Vaginitis and STI Treatment

Question 1

Chancroid Treatment

Answer 1

USE ONE:

1. Azithromycin 1g orally for one dose
2. Ceftriaxone 250mg IM for one dose
3. Ciprofloxacin 500mg orally BID x 3 days
4. Erythromycin base 500mg orally TID x 7 days

Question 2

Syphilis Treatment (including early latent)

Answer 2

Benzathine penicillin G 2.4 million units IM x 1 dose

If pt is allergic, send to ED for observed desensitization. ALWAYS treat with penicillin!!

Question 3

Late Latent or Latent Syphilis of Unknown Duration Treatment

Answer 3

Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM at 1 week intervals

Question 4

Chlamydia Treatment

Answer 4

USE ONE:

1. Azithromycin 1g orally in a single dose
2. Doxycycline 100mg orally BID x 7 days

Question 5

Gonorrhea Treatment (infection of cervix, urethra, rectum, or pharynx)

Answer 5

Ceftriaxone 250mg IM in a single dose

              AND 

Azithromycin 1g orally in a single dose

Question 6

Gonorrhea Treatment (conjunctivitis)

Answer 6

Ceftriaxone 1g IM in a single dose

              AND 

Azithromycin 1g orally in a single dose

Question 7

Bacterial Vaginosis Treatment

Answer 7

USE ONE:

1. Metronidazole 500 mg orally BID x 7 days
2. Metronidazole gel 0.75%, 5 g applicator intravaginally daily x 7 days
3. Clindamycin cream 2%, 5 g applicator intravaginally qHS x 7 days

Question 8

Cervicitis Treatment

Answer 8

USE ONE (and consider also tx for GC if at high risk):

1. Azithromycin 1g orally in a single dose
2. Doxycycline 100 mg orally BID x 7 days

Question 9

Genital Herpes Simplex Treatment

First clinical episode

Answer 9

USE ONE:

1. Acyclovir 400 mg orally TID x 7 - 10 days
2. Acyclovir 200 mg orally 5x/day x 10 days
3. Valacyclovir 1 g orally BID x 7 - 10 days
4. Famciclovir 250 mg orally TID x 7 - 10 days

Question 10

Genital Herpes Simplex Treatment

Episodic therapy for recurrent outbreak

Answer 10

USE ONE:

1. Acyclovir 400 mg orally TID x 5 days
2. Acyclovir 800 mg orally BID x 5 days
3. Acyclovir 800 mg orally TID x 2 days
4. Valacyclovir 500 mg orally BID x 3 days
5. Valacyclovir 1 g orally x 5 days
6. Famciclovir 125 mg orally BID x 5 days
7. Famciclovir 1000 mg orally BID x 1 day
8. Famciclovir 500 mg orally x 1 followed by 250 mg BID x 2 days

Question 11

Genital Herpes Simplex Treatment

Suppressive therapy for recurrent outbreaks

Answer 11

USE ONE:

1. Acyclovir 400 mg orally BID
2. Valacyclovir 500 mg orally q day
3. Valacyclovir 1 g orally q day
4. Famcyclovir 250 mg orally BID

Question 12

Genital Herpes Simplex Treatment

Episodic treatment for people with HIV infection

Answer 12

USE ONE:

1. Acyclovir 400 mg orally TID x 5 - 10 days
2. Valacyclovir 1 g orally BID x 5 - 10 days
3. Famciclovir 500 mg orally x 5 - 10 days

Question 13

Genital Herpes Simplex Treatment

Suppressive treatment for people with HIV infection

Answer 13

USE ONE:

1. Acyclovir 400 - 800 mg orally BID-TID
2. Valacyclovir 500 mg orally BID
3. Famciclovir 500 mg orally BID

Question 14

Genital Warts Treatment (external genital and perianal warts)
Patient applied

Answer 14

USE ONE:

1. Imiquimod 3.75% cream to warts qHS x 16 weeks, wash off with soap and water after 6 - 10 hours
2. Imiquimod 5% cream to warts 3x/week x 16 weeks, wash off with soap and water after 6 - 10 hours
3. Podofilox 0.5% solution or gel to warts BID x 3 days, followed by 4 days off. Can repeat this cycle PRN. Contraindicated during pregnancy
4. Sinecatechins 15% ointment to warts TID x up to 16 weeks. Don’t wash off. No sex with ointment on. Pregnancy safety unknown

Question 15

Genital Warts Treatment

Provider administered

Answer 15

USE ONE:

1. Cryotherapy
2. Trichloroacetic acid or bichloroacetic acid 80 - 90% q week PRN
3. Surgical removal

Question 16

Lymphogranuloma Venereum Treatment

Answer 16

Doxycycline 100 mg orally BID x 21 days

Question 17

Pediculosis Pubis Treatment

Answer 17

USE ONE:

1. Permethrin 1% cream rinse, apply to affected area and rinse after 10 minutes
2. Pyrethrins with piperonyl butoxide, apply to affected area and rinse after 10 minutes

Question 18

Pelvic Inflammatory Disease Treatment

Intramuscular/Oral Regimen

Answer 18

USE ONE:

1. Ceftriaxone 250 mg IM single dose PLUS Doxycycline 100 mg orally BID x 14 days WITH OR WITHOUT Metronidazole 500 mg BID x 14 days
2. Cefoxitin 2 g IM single dose PLUS Probenecid 1 g orally concurrently single dose PLUS Doxycycline 100 mg BID x 14 days WITH OR WITHOUT Metronidazole 500 mg BID x 14 days

Question 19

Scabies Treatment

Answer 19

USE ONE:

1. Permethrin 5% cream, apply everywhere from neck down, wash off after 8 - 14 hours
2. Invermectin 200mcg/kg orally, repeated in 2 weeks

Question 20

Trichomoniasis Treatment

NOT persistent or recurrent

Answer 20

USE ONE:

1. Metronidazole 2 g orally in a single dose
2. Tinidazole 2 g orally single dose

Question 21

Trichomoniasis Treatment

Persistant or recurrent infection

Answer 21

Metronidazole 500 mg orally BID x 7 days

*If that fails: treat with either Metronidazole or Tinidazole 2 g orally BID x 7 days

Question 22

Vulvovaginal Candidiasis Treatment

Answer 22

USE ONE:

1. Oral Agents:
   a) Fluconazole 150 mg orally in a single dose
2. Over-the-Counter Intravaginal Agents:
   a) Clotrimazole 1% cream 5 g intravaginally daily for 7–
   14 days
   b) Clotrimazole 2% cream 5 g intravaginally daily for 3 days
   c) Miconazole 2% cream 5 g intravaginally daily for 7 days
   d) Miconazole 4% cream 5 g intravaginally daily for 3 days
   e) Miconazole 100 mg vaginal suppository, one suppository daily for 7 days
   f) Miconazole 200 mg vaginal suppository, one suppository for 3 days
   g) Miconazole 1,200 mg vaginal suppository, one suppository for 1 day
   h) Tioconazole 6.5% ointment 5 g intravaginally in a single application
3. Prescription Intravaginal Agents:
   a) Butoconazole 2% cream (single dose bioadhesive product), 5 g intravaginally in a single application
   b) Terconazole 0.4% cream 5 g intravaginally daily for 7 days
   c) Terconazole 0.8% cream 5 g intravaginally daily for 3 days
   d) Terconazole 80 mg vaginal suppository, one suppository daily for 3 days