presentation categories

term = disease

definition = possible pathogens

cervical swab of pus: gram negative diplococci (intracellular)

aerobic, intracellular, cocci in pairs on gram stain

DOC: ceftriaxone 125 mg IM x 1 dose

Cefixime 400 mg PO x 1 dose

PRegnancy: Azithromycin

Chlamydia!!!

How?

add Azithromycin 2 gm PO x 1

or doxycycline x 7

infections caused by chlamydia trachomatis

mucopurulent discharge, dysuria, inflammation

Axithromycin 1 gm POx1 or Doxycycline x 7 days

Alternatives:

levo, erythromycin

DOC: azithromycin

treatment failure is common: repeat testing in 3 weeks after treatment?

cervical motion tenderness

uterine tenderness

fever

discharge

WBC in secretions

elevated ESR or CRP

documented cervical infection

Cover N. gonorrhoeae and C. trachomatis

consider anaerobic activity

cefoxitin or cefotetan or (Clinda plus gent)

PLUS

doxycycline x 14 days

ceftriaxone 250 mg IM x 1

plus

doxy x 14 days

Now, for the boys...

epididymyitis symptoms

Chlamydia and N. gonorrhoea

However, if they are older, instrumentation is used, or anal intercourse: think gram - bacilli, pseudomonas??? (double check this with notes)

ceftriaxone IM x 1 dose OR cefixime PO x 1 dose

PLUS doxycycline 10 days

treat the partner

true

(women can too but it is less likely)

DOC:  metronidazole 2 gm PO x 1 dose or Tinidazole 2 gm PO x 1 dose

metronidazole 2 gm dose not recommended for men: instead use tinidazole or metronidazole 500 mg BID x 7 days

well, if you like frothy discharge and cervical petechiae, then knock yourself out, but if you value your health and are smell averse, then wait until tx is complete and sx are gone. 

NO

wet mount

yeast/pseudohyphae

DOC of vulvovaginal candidiasis

topical vaginal creams (1,3 or 7 days)

clotrimazole, miconazole, terconazole

alt: fluconazole 150 mg PO x 1 dose

everyone's favorite STD:

Bacterial vaginosis

symptoms: fishy odor, homogenous thin, white discharge, clue cell (epi cells that have been sloughed off, fuzzy borders)

pH > 4.5

gram stain = if lactobaccilli is taken over

metronidazole 500 mg PO BID x 7 days or

Tinidazole 2 gm PO daily x 2 days or

metronidazole gel x 5 days or

clinda cream 3-7 days

alt:

clindamycin PO

ulcerative lesions

culture, pcr

viral sheeding intermitten

may be asyptomatic

acyclovir

valacyclovir (enhance PO abs)

famciclovir

give drugs for 7 -10 days

acyclovir daily

famciclovir BID

valacyclovir daily

treponema pallidum

(spirochete)

ulcer or chancre (indurated) that is painless

...recall George pulling down his scrubs in the locker room and Alex saying, "dude, that's syphylis"

skin rahs, mucocutaneous lesions, lymphadenopathy

- rash happens on feet or palms

EArly syphilis tx

(primary, secondary, or latent less than 1 year)

PEN G benzathine IM x 1 dose

alt: doxy x 14 days or azm single 2 gm dose

Late syph tx

(more than 1 year duration, CV, gumma, latent)

PEN G benathine IM weekly x 3 weeks

alt: doxy x 4 weeks

neurosyphilis

if only van gogh could have received treatment....

PEN G Q 4 hours 10-14 days

alt: PEN G procaine plus probenecid x 10-14 days

painful genital ulcer

no t. pallidum on darkfield exam

tender inguinal lyphadenopathy

HSV test on ulcer exudate negative

AZM 1 gm PO x 1 dose or

ceftriaxone 250 mg IM x 1 dose

usually asymptomatic

flat, papular on genital mucosa

visual inspection, confim with bx

Ask Michelle Bachmann.

treatment = removal

podophyllum, tichloracetic acid, liquid nitrogen

imiquidmod 5% 3 times per week x 16 weeks

surgical removal