STIs STDs and vaginosis Flashcards
Recommended treatment regimen for trichomonas
metronidazole 2 G single dose
or metronidazole 500 mg PO BID for 7 days
Treatment regimen for metronidazole resistant trichomonas
Tinidazole
Should you retest people diagnosed with trichamonas?
Yes –> CDC recommends to test all sexually active women within 3 months following initial treatment whether or not partner has been treated
Can women be treated with metronidazole during pregnancy?
Yes - they can be treated with metronidazole 2 G at any stage of pregancy
What is the specific and sensitive sign in BP?
Clue cells
How do you treat bacterial vaginosis
primary: metronidazole 500 mg po BID x 7 das
alternative: tinidazole or clindamycin
What is recurrent BV and how do you treat it?
3 or more episodes in 12 months
- metronidazole vaginal gel twice weekly for 4-6 months
Do probiotics help prevent BV vaginitis?
BV –> yes SOR B
candida –> no SOR B
no adverse effects SOR A
eat yogurt daily for 2 months
How do you treat vulvovaginal candidiasis - uncomplicated
Fluconazole PO or PV for 72 hours (one oral dose lasts 72 hours)
How do you treat complicated vulvovaginal candidiasis?
150 mg fluconazole in two sequential oral doses
second dose 72 hours after initial
this is because fluconazole lasts in system for 72 hours
How do you define recurrent vulvovaginal candidiasis and how do you treat?
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
Treatment for first clinical episodes of genital herpes
Acyclovir 200 mg po 5xd for 7-10 days
Treatment for recurrent genital herpes
valacyclovir 500 mg po BID x 3 days
Who should receive suppressive therapy for HSV and whats the treatment?
episodes > 6 per year
valacyclovir 500 mg po Qday
Treatment for uncomplicated N. Gonorrhea?
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
Should you retest people diagnosed with gonorrhea and treated?
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
How do you treat gonorrhea in pregnancy
Cephalosporin + azithromycin or amoxicillin
No tetracycline treatment
Should you retest people diagnosed with chlamydia and treated?
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
Treatment of chlamydia
Doxycycline 100 mg po BID x 7 days
or azithromycin 1 G po x 1
If pregnancy no doxy
A male presents with penile discharge/dysuria/or urethral pruritis. What are the criteria to treat?
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
Expedited partner therapy - should I do it?
YES - unless you are in south carolina
Treatment of PID with mild moderate clinical presentation
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
WHen should you admit to inpatient for treatment of PID?
- 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.
Treatment of PID inpatientr
Regimen A: cefotetan or cefoxitin IV + doxy po or IV
Regimen B: Clinda IV + gentamicin IV/IM
USPSTF recommendation on HIV screening
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
What does the USPSTF say about Preexposure prophylaxis in HIV?
- 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
How do you monitor people on PreP therapy?
- monitor creatinine
- HIV testing q3 months minimum
- pregnancy testing q3 months
- screen for STIs q6 months minimum
After an HIV exposure, how quickly should you start prophylaxis
within 72 hours
What is the initial test for syphilis diagnosis?
CDC recommends nontreponemal (RPR or VDRL) followed by treponemal (FTA-ABS)
according to USPSTF who should be screened for syphilis
grade A recommendation
- MSM
- HIV
- hx of commercial sex work or incarceration
- male < 29 in high prevalence areas
Treatment of syphilis
penicillin
Treatment of chancroid
Azithromycin
- test for syphilis and HIV due to high coinfection rate
treatment for granuloma inguinale
- doxycycline
- caused by klebsiella. conovan bodies on biopsy
Treatment for Lymphogranuloma venerum
rare in US
caused by chlamydia
painful lymphadenopathy
primary treatment is doxycycline, alternative is erythromycin
What is the USPSTF recommendation for Hep B screening?
- 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.
Whod does the USPSTF say should be screened for Hep C?
Grade B: high risk persons
Grade B: one-time screening to adults born between 1945 and 1965
