STIs

Question 1

What is the standard treatment for chlamydia?

Answer 1

Uncomplicated

• azithromycin 1g single dose rectal
• rectal LVG (if proctitis) + doxy 100mg BD for 21 days follow up
• review in 1 week (confirm tx adherence)
• pregnant women decrease efficacy of antibiotics (check)

MT

• contact tracing
• sexual education 3 months
• repeat investigations to exclude reinfection ensure cure

Question 2

What is a high risk screen? What puts you at high risk?

Answer 2

• STI screen:
  
  • chlamydia,
  • shyphilus,
  • HIV (ask permission - ELIZA)
  • gonorrhea,
  • hepatitis B/C (hep A in MSM)

Investigations:

• MSU,
• bloods for syphilis, HIV, Hep B, Hep C
• pharyngeal swab - gonorrhea and chlamydia NAAT
• anorectal swab - chlamydia and gonorrhea
• First pass urine - chlamydia
• Serology - syphilis, gonorrhea, Hep B, Hep A
• Slide - gonorrhoea

Question 3

What are the ST/MT/LT management goals for a STI diagnosis?

Answer 3

ST

• azithromycin 1g stat or 100mg doxy for 7 days BD
• sexual contact tracing
• notifiable condition (online form)
• hep A/B immunization

MT

• risk behaviour education
• followup testing at 3 months for chlamydia

LT

• education
• PEP, PrEP
• comorbid substance use/drug/health

Question 4

What is the treatment for PID?

Answer 4

• azithromycin 1g + doxycyclin 100mg BD 14 days + metronidazole 400mg BD for 14 days suspect travel/gonorrhoea
• add: - ceftriaxone 500mg in 2ml of 1% lignocaine as an IM single dose for mycoplasma genitalium

Question 5

What is the inital treatment for HSV?

Answer 5

ST

1. HSV PCR
2. acyclovir 200mg 2 tabs 3x daily for 7-10days (topical ineffective)
3. Pain relief: -lignocaine jelly if needed (caution as may sensitise with LT use with paracetamol)
4. treat co-morbidities - antifungals for thrush if present (preferably oral)
5. education LT review in one week with episodic therapy

Question 6

Outline treatment for a MSM in a GP clinic?

Answer 6

• once yearly all STI checks should be performed:
  
  • gonorrhoea (anorectal and pharyngeal - if NAAT test + then take swab for culture before treatment).
  • Chlamydia (FPU, ano-rectal swab, pharyngeal swab)
  • Syphilis
  • Hep A - vaccinate
  • Hep B (consider serology if high risk) If they

Other high risk too:

• have unprotected anal
• >10sexual partners 6 monthly
• use drugs
• group sex
• HIV + MSM

Question 7

what tests do you do in different types of people?

Answer 7

Asymptomatic 15-30 years and sexually active?

• Chlamydia males FPU and females (endocervical best FPU if can’t do this and ano-rectal if had anal sex)

High risk:

• hep B (HBsAg, Anti-HBs, Anti-HBc)
• HIV
• Syphilis
• gonorrhoea

Question 8

What are the examination signs of infection with gonorrhoea?

Answer 8

1. urethral discharge purulent
2. anorectal presentation
3. disseminated (septic arthritis/macular rash)
4. erythema