STIs Flashcards
What STIs to screen for in vaginal discharge?
chlamydia, mycoplasma genitalium, gonorrhoea,, trichomoniasis
What STIs to screen for in anogenital ulcers?
herpes, syphilis, donovanosis, lymphogranuloma venereum
Chlamydia first line management?
Doxycycline 100mg PO, BD 7 days
How far back to contact trace in chlamydia?
6 months
Which populations to do a test of cure in chlamydia?
Pregnant women
Rectal chlamydia
Sally presents with her first episode of herpes simplex, how to treat?
Valaciclovir 500mg PO, BD for 5 - 10 days
Sally has another episode of herpes a few months later, how to treat?
Valaciclovir 500mg PO, BD for 3 days
What is the preferred oral antiviral in pregnant women?
Aciclovir is the preferred agent in pregnancy
Benzathine penicillin 1.8g IMI, stat.
This is treatment for which condition?
Syphilis in the infectious satge (primary, secondary, early latent)
What about treatment for latent syphilis?
Benzathine penicillin 1.8g IMI, weekly for 3 weeks
What is the Jarisch-Herxheimer reaction that you should warn patients about when treating for syphilis?
A common reaction to treatment in patients with primary and secondary syphilis. It occurs 6-12 hours after commencing treatment, and is an unpleasant reaction of varying severity with fever, headache, malaise, rigors and joint pains, and lasts for several hours. Symptoms are controlled with analgesics and rest.
What about the procaine reaction?
A rare reaction to procaine penicillin (an alternate medication to benzathine penicillin). It is characterised by a sensation of impending doom with hallucinations. The reaction is self-limiting and lasts about 30 minutes.
In primary syphilis you must contact trace for? A- 2 months B- 3 months C- 4 months D- 6 months
B- 3 months
In secondary syphilis you must contact trace for? A- 2 months B- 3 months C- 4 months D- 6 months
D- 6 months
When to order syphilis serology?
- For men who have sex with men (MSM): at least annually, up to 4 times a year.
- For HIV positive MSM, up to 4 times per year or at least on each occasion of CD4/viral load monitoring
- Routine antenatal testing (repeat in late pregnancy if at risk of infection or reinfection e.g. Aboriginal women in context of current outbreak).
- Routine immigration testing
- A sexual contact of a person with syphilis
- Routine sexual health check
- Presence of any signs and symptoms of infectious syphilis.
What syphilis serology to order when testing for cure?
reactive plasma regain (RPR) testing
When to test for cure in syphilis?
3 months, then at 6 months and (if necessary) at 12 months after completing treatment
Treatment for gonorrhoea?
Ceftriaxone 500mg IMI, stat in 2mL 1% lignocaine
PLUS
Azithromycin 1g PO, stat
No sexual contact for how long whilst treating for gonorrhoea?
7 days
Contact trace how far back in gonorrhoea? A- 2 months B- 3 months C- 4 months D- 6 months
A- 2 months
Retesting in gonorrhoea when?
Retest patients 3 months after exposure
Treatment for genital warts?
Patient applied podophyllotoxin 0.15% cream or 0.5% paint topically applied, BD for 3 days, then 4 days off, repeated weekly for 4-6 cycles until resolution. Paint is more suited for use on external keratinised skin. Cream is best used in perianal area, introital area and under the foreskin.
OR
Patient applied imiquimod 5% cream topically, 3 times per week at bedtime (wash after 6-10 hours) until resolution (up to 16 weeks).
OR
Clinician initiated cryotherapy weekly
Within how many hours of exposure can PEP be offered for HIV?
within 72 hours of potential HIV exposure
What is the risk of developing chronic hepatitis B when exposed age less than 5?
A- 10%
B- 40%
C- 70%
D- 90%
D- 90%
Donovanosis management?
Azithromycin 500mg PO, daily for 7 days
or
Doxycycline 100mg PO, BD for a minimum of 4 weeks,
Chlamydia treatment in pregnant woman?
Azithromycin 1g PO, stat
Mycoplasma management?
Doxycycline 100mg bd for 7 days
followed by
Azithromycin 1 g immediately then 500 mg daily for 3 days (total 2.5 g)
ATSI population routine screening
Regular testing for chlamydia, syphilis and HIV is recommended
Hep C Offer testing if history of injecting drug use, incarceration or unsafe tattoos
MWHSM routine screening
Chlamydia
Gonorrhoea
Syphilis serology
HIV antibody/antigen: If not known to be HIV-positive
Hepatitis A antibody: Test if not vaccinated. Vaccinate if antibody negative
Hepatitis B surface antigen, core antibody, surface antibody: Test if not vaccinated. Vaccinate if no history or documentation of full vaccination course
Hepatitis C: Test once a year in people living with HIV, on PrEP or with history of injecting drug use
