DOC for Chlamydia trachomatis

Azithromycin 1gm oral single dose (AE: GI)or Doxycycline 100mg x 7d BID (Sun sensitivity)

A person infected with Chlamydia trachomatis is also likely to be infected with Gonorrhea and should be treated with:

Ceftriaxone 100mg IM in a single dose, Azithro 2g x1 (less optimal b/c hard on GI)

Gonorrhea tx for quinolones

Not recommended due to increasing resistance. Also in pregnant women, Quinolones can cause cartilage defects.

Tx of gonorrhea in Pregnancy

Cephalosporin regimen (no quinolones or tetracyclines); Azithro or amoxicillin for presumptive or diagnosed chlamydial infection

Tx for Disseminated Gonococcal infection

Ceftriaxone 1g IV or IM q 24 hr. Tx until 24-48 post sx resolution. Need at least 1 week of antimicrobial therapy

When treating for PID, cover the likely microbes:

C. trachomatis, N. gonorrhea, Anaerobes (B. fragilis)

Regimen A: Cefotetan 2gm IV q 12h plus Doxy 100mg IV or po q 12hr. Can d/c parenteral tx 24 hr post clinical improvement. Regimen B: Clindamycin plus Gentamycin. 14 week tx

Topicals: Diclucan, Nystatin. Oral: Fluconazole (not in pregnancy, topicals only)

Complicated Yeast infections

pregnant, diabetic. Tx longer: 7-14 days

Bacterial Vaginosis Tx

Flagyl BID x 7d. No alcohol (may cuase Disulfram-like Rxn). Educate: metallic taste, urine discoloration, can take with food to minimize GI upset

Can you treat STDs in pregnant women?

yes, avoid topicals. Flagyl is category B

Flagyl 2g oral single dose. Can also use Tinidazole 2g oral in a single dose

Tx of Primary Syphilis

Benzathine penicillin G 2.4 million units in single dose

Tx fir Secondary syphilis

Same as primary. Benzathin penicillin G 2.4 million units in a single dose

Tx for late latent or latent syphilis of uknown duration

Benzathine penicillin G. 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1week intervals

Tx for tertiary or neurosyphilis

Aqueous crystalline penicillin G. Tx over 10-14 days.

In a primary or secondary syphilis pt with a PCN allergy, use

doxycycline 100 mg BID for 14 days

Jarisch-Herxheimer Rxn is caused by the tx of which disease?

Syphilis. Occurs 6-12 hours post tx. Will subside in 24 hours and poses no danger

Acyclovir TID 7-10 days, Valacyclovir 1g orally BID 7-10 days.

For which illnesses is it not recommended to tx the partner?

Vaginal candidiasis, Bacterial vaginosis

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GYN Pharm STIs

Question	Answer
DOC for Chlamydia trachomatis	Azithromycin 1gm oral single dose (AE: GI)or Doxycycline 100mg x 7d BID (Sun sensitivity)
A person infected with Chlamydia trachomatis is also likely to be infected with Gonorrhea and should be treated with:	Ceftriaxone 100mg IM in a single dose, Azithro 2g x1 (less optimal b/c hard on GI)
DOC for Pharyngeal gonorrhea	Ceftriaxone
Gonorrhea tx for quinolones	Not recommended due to increasing resistance. Also in pregnant women, Quinolones can cause cartilage defects.
Tx of gonorrhea in Pregnancy	Cephalosporin regimen (no quinolones or tetracyclines); Azithro or amoxicillin for presumptive or diagnosed chlamydial infection
Tx for Disseminated Gonococcal infection	Ceftriaxone 1g IV or IM q 24 hr. Tx until 24-48 post sx resolution. Need at least 1 week of antimicrobial therapy
When treating for PID, cover the likely microbes:	C. trachomatis, N. gonorrhea, Anaerobes (B. fragilis)
PID tx	Regimen A: Cefotetan 2gm IV q 12h plus Doxy 100mg IV or po q 12hr. Can d/c parenteral tx 24 hr post clinical improvement. Regimen B: Clindamycin plus Gentamycin. 14 week tx
Yeast infection	Topicals: Diclucan, Nystatin. Oral: Fluconazole (not in pregnancy, topicals only)
Complicated Yeast infections	pregnant, diabetic. Tx longer: 7-14 days
Bacterial Vaginosis Tx	Flagyl BID x 7d. No alcohol (may cuase Disulfram-like Rxn). Educate: metallic taste, urine discoloration, can take with food to minimize GI upset
Can you treat STDs in pregnant women?	yes, avoid topicals. Flagyl is category B
Trichomonas tx	Flagyl 2g oral single dose. Can also use Tinidazole 2g oral in a single dose
Tx of Primary Syphilis	Benzathine penicillin G 2.4 million units in single dose
Tx fir Secondary syphilis	Same as primary. Benzathin penicillin G 2.4 million units in a single dose
Tx for late latent or latent syphilis of uknown duration	Benzathine penicillin G. 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1week intervals
Tx for tertiary or neurosyphilis	Aqueous crystalline penicillin G. Tx over 10-14 days.
In a primary or secondary syphilis pt with a PCN allergy, use	doxycycline 100 mg BID for 14 days
Jarisch-Herxheimer Rxn is caused by the tx of which disease?	Syphilis. Occurs 6-12 hours post tx. Will subside in 24 hours and poses no danger
Tx for HSV	Acyclovir TID 7-10 days, Valacyclovir 1g orally BID 7-10 days.
When should HSV suppressive tx be considered	>/= 6 recurrences/yr
Deliver option if a pregnant woman is having an active HSV infection at due date	Needs a C Section
Expedited Partner therapy in NC	Status: Possibly allowable
For which illnesses is it not recommended to tx the partner?	Vaginal candidiasis, Bacterial vaginosis

Created by: ltm12

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