Office- Infections & antibiotics, Syphillis

Question 1

What is the treatment for gonorrhea?

Answer 1

Ceftriaxone 500mg IM

Question 2

What is the treatment for chlamydia?

Answer 2

Doxycycline 100mg BID for 7 days

Question 3

What is the treatment for trichomonas?

Answer 3

flatly 500mg BID for 7days

Question 4

What is the treatment for endometritis/PID outpatient?

Answer 4

Ceftriaxone 500mg IM + doxycycline 100mg BID for 14 days + flagyl 500mg BID for 14 days

Question 5

What is the treatment for endometritis/PID inpatient?

Answer 5

Ceftriaxone 1g q 24hrs + doxycycline 100mg BID + flagyl 500mg BID
or
Cefoxitin 2g q6hr + doxy
or
Cefotetan 2g q12hr + doxy

Send home to complete 14 day course of doxy and flagyl

Question 6

What is the treatment for BV infection?

Answer 6

Flagyl 500mg BID for 7 days
Metrogel for 5 days
Clindamycin cream 5gm x 7 days intravaginally

Question 7

What is the treatment for UTI?

Answer 7

Bactrim 100/800mg BID for 3 days
or
Macrobid 100mg BID for 7 days
or
Fosfomycin 3gm x 1

Question 8

What is the treatment for pyelonephritis?

Answer 8

Ceftriaxone 1gm IV q24hrs, then po meds for 7-10 days

Question 9

What is the treatment for primary syphillis?

Answer 9

Benzathine penicillin 2.4mil IM x 1

Question 10

What is the treatment for unknown syphillis?

Answer 10

Benzathine penicillin 2.4mil u IM week x 3 weeks

Question 11

What is the criteria to diagnose PID?

Answer 11

Lower abdominal pain/pelvic pain in a sexually active female and 1 major criteria

Cervical motion tenderness
Uterine tenderness
Adnexal tenderness

Question 12

What are minor or supporting evidence for PID diagnosis?

Answer 12

Fever >38
Mucopurulent discharge
Positive GC/Chlamydia
Gram + diplococci on gram stain
WBC count >10
elevated C reactive protein
Elevated ESR
WBC on wet prep

Question 13

When do you give inpatient management for PID?

Answer 13

Cannot excluded surgical emergencies
Pregnant
No response to outpatient therapy
Patient unable to follow or tolerate outpatient regime
Patient has severe illness, N/V, high fever
TOA

Question 14

What is the potential longterm sequela of PID?

Answer 14

Chronic pelvic pain
Infertility
Increased risk of ectopic pregnancy

Question 15

What is the presentation for primary syphillis?

Answer 15

Cold painless ulcer with clear margins and punched out crater like appearance

Question 16

What is the presentation for secondary syphillis?

Answer 16

Condylomata lata
Maculopapular rash (torso, palms, soles)

Question 17

What is the presentation for tertiary syphillis?

Answer 17

Lesions (Gumma, cardiac lesion)
Tabes dorsalis
Argyll Robinson pupil

Question 18

What is the incubation period for primary syphillis?

Answer 18

Days to weeks

Question 19

What is the incubation period for secondary syphillis?

Answer 19

Weeks to months

Question 20

What is the incubation period for tertiary syphillis?

Answer 20

years

Question 21

What is the screening test for syphillis?

Answer 21

VDRL
STS
RPR

Question 22

What is the confirmatory test for syphillis?

Answer 22

FTA antibody
TPHA
TPI

Question 23

What are the causes of a false positive RPR?

Answer 23

Autoimmune disease
Small pox vaccination
Malaria
Mycoplasma pneumonia
Aging

Question 24

What happens to the screening test after treatment for syphillis?

Answer 24

Typically return normal but can remain positive for life

Question 25

What happens to the confirmatory test after treatment for syphillis?

Answer 25

Remain positive for life

Question 26

What is the treatment for syphillis If there is a PCN allergy?

Answer 26

Erythromycin unless pregnant then desensitize

Question 27

What causes syphillis?

Answer 27

Infection with treponema palladium

Question 28

What causes chancroid?

Answer 28

Infection with hemophilus ducreyi

Question 29

What is the difference between a chancroid and primary syphillis ulcer?

Answer 29

Chancroid has multiple lesions Lesions are painful Lymph nodes are painful lesion is hot Vague margins

Question 30

What is the differential for a vulvar ulcer?

Answer 30

1. HSV 2. Syphilis 3. Chancroid 4. LGV 5. Granuloma inguinale 6. Bechets 7. Vulvar carcinoma

Question 31

What is the management for bartholin abscess?

Answer 31

Incision and drainage word catheter 4-6 weeks

Question 32

When should you biopsy or excise the gland in case of bartholin abscess?

Answer 32

Patient >40 years old Recurrent cysts or infections

Question 33

What are the alternative treatments for bacterial vaginosis?

Answer 33

Clindamycin 300mg PO BID for 7 days Clindamycin ovules 100mg intravaginally for 3 days Secnidazole 2g x 1 dose Tinidazole 2g PO daily for 2 days Tinidazole 1g PO daily for 5 days

Question 34

What is the treatment for cervicitis?

Answer 34

Recommended: doxycylcine 100mg BID for 7 days Alternative: Azithromycin 1g PO x 1 dose

Question 35

What is the alternative treatment for Chlamydia infection in adults and adolescents?

Answer 35

Azithromycin 1g PO x 1 dose Levofloxacin 500mg daily for 7 days

Question 36

What is the treatment for chlamydia in pregnancy?

Answer 36

Recommended: Azithromycin 1g PO x 1 dose Alternative: Amoxicillin 500mg PO TID for 7 days

Question 37

What is the alternative treatment for gonorrhea infection?

Answer 37

If a allergy: Gentamicin 240mg IM + azithromycin 2g PO x 1 dose If not available: Cefixime 800mg x 1 dose

Question 38

What is the alternative treatment for trichomonas?

Answer 38

Tinidazole 2g PO x 1 dose