STI

Question 1

NGU

Answer 1

• Doxycycline 100mg PO BD for 7/7
• Abstain 1 week
• Advised if all results are negative still needs to complete course of doxycycline
• Wait until results to discuss PN
• Pen allergy: azithromycin 1g PO STAT then 500mg OD for 2/7

Question 2

Recurrent NGU

Answer 2

• Post doxy: azithromycin PO 1g-500mg-500mg + metronidazole 400mg PO BD for 5/7
• Post azithromycin: moxifloxacin 400mg PO OD for 10/7 + metronidazole 400mg PO BD for 5/7

Question 3

Chlamydia

Answer 3

• Doxycycline 100mg PO BD for 7/7
• Abstain 1 week
• PN last 4 weeks
• Pen allergy: azithromycin 1g PO STAT followed by 500mg OD for 2/7

Question 4

LGV

Answer 4

• Doxycycline 100mg PO BD for 21/7
• PN test and treat from 4 weeks prior to symptom onset /// last 3 months if asymptomatic
• F/U until symptoms resolved, consider TOC 2/52 after treatment completion if symptoms ongoing

Question 5

Gonorrhoea

Answer 5

• Ceftriaxone 1g IM STAT
• Abstain 1 week
• PN last 2 weeks
• TOC in 2 weeks (or 3 weeks if GC-T)
• Pen allergy: mild rash – cef with warning 10% cross reaction, severe rxn – d/w senior

Question 6

Mycoplasma genitalium

Answer 6

• Uncomplicated infection: doxycycline 100mg PO BD for 7/7, then azithromycin 1g PO STAT + 500mg OD for 2/7
• Complicated infection (or macrolide resistant): moxifloxacin 400mg PO OD for 14/7 (10/7)
• Abstain 2 weeks after start of treatment AND until symptoms resolved
• PN regular only to reduce re-infection, Rx with same abx
• TOC 3/52 after completion of treatment

Question 7

HSV

Answer 7

• Aciclovir 400mg PO TDS for 5/7
• Offered topical anaesthetic, advised saline bathing and analgesia

Suppression (>6/yr or if pt wants)
- Dispensed 6/12 aciclovir 400mg PO BD
- Counselled on importance of 12 hourly dosing
- Plan to discontinue after 1yr and reassess, aware 70% chance recurrence on stopping to be treated as normal flare (400mg TDS 5/7)
- Encouraged to keep a diary of future flares and TCI for consideration of further suppression treatment if recurrent

Question 8

Syphilis

Answer 8

• Benzathine Penicillin 2.4Mu IM STAT
• Advised re. JH reaction: 24h headache, myalgia, chills, rigours – Rx with paracetamol
• Abstain 2 weeks
• PN 3/12 before last negative, treat contacts within 3/12
• FU serology in 3, 6, 12 months

Late latent (>2yr no negative test): benzathine penicillin 2.4Mu IM weekly for 3 weeks. If dose >1 day late, restart

Tertiary/Neurosyphilis: d/w senior

Pen allergy: d/w senior - doxycycline 100mg BD 14/7

Question 9

Epididymo-orchitis

Answer 9

• Urinalysis +/- culture, MGen, GC culture
• If likely STI: ceftriaxone 1g IM STAT. Advised numbness in buttock/leg and to wait 15 mins in WR
• If likely NGU: ofloxacin 200mg PO BD for 14/7
• Abstain 2 weeks
• PN last 4 weeks
• Review in 2-3 weeks
• If symptoms worsening, develops severe pain or ++swelling, to attend A&E

Question 10

Proctitis

Answer 10

• Doxycycline 100mg PO BD for 2/52
• If neuropathic pain, consider HSV proctitis: Multiplex & aciclovir 400mg PO TDS for 5/7

Question 11

Balanitis

Answer 11

• Full SHS + candida culture, multiplex, TV
• Urinalysis
• Advised to avoid soap while inflamed, wash with emollients, saline washes
• Counselled that emollients can reduce condom efficacy
• Trial Canestan HC 1% BD TOP for 2/52
• Consider broad spec abx e.g. co-amox (d/w senior)

Question 12

Thrush

Answer 12

• Fluconazole 150mg PO STAT
• Clotrimazole pessary 500mg STAT +/- clotrimazole cream BD for 1 week
• Potential triggers: wearing poorly fitting clothes from non-breathable fabric (cotton pants may help), using daily panty liners, vaginal douching
• TCI if no improvement, consider Canestan HC

Question 13

Bacterial vaginosis

Answer 13

• Metronidazole 400mg PO BD for 5/7 OR 2g PO STAT
• Avoid alcohol whilst taking metronidazole and for 48h after treatment
• Balance active gel
• Advised not an STI, educated on how BV develops
• Hygiene advice given - avoid douching, frequent washing or bathing, bubble baths, scented soaps, antiseptics such as Dettol and feminine washes
• TCI if no improvement

Question 14

TV

Answer 14

• Metronidazole 400mg PO BD for 7/7
• Avoid alcohol whilst taking metronidazole and for 48h after treatment
• PN: treat any contacts in last 4 weeks
• Abstain from SI 1 week and until all partners completed full course of treatment
• TCI if no improvement, consider 4/52 TOC if ongoing symptoms

Question 15

Scabies

Answer 15

• Wash bedding, clothing and towels @60deg and hot drying, or seal in plastic bag for 72hrs
• Permethrin 5% cream: thick application to cool DRY skin, neck to toes, wash off after 12hrs
• Advised if hands washed with soap within 8hrs of application, reapply
• If immunosuppressed/very young/old, apply to face and scalp as well
• Advised of post-scabetic itch up to 2 weeks after treatment, Rx with antihistamine
• PN: treat close household contacts
• TCI if no improvement 2 weeks after treatment, consider oral ivermectin (d/w senior)