Tx: STI & ID

Question 1

Trichomoniasis

Answer 1

1. Metronidazole 500mg PO BID x 7 days
   
   • Can do 1 dose of 2g PO
2. Spermicidal agents reduce transmission
3. Treat partners

Failed treatment: Metronidazole or tinidazole 2g PO QD x 5 days – call CDC

Question 2

Chlamydia

Answer 2

1. Azithromycin 1g PO once
2. PID, proctitis, epididymitis: doxycycline
3. Gonorrhea cotreatment: Ceftriaxone 250 mg IM
4. Treat partners

No sex for 7 days, use condoms, limit sexual partners.

Question 3

Gonorrhea

Answer 3

1. Ceftriaxone 250mg IM once
2. Chlamydia cotreatment: Azithromycin 1g PO once

Question 4

Chancroid

Answer 4

1. Azithromycin 1g PO once
2. PG: Ceftriaxone 150mg IM once or Erythromycin or Cipro

Question 5

Human Papillomavirus (HPV) (6)

Answer 5

1. Trichloroacetic acid (give sodium bicarb to help with pain)
2. Podophyllin resin
3. Cryotherapy
4. Surgical removal
5. Podofilox
6. Imiquimod

Question 6

Syphilis

Answer 6

1. Penicillin G 2.4 U IM
2. Alt: doxycycline BID x 14 days
3. Tertiary syphilis: Penicillin G 2.4 U IM q week x 3 weeks
4. Treat partners (last 90 days)

Question 7

Herpes simplex virus (HSV)

• recurrent, severe recurrent episodes

Answer 7

1. Valacyclovir 1g PO BID x 7-10 days
2. Acyclovir 400mg PO TID x 7-10 days

Recurrent episodes:

1. Valacyclovir 500mg PO TID x 5 days
2. Acyclovir 400mg PO TID x 5 days

Severe recurrent episodes:

1. Acyclovir 5-10 mg/kg q8h IV x 2 days, then oral

Question 8

Vaginitis and Cervicitis

Answer 8

Treat underlying cause

Question 9

Pelvic Inflammatory Disease (PID)

Answer 9

1. Outpt: doxycycline 100mg PO BID x 14 days + Ceftriaxone 250mg IM
2. Recent GYN instrumentation or bacterial vaginosis: add metronidazole 500mg PO BID x 14 days
3. PG: admit. Cefoxitin and Doxycycline IV until stable. Switch to oral.

DO NOT use fluoroquinolones.

Question 10

Tubo-ovarian abscess (TOA)

Answer 10

1. Admit
2. IV abx
3. Surgery

Question 11

Fitz-High Curtis Syndrome (from PID)

Answer 11

1. Treat underlying STI
2. Laparoscopy to lyse adhesions

Question 12

Mycoplasma genitalium

Answer 12

1. Moxifloxacin 400mg PO QD x 7 days

Question 13

Bacterial vaginosis

Answer 13

1. Metronidazole PO or vaginal gel
2. Treat to reduce STI risk

Question 14

Vulvovaginal candidiasis

Answer 14

1. Fluconazole 150mg PO once
2. topical if PG
3. Avoid: heat, moisture, occlusive clothing, feminine deoderants

Question 15

Toxic shock syndrome (TSS)

Answer 15

1. Admit
2. Supportive care
3. Empiric abx: Vancomycin + Clindamycin + Piperaxillin-Taxobactam or Cefepime
4. Anti-staph abx x 1 week

Question 16

Pediculosis pubis

Answer 16

1. Permethrin 1% cream
   
   • Leave on 10 min
   • Rinse off
   • Remove nits

Question 17

Scabies

Answer 17

1. Permethrin 5% cream
   
   • Leave on 8-24 hours
   • Rinse off
   • Apply again in 1-2 weeks

Question 18

Latent Tuberculosis (TB) in PG

Answer 18

Treat immediately in PG for 2 mos.

1. Mom: Pyridoxine (vitamin B6) + Isoniazid 6-9 months (depending on dose)
   
   • Ethambutol for 2 months
2. Infant (+): isoniazid 6 months
3. Infant (-): isoniazid 3-4 months

Question 19

Active Tuberculosis (TB) in PG

Answer 19

• isoniazid + rifampin + ethambutol x 2 months
  
  • followed by isoniazid + rifampin x 7 months

Question 20

Breastfeeding and TB

Answer 20

• Latent: breastfeed. Consider mask
• Active: breastfeed after 2 weeks of treatment

Question 21

Human immunodeficiency virus (HIV) in PG

Answer 21

• ART: Tenofovir-embtricitabine, abacavir-lamivudine
• ART in Tanzania: Tenofovir + Lamidvudine + Efavirenz
• AVR prophylaxis after delivery: Nevirapine
  
  • Lifelong for mom

Question 22

Malaria in PG

• 1st and 2nd trimester, complicated, preventative

Answer 22

• 1st trimester: Quinine + clindamycin
  
  • Alt: Artemisinin combo
• 2nd trimester: ACT (artemether-lumefantrine)
  
  • Alt: Artesunate + clindamycin + quinine
• Complicated in any trimester: IV artesunate
• Iron supplementation
• Monthly f/u
• Preventative: chloroquine, mofloquine