STI treatment and investigation Flashcards
chlamydia 1st line
doxycycline 7 days BD
chlamydia 2nd line
azithromycin 1g once then 500mg OD for 2 days
chlamydia in pregnancy
azithromycin
is there a TOC for chlamydia
no
ix for chlamydia
NAAT
- male - first pass urine
- female - VVS
if symptomatic male - urethral swab for GS + Microscopy
gonorrhoea 1st line
IM ceftriaxone 1g
gonorrhoea needle phobic
oral cefixime 400mg + oral azithromycin 2g
both single dose
gonorrhoea ix
NAAT
- male - first pass urine
- female - VVS
if symptomatic male - urethral swab for GS + Microscopy + NG culture
female - cervical swab - GS + microscopy + NG culture
gonorrhoea and chlamydia ix in throat / rectum
throat- pharyngeal swab
rectum - anorectal swab
for NAAT
is there a TOC for gonorrhoea
yes
syphilis 1st line
benzathine penicillin IM
syphilis 2nd line
doxycycline
what is the TOC for syphilis
monitor VDLR levels
examples of non-treponemal tests
rapid plasma reagin (RPR)
venereal diseases research laboratory (VDRL)
examples of treponemal tests
TP-EIA (TP enzyme immunoassay)
TPHA - TP haemagglutination test
treponemal test: positive
non-treponemal test: positive
active syphilis infection
treponemal test: negative
non-treponemal test: positive
false positive
treponemal test: positive
non-treponemal test: negative
successfully treated syphilis
syphilis diagnostic test
swab of ulcer for treponema pallidum PCR
venous blood - syphillis IgG/IgM EIA
syphilis screening
IgM/IgG Elise
during latent syphilis how is it dx
serology
tx herpes gingivostomatitis
oral aciclovir
chlorhexidine mouthwash
tx herpes cold sores
topical aciclovir
tx herpes genital sores
oral aciclovir
ix herpes
swab of base of ulcer for NAAT / HSV PCR
venous blood - HSV-type specific serology (only under specialist guidance)
ix trichomoniasis
High vaginal swab - ideally posterior fornix
wet mount and microscopy
trichomoniasis tx
oral metronidazole 5-7 days or once off dose 2g
tx genital warts - solitary keratinised
cryotherapy
tx multiple non-keratinised genital wart
topical podophyllum
2nd line treatment genital warts
imiquimod
tx crabs
malathion lotion
ix candidiasis (thrush)
not needed if clinical features highly suggestive
if doubt
female: swab of vaginal walls (HVS) for GS + microscopy, candida culture
male: swab of sub-prepuce (penile) for candida culture
+/- anti fungal susceptibility
tx candidiasis (thrush)
oral fluconazole 150mg single dose
tx candidiasis (thrush) 2nd line or pregnant
topical cotrimazole pessary
what can be added to pessary / oral in tx of candidiasis (thrush) if vulval s/s
topical imidazole
ix recurrent candidiasis (thrush)
HVS, OGTT
tx recurrent candidiasis (thrush)
oral fluconazole induction 3 days then weekly for 6 months
bacterial vaginosis ix
microscopy - clue cells - HVS
positive whiff test
tx bacterial vaginosis
oral metronidazole 400mg BD 5 days
or 2mg once (latter not in breast feeding)
tx bacterial vaginosis in pregnancy
oral metronidazole or topical clindamycin
prostatitis ix
MSSU for C + S
prostatitis tx
ofloxacin 14 days
tx epididymo-orchitis
ceftriaxone 500mg IM single dose + doxycycline 100mg oral 10-14 days
what tests are done for CT and NG as well as NAAT - male
if symptomatic - urethral swab for gram stain and microscopy
NG culture
what specimen is used for CT and NG in a male for gram stain and microscopy
(and NG culture)
uretheral swab if symptomatic
what specimen is used for NG gram stain and microscopy and culture in females
cervical swab
HIV ix
venous blood
HIV Ab/Ag test
