STIs STDs and vaginosis

Question 1

Recommended treatment regimen for trichomonas

Answer 1

metronidazole 2 G single dose

or metronidazole 500 mg PO BID for 7 days

Question 2

Treatment regimen for metronidazole resistant trichomonas

Answer 2

Tinidazole

Question 3

Should you retest people diagnosed with trichamonas?

Answer 3

Yes –> CDC recommends to test all sexually active women within 3 months following initial treatment whether or not partner has been treated

Question 4

Can women be treated with metronidazole during pregnancy?

Answer 4

Yes - they can be treated with metronidazole 2 G at any stage of pregancy

Question 5

What is the specific and sensitive sign in BP?

Answer 5

Clue cells

Question 6

How do you treat bacterial vaginosis

Answer 6

primary: metronidazole 500 mg po BID x 7 das
alternative: tinidazole or clindamycin

Question 7

What is recurrent BV and how do you treat it?

Answer 7

3 or more episodes in 12 months

- metronidazole vaginal gel twice weekly for 4-6 months

Question 8

Do probiotics help prevent BV vaginitis?

Answer 8

BV –> yes SOR B
candida –> no SOR B
no adverse effects SOR A

eat yogurt daily for 2 months

Question 9

How do you treat vulvovaginal candidiasis - uncomplicated

Answer 9

Fluconazole PO or PV for 72 hours (one oral dose lasts 72 hours)

Question 10

How do you treat complicated vulvovaginal candidiasis?

Answer 10

150 mg fluconazole in two sequential oral doses
second dose 72 hours after initial
this is because fluconazole lasts in system for 72 hours

Question 11

How do you define recurrent vulvovaginal candidiasis and how do you treat?

Answer 11

4 episodes occurring in 12 months - at least 3 episodes not related to antibiotic therapy.

• Induction therapy: fluconazole 150 mg q72 h x 3 or 7-14 days topical tx
• maintenance therapy: fluconazole 150 mg once weekly for 6 months

Question 12

Treatment for first clinical episodes of genital herpes

Answer 12

Acyclovir 200 mg po 5xd for 7-10 days

Question 13

Treatment for recurrent genital herpes

Answer 13

valacyclovir 500 mg po BID x 3 days

Question 14

Who should receive suppressive therapy for HSV and whats the treatment?

Answer 14

episodes > 6 per year

valacyclovir 500 mg po Qday

Question 15

Treatment for uncomplicated N. Gonorrhea?

Answer 15

Ceftriaxone 250 IM + azithromycin 1 g po OR doxycycline 100 mg BID for 7 days.
- alternative to ceftriaxone is cefixime 400 mg PO X 1

Question 16

Should you retest people diagnosed with gonorrhea and treated?

Answer 16

Yes - test of cure after 14 days and retreatment if needed.

ALSO test of reinfection 3 months after treatment regardless of whether partner has been treated

Question 17

How do you treat gonorrhea in pregnancy

Answer 17

Cephalosporin + azithromycin or amoxicillin

No tetracycline treatment

Question 18

Should you retest people diagnosed with chlamydia and treated?

Answer 18

Test of Cure: not recommended unless reinfection suspected, symptoms persist, or compliance in question
Pregnant: retest 3 months after treatment

Test of reinfection: men and women should be retested approximately 3 months after treatment for reinfection

Question 19

Treatment of chlamydia

Answer 19

Doxycycline 100 mg po BID x 7 days
or azithromycin 1 G po x 1

If pregnancy no doxy

Question 20

A male presents with penile discharge/dysuria/or urethral pruritis. What are the criteria to treat?

Answer 20

gram stain of urethral secretions > 5 WBC
+ LE on first void urine of > 10 WBC
high risk unlikely to return

Test now, treat now, diagnose later

Question 21

Expedited partner therapy - should I do it?

Answer 21

YES - unless you are in south carolina

Question 22

Treatment of PID with mild moderate clinical presentation

Answer 22

Regimen A: ceftriaxone 250 mg IV x 1 + doxy 100 mg PO BID x 14 days. May include metronidazole 500 mg BID x 14 days

Regimen B: cefoxitin 2g IM x 1 + probenecid 1 g PO + doxy and metronidazole

Question 23

WHen should you admit to inpatient for treatment of PID?

Answer 23

• concurrent pregnancy
• they look terrible
• unsure compliance with therapy
• lack or response in 72 hours of tx
• concurrent HIV infection
• clinical follow up cannot be arranged within 72 hours.

Question 24

Treatment of PID inpatientr

Answer 24

Regimen A: cefotetan or cefoxitin IV + doxy po or IV

Regimen B: Clinda IV + gentamicin IV/IM

Question 25

USPSTF recommendation on HIV screening

Answer 25

screen all patients age 15-64 for HIV regardless of risk level. Also screen people at increased risk

20% of those infected are unaware

SOR A

Question 26

What does the USPSTF say about Preexposure prophylaxis in HIV?

Answer 26

• recommend that it be offered to those with high risk of HIV acquisition SOR A
• MSM or hetero women with one of following: serodiscordant partner, inconsistent condom use during receptive sex, STI in past 6 months
• persons who use IV drugs

Question 27

How do you monitor people on PreP therapy?

Answer 27

• monitor creatinine
• HIV testing q3 months minimum
• pregnancy testing q3 months
• screen for STIs q6 months minimum

Question 28

After an HIV exposure, how quickly should you start prophylaxis

Answer 28

within 72 hours

Question 29

What is the initial test for syphilis diagnosis?

Answer 29

CDC recommends nontreponemal (RPR or VDRL) followed by treponemal (FTA-ABS)

Question 30

according to USPSTF who should be screened for syphilis

Answer 30

grade A recommendation

• MSM
• HIV
• hx of commercial sex work or incarceration
• male < 29 in high prevalence areas

Question 31

Treatment of syphilis

Answer 31

penicillin

Question 32

Treatment of chancroid

Answer 32

Azithromycin

- test for syphilis and HIV due to high coinfection rate

Question 33

treatment for granuloma inguinale

Answer 33

• doxycycline

- caused by klebsiella. conovan bodies on biopsy

Question 34

Treatment for Lymphogranuloma venerum

Answer 34

rare in US
caused by chlamydia
painful lymphadenopathy
primary treatment is doxycycline, alternative is erythromycin

Question 35

What is the USPSTF recommendation for Hep B screening?

Answer 35

• screen all pregnant women at first prenatal visit, grade A
• screen persons at high risk Grade B: includes US born persons not vacicinated whose parents were born in regions with high prevalence.

Question 36

Whod does the USPSTF say should be screened for Hep C?

Answer 36

Grade B: high risk persons

Grade B: one-time screening to adults born between 1945 and 1965