Notes on Treatment of Sexually Transmitted Diseases (STDs) and MCQ for GPAT, NEETPG, Nursing, Pharmacy exams
1. Chlamydia trachomatis
Treatment:
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First-line:
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Doxycycline 100 mg PO BID × 7 days
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Alternative (e.g., pregnancy):
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Azithromycin 1 g PO single dose
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Notes:
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Treat sexual partners
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Abstain from sex for 7 days after treatment
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Often co-infected with gonorrhea → treat both if not ruled out
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2. Neisseria gonorrhoeae
Treatment:
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First-line:
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Ceftriaxone 500 mg IM single dose
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(If chlamydia not ruled out: add Doxycycline 100 mg PO BID × 7 days)
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Notes:
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Dual therapy to prevent resistance
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Test for co-infections (chlamydia, HIV, syphilis)
3. Treponema pallidum (Syphilis)
Early Syphilis (Primary, Secondary, Early Latent <1 year):
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Benzathine Penicillin G 2.4 million units IM single dose
Late Latent or Unknown Duration:
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Benzathine Penicillin G 2.4 million units IM weekly × 3 weeks
Neurosyphilis:
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Aqueous Penicillin G IV 3–4 million units q4h × 10–14 days
Notes:
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Penicillin allergy: Doxycycline or Desensitization (preferred in pregnancy)
4. Trichomoniasis (Trichomonas vaginalis)
Treatment:
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Metronidazole 2 g PO single dose
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OR Tinidazole 2 g PO single dose
Notes:
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Treat partners
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Avoid alcohol for 24–72 hours after dose (disulfiram reaction)
5. Genital Herpes (HSV-1, HSV-2)
First Episode:
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Acyclovir 400 mg TID × 7–10 days
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OR Valacyclovir 1 g BID × 7–10 days
Recurrent Episodes:
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Acyclovir 400 mg TID × 5 days
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OR Valacyclovir 500 mg BID × 3 days
Suppressive Therapy:
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Acyclovir 400 mg BID
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OR Valacyclovir 500–1000 mg daily
6. Human Papillomavirus (HPV)
Treatment:
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Genital Warts (external):
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Podophyllotoxin, Imiquimod, Cryotherapy, or Surgical removal
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Prevention:
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HPV vaccine (e.g., Gardasil-9)
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Notes:
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Vaccine recommended for males and females aged 9–26 years (up to 45 in some cases)
7. Pelvic Inflammatory Disease (PID)
Outpatient:
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Ceftriaxone 500 mg IM single dose
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PLUS Doxycycline 100 mg BID × 14 days
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± Metronidazole 500 mg BID × 14 days
Inpatient:
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Cefotetan IV + Doxycycline
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OR Clindamycin + Gentamicin
8. HIV Post-Exposure Prophylaxis (PEP)
Start within 72 hours:
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Tenofovir + Emtricitabine (Truvada) + Raltegravir or Dolutegravir × 28 days
General Principles of STD Management
| Principle | Description |
|---|---|
| Partner Notification | Sexual partners should be tested/treated |
| Abstinence | Avoid sex until treatment complete and symptoms resolved |
| Retesting | Retest after 3 months for chlamydia/gonorrhea |
| Counseling | Educate about safe sex, condom use, and risk reduction |
| Vaccination | HPV and hepatitis B vaccination recommended for prevention |
MCQs on STD Treatment
1. A 24-year-old woman is diagnosed with uncomplicated Chlamydia trachomatis infection. Which is the preferred first-line treatment?
A. Azithromycin 1 g PO single dose
B. Doxycycline 100 mg PO BID for 7 days
C. Ciprofloxacin 500 mg BID for 7 days
D. Ceftriaxone 250 mg IM single dose
Answer: B. Doxycycline 100 mg PO BID for 7 days
2. Which antibiotic is used as a single-dose intramuscular injection for treating gonorrhea?
A. Doxycycline
B. Azithromycin
C. Ceftriaxone
D. Metronidazole
Answer: C. Ceftriaxone
3. What is the drug of choice for primary syphilis?
A. Benzathine Penicillin G IM single dose
B. Ceftriaxone IM single dose
C. Doxycycline PO for 3 days
D. Azithromycin PO single dose
Answer: A. Benzathine Penicillin G IM single dose
4. Which of the following is contraindicated with alcohol due to a disulfiram-like reaction?
A. Acyclovir
B. Ceftriaxone
C. Metronidazole
D. Doxycycline
Answer: C. Metronidazole
5. A sexually active woman presents with a frothy green vaginal discharge and is diagnosed with Trichomoniasis. Which of the following is appropriate treatment?
A. Acyclovir 400 mg BID for 5 days
B. Metronidazole 2 g PO single dose
C. Doxycycline 100 mg BID for 7 days
D. Valacyclovir 1 g BID
Answer: B. Metronidazole 2 g PO single dose
6. Which antiviral is commonly used for suppressive therapy in recurrent genital herpes?
A. Metronidazole
B. Valacyclovir
C. Amoxicillin
D. Doxycycline
Answer: B. Valacyclovir
7. A 30-year-old man with genital warts asks about prevention. What is the best option?
A. Doxycycline
B. Benzathine Penicillin G
C. HPV Vaccine (Gardasil 9)
D. Metronidazole
Answer: C. HPV Vaccine (Gardasil 9)
8. Which of the following drug combinations is appropriate for Pelvic Inflammatory Disease (PID) outpatient treatment?
A. Ceftriaxone + Doxycycline
B. Acyclovir + Valacyclovir
C. Azithromycin + Metronidazole
D. Penicillin G + Gentamicin
Answer: A. Ceftriaxone + Doxycycline
9. Post-exposure prophylaxis (PEP) for HIV should ideally be started within how many hours of exposure?
A. 12 hours
B. 24 hours
C. 48 hours
D. 72 hours
Answer: D. 72 hours
10. What is the treatment of choice for neurosyphilis?
A. Benzathine Penicillin G IM
B. Oral Doxycycline
C. IV Aqueous Penicillin G
D. Azithromycin
Answer: C. IV Aqueous Penicillin G