GU part 1 STI

Question 1

If someone is greater than 35, what is the likley causative organism for epididymitis

Answer 1

E-coli

Question 2

if someone is less than 35 or they have multiple sex partners, what organisms are likley to cause epididymitis?

Answer 2

N. Gonorrhoeae
C. Trachomatis

Question 3

if someone is greater than 35 with Epididymitis what are your first line abx?

Answer 3

Ciprofloxacin 500mg BID or 1g daily
Levofloxacin 500mg once daily

duration of therapy is 10-14 days unless otherwise indicated

Question 4

if someone is LESS THAN 35 or has lots of sex partners and you are treating them for epididymitis what are your first lines ?

Answer 4

CEFixime 400-800 po
OR CEFtriaxone 250mg IM

AND both below

Azithromycin 1g single dose
Doxycycline 100mg BID X10days

Question 5

if you are treating STI suspected epididymtis what are your second line treatments?

Answer 5

fluorquinolones
Ciprofloxacin 500mg single dose (not approved for kids less than 18)
Levofloxacin 500 mg single dose (not approved for kids less than 18)

and BOTH below

Azithromycin 1g single dose
Doxycycline 100mg BID X10 days

Question 6

T/F

assess all sexual partners of patients with sexually aquired epididymitis from 60 days prior to symptom onset

Answer 6

true

Question 7

what are first line tx for PID mild -moderate

Answer 7

Cefixime 800mg single dose OR
Ceftriaxone IM 250 single dose

AND +/- Either of those below

Doxy 100mg BID X14 days
Metronidazole 500mg 14 days

Question 8

what are second line tx for PID?

Answer 8

levofloxacin 500mg X14 days or
Moxifloxacin 400mg X14 days

+/-
Metronidazole X14days

Question 9

T/F

Fluoroquinolones and tetracyclines are contraindicated in pregnancy and breastfeeding

Answer 9

true

Question 10

when do you re-assess someone with PID that you are treating?

Answer 10

48-72 hours, if not improving send to hospital

Question 11

what are your first lines for urethritis gonococcal for individuals greater than 9 years of age

Answer 11

cefixime 400-800 mg single dose OR
ceftriaxone IM 250mg

PLUS ONE OF THE FOLLOWING BELOW
Azithromycin 1g single dose
Doxycycline 100mg X7 days

Question 12

how long is the treatment for:

PID
epididymitis (sti)
urethritis gonococcal
Cervicitis

Answer 12

PID - 14 days
epididymitis - 10 days
U. gonococcal 7 days
Cervicitis 7 days

first lines are always cefixim/ceftriaxone plus something

Question 13

When would you perform an STI test of cure for urethritis n.gonococcal tx?

Answer 13

test of cure should only be done if an alternate regime was used.

test of cure using CULTURES can be done 1-2 weeks post treatment

if using NAAT, you must wait 3-4 weeks post treatment for test of cure to avoid false positive

Repeat screening for individuals with gonococcal ingestion is recommended 6 months post-treatment

Question 14

how would you treat gonococcal urethritis in children less than 9 years of age?

Answer 14

cefixime or
ceftriaxone

AND

Azithromycin 10-15mg one dose

Question 15

what is first line treatment for nongonococcal urethritis greater than 9 years of age

Answer 15

Azithromycin 1g single dose OR (not advised to do the one day dose because it can increase macrolide resistance)
doxy 100mg BID X7 days

Question 16

What are second line tx non gonococcal urethritis greater than 9 years of age?

Answer 16

erythromycin and if used repeat testing after tx is advised

Question 17

what is first line for urethritis NON gonococcal child less than 9

Answer 17

azithromycin 10-15mg/kg single dose

Question 18

What are the likely causative agents for cervicitis?

Answer 18

C.Trachomatis
N.gonorrhoeae

Question 19

what are first line tx for cervicitis

Answer 19

cefixime 400-800mg single dose

AND ONE OF THE FOLLOWING

Azithromycin 1g single dose
doxycycline 100mg 7 days

Question 20

when patients have genital HSV1/HSV2 when should they abstain from sexual activity?

Answer 20

when they have active lesions and prodromal symptoms
they should also be encouraged to tell their partner they have HSV1/HSV2

Question 21

when would you provide prophylaxis treatment to a pregnant women with genital HSV?

Answer 21

for women with prior infection within the previous year prophylaxis at 36 week gestation is advised

Question 22

which of the two options are more likley to cause transmission of HSV1/HSV2 during pregnancy (perinatal)

A. the PRIMARY outbreak in the first trimester
B. a RECURRENT outbreak in the first trimester

Answer 22

A. Primary outbreak in first trimester is more likley to cause perinatal transmission and increases if this outbreak occurs at the time of delivery so you should consider C-section

Question 23

What is considered chronic genital HSV1/HSV2 outbreaks and what are the treatments?

Answer 23

if the patient has more than 6 episodes in one year, its considered chronic and your treatment would be 3-6 months

try to DC after one year and re-evaluate after 6-12 months

Question 24

What are the indications to starting PREP

Answer 24

advised for MSM and transgender women who report condomless anal sex within the last six months AND have any of the following:

• STI in the last year
  -recurrent us of nonoccupational post exposure prophylaxis (nPEP) more than once
• ongoing sexual relationship with HIV positive partner
• high-incidence risk index greater than 11

Question 25

when is prep not reccomended

Answer 25

in stable closed relationships with single partner with is either: HIV-negative partner is HIV positive, stable, undetectable HIV viral load AND on antiretroviral therapy

Question 26

What medications are approved for PrEP?

Answer 26

Truvada once daily- tenovir DF/emtricitabine 300/200 Descovy once daily- Tenovir AF/emtricitabine 250mg/200

Question 27

Which prep medication is associated with reduced bone density and disruption of vitamin D metabolism?

Answer 27

Truvada is associated with these side effects

Question 28

if a pregnant women had an acute HIV infection during pregnancy or while breastfeeding what medication would you advise?

Answer 28

there is a very high risk of transmission if the pregnant women has an acute HIV infection Truvada (tenovir DF/emtricitabine 300/200mg) has limited evidence but has been shown to have no increased risk of birth defects THIS IS THE ONLY PREP ONE TO USE

Question 29

what is the first line treatment of Trichonomiasis?

Answer 29

Metronidazole 2g PO once or 500mg X7 days TREAT ALL CASES AND PARTNERS REGARDLESS OF SYMPTOMS

Question 30

what considerations should be made for vaginitis trichonomiasis treatment in pregnancy and breastfeeding?

Answer 30

you only treat if they have symptoms!! if asymptomatic dont treat (but still treat partner) metronidazole is safe, if mom wants they can hold off on breastfeeding for 12-24 hours

Question 31

When would you treat someone with bacterial vaginosis if they are asymptomatic?

Answer 31

1. high risk pregnancy 2. prior to IUD insertion 3. prior to gyne surgery 4. prior to induced abortion 5. prior to any upper tract surgery

Question 32

What are first line treatments for symptomatic bacterial vaginosis

Answer 32

1. Metronidazole 7 days duration (can be taken once daily but this is SECOND LINE as it can relapse at 1 month) 2. clinda cream (be careful with condoms, and with pregnancy) 3. metronidazole cream

Question 33

what is the preferred treatment for pregnant women with symptomatic candidiasis infection?

Answer 33

topical antifungal agent (any) oral azoles are not recommended

Question 34

if you patient was pregnant with symptomatic bacterial vaginosis and was in the first trimester, which med would be your first line?

Answer 34

topical metronidazole is recommended for first and second trimester third trimester can have oral