STIs

Question 1

What is syphilis caused by?

Answer 1

1. Treponema pallidum (Spirochete)

Question 2

What is the clinical presentation of syphilis?

Answer 2

1. Appearance of a chancre

Question 3

How long does primary, secondary, latent, and tertiary syphilis last for?

Answer 3

P: (1-3weeks) chancre
S: (6-12weeks) fever, lymphadenopathy, rash
L: (1-10 years) “hidden” stage
T: (10-30 years) damage to internal organs=death

Question 4

What is the treatment of primary, secondary, early latent syphilis?

Answer 4

1. Benezathine Penicillin G 2.4 million units IM X 1 dose

Question 5

What is the treatment for late latent syphilis?

Answer 5

1. Benzathine pencillin G 2.4 million units IM X 3 doses at weekly intervals

Question 6

What causes gonorrhea?

Answer 6

Neisseria gonorrhoeae
*gram negative

Question 7

What is the treatment for gonorrhea?

Answer 7

1. Ceftriaxone 500 mg IM X 1 dose
   AND
2. Doxycycline 100mg PO BID X 7 days (if chlamydia is not excluded)
   *this is weight based
   *>150kg use 1000mg Ceftriaxone

Question 8

What causes chlamydia?

Answer 8

1. Chlamydia trachomatis

Question 9

What is the treatment for chlamydia?

Answer 9

1. Doxycycline 100mg by mouth BID X 7 days

Question 10

What is Trichomoniasis caused by?

Answer 10

1. Protozoan parasite Trichomonas vaginalsis

Question 11

What is the treatment for men and women for trichomoniasis

Answer 11

W: metronidazole 500 mg PO BID X 7 days
M: Metronidazole 2g PO X 1 dose

Question 12

What causes herpes?

Answer 12

Herpes simplex virus
1. HSV-1 (oral)
2. HSV-2 (genital)

Question 13

What is the treatment of herpes for the first episode?

Answer 13

Antivirals
1. Acyclovir 400mg by mouth TID 7-10 days
OR
2. Valacyclovir 1g PO BID/ 7-10 days

Question 14

What is the treatment of herpes for recurrent infections?

Answer 14

1. Acyclovir 800mg BID or TID/ 5 days
2. Valacyclovir 1g PO QD/ 5 days

Question 15

What is the treatment of herpes for suppressive therapy?

Answer 15

1. Acyclovir 400mg BID
2. Valacyclovir 500mg/1g QD

Question 16

What causes genial warts?

Answer 16

HPV

Question 17

What is the treatment for genital warts if they’re external? (Self-administered)

Answer 17

Self-administered
1. Imiquimod cream
2. Podofilox solution/gel
3. Sinecatechins ointment

Question 18

What is the treatment for genital warts? (Vaginal, urethra, cervical, anal)

Answer 18

1. Cryotherapy with liquid nitrogen
2. Surgical removal
3. Trichloroacetic acid

Question 19

What causes bacterial vaginosis

Answer 19

1. Due to the replacement of lactobacillus species with anaerobic bacteria

Question 20

What is the treatment of bacterial vaginosis (anaerobic coverage)

Answer 20

1. Metronidazole 500mg PO BID X 7 days
2. Metronidazole gel 0.75% 5g once daily/5 days
3. Clindamycin cream 2% 5g at bedtime/7 days

Question 21

What are the ADE of antivirals?

Answer 21

1. Decrease in ANC (absolute neurotropil count)
2. Decreased Hgb
3. Rash

Question 22

What are the ADE of valacyclovir?

Answer 22

1. Increased LFTs
2. Nasopharyngitis

Question 23

If there is an infection of candidiasis what is the preferred treatment? (Secondary prophylaxis)

Answer 23

Fluconazole

Question 24

If there is an infection of Cryptococcal meningitis what is the preferred treatment? (Secondary prophylaxis)

Answer 24

1. Amphotericin B + flucytosine

Question 25

If there is an infection of Cytomegalovirus (CMV) what is the preferred treatment? (Secondary prophylaxis)

Answer 25

Valganciclovir or ganciclovir

Question 26

If there is an infection of MAC what is the preferred treatment? (Secondary prophylaxis)

Answer 26

Clarithromycin or Azithromycin + ethambutol

Question 27

If there is an infection of PCP what is the preferred treatment? (Secondary prophylaxis)

Answer 27

Bactrim +/- prednisone OR Methylprednisolone X 21 days

Question 28

If there is an infection of Toxo what is the preferred treatment? (Secondary prophylaxis)

Answer 28

Pyrimethamine + Leucovorin + sulfadiazine

Question 29

If there is an infection of Pneumocysitis (PCP) what is the indication of that? (HIV primary prophylaxis)

Answer 29

CD4 count <200 OR oropharyngeal candidiasis OR Other AIDS defining illness

Question 30

If there is an infection of Pneumocytis what is the preferred treatment? (HIV Primary Prophylaxis)

Answer 30

Bactrim DS/SS daily

Question 31

If there is an infection of Toxoplasma Gondi encephalitis what is the indication? (HIV Primary Prophylaxis)

Answer 31

Toxoplasma IgG + with CD4 <100

Question 32

If there is an infection of Toxoplasma Gondi encephalitis what is the preferred treatment? (HIV Primary Prophylaxis)

Answer 32

Bactrim DS daily

Question 33

If there is an infection of Mycobacterium Avium complex what is the indication? (HIV Primary Prophylaxis)

Answer 33

Not taking ART +CD4 <50

Question 34

If there is an infection of Mycobacterium Avium complex (MAC) what is the preferred treatment? (HIV Primary Prophylaxis)

Answer 34

Azithromycin 1200mg weekly

Question 35

What is the treatment for neurosyphilis?

Answer 35

Penicillin G 3-4 million units IV q4h X 10-14 days

Question 36

What is the clinical presentation of trichomoniasis?

Answer 36

1. Yellow/green frothy discharge 2. Soreness 3. Pain with intercourse