STIs Flashcards
PrEP
Emtricitabine (F) 200 mg in combination with tenofovir disoproxil fumarate (TDF) 300 mg - F/TDF- Truvada
Emtricitabine (F) 200 mg in combination with tenofovir alafenamide (TAF) 25 mg (F/TAF -Descovy)
___ (CAB) 600 mg injection (Apretude)
Cabotegravir
T or F: People who
are already using PrEP typically do not need PEP
TRUE
nPEP REGIMENS
preferred: TDF + F + ___ RAL (or Dolutegravir DTG) x 28 days
alternative: TDF + F + ___ (DRV) + ___ (RTV)
- Raltegravir
- Darunavir, Ritonavir
Ritonavir is just a booster
UNCOMPLICATED GONOCOCCAL INF: CERVIX, URETHRA, AND RECTUM, & PHARYNX
150 lbs?
___ 500 mg or 1 g IM
chlamydia?
___ 100 mg PO BID x 7 days
- pregnant? ___ 1 gm PO x1 instead of doxy
if ceftriaxone not available?
- ___ + ___ or ___
- ceftriaxone
- doxy
- azithromycin
- gent, azithro, cefixime
SYPHILIS
T or F: NEUROSYPHILIS May occur at any stage of
syphilis
True
SYPHILIS
___ – treatment of choice for all stages of syphilis (parenteral)
Penicillin G
SYPHILIS
primary, 2ndary, early latent
1) ___ 2.4 million units IM x 1 dose
allergy?
- ___ 100 mg PO BID x 14 days
- ___ 500 mg PO QID x 14 days
- Azithromycin 2 g PO x 1 dose (ehhh resistance)
1) Benzathine penicillin G
- doxcy
- tetra
SYPHILIS
Late latent (> 1 year duration) & tertiary
1) Benzathine penicillin G 2.4 million units IM once weekly x ___ weeks
allergy?
- Doxycycline 100 mg PO BID x ___ days
- Tetracycline 500 mg PO QID x ___ days
- 3
- 28
- 28
SYPHILIS
NEUROSYPHILIS
1) ___ 3-4 million units IV q4h x 10-14 days (or 18-24 million units per day as a continuous infusion OR ___ 2.4
million units IM daily + ___ 500 mg PO QID x 10-14 day
allergy?
- ___ 2 g IM or IV daily x 10-14 days (depending on severity of allergy)
1) Aqueous crystalline
penicillin G, Procaine penicillin, probenecid
- Ceftriaxone
SYPHILIS: HIV+
primary, secondary, early latent:
- ___ 2.4 million units IM x 1 dose
Late latent or unknown duration
- Benzathine penicillin 2.4 million
units IM once weekly x __ weeks
Neurosyphilis
- same
all these are the same
- Benzathine penicillin G
- 3
SYPHILIS: pregnant
___ is only agent that reliably protects and treats the fetus
- if “allergic” do skin test
Penicillin
Syphilis CLINICAL PEARLS
___ reaction
- rash, NOT allergic
- begins 2-4 hours after therapy
- typically in early stage (increased bacterial load)
- Treat with ___
- Jarisch-Herxheimer
- antipyretics
CHLAMYDIA
Recommended regimen for adolescents and adults
- ___ 100 mg PO BID x 7 days
Alternative regimens
- ___ 1 gram PO x 1 dose (not great for rectal)
- ___ 500 mg PO q24h x 7 days
Doxycycline
- Azithromycin
- Levofloxacin
CHLAMYDIA: pregnancy
standard:
- ___ 500 mg PO x 1 dose
Alternative
- ___ 500 mg PO TID x 7 days
- Azithromycin
- Amoxicillin
MYCOPLASMA GENITALIUM
*DEPENDS ON AVAILABILITY OF RESISTANCE TESTING
Macrolide-susceptible
- ___ 100 mg PO BID x 7 days followed by ___ 1 gram PO x 1 followed by 500 mg PO daily x 3 additional
days (total azithromycin 2.5 grams
Macrolide- resistant or Testing not
available
- ___ 100 mg PO BID x 7 days followed ___ 400 mg PO daily x 7 days
- doxy, azithro
- doxy, moxi
GENITAL HERPES SIMPLEX VIRUS INFECTION
INITIAL TREATMENT (any of these)
- ___ 400 mg PO TID
- ___ 250 mg PO TID
- ___ 1 g PO BID
Treat x __ - __ days
- Acyclovir
- Famciclovir
- Valacyclovir
- 7-10
GENITAL HERPES SIMPLEX VIRUS INFECTION: RECURRENT TREATMENT
___ treatment duration than initial episode
- Acyclovir 800 mg PO ___ x 5 days OR Acyclovir 800 mg PO TID x __ days
- Famciclovir 125 mg PO BID x 5 days OR Famciclovir __ g PO BID x __ day
- Valacyclovir 500 mg PO BID x 3 days OR Valacyclovir 1 g PO ___ x __ days
shorter
- BID, 2
- 1,1
- daily, 5
GENITAL HERPES SIMPLEX VIRUS INFECTION: additional treatment
Severe disease
- ___ 5- ___ mg/kg/dose IV q8h for 2-7 days or until clinical improvement is observed, followed by oral therapy to
complete at least 10 days
Acyclovir
10
HERPES: SUPPRESSIVE TREATMENT
___ suppressive therapy
- Reduces frequency of recurrences by 70-80% in patients who have frequent recurrences (≥ __ /year)
- Acyclovir 400 mg PO ___
- Famciclovir 250 mg PO ___
- Valacyclovir 1 g PO ___
- Valacylovir 500 mg PO daily (not as effective as others)
- Daily
- 6
- BID, BID, daily
HERPES: special populations
HIV
Regimens for episodic infections – treat x __ - __ days
- Acyclovir 400 mg PO TID
- Famciclovir 500 mg PO BID
- Valacyclovir 1 g PO BID
Regimens for daily suppressive therapy
- Acyclovir 400-800 mg PO BID to TID
- Famciclovir 500 mg PO BID
- Valacyclovir 500 mg PO BID
Resistant
- If acyclovir resistant HSV → ___ 40-80 mg/kg/dose IV q8h or ___ 5 mg/kg IV once weekly
Pregnancy
- Start ___ therapy at ___ weeks gestation
- Acyclovir 400 mg PO TID
- Valacyclovir 500 mg PO BID
- 5-10
- foscarnet, cidofovir
- suppressive, 36
TRICHOMONIASIS
Nitroimidazoles are only drug class with documented clinica efficacy ( ___ and ___ )
- Metronidazole gel is not recommended
- If allergy to metronidazole must use ___
metronidazole, tinidazole
desensitization
TRICHOMONIASIS
women
- Metronidazole 500 mg PO ___ x __ days (more effective than single dose)
- Alternative: tinidazole 2 g PO x 1 dose
men
- Metronidazole 2 g PO x 1 ___
- Alternative: tinidazole 2 g PO x 1 dose
HIV +
- Metronidazole 500 mg PO ___ x __ days
men get the huge dose once
- BID, 7
- dose
- BID, 7
TRICHOMONIASIS
CLINICAL PEARLS
- ___ all sexually active women < 3 months of initial treatment
- Avoid ___ with metronidazole (24 hours) and tinidazole (72 hours)
- Excreted in breast milk
- Retest
- alcohol
PELVIC INFLAMMATORY DISEASE
Standard regimen
- ___ 1 gram IV q24h + ___ 100 mg IV or PO q12h + ___ 500 mg 100 mg IV or PO q12h x 14 days
Alternative parenteral regimen
- ___ 3 g IV q6h + ___ 100 mg IV/PO q12h x 14 days
- Severe allergy: ___ 900 mg IV q8h + ___ 2 mg/kg loading dose, then 1.5 mg/kg q8h (single daily dose of 3-5 mg/kg may be substituted) x 14 days
IM/Oral treatment regimen
- ___ 500 mg IM x 1 dose + ___ 100 mg PO q12h + ___ 500 mg PO q12h x 14 days
- ceftriaxone, doxy, metronidazole
- Ampicillin/sulbactam, doxycycline
- clindamycin, gent
- ceftriaxone, doxy, metronidazole
