STI Guidelines

Question 1

Bacterial Vaginosis

Definition and management

Answer 1

Increased discharge and malodour due to excessive anaerobic bacteria. Clue cells on gram staining. pH > 4.5

1. Reassurance if asymptomatic BV does not need to be treated
2. Treatment warranted if undergoing invasive gynae procedure
3. IUD does not have to be removed
4. Metronidazole 400mg BD with food for 5 days or Clindamycin 2% vaginal cream 5g, intravaginally nocte for 7 days, or Tinidazole 2gm stat (less affective)
5. Douching should be avoided
6. Contact tracing is not required

Question 2

Diagnosis, Organism and Management:
Male
Multiple, deep, painful genital ulcers with ragged undermined edges typically occur on the prepuce and in the coronal sulcus.

Answer 2

Chanchroid
Haemophilus ducreyi

1. Test for HSV, Syphilis, Chlamydia.
2. Offer testing for HIV + pre test counselling
3. No sexual contact for 7 days after treatment
4. Contact Tracing
5. Provide information / fact sheet
6. Notify Health Department
7. Seek specialist advice
8. Ceftriaxone 500mg in 2ml 1% lignocaine Stat

Question 3

Chlamydia management

Answer 3

1. Azithromycin 1gm Stat PO
   2 Avoid unprotected sex for 1 week following treatment
2. Contact tracing - Male and Female partners prev. 6/12 for treatment.
3. Advise no sex with any partners from last 6 months until they have been treated (Australian STI Guidelines)
4. Retesting at 3/12 (for reinfection)
5. Annual screening if 15 - 29 and sexually active.
6. Follow-up 1 week (inc. Sexual Health Education)

Question 4

3 Complications of Chlamydia infection in women?

Answer 4

Pelvic Inflammatory Disease
Tubal infertility
Chronic Pelvic Pain

Question 5

Treatment for Scabies

Answer 5

1. Apply 5% Permethrin cream from neck down (inc hands, under nails and genitals) for 8 hours (24 hrs if prev failed treatment).
2. Repeat in 1 week.
3. Bag all towels, bedding, clothing, soft toys, etc for 1 week, used in the prev. 3 days.
4. Treat partners
5. Avoid skin to skin contact, sex etc for 7 days following treatment
6. Contact tracing and treatment of contacts in previous month including partners and household members
7. Treat itch with antihistamine, and/or topical steroids
8. Itch may take 2 weeks to resolve
9. Review in 1 week

Treat Pubic lice with 1% permethrin cream rinse to all affected body hair, leave on for 10 mins then rinse off.

Question 6

Gonorrhoea Management

Answer 6

1. 500mg Ceftraixone in 2ml 1% lignocaine, IM stat +
2. 1 gm Azithromycin PO stat
3. Contact tracing all partners > last 2 months
4. Treatment offered to all contacts
5. Avoid all sexual intercourse for 7 days after treatment
6. Notify Health Department
7. Provide information
8. Avoid sexual contact with any partners from prev 2/12 if they are untreated.
9. Offer full STI if not performed at initial presentation
10. Follow up 1 week (symptoms and sexual health education)
11. Test of cure at 2 weeks if Anal, cervival or pharyngeal
12. Test for reinfection at 3/12
13. Refer to specialist if TOC or reinfection test positive.