What patient populations should chlamydia AND gonorrhea screening occur?
- sexually active women < 25
- Women 25+ at increased risk of infection (new sex partner, more than one sex partner, sex partner with concurrent partners)
- Pregnancy
- MSM
- Correctional facilities
What is first line therapy for Chlamydia?
- Azithromycin 1 g PO x1 (preferred in pregnancy)
- Doxycycline 100 mg PO BID x 7 days
When should test of cure be done for chlamydia?
Pregnancy (3-4 weeks after tx)
What counseling point should you instruct a patient after chlamydia AND gonorrhea treatment?
Abstain from sex for 7 days after treatment
When should patients repeat test for chlamydia and gonorrhea?
3 months (to test for re-infection)
What is the CDC recommended first line therapy for uncomplicated gonococcal infections?
Preferred: CTX 250 mg IM x 1 + Azithromycin 1 g PO x 1
Alternative: Cefixime 400 mg PO x 1 + Azithromycin 1 g PO x 1
What is the dosing regimen for gonococcal conjunctivitis?
CTX 1 g IM x 1 + Azithromycin 1 g PO x 1
What is the dosing regimen for gonococcal arthritis and arthritis-dermatitis syndrome?
CTX 1 g IV or IV Q24H x 7 days + Azithromycin 1 g PO x 1
What does CDC recommend for gonorrhea if there is a beta lactam allergy?
Gentamicin 240 mg IM + Azithromycin 2 g PO x 1
When should test of cure occur for gonorrhea? In what conditions?
- For patients not treated with CTX
- Persistent symptoms
- 14 days after treatment
- Include antimicrobial susceptibility testing for positive cultures
How far back would you need to go back when counseling about sexual partners getting treatment due to a sexual partner with gonorrhea?
60 days
Cefixime 400 mg PO x 1 and azithromycin 1 g x 1
How is latent syphilis defined as? What about late latent?
Lacking clinical manifestations, and are detected by serologic testing
Late latent is acquired a year or more prior (or unknown duration)
What patient populations should syphilis be screened?
- Pregnant women - first prenatal visit
- Correctional facilities
- MSM
What is first line therapy for primary, secondary and early latent syphilis?
Benzathine G 2.4 million units IM x 1
What is the first line therapy for late latent syphillis and latent syphillis of unknown duration?
Benzathine G 2.4 million units IM x3 on a weekly basis
What is the first line therapy for neurosyphilis and ocular syphilis?
Aqueous crystalline penicillin G 18-24 million units per day, administered 3-4 million units IV every 4 hours or continuous infusion x 10-14 days
(Also used for retreatment)
What is a preferred alternative therapy in non-desensitized beta-lactam allergy for primary syphilis? latent syphillis?
Doxycycline 100 mg PO BID x 14 days
Doxycyline 100 mg PO BID x 28 days
What is the Jarisch-Herxheimer Reaction?
Can occur first 24 hours of treatment for spirochetal diseases due to reaction to treatment (SHOULD CONTINUE THERAPY)
Reaction: fever, rigors, sweats, hypotension and skin rashes
What serology result would be considered to demonstrate clinically significant response?
Fourfold decrease in titer (1:16 to 1:4 or 1:32 to 1:8)
When should follow up for syphilis treatment occur?
6-12 months after treatment
What is the first line therapy for pelvic inflammatory disease?
Cefotetan 2 g IV Q12H + Doxycycline 100 mg PO/IV Q12H x 14 days
Cefoxitin 2 g IV Q6H + Doxycycline 100 mg PO/IV Q12H x 14 days
*Add anaerobic coverage due to high involvement of of bacterial vaginosis in PID
How do you treat epididymitis?
Due to chlamydia and gonorrhea
- CTX 250 mg IM x 1 + Doxycycline 100 mg PO BID x 10 days
Due to chlamydia, gonorrhea and enteric organisms (men who practice insertive anal sex)
- CTX 250 mg IM x 1 + levofloxacin 500 mg PO Q24H x 10 day or ofloxacin 300 mg PO BID x 10 days
Due to enteric organisms
- Levofloxacin 500 mg PO Q24H x 10 days or ofloxacin 300 mg PO BID x 10 days
What is the recommended treatment for external anogenital warts due to HPV?
- Imiquimod 3.75% cream applied QHS x 16 weeks or 5% TIW x 16 weeks
- Podofilox 0.5^ solution/gel applied to warts BID x 3 days, followed by 4 days of no therapy
What is the CDC recommendation for HPV immunization?
9-valent HPV for females and males
- Start 11-12 yo (but as early as 9 years)
- Up to 26 years if not previously immunized
- Up to 45 years with shared clinical decision making
