Image may be NSFW.
Clik here to view.
Clik here to view.
- CDC 2015 recommendations include screening all patients age 13-64 for HIV, especially if they have another STD in opt out approach. We need to consider working towards doing this here at CMC and wherever you go practice.
- Managing sexual partners: options include patient referral, provider referral, expedited partner therapy (EPT). EPT based on multiple RCTs appears to be superior and involves sending prescription with patient to give to partner.
- Sexual Assault victim: treat with rocephin, azithromycin, flagyl, hepatitis B vaccine. CDC with algorithm for HIV prophylaxis. If significant exposure and presents within 72 hours treat with zidovudine for 28 days.
- PID: spectrum from cervicitis to TOA and peritonitis. Strongly consider ultrasound as first line imaging. 50 % STD related. Treat uncomplicated with rocephin and 2 weeks doxycycline. TOA, pregnancy, ill appearing admit for IV antibiotics/OB GYN consultation.
- Epidydimitis: Consider US also. Less than 35 or STD exposure-treat rocephin, 2 weeks doxycycline.
- Complications of gonorrhea: PID, septic arthritis, Fitz Hugh Curtis, disseminated gonococcemia, meningitis, conjunctivitis. Neonates-day 2-5, full sepsis workup and admit for IV antibiotics.
- Complications of chlamydia: infertility, PID, Reiter syndrome. Recommend treating with PO azithromycin 1 g including pregnancy.
- Syphillis: treat with penicillin, different regimens depending on stage. Ocular and neurosyphilis requires CSF, admission, IV antibiotics.
- Less common STDs include Chancroid, Lymphogranuloma Venereum, Donovanosis. Treat with rocephin and doxycycline.
