STDs

STD screening:

If a patient is sexually active and young (<25yo), will need STD screening: 1) Chlamydia and 2) HIV only!

  • MALE: HIV only!
  • FEMALE: HIV and Chlamydia – screen for both!
  • If high risk, order: Syphilis (RPR). If symptomatic, order Gonorrhea screen too.

When a pt tells you that they want to be tested for STDs in general, order:

  • Gonorrhea/Chlamydia (urine sample) – Need to treat partner too!
    1. Tx Chlamydia: Azithromycin 1g PO in a single dose OR Doxycycline 100 mg PO bid for 7 days
    2. Tx Gonorrhea: Ceftriaxone 250 mg IM single dose
  • Syphilis (RPR or VDRL)
    1. Diagnose:
      1. Elevated RPR (rapid plasma reagin) titer
      2. Positive confirmatory test: Treponema pallidum enzyme immunoassay (EIA)
    2. Treat: [Doxycycline can be used if severe penicillin allergy.]
      • Primary syphilis (chancre), Secondary syphilis (rash, aseptic meningitis), or latent (<1 year duration, if proven) -> Benzathine Penicillin IM X 1 dose
      • Tertiary/late syphilis (gummas, cardiovascular complications) or latent > 1 year / unknown duration -> Benzathine Penicillin IM weekly X 3 weekly doses
      • Neurosyphilis -> Penicillin G IV q6hrs X 2 weeks
  • HIV
  • Hepatitis Panel
  • PAP smear (if female), can also test for Trichonomonas (wet mount prep on slide – look for motility)

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