IM + Azithromycin 2g stat
(not pharyngeal GC)

Azithromycin 2g stat

Question 19

Treatment for disseminated GC?

Answer 19

Ceftriaxone 1g IM/IV 24 hrly
Cefitaxime 1g IV 8 hrly
Ciprofloxacin 500mg IV 12 hrly
Spectinomycin 2g IM 12 hrly
7 days treatment may be switched to oral 24-48 hrs after sx improve
Cefixime 400mg BD
Ciprofloxacin 500 mg bd
Ofloxacin 400mg BD

Question 20

Treatment of GC in pregnancy

Answer 20

Ceftriaxone 1g IM
Spectinomycin 2g IM
Azithromycin 2g PO

Question 21

Treatment for chancroid

Answer 21

Azithromycin 1g

Ceftriaxone 250mg IM

Cipro 500mg bd 3 days
Erythromycin 500mg qds 7 days
Last 2 pref in HIV

Question 22

Treatment for donovanosis

Answer 22

Azithromycin 1g weekly or 500mg daily for 3 weeks or until ulcers healed

Alternative
Co-trimoxazole 160/800mg bd
Doxycycline 100mg bd
Erythromycin 500mg qds (in pregnancy) 
Gentamycin 1mg/kg 8hrly

Question 23

Treatment for PID

Answer 23

Ceftriaxone 1g IM plus doxycycline 100mg bd plus metronidazole 400mg bd for 14 days

2nd line:
Ofloxacin 400mg bd plus metronidazole 400mg bd for 14 days (can use levofloxacin 500mg od)

Moxifloxacin 400mg od for 14 days

Question 24

Alternative treatment for PID

Answer 24

Ceftriaxone 1g plus Azithromycin 1g per week 2 weeks

Question 25

Inpatient treatment for PID

Answer 25

IV ceftriaxone 2g daily plus IV doxycycline 100mg bd followed by oral doxy and metro for a total of 14 days IV clindamycin 900mg daily plus IV Gentamycin (2mg/kg loading, 1.5mg/kg tds) followed by clindamycin 450mg qds or doxy plus metro total 14 days

Question 26

Treatment for LGV

Answer 26

``` Doxycycline 100mg bd for 21 days or Erythromycin 500mg qds 21 days or Azithromycin 1g weekly for 3 weeks ``` Alternative consider at least 2 weeks of oflox or moxiflox

Question 27

Treatment for EO STI related

Answer 27

Ceftriaxone 1g IM plus doxycycline 100mg bd 10-14 days If micro NG Doxycycline 100mg bd 10-14 days or Ofloxacin 200mg bd 14 days

Question 28

Treatment for EO probably enteric organism

Answer 28

Ofloxacin 200mg bd 14 days or Ciprofloxacin 500mg bd 10 days

Question 29

Treatment for incubating STS or epidemiological tx

Answer 29

Benzathine penicillin 2.4 MU im Doxycycline 100mg bd 14 days Azithromycin 2g stat

Question 30

Treatment for early STS

Answer 30

Benzathine penicillin 2.4 MU im single dose ``` Alternative Procaine penicillin G 600 000 im 10 days Doxycycline 100mg bd 14 days Ceftriaxone 500mg IM 10 days Amoxycillin 500mg qds plus probenecid 500mg 14 days Azithromycin 2g stat or 500mg od 10 days Erythromycin 500mg qds 14 days ```

Question 31

Treatment for late latent, CV and gummatous STS

Answer 31

Benzathine penicillin 2.4 MU IM weekly for 3 weeks Alternative Procaine penicillin G 600 000 im 14 days Doxycycline 100mg bd 28 days Amoxycillin 2g tds plus probenecid 500mg qds 28 days

Question 32

Treatment for neurosyphilis

Answer 32

Procaine penicillin 1.8 - 2.4 MU IM od plus probenecid 500mg qds 14 days or Benzyl penicillin 10.8-14.4g 4 hrly 14 days Alternative Doxycycline 200mg bd 28 days Amoxycillin 2g tds plus probenecid 500mg qds 28 days Ceftriaxone 2g IM od 10-14 days

Question 33

Treatment of early syphilis in pregnancy

Answer 33

Benzathine penicillin 2.4 MU single dose 1st and 2nd trimesters If 3rd trimester 2 doses a week apart Alternative Procaine penicillin G 600 000 im 10 days Ceftriaxone 500mg IM 10 days Amoxycillin 500mg qds plus probenecid 500mg qds 14 days No longer recommended in pregnancy due to high risk treatment failure and CS Azithromycin 2g stat or 500mg od 10 days Erythromycin 500mg qds 14 days plus evaluation and treatment neonates at birth with penicillin

Question 34

Treatment of late syphilis in pregnancy

Answer 34

As non pregnant doxycycline contraindicated

Question 35

Treatment syphilis in HIV

Answer 35

As appropriate per stage as non HIV

Question 36

When do you use steroids alongside syphilis treatment?

Answer 36

For CV and neuro syphilis | 40-60mg prednisone OD 3 days starting 24 hrs before antibiotics

Question 37

What is initial drug treatment for HSV?

Answer 37

5 day course Aciclovir 400mg tds Valaciclovir 500mg bd Alternative Aciclovir 200mg 5xday Famciclovir 250mg tds

Question 38

What are the short course treatments for episodic HSV?

Answer 38

Aciclovir 800mg tds 2/7 Famciclovir 1g bd 1 day Valaciclovir 500mg bd 3/7

Question 39

Suppressive regimens for HSV (6+ episodes per year)

Answer 39

``` For 6-12 months Aciclovir 400mg bd (^tds) Aciclovir 200mg qds (^5xday) Famciclovir 250mg bd (^tds) Valaciclovir 500mg od (^bd) ``` ^increase frequency of dosage if breakthrough episodes

Question 40

Mgt of HSV in HIV

Answer 40

Aciclovir 400mg 5xday 7-10 days Valaciclovir 500mg-1g bd 10 days Famciclovir 250-500mg tds 10 days Should be continued until all lesions re-epithelialised