STIs Flashcards
Primary, Secondary and Early latent Syphilis
Parenteral Penicillin G is drug of choice.
2.4 million Units IM x 1 dose.
Penicillin allergy: Doxycycline 100 mg BID x 14 days Tetracycline 500 mg four times daily x 14 days Or azithromycin 2 g x 1 dose. Follow up in 6 months.
Late Latent or Tertiary Syphilis
Parenteral Penicillin G is drug of choice.
2.4 million Units IM x once a week x 3 doses.
Penicillin allergy: Doxycycline 100 mg BID x 14 days Tetracycline 500 mg four times daily x 14 days Or azithromycin 2 g x 1 dose. Follow up in 6 months.
Gonorrhea
Ceftriaxone 250 mg intramuscular (IM) one time is the drug of choice.
May use cefixime 400 mg by mouth one time.
Repeat screening of women 3 to 6 months after treatment.
Sequelae: Urethritis; Cervicitis; Dysuria.
Often co-infected with chlamydia, so treat for both.
Chlamydia
Azithromycin 1 gm by mouth one time,
Or doxycycline 100 mg twice daily for 7 days.
Pregnant women: Azithromycin 1 gm PO x 1, or Amoxicillin 1 gm PO x 1, or Amoxicillin 500 mg PO TID x 7 days.
Need to test if cure; retest in 3 months.
Patient should also be treated for gonorrhea.
Trichomoniasis
Protozoa infection. Women may be symptomatic. Men may harbor trichomonas in the prostate gland.
Metronidazole (Flagyl) 2 gm PO x 1, or Tinidazole 2 gm PO x 1, or Metronidazole (Flagyl) 500 mg BID x 7 days.
Avoid alcohol while on metronidazole.
Rescreen 3 months after treatment. Pregnant women are rescreened in 1 month.
Chancroid
Human genital ulcer disease.
STI occurs mainly in developing countries, especially in Africa, Asia and Latin America.
Azithromycin: 1 gm by mouth one time, or
Ceftriaxone: 250 mg IM, or
Ciprofloxacin: 500 mg by mouth twice daily for 3 days, or
Erythromycin: 500 mg by mouth three times/day for 7 days.
Granuloma Inguinale
Endemic in tropical and developing areas of India, Papua New Guinea, central Australia, and southern Africa.
Doxycycline 100 mg BID x 3 weeks.
Relapse is common within 6 to 18 months.
Lymphogranuloma Venereum
Rare in the United States
Doxycycline 100 mg BID x 21 days.
Pregnant women treated with erythromycin.
Human Papillomavirus
Some strains cause genital warts and cancers.
Spread via vaginal, anal, or oral sex with infected individual.
Treatment of genital warts:
Patient-applied therapy:
Podofilox 0.5% solution or gel or Imiquimod 5% cream.
Provider-applied therapy:
Cryotherapy with liquid nitrogen or cryoprobe or podophyllin resin or trichloroacetic acid or bichloroacetic acid.
Vaccinate males and females with Gardasil 9.
Genital Herpes
Acyclovir, famciclovir, and valacyclovir are the mainstay of treatment.
Scabies
Permethrin 5% cream is drug of choice.
Lindane is second-line treatment.
Ivermectin 200 mcg/kg by mouth can be prescribed for immunocompromised or those who have refractory scabies (consultation recommended).
Sexual contacts and family members should be treated
Pelvic Inflammatory Disease
Can result from delayed treatment for STI.
Multidrug regimen with empirical, broad-spectrum coverage of the most likely pathogens. May need IV antibiotics or hospitalization.
STIs: Sexual Assault
Common: Trichomoniasis, bacterial vaginosis, gonorrhea, and chlamydia.
Post-exposure administration of hepatitis B immune globulinand hepatitis B vaccine.
STIs: Men Who Have Sex With Men
Frequent screening of high-risk males every 3 to 6 months.
Vaccinate against hepatitis A, hepatitis B, and HPV.
Bacterial Vaginitis
Most prevalent vaginal infection
Associated with having multiple sex partners, douching, and lack of vaginal lactobacilli. All symptomatic women should be treated.
Metronidazole: 500 mg PO BID x 7 days, or
Metronidazole gel, 0.75%: one applicator intravaginally daily x 5 days, or
Clindamycin cream, 2%: one applicator intravaginally at bedtime x 7 days.
Not treating BV will increase chance of PID, infertility, and HIV.
