STIs Flashcards
First-episode, primary HSV infection tx
Acyclovir 400mg TID
Famciclovir 250mg TID
Valacyclovir 1g BID
7-10 days
Recurrent HSV infection
Tx is for HSV2
Start as soon as prodromal symptoms begin or within 1 day of lesion onset
Acyclovir, famciclovir, valacyclovir range from 2-5 days
Daily suppressive therapy for HSV
Indicated if >= 6 episodes/year
Acyclovir 400mg BID
Famciclovir 250mg BID
Valacyclovir 500-1000mg daily
HSV severe infection
Acyclovir IV 5-10mg/kg q8H x2-7 days, then PO for 10 days total therapy
Herpes encephalitis
Nonspecific signs/symptoms (HA, fever, speech disorder, AMS, focal seizure)
Need lumbar puncture to analyze CSF
Acyclovir IV x21 days
Jarish-Herxheimer reaction
May occur within 4-8 hours of receiving first antibiotic dose for syphilis
T. pallidum is a spirochete. When these breakdown from antibiotics, they release inflammatory cytokines
May include fever, chills, myalgias, flushing, dizziness, rash
Use antipyretics, IV fluids to treat (if needed)
Steroid/antipyretics pretreatment does not prevent
Syphilis bug
Treponema pallindum
Primary syphilis treatment
Primary = 10-90 days from exposure
Primary symptom: chancre (painless, round, firm sore)
Benazthine penicillin 2.4 million units IM. Single dose.
Primary syphilis tx if PCN allergy
doxycycline 100mg BID x14 d
Tetracycline 500mg QID x14 d
Ceftriaxone 1g IM/IV x10 days
Pregnant: ceftriaxone or pcn desensitization
Secondary/early latent syphilis
4-10 weeks after exposure
Skin lesions on palms, soles
Same treatment & alternatives as primary syphilis however if using doxy/tetra, use for 28 days
Late latent syphilis
> 1 year in duration
Benzathine penicillin G 2.4 million units IM weekly x3 weeks
Late latent syphilis if PCN allergy
Doxycycline 100mg BID x4 weeks
Tetracycline 500mg QID x4 weeks
Tertiary syphilis treatment
Infectious granulomas and CV effects
Benzathin penicillin G 2.4 million units IM weekly x3 weeks
Neurosyphilis treatment
aqueous crystalline penicillin G 3-4 million units IV q4H (or continuous) (total 18-24 million units/day) for 10-14 days
Neurosyphilis alternative treatment
Procaine penicillin 2.4 million units/day IM plus probenecid 500mg QID x10-14 days
PCN allergy: ceftriaxone 2g/day IM/IV x10-14 days, or desensitization
Treatment of sexual partners for syphilis
<90 days: presumptively treat
>90 days: test & monitor - or treat presumptively
Chlamydia treatment
Doxycycline 100mg BID x7 days
Alt: azithromycin 1gm x1 (if pregnant)
Alt: levofloxacin 500mg daily x 7 days
Do not have sex for 7 days
Treat all partners within last 60 days
Gonorrhea treatment
Ceftriaxone 500mg IM
If >150kg, then 1g
If chlamydia cannot be excluded, then treat with doxycycline 100mg BID x 7 days
Abstain from sex for 7 days
Treat all partners within last 60 days
Gonorrhea symptoms compared to chlamydia
Chlamydia:
-Women: can lead to PID, ectopic pregnancy, infertility
-Men: more asymptomatic compared to gonorrhea
Gonorrhea:
-Women: asymptomatic (some vaginal discharge, dysuria) - can lead to PID
-Men: penile discharge and dysuria
Urethritis
Treat for chlamydia and gonorrhea
Consider trichomonas if recurrent or persistent (metronidazole or tinidazole and azithromycin)
Treat all partners in past 60 days
Pelvic Inflammatory Disease background
Infection of female genital tract involving fallopian tubes
If untreated can lead to abscess, infertility, ectopic pregnancies
usually sexually transmitted & caused by gonorrhea, chlamydia, anaerobes, gram negative facultative bacteria, strep
PID treatment
Ceftriaxone 1g IV q24h + doxycycline 100mg PO or IV q12H + metronidazole 500mg PO or IV q12H
Cefotetan 2g IV q12H + doxycycline 100mg PO or IV q12H
Cefoxitin 2g IV q6H + doxycycline 100mg PO or IV q12H
Cefoxitin and cefotetan are second generation cephs with anaerobic activity
Parenteral therapy can be d/cd after 24-48 hours then PO for 14 days
If no improvement after 7-10 days, add on moxifloxacin 400mg daily x14 days
Sexual partners in past 60 days should be tested & treated
Trichomoniasis treatment
Men (asymptomatic): metronidazole 2g once
Women (malodorous, yellow-green vaginal discharge): metronidazole 500mg BID x7 days
Alt: tinidazole 2g once
Treat all sexual partners
Desensitize metronidazole allergic patients
Recurrent vulvovaginal candidiasis
> =3 episodes/year
Initial treatment for 7-14 days OR
fluconazole q3 days for 3 doses
Maintenance: fluconazole once weekly for 6 months
Oteseconazole
FDA approved for postmenopausal or permanent infertility women for recurrent vulvovaginal candidiasis
HA/nausea
DOC for pregnant women with vulvovaginal candidiasis
Topical azoles for 7 days
Contraindication for testosterone therapy
Prostate cancer
Testosterone monitoring for replacement
Monitor within 1-3 months of initiating
then 6-12 months
If no improvement after 3 months, discontinue
Treatment of premature ejaculation
off label
SSRI (fluoxetine, paroxetine, sertraline)
TCA (clomipramine)
EMLA cream before intercourse
