STIs

Question 1

Genital Herpes

Answer 1

HSV1 > HSV2
-First clinical episode: genital ulcers, pain, itching, discharge, fever/systemic sx
-Recurrent infection: shorter/milder lesions, no systemic sx (prodromal sx of tingling/burning are common and begin before lesions)

Question 2

Genital Herpes Tx

Answer 2

1st clinical episode: A43, F23, V12
1. Acyclovir 400 mg TID x 7-10 (can also do 200 mg five times a day but not preferred)
2. Famciclovir 250 mg TID x 7-10
3. Valacyclovir 1 g BID x 7-10
*all durations are 7-10

Recurrent infection: 1-5 day tx, A43, F12, V52
1. Acyclovir 400 mg TID x 5 (800 BID x 5 or 800 TID x 2)
2. Famciclovir 1000 mg BID for 1 day
3. Valacyclovir 500 mg BID x 3 or 1 g QD x 5

Question 3

Genital Herpes: Suppressive Therapy

Answer 3

1. Acyclovir 400 BID
2. Famciclovir 250 BID
3. Valacyclovir 1 QD (500 QD is less effective for ppl with 10+ recurrences a yr)

-42-22-11

Question 4

Genital Herpes: AEs/Adj

Answer 4

Well-tolerated
-NVD, food helps, can be taken w/o
-Precipitate in kidneys: hydration

Renal dose adj
-Acyclovir < 50
-Fami < 40
-Val < 30

Question 5

Syphilis

Answer 5

Trep pallidum
-Sexual contact, kissing, congenital, blood

Sx
-1: lesion, lymph
-2: rash, lesion, systemic sx
-Latent: asymptomatic
-3: CV, neuro, gummatous lesions

Question 6

Syphilis Tx

Answer 6

Primary, secondary, or early latent (< 12 mo)
= Benzathine Penicillin G 2.4 mil u IM x 1 dose
*site rxn, burning, soreness

Alt
-Doxy 100 mg BID x 14
-Tetra 500 QID x 14
*these are NOT for pregnany
*photosensitivity, NV (WITH FOOD)

Tertiary or late latent (> 1 yr)
= Benzathine Penicillin G 2.4 mil u IM x 1 dose per week for 3 weeks

Question 7

Syphilis: Neuro/oto/ocular

Answer 7

Aq Crystalline Penicillin G 18-24 mil u IV for 10-14 days

Alt
-Procaine Penicillin 2.4 mil u IM once daily plus Probenecid 500 mg PO QID for 10-14 days

Question 8

Syphilis: PCN Allergy

Answer 8

-Ceftriaxone 2 g daily IV 10-14 days
-Doxycycline/tetracycline

Skin testing to confirm allergy
-Perform penicillin desensitization
-Specialist

Question 9

Chlamydia

Answer 9

Chlamydia trachoma’s
-Urine test to detect

Sx
-Dysuria, discharge, bleeding

Comps
-PID, Reiter’s, infertility, ectopic (RIPE)

Question 10

Chlamydia Tx

Answer 10

Doxycycline 100 BID x 7 days
*with food, photosensitivity, cations

Alt
-Azithromycin 1 g, single dose (for pregnancy)
-Levofloxacin 500 QD for 7 days

Question 11

Gonorrhea

Answer 11

Neisseria gonorrhoeae
-Urine test, NAAT

Sx
-Dysuria, urinary frequency, discharge (DUD)

Comps
-Dis gono, PID, ectopic, infertility (PIED)

Question 12

Gonorrhea Tx

Answer 12

Uncomplicated, cervix/urethra/rectum
= Ceftriaxone 500 mg IM x 1 for < 150 kg wt
- If > 150 kg wt, use 1 g

If chlamydia co-infection:
-Add Doxycycline 100 mg BID for 7 days
-Azithro 1 g x 1 if pregnant

Alternatives
-Gentamicin + Az or Cefixime + Az/Doxy